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[Serum markers for early detection and staging of prostate cancer. Status report on current and future markers].

Prostate-specific antigen (PSA) is by far the most important tumor marker in urology and has revolutionized early detection, staging, treatment, and aftercare of prostate cancer [77]. Despite these merits, inadequacies have surfaced which prohibit characterizing PSA as a perfect tumor marker. First, PSA is not a marker for prostate cancer as such:benign prostate hyperplasia, prostatitis [40,69], or prostatic manipulation [66] influence serum concentrations of PSA and lead to biopsies that are costly and potentially harmful. In the entire PSA range between 4 and 10 ng/ml, the specificity at a sensitivity of 95% continues to remain unsatisfactory. Furthermore, 30-40% of all men develop prostate cancer, but only 9-11% a clinically significant tumor burden, and 2.5-4.3% of all men die from prostate cancer. The vast majority of all carcinomas are thus in significant in terms of the patient's life expectancy. PSA is incapable of differentiating these clinically insignificant carcinomas from significant ones. Finally, prevalence of prostate cancer is increasing due to higher life expectancy. On the other hand, particularly patients aged 50-70 years are the ones who develop an aggressive form of carcinoma and profit from early detection and treatment. The global term "total PSA"encompasses a heterogeneous blend of bound and free molecular forms of PSA. Complexed PSA represents the major form of total PSA. The smaller portion, free PSA, is enzymatically inactive. In addition, different isoforms of free PSA exist Recent studies provide support for clinical application of these isoforms for early detection of prostate cancer. Clinical measurement of human glandular kallikrein 2 (hK2) serves as a complementary marker to PSA for early detection of prostate cancer and constitutes a considerable improvement over PSA as a staging marker for clinically localized prostate cancer. This overview summarizes established and potentially new forms of PSA and hK2 for early detection and staging of prostate cancer.

Biomarkers, Tumor↗

Health beliefs and early detection among Chinese women.

Little is known about the knowledge and practices regarding early detection of cancer for Chinese women either living in their homelands or worldwide. The purpose of this exploratory study is to describe how cultural beliefs and understandings may influence participation in early detection programs for the increasing numbers of Chinese women who live in the United States. The Health Belief Model (HBM) emerged as a useful framework for categorizing data obtained in Mandarin from a qualitative study of married, educated Chinese women (n = 23; mean age 30.4 years) who attended a university clinic. Cultural beliefs about modesty, husband's involvement, self-care, relationship between health and body functions, and use of preventive health behaviors in the absence of illness influenced women's participation and supported the HBM. Early detection was not a clear concept for these women: 80% believed performing monthly breast self-examinations and 70% believed receiving annual Papanicolaou smears would prevent cancer.

Adult↗

Present state and possibilities for improvement of cancer prevention and early detection in the Osijek-Baranya county.

Cancer morbidity and mortality are on a steady increase in Croatia. Technologic possibilities for appropriate management are available for four cancer sites, i.e. cancer of the breast, cervix uteri, colorectum and prostate, and include cancer prevention and early detection in individuals yet free from manifest signs of the disease. The magnitude of the problem, the experience acquired to date, health care personnel available, and additional resources required to launch a systematic program of early detection of the disease are presented. The program should be initially launched in a county with greatest experience in early detection of cancer, where health care service is ready to immediately start its implementation. The role of family physician, gynecologic service at primary health care level, and polyclinic-consultation hospital service in program implementation is described. The following three possible options for early detection of cancer are analyzed and proposed: minimal program (early detection every 3 years), medium program (the same individuals examined every 2 years), and optimal program proposed by the American Cancer Society and other national and international organizations.

Adult↗

A study of breast cancers detected in the incident round of the UK NHS Breast Screening Programme: the importance of early detection and treatment of ductal carcinoma in situ.

