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PubMed1990

Early cancer detection: update for primary-care physicians.

This article highlights information about the importance of early detection of cancer in the primary care physician's office. It represents information derived from a cancer prevention reference manual, ReCap: Recommendations for Cancer Prevention, developed by the Department of Cancer Prevention and Control at The University of Texas M.D. Anderson Cancer Center. Production, evaluation, and distribution to all primary care physicians in Texas were funded by the Physician Oncology Education Program, a program of the Texas Medical Association funded by the Texas Cancer Council.

Female↗
PubMed1998

[The clinical value of prostate-specific antigen velocity as a method for prostate cancer detection].

The usefulness and problems associated with measuring of prostate-specific antigen (PSA) velocity (PSAV) for detecting prostate cancer are reviewed. PSA is not a cancer-specific serum marker, and various physiologic and benign pathologic processes influence serum PSA concentrations. Thus, it is important to distinguish between the elevation of serum PSA caused by cancerous tissue and biological variations. Smith suggested that a PSAV cutoff point of 0.75 and 0.4 ng/ml/year or more maximized the sensitivity and specificity of predicting cancer in those with normal PSA levels and elevated PSA levels (greater than 4.0 ng/ml), respectively. We also demonstrated that PSAV is significantly higher in moderately to poorly differentiated cancer than that in well differentiated cancer.

Biomarkers, Tumor↗
PubMed1997

[Prostate cancer screening (III): risk factors, natural history, course without treatment. Characteristics of detected cancers].

The Oncology Committee of the Association Française d'Urologie has up-dated the knowledge concerning prostatic cancer screening since the 1989 Consensus Conference. The results are published in the form of a series of articles referring to the criteria used as prerequisites for cancer screening programmes. This article reports the data of the literature concerning risk factors, natural history, course without treatment and histological characteristics of the cancer detected. 1) Certain populations have an increased risk due to genetic factors. A family history (first degree relative) is associated with a 2- to 3-fold higher risk of prostatic cancer. This familial aggregation can be used to define a high-risk group constituting a primary target for screening. 2) The natural history of the disease, especially the progression from the asymptomatic stage to the clinical stage and the natural history of the disease at the clinical stage are now sufficiently well known. The concept of latent cancer has not been confirmed as the disease inevitably progresses. Cancers of insignificant volume, less than 0.5 cc (discovered at autopsy) are classically distinguished from cancers of significant volume, greater than 0.5 cc, but asymptomatic (risk of progression with mortality within 15 years), and local and/or metastatic symptomatic cancers. The histological prevalence of prostatic cancer is 43% in a group of men with a mean age of 64 years and increases with age. 92% of histological cancers have a volume less than 0.5 cc. It takes an estimated 12 years (3 doubling times) for a 0.5 cc cancer to reach a volume of 4 cc, the volume beyond which there is a risk of distant metastases. In the absence of curative treatment, a cancer diagnosed at the localized stage before the age of 65 years is associated with a specific survival of less than 30%. The median survival of metastatic prostatic cancer is 2 to 3 years. 3) The disease can be detected at an early stage. Cancers diagnosed by an isolated elevation of PSA in a screening setting have a significant volume in more than 3 out of 4 cases, can be entirely removed by prostatectomy in more than 3 out of 4 cases and have a less advanced pathological stage than cancers diagnosed on the basis of classical criteria.

Age Distribution↗
PubMed1950

Cancer detection centers; the experience to date in California.

Cancer "detection centers" (that is, centers for the examination of presumably well or asymptomatic persons) have been tried out in four different California communities during the last three years. In all instances-as in most other such centers throughout the United States-they have not been successful in restricting examination to well persons.The detection centers in California may therefore be described more accurately as "cancer examination and detection clinics."Three of the four centers have been closed owing to the small yield of cancer cases discovered, plus the fact that the cost of operation exceeded the total available funds of the local branch of the Cancer Society. In addition, it was extremely difficult to obtain and maintain competence on the part of the professional staff in such centers.A more practical approach to the problem of earlier tumor detection would appear to be emphasis on making "every physician's office a detection center," and stressing the annual examination of persons over 40 years of age for tumors in the five common accessible sites. These are the tumors most readily curable today.

