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Hematology/oncology Clinics of North... Jun 2022Colorectal cancer (CRC) is the second-leading cause of cancer death in the United States. Screening reduces CRC incidence and mortality. 2021 US Preventive Service Task... (Review)
Review
Colorectal cancer (CRC) is the second-leading cause of cancer death in the United States. Screening reduces CRC incidence and mortality. 2021 US Preventive Service Task Force (USPSTF) guidelines and available evidence support routine screening from ages 45 to 75, and individualized consideration of screening ages 76 to 85. USPSTF guidelines recommend annual guaiac fecal occult blood testing, annual fecal immunochemical testing (FIT), annual to every 3-year multitarget stool DNA-FIT, every 5-year sigmoidoscopy, every 10-year sigmoidoscopy with annual FIT, every 5-year computed tomographic colonography, and every 10-year colonoscopy as options for screening. The "best test is the one that gets done."
Topics: Aged; Aged, 80 and over; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Humans; Mass Screening; Middle Aged; Occult Blood; Sigmoidoscopy; United States
PubMed: 35501176
DOI: 10.1016/j.hoc.2022.02.001 -
Journal of Dental Research Nov 2021Oral cancer is a major public health problem, and there is an increasing trend for oral cancer to affect young men and women. Public awareness is poor, and many patients... (Review)
Review
Oral cancer is a major public health problem, and there is an increasing trend for oral cancer to affect young men and women. Public awareness is poor, and many patients present with late-stage disease, contributing to high mortality. Oral cancer is often preceded by a clinical premalignant phase accessible to visual inspection, and thus there are opportunities for earlier detection and to reduce morbidity and mortality. Screening asymptomatic individuals by systematic visual oral examinations to detect the disease has been shown to be feasible. A positive screen includes both oral cancer and oral potentially malignant disorders. We review key screening studies undertaken, including 1 randomized clinical trial. Screening of high-risk groups is cost-effective. Strengths and weaknesses of oral cancer screening studies are presented to help guide new research in primary care settings and invigorated by the prospect of using emerging new technologies that may help to improve discriminatory accuracy of case detection. Most national organizations, including the US Preventive Services Task Force, have so far not recommended population-based screening due a lack of sufficient evidence that screening leads to a reduction in oral cancer mortality. Where health care resources are high, opportunistic screening in dental practices is recommended, although the paucity of research in primary care is alarming. The results of surveys suggest that dentists do perform oral cancer screenings, but there is only weak evidence that screening in dental practices leads to downstaging of disease. Where health care resources are low, the feasibility of using primary health care workers for oral cancer screening has been tested, and measures indicate good outcomes. Most studies reported in the literature are based on 1 round of screening, whereas screening should be a continuous process. This review identifies a huge potential for new research directions on screening for oral cancer.
Topics: Early Detection of Cancer; Female; Humans; Male; Mass Screening; Mouth Neoplasms; Precancerous Conditions; Primary Health Care; Randomized Controlled Trials as Topic
PubMed: 34036828
DOI: 10.1177/00220345211014795 -
BMJ (Clinical Research Ed.) Sep 2018To investigate the efficacy and safety of prostate-specific antigen (PSA) testing to screen for prostate cancer. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To investigate the efficacy and safety of prostate-specific antigen (PSA) testing to screen for prostate cancer.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
Electronic search of Cochrane Central Register of Controlled Trials, Web of Science, Embase, Scopus, OpenGrey, LILACS, and Medline, and search of scientific meeting abstracts and trial registers to April 2018.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Randomised controlled trials comparing PSA screening with usual care in men without a diagnosis of prostate cancer.
DATA EXTRACTION
At least two reviewers screened studies, extracted data, and assessed the quality of eligible studies. A parallel guideline committee Rapid Recommendation) provided input on the design and interpretation of the systematic review, including selection of outcomes important to patients. We used a random effects model to obtain pooled incidence rate ratios (IRR) and, when feasible, conducted subgroup analyses (defined a priori) based on age, frequency of screening, family history, ethnicity, and socioeconomic level, as well as a sensitivity analysis based on the risk of bias. The quality of the evidence was assessed with the GRADE approach.