One hundred and seventy eight cancers detected on incident round screening in the UK National Health Service Breast Screening Programme were reviewed. Critical review of the immediately preceding screening films (from 3 years previously) found abnormalities at the site of the subsequently detected cancer in 93 cases (52%). Forty-eight of these (27% of the total) had microcalcification as the sole abnormality. All of these 48 women had invasive ductal carcinoma and/or ductal carcinoma in situ (DCIS) (including four cases in which DCIS was associated with another type of primary invasive breast cancer). The finding of microcalcification on the previous mammograms at the site of a subsequently detected cancer was a strong predictor for the presence of DCIS (with or without associated invasive disease) (P<0.0001). Of the women with invasive ductal carcinoma, those with microcalcification on previous films were significantly more likely to have intermediate or high grade (grade 2 or 3) tumours than those women without microcalcification on previous films (P=0.0015). Previous films were also read blind by two independent experienced breast radiologists. Cancers were correctly identified by one or both readers in 39 cases. However, 35 of the remaining 139 cases showed microcalcification which was not detected or considered significant by the readers. If only these 139 'true negative' screens are analysed, similar associations are seen between microcalcification on previous films and subsequent finding of DCIS (P=0.03) and between microcalcification on previous films and high grade invasive ductal carcinomas (P=0.015). These findings provide support for the hypothesis that microcalcification seen on previous screening films at the site of a subsequently detected invasive ductal carcinoma represents ductal carcinoma in situ. In this series, 19 of 82 women (23%) with invasive ductal carcinoma in the 'true negative' screen group had microcalcification suggestive of DCIS on mammograms taken, on average, 3 years previously. Significant microcalcification is often overlooked using current detection criteria. Early detection and treatment of DCIS is essential in order to prevent the development of aggressive invasive disease. Revision of the NHSBSP targets for DCIS detection is recommended.

Journal Article↗

Early detection of anastomotic leaks after colorectal surgery by measuring endotoxin in the drainage fluid.

BACKGROUND/AIMS: Early detection of anastomotic leaks after colorectal anastomosis is essential for adequate intervention to prevent peritonitis. We investigated whether the measurement of endotoxin (LPS) concentrations in the drainage has any value for the early detection of anastomotic leaks. MATERIALS AND METHODS: Twenty two patients with colorectal anastomosis were enrolled in this study, 3 developed clinically established signs of anastomotic leaks and 19 recovered without complications. LPS concentrations in the drainage, the total daily excreted LPS amounts, leukocyte and thrombocyte counts, plasma urea and creatinine, and body temperature were measured for up to 8 days after surgery and tested for their value to detect anastomotic leaks. RESULTS: LPS concentrations in the drainage fluid and daily excreted LPS amounts of patients with anastomotic leaks were significantly higher compared to the group without anastomotic leaks. On the third postoperative day, LPS concentrations ranged from 5270 to 6750 pg/ml in patients with anastomotic leaks and from 1 to 1848 pg/ml in patients without complications. Total daily excreted LPS amounts were 270-675 ng/day in patients with anastomotic leak and 0-92 ng/day in patients without anastomotic leaks. Both LPS-related parameters allowed reliable detection of anastomotic leaks on day 3 after surgery (Student's t-Test, p < 0.0005), while leukocyte and thrombocyte counts, plasma urea and creatinine, and body temperatures of both patient groups were not significantly different at any time (p > 0.05). CONCLUSION: We found that the measurement of LPS concentrations in the drainage and the daily excreted LPS amount could be valuable parameters for the early detection of anastomotic leaks as early as on the third post-operative day.

Adult↗

[New methods in the early detection of pulmonary fibrosis in asbestosis and silicosis].

Much recent work in thoracic medicine has been slanted towards the early detection of respiratory disease and the prevention of disabling sequelae. In the field of pneumoconioses associated with inhalation of mineral dust the interest of research workers has been largely orientated towards the objectives of early detection and the prevention of fibrotic scarring. To achieve real progress the research workers have used new investigational techniques such as axial tomography of the thorax, quantitative scintigraphy using Gallium-67 and analyses of bronchiolar lavage in parallel with a traditional approach, namely: a clinical examination of the patient, a pulmonary radiograph and respiratory function tests. These studies have enabled further clarification of the specific value of each of these new methods of investigation, whether at the level of early detection, the early recognition of pulmonary fibrosis, the characterisation of the current state of the disease and the prediction of fibrogenic power. Several different forms of intervention on the fibrotic process are currently under trial and may contribute to the prevention of pulmonary fibrosis.

Asbestosis↗

[The significance of screening studies for the early detection of metastases in curatively operated breast carcinoma].