California↗
PubMed1993

Breast Cancer Detection Demonstration Project data can determine whether the prognosis of breast cancer is affected by the time of surgery during the menstrual cycle.

The purpose of this study was to determine the feasibility of using Breast Cancer Detection Demonstration Project (BCDDP) data to ascertain whether the prognosis of breast cancer in premenopausal women is affected when surgery is performed relative to the different phases of the menstrual cycle. In the Louisville BCDDP only 40 cases were available for study, but even with this small number, the data indicate that survivorship was superior when the surgery was performed between days 7-20 of the menstrual cycle (P < 0.06). One thousand eighty-seven premenopausal women underwent surgery for breast cancer during the first 5 years of the national BCDDP, beginning in 1972. This large number of cases, plus the long period of follow-up should provide sufficient statistical power for us to evaluate if there is any relationship between the day of the menstrual cycle, the day surgery was performed, and prognosis. This feasibility study indicates that these women should be followed up and the appropriate statistical studies should be done.

Adult↗
PubMed2003

Prospective evaluation of a 21-sample needle biopsy procedure designed to improve the prostate cancer detection rate.

OBJECTIVES: To evaluate prospectively the diagnostic yield of a 21-sample ultrasound-guided needle biopsy procedure for prostate cancer in patients with elevated serum prostate-specific antigen and/or abnormal digital rectal examination findings. METHODS: Between December 2000 and May 2002, 303 patients underwent 21-sample needle biopsy under local anesthesia, comprising sextant biopsies at a 45 degrees angle, 3 biopsies in each peripheral zone at an 80 degrees angle, 3 biopsies in each transition zone (TZ), and 3 biopsies in the midline peripheral zone. Morbidity was assessed clinically. A short questionnaire was filled out by 90 consecutive patients. RESULTS: The cancer detection rate using 6 biopsy samples (sextant biopsies only), 12 samples (sextant plus lateral biopsies), 18 samples (sextant plus lateral plus TZ biopsies), and 21 samples (sextant plus lateral plus TZ, plus midline biopsies) was 22.7%, 28.3%, 30.7%, and 31.3%, respectively. The 21-sample procedure statistically improved the cancer detection rate by 37.9% relative to the 6-sample procedure. The improvement was most marked in patients with a prostate volume of more than 40 cm(3) (48.3%), patients with Stage T1c prostate disease (44.9%), patients undergoing repeat biopsy (66.2%), and patients with prostate-specific antigen levels greater than 10 ng/mL (38.5%). Adverse effects were infrequent (3%), consisting of prostatitis in 3 patients, acute urinary retention in 6 patients, and rectal bleeding requiring hospitalization in 1 patient taking aspirin. Using the questionnaire, 84% of patients reported macroscopic hematuria for an average of 3.4 days and hematospermia for 12.8 days, and 45% reported minor rectal bleeding lasting 1.1 days. The mean pain score, with a visual analog scale ranging between 0 (no pain) and 10 (intense pain), was 4.56. CONCLUSIONS: A 21-sample needle biopsy procedure increased the prostate cancer detection rate relative to a 6-sample procedure, without increasing morbidity. Patients with elevated prostate-specific antigen values should undergo sextant biopsies and at least 6 additional biopsies in the peripheral zone and 6 in the TZ.

Aged↗
PubMed2004

Does transrectal ultrasound guided eight-core prostate biopsy improve cancer detection rates in patients with prostate-specific antigen levels of 4.1-10 ng/mL?