RESULTS
Five randomised controlled trials, enrolling 721 718 men, were included. Studies varied with respect to screening frequency and intervals, PSA thresholds for biopsy, and risk of bias. When considering the whole body of evidence, screening probably has no effect on all-cause mortality (IRR 0.99, 95% CI 0.98 to 1.01; moderate certainty) and may have no effect on prostate-specific mortality (IRR 0.96, 0.85 to 1.08; low certainty). Sensitivity analysis of studies at lower risk of bias (n=1) also demonstrates that screening seems to have no effect on all-cause mortality (IRR 1.0, 0.98 to 1.02; moderate certainty) but may have a small effect on prostate-specific mortality (IRR 0.79, 0.69 to 0.91; moderate certainty). This corresponds to one less death from prostate cancer per 1000 men screened over 10 years. Direct comparative data on biopsy and treatment related complications from the included trials were limited. Using modelling, we estimated that for every 1000 men screened, approximately 1, 3, and 25 more men would be hospitalised for sepsis, require pads for urinary incontinence, and report erectile dysfunction, respectively.
CONCLUSIONS
At best, screening for prostate cancer leads to a small reduction in disease-specific mortality over 10 years but has does not affect overall mortality. Clinicians and patients considering PSA based screening need to weigh these benefits against the potential short and long term harms of screening, including complications from biopsies and subsequent treatment, as well as the risk of overdiagnosis and overtreatment.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO registration number CRD42016042347.
Topics: Aged; Biopsy; Early Detection of Cancer; Erectile Dysfunction; Humans; Magnetic Resonance Imaging; Male; Mass Screening; Medical Overuse; Middle Aged; Prostate-Specific Antigen; Prostatic Neoplasms; Randomized Controlled Trials as Topic; Urinary Incontinence
PubMed: 30185521
DOI: 10.1136/bmj.k3519 -
Journal of Internal Medicine Jul 2022Lung cancer causes more deaths than breast, cervical, and colorectal cancer combined. Nevertheless, population-based lung cancer screening is still not considered... (Review)
Review
Lung cancer causes more deaths than breast, cervical, and colorectal cancer combined. Nevertheless, population-based lung cancer screening is still not considered standard practice in most countries worldwide. Early lung cancer detection leads to better survival outcomes: patients diagnosed with stage 1A lung cancer have a >75% 5-year survival rate, compared to <5% at stage 4. Low-dose computed tomography (LDCT) thorax imaging for the secondary prevention of lung cancer has been studied at length, and has been shown to significantly reduce lung cancer mortality in high-risk populations. The US National Lung Screening Trial reported a 20% overall reduction in lung cancer mortality when comparing LDCT to chest X-ray, and the Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON) trial more recently reported a 24% reduction when comparing LDCT to no screening. Hence, the focus has now shifted to implementation research. Consequently, the 4-IN-THE-LUNG-RUN consortium based in five European countries, has set up a large-scale multicenter implementation trial. Successful implementation of and accessibility to LDCT lung cancer screening are dependent on many factors, not limited to population selection, recruitment strategy, computed tomography screening frequency, lung-nodule management, participant compliance, and cost effectiveness. This review provides an overview of current evidence for LDCT lung cancer screening, and draws attention to major factors that need to be addressed to successfully implement standardized, effective, and accessible screening throughout Europe. Evidence shows that through the appropriate use of risk-prediction models and a more personalized approach to screening, efficacy could be improved. Furthermore, extending the screening interval for low-risk individuals to reduce costs and associated harms is a possibility, and through the use of volumetric-based measurement and follow-up, false positive results can be greatly reduced. Finally, smoking cessation programs could be a valuable addition to screening programs and artificial intelligence could offer a solution to the added workload pressures radiologists are facing.