A retrospective analysis of 80 women with breast cancer operated on with curative intent showed that metastases developed within 8 years. The value of laboratory tests and radiological surveys for the early detection of metastases is considered. In fewer than 50% of the patients was the finding of a single abnormal laboratory result associated with tumor recurrence. However, when several findings were abnormal concomitantly this suggested tumor dissemination in about 90% of women. In 80% of the patients clinical symptoms were present at the time of tumor recurrence. In only 20% of the patients were metastases clinically silent. Since metastatic breast cancer cannot be cured by present treatment modalities, the relevance of detecting early recurrence is limited.

Adult↗

[High risk factors of lung cancer and its early detection].

High risk factors and early detection of lung cancer were studied in a population of greater than 45 years old of 10 122 in Lu Wen District. It was shown as follows: 1. The high risk factors of lung cancer were male greater than 50 years old, and with a smoking history of greater than 400 pack year. 2. Questionnaire 70-110 mm X-ray chest film and sputum cytological examination for the suspicious lung cancer were the screen test for the high risk group. Their prevalence rate of lung cancer was 4.74/1000, 50% of them was in p-staging I, it was 6.3 times higher, than in the specialized hospital, their 5-yr survival rate was 31.5%. It was higher than that in the general population.

Age Factors↗

[Early detection of residents in trouble].

Early detection of residents' learning difficulties helps teachers offer appropriate help. During a series of educational workshops, a variety of behaviours associated with learning difficulties were described and four behavioural categories were established: limited cognitive response, disturbed affective response, deviant moral response, and diminished self-motivation.

Affect↗

[A prospective study of early detection for primary liver cancer].

In order to evaluate the effectiveness of early detection for primary liver cancer (PLC), a randomized, prospective study was performed in Shanghai from 1992 to 1995. The study population was 35 through 55 years of age, with serum evidence of HBV infection or tory of chronic hepatitis. Seventeen thousand nine hundred and twenty individuals were randomly to allocated screening group and control group. In the screening group, every individual was checked up by serum AFP test and ultrasound every 6 months and in the control group, they were unchecked. After a mean time of 1.2 years, 38 patients with PLC in the screening group were detected while 18 patients with PLC occur in the control group. In patients from the screening group, 76.8% were in subclinical stage, 70.6% of them were treated by surgical resection with 1-, 2-year survival rate of 88.1% and 77.5%, respectively. However, in the control group, none of patients was in subclinical stage, none of the tumors resected, and none of patients survived over 1 year. The lead time was estimated to be 0.45 years. The cost for detecting an early stage PLC patient is RMB 12,600 (US$1,500). The study indicates that screening in the high risk population of PLC can detect patients in early stage, increase the resection rate and the survival rate. Screening program for PLC carried out in high risk populations is thus recommended.

Adult↗

Knowledge of breast cancer and its early detection measures among rural women in Akinyele Local Government Area, Ibadan, Nigeria.

BACKGROUND: Breast cancer is the commonest cancer among women in Nigeria and globally. In Nigeria, late presentations of breast cancer cases have also been consistent for three decades. In an environment where there is no established national screening program for breast cancer, it is pertinent to assess the knowledge of breast cancer and its early detection measures. The objective of this study therefore, was to assess rural women's level of knowledge of breast cancer and its early detection measures. METHODS: The knowledge of various aspects of breast cancer; etiology, early warning signs, treatment modes and early detection measures; was assessed among women in two randomly selected health districts in Akinyele Local Government in Ibadan. The assessment was performed with the use of a self-structured validated questionnaire administered by trained interviewers to 420 women randomly selected from the two health districts. The various aspects of facts about breast cancer were scored and added together to determine respondents' level of knowledge RESULTS: The mean score of knowledge of breast cancer was 55.4 SD 5.4 (range of scores obtainable was 26-78), while the mean score for knowledge of early detection of breast cancer was 24.8 SD 2.3 (range of scores obtainable was 12-36). The leading source of information about breast cancer was "elders, neighbors and friends" and 63(15.4%) acknowledged this source, while only 18 (4.4%) respondents acknowledged health workers as source. Only 54 (13.3%) claimed to have heard about breast self- examination (BSE) however, and the leading source of information about BSE were health workers. Nine (2.2%) of respondents claimed this source. CONCLUSION: This study revealed that respondents lacked knowledge of vital issues about breast cancer and early detection measures. It also revealed that health workers were not forthcoming with information to the public thereby constituting a challenge to community health nurses and other health workers, to provide vital information to the public.

