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Breast Cancer Screening for Women at Higher-Than-Average Risk: Updated Recommendations From the ACR.Journal of the American College of... Sep 2023Early detection decreases breast cancer death. The ACR recommends annual screening beginning at age 40 for women of average risk and earlier and/or more intensive...
Early detection decreases breast cancer death. The ACR recommends annual screening beginning at age 40 for women of average risk and earlier and/or more intensive screening for women at higher-than-average risk. For most women at higher-than-average risk, the supplemental screening method of choice is breast MRI. Women with genetics-based increased risk, those with a calculated lifetime risk of 20% or more, and those exposed to chest radiation at young ages are recommended to undergo MRI surveillance starting at ages 25 to 30 and annual mammography (with a variable starting age between 25 and 40, depending on the type of risk). Mutation carriers can delay mammographic screening until age 40 if annual screening breast MRI is performed as recommended. Women diagnosed with breast cancer before age 50 or with personal histories of breast cancer and dense breasts should undergo annual supplemental breast MRI. Others with personal histories, and those with atypia at biopsy, should strongly consider MRI screening, especially if other risk factors are present. For women with dense breasts who desire supplemental screening, breast MRI is recommended. For those who qualify for but cannot undergo breast MRI, contrast-enhanced mammography or ultrasound could be considered. All women should undergo risk assessment by age 25, especially Black women and women of Ashkenazi Jewish heritage, so that those at higher-than-average risk can be identified and appropriate screening initiated.
Topics: Female; Humans; Adult; Middle Aged; Breast Neoplasms; Early Detection of Cancer; Mammography; Breast; Ultrasonography; Mass Screening; Breast Density
PubMed: 37150275
DOI: 10.1016/j.jacr.2023.04.002 -
JAMA Dec 2023
Topics: Female; Humans; Pregnancy; Depression; Depression, Postpartum; Postpartum Period; Prenatal Care; Mass Screening
PubMed: 38010647
DOI: 10.1001/jama.2023.21311 -
Journal of Critical Care Feb 2024Dysphagia is common in intensive care unit (ICU) patients, yet it remains underrecognized and often unmanaged despite being associated with life-threatening... (Review)
Review
BACKGROUND
Dysphagia is common in intensive care unit (ICU) patients, yet it remains underrecognized and often unmanaged despite being associated with life-threatening complications, prolonged ICU stays and hospitalization.
PURPOSE
To propose an expert opinion for the diagnosis and management of dysphagia developed from evidence-based clinical recommendations and practitioner insights.
METHODS
A multinational group of dysphagia and critical care experts conducted a literature review using a modified ACCORD methodology. Based on a fusion of the available evidence and the panel's clinical experience, an expert opinion on best practice management was developed.
RESULTS
The panel recommends adopting clinical algorithms intended to promote standardized, high-quality care that triggers timely systematic dysphagia screening, assessment, and treatment of extubated and tracheostomized patients in the ICU.
CONCLUSIONS
Given the lack of robust scientific evidence, two clinical management algorithms are proposed for use by multidisciplinary teams to improve early systematic detection and effective management of dysphagia in ICU patients. Additionally, emerging therapeutic options such as neurostimulation have the potential to improve the quality of ICU dysphagia care.
Topics: Humans; Deglutition Disorders; Expert Testimony; Critical Care; Mass Screening; Intensive Care Units
PubMed: 37924574
DOI: 10.1016/j.jcrc.2023.154447 -
Annals of Internal Medicine Sep 2023Overdiagnosis is increasingly recognized as a harm of breast cancer screening, particularly for older women.
BACKGROUND
Overdiagnosis is increasingly recognized as a harm of breast cancer screening, particularly for older women.
OBJECTIVE
To estimate overdiagnosis associated with breast cancer screening among older women by age.
DESIGN
Retrospective cohort study comparing the cumulative incidence of breast cancer among older women who continued screening in the next interval with those who did not. Analyses used competing risk models, stratified by age.
SETTING
Fee-for-service Medicare claims, linked to the SEER (Surveillance, Epidemiology, and End Results) program.
PATIENTS
Women 70 years and older who had been recently screened.
MEASUREMENTS
Breast cancer diagnoses and breast cancer death for up to 15 years of follow-up.
RESULTS
This study included 54 635 women. Among women aged 70 to 74 years, the adjusted cumulative incidence of breast cancer was 6.1 cases (95% CI, 5.7 to 6.4) per 100 screened women versus 4.2 cases (CI, 3.5 to 5.0) per 100 unscreened women. An estimated 31% of breast cancer among screened women were potentially overdiagnosed. For women aged 75 to 84 years, cumulative incidence was 4.9 (CI, 4.6 to 5.2) per 100 screened women versus 2.6 (CI, 2.2 to 3.0) per 100 unscreened women, with 47% of cases potentially overdiagnosed. For women aged 85 and older, the cumulative incidence was 2.8 (CI, 2.3 to 3.4) among screened women versus 1.3 (CI, 0.9 to 1.9) among those not, with up to 54% overdiagnosis. We did not see statistically significant reductions in breast cancer-specific death associated with screening.