BACKGROUND: To investigate retrospectively whether the eight-core biopsy method improves the prostate cancer detection rate when compared with the standard sextant biopsy method in patients with prostate specific antigen (PSA) levels of 4.1-10 ng/mL. MATERIAL AND METHODS: Of 437 patients whose PSA levels ranged from 4.1 to 10 ng/mL, 237 underwent a transrectal ultrasound guided sextant biopsy (sextant group), and 200 underwent an eight-core biopsy (eight-core group). Eight core samples were obtained from each of the far lateral regions in addition to the standard sextant biopsy cores. None of the patients had a previous history of prostate biopsy. RESULTS: Of the 237 patients in the sextant group, prostate cancer was detected in 47 patients (19.8%) and in 50 of the 200 patients in the eight- core group (25.0%). The rates of detection in the two methods were not statistically significant. However, in patients whose PSA density was less than 0.1 ng/mL per cc, the cancer detection rates in the sextant group and the eight-core group were 4.5% and 18.8%, respectively (P = 0.046). The morbidity and complications of the eight-core biopsy method were not notable. CONCLUSIONS: Only in patients with PSA levels of 4.1-10 ng/mL and density of less than 0.1 ng/mL per cc was the eight-core biopsy method an improvement on the sextant biopsy method in terms of prostate cancer detection rate. Accordingly, a number of cores greater than eight will be required to improve the cancer detection rates in patients with PSA levels of 4.1-10 ng/mL and PSA densities of more than 0.1 ng/mL per cc.

Adult↗
PubMed2026

Development and preliminary validation of plasma cell-free DNA methylation-based diagnostic prediction model for colorectal cancer detection.

BACKGROUND: Colorectal cancer (CRC) is a common malignancy associated with genetic and epigenetic alterations. Several methylation biomarkers have been investigated for non-invasive CRC detection; however, their reported performance varies across clinical settings, and the detection of early-stage or precancerous disease and discrimination from non-malignant colorectal conditions remain challenging. This exploratory study aimed to identify reproducible CRC-associated plasma cell-free DNA (cfDNA) methylation regions and to develop and preliminarily evaluate diagnostic prediction model for distinguishing CRC from healthy controls and benign samples. METHODS: Public CRC tissue methylation datasets from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) were analyzed to identify reproducible CRC-associated methylation alterations. Plasma cfDNA methylation was profiled using methyl-CpG-binding-domain enrichment followed by paired-end sequencing in patients with CRC, patients with colorectal polyps, and healthy controls. After quality-control filtering, 30 CRC and healthy-control samples were randomly allocated at the participant level in a 7:3 ratio to a development set comprising 10 patients with CRC and 11 healthy controls and a held-out test set comprising 4 patients with CRC and 5 healthy controls. Hypermethylated regions were selected using least absolute shrinkage and selection operator (LASSO) logistic regression. The 12-region model was evaluated in the held-out test set and subsequently applied to 10 colorectal polyp samples without refitting or recalibration. RESULTS: Tissue methylation analysis identified reproducible CRC-associated alterations across independent datasets. In the plasma development set, 707 differentially methylated regions (DMRs) were identified between CRC and healthy-control samples, including 324 hypermethylated and 383 hypomethylated regions. LASSO regression selected a 12-region hypermethylation signature. In the held-out test set, the model achieved an area under the curve (AUC) of 0.85 [95% confidence interval (CI): 0.579-1.000]. At the development-set-derived threshold, sensitivity was 75.0% (3/4), specificity was 60.0% (3/5), and accuracy was 66.7% (6/9). When the original model was applied to colorectal polyp samples, model scores were significantly higher in both CRC and polyp samples than in healthy controls, while CRC samples showed a tendency toward higher scores than polyp samples. CONCLUSIONS: This exploratory study identified a 12-region plasma cfDNA hypermethylation signature associated with CRC and developed a LASSO-based diagnostic prediction model that showed preliminary discrimination between CRC and healthy controls in a small held-out test set. By integrating tissue methylation evidence with plasma cfDNA profiling, this study expands the repertoire of candidate region-level methylation markers for blood-based CRC detection.

Colorectal cancer (CRC)↗
PubMed1996

[Tissue spectroscopy. New generation of optical methods for cancer detection].