Adult↗

The right to prevention, early detection and medical rehabilitation under national and international aspects.

The importance of prevention and early detection and rehabilitation has been recognized and emphasized at national and international level for more than a decade. But systematic measures for implementation are still lagging far behind other rehabilitation activities. Civil rights legislation established the rights of citizens to protection of health, but health promoting and protecting measures must also be spelled out specifically in legislation. The most important aspects of such legislation are highlighted and illustrated by examples from the Federal Republic of Germany. The population needs information on possible prevention which should start in school. Human genetic counselling and prenatal counselling must be made readily available. Vigorous campaigns against substance abuse are vital. Pregnant women need special health protection support. Transportation, workplace and home must be made safer to name only a few areas in need of special legislation. Experiences in the beneficial effects of early detection have been made and documented in recent years and can serve as guidelines for further improvements. Assistance to developing countries in the areas of prevention, early detection and medical rehabilitation should become the most important task of development aid.

Developing Countries↗

Bioethical considerations in cancer prevention and early detection practice and research.

PURPOSE/OBJECTIVES: To review current ethical issues in cancer prevention and early detection, discuss some of the key methods and theories in contemporary bioethics, present clinical scenarios that illustrate moral problems that nurses may encounter, and show how the theories and methods can assist ethical decision making. DATA SOURCES: Published articles, abstracts, and books; case studies developed from clinical experience and literary sources. DATA SYNTHESIS: Oncology nurses face a host of ethical considerations when providing cancer prevention and early detection education and services and when conducting research in this arena. A variety of ethical methods and theories--including principlism, casuistry, utilitarianism, rights-based theories, virtue ethics, ethics of care, and communitarian ethics--may assist nurses in tackling ethical challenges. CONCLUSIONS: The growing field of cancer prevention and early detection raises a number of moral issues that have implications for oncology nursing. Because no single method or theory provides a complete account of bioethics, ethical problem solving should be approached using a variety of methods and theories whereby they can be coherently and appropriately applied together. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses need to increase their awareness of ethical issues related to cancer prevention and control and consider them when planning patient care and research programs.

Bioethics↗

Early detection of cardiac involvement in patients with sarcoidosis by a non-invasive method with ultrasonic tissue characterisation.

OBJECTIVES: To clarify the value of cycle dependent variation of myocardial integrated backscatter (CV-IB) analysis, which non-invasively measures acoustic properties of the myocardium, for early detection of cardiac involvement in patients with sarcoidosis. METHODS: The study population consisted of 22 consecutive patients with biopsy proven sarcoidosis who did not have any abnormal findings on conventional two dimensional echocardiogram. Cardiac sarcoidosis was diagnosed by radionuclide testing including thallium-201 scintigraphy, gallium-67 scintigraphy, and cardiac fluorine-18-deoxyglucose positron emission tomography. The magnitude and delay of the CV-IB were analysed in the basal mid septum and the basal mid posterior wall of the left ventricle of all patients. RESULTS: The patients were divided into two groups: 8 patients with cardiac involvement and 14 patients without cardiac involvement. In the basal septum, a major reduction in the magnitude (mean (SD) 1.8 (4.4) v 6.6 (1.3), p = 0.012) and an increase in the time delay (1.3 (0.5) v 1.0 (0.1), p = 0.038) of CV-IB were observed in patients with cardiac sarcoidosis even in the absence of two dimensional echocardiographic abnormalities. The sensitivity for detecting cardiac involvement was such that the magnitude of CV-IB in the basal septum discriminated 75% of patients with cardiac sarcoidosis from those with non-cardiac sarcoidosis, whereas two dimensional echocardiographic parameters did not discriminate between these two groups. CONCLUSIONS: The CV-IB is decreased in the basal septum in patients with cardiac sarcoidosis even in the absence of two dimensional echocardiographic abnormalities. Analysis of CV-IB may be a useful method to detect early myocardial involvement in patients with sarcoidosis.