LIMITATIONS
This study was designed to estimate overdiagnosis, limiting our ability to draw conclusions on all benefits and harms of screening. Unmeasured differences in risk for breast cancer and differential competing mortality between screened and unscreened women may confound results. Results were sensitive to model specifications and definition of a screening mammogram.
CONCLUSION
Continued breast cancer screening was associated with greater incidence of breast cancer, suggesting overdiagnosis may be common among older women who are diagnosed with breast cancer after screening. Whether harms of overdiagnosis are balanced by benefits and for whom remains an important question.
PRIMARY FUNDING SOURCE
National Cancer Institute.
Topics: Aged; Female; Humans; United States; Breast Neoplasms; Mammography; Overdiagnosis; Retrospective Studies; Early Detection of Cancer; Medicare; Mass Screening
PubMed: 37549389
DOI: 10.7326/M23-0133 -
The Surgical Clinics of North America Jun 2024Colorectal cancer remains the third leading cause of cancer death in the United States. Colorectal cancer screening allows for prevention and early detection of... (Review)
Review
Colorectal cancer remains the third leading cause of cancer death in the United States. Colorectal cancer screening allows for prevention and early detection of precancerous and cancerous lesions, and screening has been shown to be effective in preventing colorectal cancer deaths. Screening recommendations vary by patient risk profile. A variety of screening modalities exist.
Topics: Humans; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Mass Screening; Occult Blood; United States; Practice Guidelines as Topic
PubMed: 38677823
DOI: 10.1016/j.suc.2023.11.009 -
The New England Journal of Medicine Mar 2024
Topics: Humans; Cell-Free Nucleic Acids; Colorectal Neoplasms; Early Detection of Cancer; Mass Screening
PubMed: 38477993
DOI: 10.1056/NEJMe2311101 -
The New England Journal of Medicine Mar 2024
Topics: Humans; Early Detection of Cancer; Colorectal Neoplasms; Mass Screening
PubMed: 38477992
DOI: 10.1056/NEJMe2400366 -
Journal of Gastroenterology and... Jun 2024Helicobacter pylori infection is a major global health concern, and its management has witnessed a revolutionary shift with the emergence of antibiotic resistance. In... (Review)
Review
Helicobacter pylori infection is a major global health concern, and its management has witnessed a revolutionary shift with the emergence of antibiotic resistance. In this review, I explore the mechanisms of H. pylori antibiotic resistance and highlight the critical need for susceptibility-based eradication treatments. The increasing prevalence of antibiotic-resistant strains requires innovative approaches to combat this resilient pathogen. I also delve into the importance of mass screening as a preventive strategy for early detection and intervention, describing my experience in Bhutan. Additionally, I explore promising alternatives, such as vaccination. The aim of this review is to provide insight into the evolving landscape of H. pylori treatment and highlight the need for a paradigm shift in the approach to combating this persistent bacterial infection.
Topics: Helicobacter Infections; Helicobacter pylori; Humans; Anti-Bacterial Agents; Drug Resistance, Bacterial; Mass Screening; Bhutan; Bacterial Vaccines; Drug Therapy, Combination
PubMed: 38414319
DOI: 10.1111/jgh.16526 -
Thoracic Surgery Clinics Nov 2023Lung cancer screening has been shown to reduce lung cancer mortality and is recommended for individuals meeting age and smoking history criteria. Despite the expansion... (Review)
Review
Lung cancer screening has been shown to reduce lung cancer mortality and is recommended for individuals meeting age and smoking history criteria. Despite the expansion of lung cancer screening guidelines in 2021, racial/ethnic and sex disparities persist. High-risk racial minorities and women are more likely to be diagnosed with lung cancer at younger ages and have lower smoking histories when compared with White and male counterparts, resulting in higher rates of ineligibility for screening. Risk prediction models, biomarkers, and deep learning may help refine the selection of individuals who would benefit from screening.
Topics: Humans; Male; Female; Lung Neoplasms; Smoking; Early Detection of Cancer; Lung; Mass Screening
PubMed: 37806735
DOI: 10.1016/j.thorsurg.2023.04.002 -
Thoracic Surgery Clinics Nov 2023Lung cancer is the leading cause of cancer-related mortality in Japan and worldwide. Early detection of lung cancer is an important strategy for decreasing mortality.... (Review)
Review
Lung cancer is the leading cause of cancer-related mortality in Japan and worldwide. Early detection of lung cancer is an important strategy for decreasing mortality. Advances in diagnostic imaging have made it possible to detect lung cancer at an early stage in medical practice. Conversely, screening of asymptomatic healthy populations is recommended only when the evidence shows the benefits of regular intervention. Due to a variety of evidence and racial differences, screening methods vary from country to country. This article focused on the perspective of lung cancer screening in Japan.
Topics: Humans; Lung Neoplasms; Early Detection of Cancer; Tomography, X-Ray Computed; Radiography, Thoracic; Sputum; Mass Screening
PubMed: 37806741
DOI: 10.1016/j.thorsurg.2023.03.004