Recent developments in the field of new, non-invasive, sensitive methods of cancer detection based on measurements of autofluorescence of cells are discussed. Research oriented on a detection of human cancer has been carried on by several groups for last six years only but has already yielded important data pointing to a possibility of both in situ and in vitro detection of cancerous tissues in several human organs, especially lung, gynecological tract, skin and gastro-intestinal tract. At least two such methods have been currently subject to clinical tests.

Humans↗
PubMed2002

Prospective study of cancer detection in black and white men with normal digital rectal examination but prostate specific antigen equal or greater than 4.0 ng/mL.

BACKGROUND: The serum prostate specific antigen (PSA) concentration with no clinical evidence of prostate carcinoma is higher and more variable in black than in white American men. The influence of this phenomenon on relations between race, PSA, and cancer detection in men with a PSA greater than or equal to 4.0 ng/mL has not been investigated. METHODS: Between January 1992 and December 2000, 451 black and 480 white men with a normal digital rectal examination and a PSA greater than or equal to 4.0 ng/mL had an initial prostate biopsy at one medical center. The histology of the biopsy specimens and the Gleason score of malignant specimens was determined by one uropathologist. RESULTS: Cancer was detected in 207 (46%) black and 167 (35%) white men (P = 0.0006). When adjusted for PSA, cancer detection was also greater in the black than the white men, but the difference did not achieve statistical significance (relative risk, 1.30; 95% confidence interval [CI], 0.99-1.71; P = 0.06). Gleason score 7-10 cancer was detected in 88 (20%) black and 45 (9%) white men (P = 0.0001), and the difference remained significant when adjusted for PSA (relative risk, 1.73; 95% CI, 1.16-2.61; P = 0.0008). In the intermediate PSA range of 4.0-9.9 ng/mL, cancer detection and Gleason score 7-10 cancer detection was greater in black than in white men younger than 60, 60-69, and 70 years of age or older, but the difference was significant only for Gleason score 7-10 cancer detection among men 60-69 years of age (P = 0.006). CONCLUSIONS: There is a direct correlation between Gleason score and cause specific survival with local stage prostate carcinoma. The authors' study indicates that prostate carcinomas with established malignant potential are more likely to be identified in black than in white men with PSA elevation as the only indication of malignancy and raises the possibility that a PSA threshold less than 4.0 ng/mL in black men younger than 70 years of age may reduce racial disparities in prostate carcinoma morbidity and mortality.

Age Factors↗
PubMed2002

Prospective evaluation of prostate cancer detection by prostate specific antigen related parameters: comparison in serum and plasma samples.

PURPOSE: We compared the usefulness of serum and plasma samples for enhancing the specificity of prostate cancer detection. MATERIALS AND METHODS: We analyzed receiver operating characteristics curves to evaluate prospectively the cancer detection performance of prostate specific antigen (PSA) related parameters derived from serum and plasma samples in 248 and 249 consecutive patients, respectively. RESULTS: Receiver operating characteristics curve analysis showed that PSA density and transition zone PSA density were more powerful predictors of prostate cancer than total or free PSA in the group overall at intermediate serum PSA 2.1 to 10 ng./ml. and in the subgroup with total PSA 4.1 to 10 ng./ml. regardless of digital rectal examination findings. Percent free PSA performed significantly better than total PSA in patients with serum total PSA 4.1 to 10 ng./ml. PSA density, transition zone PSA density and percent free PSA did not differ substantially in patients with serum total PSA 4.1 to 10 ng./ml. However, none of these parameters distinguished patients with prostate cancer from those with benign histology when PSA was in the lower range of 2.1 to 4 ng./ml. The performance of these parameters was worse when plasma sample data were used for calculation. CONCLUSIONS: The performance of percent free PSA appears at least comparable to that of PSA density and transition zone PSA density in patients in this cohort with serum total PSA 4.1 to 10 ng./ml. without regard to digital rectal examination. The poor performance of these parameters in the lower PSA range underscores the need for other parameters to improve the specificity of cancer detection in elderly Japanese males. Continued use of serum samples is justified for measuring PSA related parameters by current assay techniques.