Topics: Artificial Intelligence; Early Detection of Cancer; Humans; Lung Neoplasms; Mass Screening; Multicenter Studies as Topic; Tomography, X-Ray Computed
PubMed: 35253286
DOI: 10.1111/joim.13480 -
Breast Cancer Research : BCR May 2015Mammography screening for breast cancer is widely available in many countries. Initially praised as a universal achievement to improve women's health and to reduce the... (Review)
Review
Mammography screening for breast cancer is widely available in many countries. Initially praised as a universal achievement to improve women's health and to reduce the burden of breast cancer, the benefits and harms of mammography screening have been debated heatedly in the past years. This review discusses the benefits and harms of mammography screening in light of findings from randomized trials and from more recent observational studies performed in the era of modern diagnostics and treatment. The main benefit of mammography screening is reduction of breast-cancer related death. Relative reductions vary from about 15 to 25% in randomized trials to more recent estimates of 13 to 17% in meta-analyses of observational studies. Using UK population data of 2007, for 1,000 women invited to biennial mammography screening for 20 years from age 50, 2 to 3 women are prevented from dying of breast cancer. All-cause mortality is unchanged. Overdiagnosis of breast cancer is the main harm of mammography screening. Based on recent estimates from the United States, the relative amount of overdiagnosis (including ductal carcinoma in situ and invasive cancer) is 31%. This results in 15 women overdiagnosed for every 1,000 women invited to biennial mammography screening for 20 years from age 50. Women should be unpassionately informed about the benefits and harms of mammography screening using absolute effect sizes in a comprehensible fashion. In an era of limited health care resources, screening services need to be scrutinized and compared with each other with regard to effectiveness, cost-effectiveness and harms.
Topics: Breast Neoplasms; Early Detection of Cancer; Female; Humans; Mammography; Mass Screening; Mortality; Sensitivity and Specificity
PubMed: 25928287
DOI: 10.1186/s13058-015-0525-z -
Cancer Control : Journal of the Moffitt... Jan 2014Lung cancer is the leading cause of cancer death in the United States. Results from the National Lung Screening Trial (NLST) have shown that low-dose computed tomography... (Review)
Review
BACKGROUND
Lung cancer is the leading cause of cancer death in the United States. Results from the National Lung Screening Trial (NLST) have shown that low-dose computed tomography (CT) is capable of detecting lung neoplasms in individuals at high risk. However, whether it is advantageous to perform lung cancer screening on these patients is a significant concern, as are the potential adverse outcomes from screening.
METHODS
A review of several randomized clinical trials, focusing on the NLST, was undertaken. Adverse outcomes and costs related to lung cancer screening were also examined.
RESULTS
Lung cancer screening using low-dose CT in high-risk individuals reduced lung cancer deaths by more than 20% when compared with those screened by chest radiography. False-positive results were seen in both groups, but the number of adverse events from the screening test and subsequent diagnostic procedures was low.
CONCLUSIONS
Lung cancer screening is controversial, but the NLST has demonstrated that such testing may reduce lung cancer deaths in high-risk individuals when performed with low-dose CT rather than chest radiography. Guidelines should be established to not only help identify an appropriate screening population, but also develop standards for radiological testing.
Topics: Cost-Benefit Analysis; Early Detection of Cancer; Humans; Lung Neoplasms; Randomized Controlled Trials as Topic; Tomography, X-Ray Computed
PubMed: 24357736
DOI: 10.1177/107327481402100102 -
Journal of the National Comprehensive... Apr 2018Lung cancer is the leading cause of cancer-related mortality in the United States and worldwide. Early detection of lung cancer is an important opportunity for... (Meta-Analysis)
Meta-Analysis Review
Lung cancer is the leading cause of cancer-related mortality in the United States and worldwide. Early detection of lung cancer is an important opportunity for decreasing mortality. Data support using low-dose computed tomography (LDCT) of the chest to screen select patients who are at high risk for lung cancer. Lung screening is covered under the Affordable Care Act for individuals with high-risk factors. The Centers for Medicare & Medicaid Services (CMS) covers annual screening LDCT for appropriate Medicare beneficiaries at high risk for lung cancer if they also receive counseling and participate in shared decision-making before screening. The complete version of the NCCN Guidelines for Lung Cancer Screening provides recommendations for initial and subsequent LDCT screening and provides more detail about LDCT screening. This manuscript focuses on identifying patients at high risk for lung cancer who are candidates for LDCT of the chest and on evaluating initial screening findings.