Cardiomyopathies↗

Cancer: improving early detection and prevention. A community practice randomised trial.

OBJECTIVE: To test the impact of physician education and facilitator assisted office system interventions on cancer early detection and preventive services. DESIGN: A randomised trial of two interventions alone and in combination. SETTING AND SUBJECTS: Physicians in 98 ambulatory care practices in the United States. INTERVENTIONS: The education intervention consisted of a day long physician meeting directed at improving knowledge, attitudes, and skills relevant to cancer prevention and early detection. The office system intervention consisted of assistance from a project facilitator in establishing routines for providing needed services. These routines included division of responsibilities for providing services among physicians and their staff and the use of medical record flow sheets. MAIN OUTCOME MEASURES: The proportions of patients provided the cancer prevention and early detection services indicated annually according to the US National Cancer Institute. RESULTS: Based on cross sectional patient surveys, the office system intervention was associated with an increase in mammography, the recommendation to do breast self examination, clinical breast examination, faecal occult blood testing, advice to quit smoking, and the recommendation to decrease dietary fat. Education was associated only with an increase in mammography. Record review for a patient cohort confirmed cross sectional survey findings regarding the office system for mammography and faecal occult blood testing. CONCLUSION: Community practices assisted by a facilitator in the development and implementation of an office system can substantially improve provision of cancer early detection and preventive services.

Adult↗

[Effectiveness of programme for early detection of recurrence of cervical carcinoma (author's transl)].

Various diagnostic methods, generally suitable for early diagnosis of carcinoma recurrence, were used in a systematic localised search programme on 799 patients with invasive cervical carcinoma. The practicability of a concept for early detection of recurrence was verified and established by shortening of latency from first manifestation to recurrence and by more frequent detection of recurrent processes even without symptoms. Reported are methods selected from the programme for their suitability for early recurrence detection. These were necessarily restricted to detection of localised recurrence, following radiological or combined treatment, whereas early detection of parametrial and pelvic wall recurrences seemed to be purposeful, too, when preceded exclusively by primary surgical therapy. Rates of survival, following at least one year of recurrence observation, were encouraging and the support of the view that early detection of recurrence might help to improve the chance of healing.

Female↗

High-sensitivity array analysis of gene expression for the early detection of disseminated breast tumor cells in peripheral blood.

Early detection is an effective means of reducing cancer mortality. Here, we describe a highly sensitive high-throughput screen that can identify panels of markers for the early detection of solid tumor cells disseminated in peripheral blood. The method is a two-step combination of differential display and high-sensitivity cDNA arrays. In a primary screen, differential display identified 170 candidate marker genes differentially expressed between breast tumor cells and normal breast epithelial cells. In a secondary screen, high-sensitivity arrays assessed expression levels of these genes in 48 blood samples, 22 from healthy volunteers and 26 from breast cancer patients. Cluster analysis identified a group of 12 genes that were elevated in the blood of cancer patients. Permutation analysis of individual genes defined five core genes (P < or = 0.05, permax test). As a group, the 12 genes generally distinguished accurately between healthy volunteers and patients with breast cancer. Mean expression levels of the 12 genes were elevated in 77% (10 of 13) untreated invasive cancer patients, whereas cluster analysis correctly classified volunteers and patients (P = 0.0022, Fisher's exact test). Quantitative real-time PCR confirmed array results and indicated that the sensitivity of the assay (1:2 x 10(8) transcripts) was sufficient to detect disseminated solid tumor cells in blood. Expression-based blood assays developed with the screening approach described here have the potential to detect and classify solid tumor cells originating from virtually any primary site in the body.

Breast Neoplasms↗

Prevention and early detection clinical trials: opportunities for primary care providers and their patients.

Enrollment into cancer prevention and early detection clinical trials represents a unique challenge compared with a diagnostic or treatment trial because it involves subjects without a diagnosis of cancer. This paper examines some of the barriers to participation in prevention and early detection trials and provides detailed information about two ongoing prevention and two ongoing early detection clinical trials open to enrollment as well as brief summaries of seven additional trials now open to enrollment.

Anticarcinogenic Agents↗