Biomarkers, Tumor↗
PubMed1994

Dithiothreitol homogenization of prefixed sputum for lung cancer detection.

The technique of chemical homogenization of sputum for cancer detection was revisited. The mucolytic agent dithiothreitol (DTT) had been used by the authors on fresh specimens. In this study, its effectiveness in homogenizing prefixed sputum was investigated. Fifty-seven positive samples were examined: 28 were prefixed with 2% carbowax in 60% ethanol and 29 in 3% carbowax in 60% ethanol. Each specimen was divided equally into three parts and homogenized immediately, 3 and 7 days later, respectively, with 0.2% (0.013 mol/L) DTT in the respective prefixative. Five samples were prefixed for 4 wk before homogenization. The homogenization time varied from 30 min to 48 hr. The cellular morphology was compared to directly smeared controls from the same samples. It was found that the cellular morphology was well preserved and best with the 3% carbowax in 60% ethanol. The specimen could be prefixed for up to 4 wk before homogenization and the homogenization process could last from 30 min to 48 hr without any damaging effect on morphology. Furthermore, screening was made easy with the mucus lysed and its obscuring effect removed and the cells concentrated and evenly distributed. The method was versatile and could be of value in enhancing the detection rate of cancer in sputum.

Adenocarcinoma↗
PubMed2006

Saturation technique does not improve cancer detection as an initial prostate biopsy strategy.

PURPOSE: We reported on the results of a sequential cohort study comparing office based saturation prostate biopsy to traditional 10-core sampling as an initial biopsy. MATERIALS AND METHODS: Based on improved cancer detection of office based saturation prostate biopsy repeat biopsy, we adopted the technique as an initial biopsy strategy to improve cancer detection. Two surgeons performed 24-core saturation prostate biopsies in 139 patients undergoing initial biopsy under periprostatic local anesthesia. Indication for biopsy was an increased PSA of 2.5 ng/dl or greater in all patients. Results were compared to those of 87 patients who had previously undergone 10-core initial biopsies. RESULTS: Cancer was detected in 62 of 139 patients (44.6%) who underwent saturation biopsy and in 45 of 87 patients (51.7%) who underwent 10-core biopsy (p >0.9). Breakdown by PSA level failed to show benefit to the saturation technique for any degree PSA increase. Men with PSA 2.5 to 9.9 ng/dl were found to have cancer in 53 of 122 (43.4%) saturation biopsies and 26 of 58 (44.8%) 10-core biopsies. Complications included 3 cases of prostatitis in each group. Rectal bleeding was troublesome enough to require evaluation only in 3 men in the saturation group and 1 in the 10-core group. CONCLUSIONS: Although saturation prostate biopsy improves cancer detection in men with suspicion of cancer following a negative biopsy, it does not appear to offer benefit as an initial biopsy technique. These findings suggest that further efforts at extended biopsy strategies beyond 10 to 12 cores are not appropriate as an initial biopsy strategy.

Adult↗
PubMed2001

Comparison of full-field digital mammography with screen-film mammography for cancer detection: results of 4,945 paired examinations.

PURPOSE: To prospectively compare full-field digital mammography (FFDM) with screen-film mammography (SFM) for cancer detection in a screening population. MATERIALS AND METHODS: At two institutions, 4,945 FFDM examinations were performed in women aged 40 years and older presenting for SFM. Two views of each breast were acquired with each modality. SFM and FFDM images were interpreted independently. Findings detected with either SFM or FFDM were evaluated with additional imaging and, if warranted, biopsy. RESULTS: Patients in the study underwent 152 biopsies, which resulted in the diagnosis of 35 breast cancers. Twenty-two cancers were detected with SFM and 21 with FFDM. Four were interval cancers that became palpable within 1 year of screening and were considered false-negative findings with both modalities. The difference in cancer detection rate was not significant. FFDM had a significantly lower recall rate (11.5%; 568 of 4,945) than SFM (13.8%; 685 of 4,945) (P <.001, McNemar chi(2) model; P <.03, generalized estimating equations model). The positive biopsy rate for findings detected with FFDM (30%; 21 of 69) was higher than that for findings detected with SFM (19%; 22 of 114), but this difference was not significant. CONCLUSION: No difference in cancer detection rate has yet been observed between FFDM and SFM. FFDM has so far led to fewer recalls than SFM.