Topics: Clinical Decision-Making; Cost-Benefit Analysis; Early Detection of Cancer; Humans; Lung Neoplasms; Mass Screening; Multimodal Imaging; Randomized Controlled Trials as Topic; Reproducibility of Results; Risk Assessment; Risk Factors; Tomography, X-Ray Computed; Tumor Burden; United States
PubMed: 29632061
DOI: 10.6004/jnccn.2018.0020 -
Lancet (London, England) Nov 2012Whether breast cancer screening does more harm than good has been debated extensively. The main questions are how large the benefit of screening is in terms of reduced... (Meta-Analysis)
Meta-Analysis Review
Whether breast cancer screening does more harm than good has been debated extensively. The main questions are how large the benefit of screening is in terms of reduced breast cancer mortality and how substantial the harm is in terms of overdiagnosis, which is defined as cancers detected at screening that would not have otherwise become clinically apparent in the woman's lifetime. An independent Panel was convened to reach conclusions about the benefits and harms of breast screening on the basis of a review of published work and oral and written evidence presented by experts in the subject. To provide estimates of the level of benefits and harms, the Panel relied mainly on findings from randomised trials of breast cancer screening that compared women invited to screening with controls not invited, but also reviewed evidence from observational studies. The Panel focused on the UK setting, where women aged 50-70 years are invited to screening every 3 years. In this Review, we provide a summary of the full report on the Panel's findings and conclusions. In a meta-analysis of 11 randomised trials, the relative risk of breast cancer mortality for women invited to screening compared with controls was 0·80 (95% CI 0·73-0·89), which is a relative risk reduction of 20%. The Panel considered the internal biases in the trials and whether these trials, which were done a long time ago, were still relevant; they concluded that 20% was still a reasonable estimate of the relative risk reduction. The more reliable and recent observational studies generally produced larger estimates of benefit, but these studies might be biased. The best estimates of overdiagnosis are from three trials in which women in the control group were not invited to be screened at the end of the active trial period. In a meta-analysis, estimates of the excess incidence were 11% (95% CI 9-12) when expressed as a proportion of cancers diagnosed in the invited group in the long term, and 19% (15-23) when expressed as a proportion of the cancers diagnosed during the active screening period. Results from observational studies support the occurrence of overdiagnosis, but estimates of its magnitude are unreliable. The Panel concludes that screening reduces breast cancer mortality but that some overdiagnosis occurs. Since the estimates provided are from studies with many limitations and whose relevance to present-day screening programmes can be questioned, they have substantial uncertainty and should be regarded only as an approximate guide. If these figures are used directly, for every 10,000 UK women aged 50 years invited to screening for the next 20 years, 43 deaths from breast cancer would be prevented and 129 cases of breast cancer, invasive and non-invasive, would be overdiagnosed; that is one breast cancer death prevented for about every three overdiagnosed cases identified and treated. Of the roughly 307,000 women aged 50-52 years who are invited to begin screening every year, just over 1% would have an overdiagnosed cancer in the next 20 years. Evidence from a focus group organised by Cancer Research UK and attended by some members of the Panel showed that many women feel that accepting the offer of breast screening is worthwhile, which agrees with the results of previous similar studies. Information should be made available in a transparent and objective way to women invited to screening so that they can make informed decisions.
Topics: Adult; Aged; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Early Detection of Cancer; Female; Humans; Mass Screening; Middle Aged; Randomized Controlled Trials as Topic; United Kingdom
PubMed: 23117178
DOI: 10.1016/S0140-6736(12)61611-0 -
American Journal of Preventive Medicine Aug 2020Adherence to breast and colorectal cancer screenings reduce mortality from these cancers, yet screening rates remain suboptimal. This 2 × 2 RCT compared 3... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Adherence to breast and colorectal cancer screenings reduce mortality from these cancers, yet screening rates remain suboptimal. This 2 × 2 RCT compared 3 theory-based interventions to usual care to simultaneously increase breast and colon cancer screening in women who were nonadherent to both screenings at study entry.
DESIGN
RCT.
SETTING/PARTICIPANTS
Women (n=692) who were nonadherent to both breast and colon cancer screenings and aged 51-75 years were recruited. Enrollment, intervention delivery, and data collection were completed between 2013 and 2017, and data analyzed in 2018.
INTERVENTION
The randomized intervention included the following 4 groups: 3 intervention arms (personally tailored messages using a web-based intervention, phone delivery by a trained navigator, or both) compared with usual care. Women at an average risk for colon cancer were allowed to select either colonoscopy or stool test as their preferred colon cancer screening. Mammography was promoted for breast cancer screening.
MAIN OUTCOME MEASURES
Outcome data at 6 months included self-report and medical records for screening activity.
RESULTS
All intervention arms significantly increased receipt of either a mammogram or stool test compared with control (web: p<0.0249, phone: p<0.0001, web + phone: p<0.0001). When considering receipt of both mammogram and stool test, all intervention arms were significantly different from usual care (web: p<0.0249, phone: p<0.0003, web + phone: p<0.0001). In addition, women who were adherent to mammography had a 4.5 times greater odds of becoming adherent to colonoscopy.
CONCLUSIONS
The tailored intervention simultaneously supporting both breast and colon cancer screenings significantly improved rates of obtaining one of the screenings and increased receipt of both tests.
TRIAL REGISTRATION
This study is registered with the clinical trials identifier NCT03279198 at www.clinicaltrials.gov.
Topics: Aged; Breast Neoplasms; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Female; Humans; Male; Mammography; Mass Screening; Middle Aged; Occult Blood
PubMed: 32690203
DOI: 10.1016/j.amepre.2020.03.008 -
Journal of Clinical Oncology : Official... Mar 2022To investigate whether a panel of circulating protein biomarkers would improve risk assessment for lung cancer screening in combination with a risk model on the basis of...
PURPOSE
To investigate whether a panel of circulating protein biomarkers would improve risk assessment for lung cancer screening in combination with a risk model on the basis of participant characteristics.
METHODS
A blinded validation study was performed using prostate lung colorectal ovarian (PLCO) Cancer Screening Trial data and biospecimens to evaluate the performance of a four-marker protein panel (4MP) consisting of the precursor form of surfactant protein B, cancer antigen 125, carcinoembryonic antigen, and cytokeratin-19 fragment in combination with a lung cancer risk prediction model (PLCO) compared with current US Preventive Services Task Force (USPSTF) screening criteria. The 4MP was assayed in 1,299 sera collected preceding lung cancer diagnosis and 8,709 noncase sera.
RESULTS
The 4MP alone yielded an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.77 to 0.82) for case sera collected within 1-year preceding diagnosis and 0.74 (95% CI, 0.72 to 0.76) among the entire specimen set. The combined 4MP + PLCO model yielded an area under the receiver operating characteristic curve of 0.85 (95% CI, 0.82 to 0.88) for case sera collected within 1 year preceding diagnosis. The benefit of the 4MP in the combined model resulted from improvement in sensitivity at high specificity. Compared with the USPSTF2021 criteria, the combined 4MP + PLCO model exhibited statistically significant improvements in sensitivity and specificity. Among PLCO participants with ≥ 10 smoking pack-years, the 4MP + PLCO model would have identified for annual screening 9.2% more lung cancer cases and would have reduced referral by 13.7% among noncases compared with USPSTF2021 criteria.
CONCLUSION
A blood-based biomarker panel in combination with PLCO significantly improves lung cancer risk assessment for lung cancer screening.
Topics: Clinical Trials as Topic; Early Detection of Cancer; Humans; Lung; Lung Neoplasms; Male; Mass Screening; Risk Assessment
PubMed: 34995129
DOI: 10.1200/JCO.21.01460