Biopsy↗
PubMed2003

Colorectal cancer detection by colonoscopy in a Swedish county, 1979-95.

BACKGROUND: Colorectal cancer is the third most common cancer in Sweden, and incidence is increasing. We analysed colorectal cancer detection by colonoscopy in a defined population in Sweden. METHODS: All colonoscopy records for the period 1979-95 in one Swedish county (population 258,000) were retrieved. Information was obtained about patient demographics, date of examination, endoscopists, indications, findings, colonoscopy type and completion level. Records were linked to the Swedish Cancer Register and the Cause of Death Register. RESULTS: The majority of 2214 colorectal cancers were detected by means other than colonoscopy. In total, 192 were diagnosed and 6 were not detected by colonoscopy, with no significant differences in gender, age, indications, presence of polyps or diverticulosis, time-period or experience of the endoscopist. The mean completion rate of the endoscopist was lower in patients with undetected cancers. Coexisting inflammatory bowel disease was more common in patients with late diagnosis. Sensitivity was 97.0%, and higher when the indication was bleeding, cancer or unclear X-ray findings. CONCLUSIONS: Sensitivity in detecting colorectal cancer was high, and the proportion detected by colonoscopy increased over time. Mean completion rate was lower in patients with undetected cancers. Coexisting IBD was more common in patients with a late diagnosis.

Aged↗
PubMed2005

Value of prostate volume measurement using transabdominal ultrasonography for the improvement of prostate-speci fi c antigen-based cancer detection.

PURPOSE: To examine value of prostate-speci fi c antigen (PSA) adjusted by prostate volume measured using transabdominal ultrasonography in prostate cancer detection among men with elevated PSA. METHODS: 238 men aged 79 years or younger with serum PSA levels of 2.0-20.0 ng/mL and normal digital rectal examination fi ndings were studied in terms of total and free PSA, prostate volumes with transrectal (TRUS) and transabdominal (TAUS) ultrasonography and transition zone volumes with TRUS prior to transrectal 10-core biopsy. In addition to sole PSA values and the free-to-total PSA ratio, volume-adjusted PSA values, PSA densities determined by TRUS (PSAD(TRUS)), and TAUS (PSAD(TAUS)), and PSA transition zone densities (PSATzD) were compared using receiver operating characteristic (ROC) analysis. RESULTS: Prostate cancer was diagnosed in 58 (24.4%) of the 238 men who underwent prostate biopsies. Of the areas under ROC curves (AUC) of studied parameters, PSATzD (AUC 0.751) was the best and signi fi cantly superior to PSAD(TAUS) (AUC 0.664, P = 0.007). However, PSAD(TAUS) exceeded PSA (AUC 0.559, P = 0.004) and showed potential capability of a one-fourth reduction in unnecessary biopsies without spoiling sensitivity (90%). Cancer detection rate was only 4.2% in the 48 patients whose prostate volume in TAUS was > 50 mL and PSAD(TAUS) was < 0.075. CONCLUSIONS: Since PSAD(TRUS) and PSATzD were signi fi cantly superior to PSAD(TAUS), TRUS is feasible as the standard fashion to determine prostate volume in the diagnosis of prostate cancers. However, TAUS is also worthwhile as it can improve the prostate cancer detection using sole PSA, and primary use of TAUS has the potential to reduce the substantial number of unnecessary biopsy safely.

Adult↗