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PubMedDate not supplied

A systematic review and lessons learned from early lung cancer detection trials using low-dose computed tomography of the chest.

BACKGROUND: Computed tomography (CT) screening of the chest has shown promise for early detection of lung cancer, but evidence for a reduction in lung cancer mortality by CT screening is not available. METHODS: We reviewed 208 articles to synthesize available evidence for efficacy of CT screening in detecting potentially curative stages of lung cancer and for evidence in reducing lung cancer mortality. Other outcomes of interest included detection rate of cancer and of suspicious lesions, histology and stage of cancer at detection, screening-related morbidity, and the identification of populations uniquely suited for CT screening. We identified eight papers that reported the outcomes for CT of the chest in lung cancer screening. RESULTS: Since none of the studies utilized a control group, quantitative pooling was not done. In two studies, both CT and chest radiography (CXR) were used as screening tools in the same cohorts. A total of 19,107 subjects were screened using CT. The detected prevalence rate for lung cancer ranged from 0.40% to 13.6% and was a function of the subjects' age and smoking history. CT screening resulted in a 3-fold higher detection rate and a 5-fold increase in the rate of resectable cancers compared to CXR. Data on lung cancer and overall mortality and screening-related morbidity and mortality were incomplete. CT screening resulted in selective detection of adenocarcinomas with an approximately 2- to 3-fold oversampling of this histologic subtype. The positive predictive value of CT screening was highest for subjects in the 8th decade of life, and it was virtually nil for those in their 5th decade. CONCLUSIONS: Evidence regarding lung cancer screening by CT shows that this technology detects earlier-stage and smaller lung cancers with greater frequency than other screening methods. To date, no trials have demonstrated that CT screening leads to a reduction in lung cancer mortality. Until mortality trials are completed, low-dose CT screening should be considered an investigative tool rather than the standard of care.

Humans↗
PubMed2004

New molecular markers for bladder cancer detection.

PURPOSE OF REVIEW: Bladder cancer continues to be one of the most common genitourinary malignancies. The mainstay of diagnosis remains cystoscopic visualization with transurethral biopsy or resection. As over two-thirds of bladder tumors recur, vigilant surveillance is required. Due to the invasiveness and expense of frequent cystoscopies and the lack of sensitivity of urinary cytology, especially for low-grade superficial lesions, novel molecular markers have been investigated as a means to detect bladder cancer noninvasively. RECENT FINDINGS: As our understanding of the pathogenesis of urothelial neoplasia improves, coupled with recent advances in molecular biological techniques, an array of new approaches to the diagnosis of bladder cancer has emerged. Several urine-based markers have been tested against the standard of urinary cytology with promising results. However, lack of standardization of technique and heterogeneity of bladder cancer itself may hinder the widespread dissemination of these diagnostic aids. SUMMARY: A host of new molecular markers based on the pathogenesis of bladder cancer have been investigated, such as telomerase, survivin, and multitarget fluorescence in situ hybridization, which may eventually improve detection and management of urothelial malignancies. By improving the sensitivity of urinary cytology for low-grade superficial lesions and detecting recurrent disease noninvasively early in its course, these new molecular markers might someday allow changes in the way bladder cancer is diagnosed and followed. At the present time, however, no single molecular marker provides 100% accuracy. Perhaps panels utilizing the most promising of these markers may alter bladder cancer detection and management policy.

Biomarkers, Tumor↗
PubMed1994

The effect of benign breast biopsy on subsequent breast cancer detection practices.

PURPOSE/OBJECTIVES: To determine the effect of benign breast biopsy results on the frequency of subsequent breast self-examination (BSE), mammograms, and clinical examinations. DESIGN: Retrospective, descriptive design. SETTING: Two surgical oncology practices of an academic health science center in the southeastern United States and one surgical oncology practice and three family practices in another southern U.S. city. SAMPLE: A nonprobability sample consisting of 238 women with benign breast biopsies and a comparison group of 243 women with no histories of breast disease. METHODS: Questionnaires based on American Cancer Society (ACS) breast cancer detection guidelines were designed and mailed to all women who had benign breast biopsies within the past three years at the academic health science center. Similar questionnaires were mailed to women randomly selected from three family practices who had no histories of breast disease. Chi-square, Kruskal-Wallis one-way analysis of variance, and Wilcoxon matched pairs signed-ranks test were used in the data analysis. MAIN RESEARCH VARIABLES: Frequency of breast cancer detection practices including BSE, mammography, and clinical breast examinations. FINDINGS: In the group that had undergone biopsies, breast abnormalities were found by mammogram (38.8%), BSE (28.3%), clinical examination (16.9%), and accidental discovery (8.7%). The percentage of women performing monthly BSE increased from 47.4% to 67.3% postbiopsy (p < 0.0001). The frequency of mammography and clinical breast examinations also significantly increased postbiopsy (p < 0.0001). Similarly, the postbiopsy rate of BSE, mammography, and clinical breast examinations was higher than the rates for the control group. Women whose breast abnormalities were found by mammography became significantly more fearful of mammography (p < 0.05). CONCLUSIONS: Benign breast biopsies are associated with increased breast cancer detection practices. IMPLICATIONS FOR NURSING PRACTICE: All women need to follow ACS guidelines for breast cancer detection. Women who have undergone breast biopsy may be unduly afraid about the results of future detection practices and may need support and encouragement.

Adult↗
PubMed1991

A survey of breast cancer detection methods in long-term care facilities.

The majority of women residents in long-term care facilities are at high risk for the development of breast cancer. Routine breast cancer detection methods are indicated but not used for women in long-term care facilities on Long Island, New York. There appears to be an age-related bias concerning breast cancer detection of long-term care residents among health-care providers. There is no literature that addresses the need for breast cancer detection among residents in long-term care facilities.

Aged↗
PubMed1993

A comparison of breast cancers detected by mass screening and those found in out-patient clinics.

We evaluated the results of a mass screening study on breast cancer detection by physical examination alone conducted in Ishikawa Prefecture from 1978 to 1990. The number of cases of breast cancer detected by mass screening was then compared with that found in out-patient clinics during the same period. Breast cancer was detected in 88 of 152,969 women by mass screening, the detection rate being 0.06% for the total study: 0.08% at the initial screening and 0.04% at periodic screenings. Early stage breast cancer was more frequently detected during periodic screenings than at the initial screening or in out-patient clinics. Moreover, although the initial screenings may have identified patients with breast cancer at more advanced stages, the survival was not significantly different. The results of this series led us to conclude that mass screening by physical examination alone may have no impact on the mortality rate of breast cancer.

Adult↗
PubMedDate not supplied

Survival experience in the Breast Cancer Detection Demonstration Project.

Very high survival rates have been observed in four through 11 years of follow-up in 4,240 women with a histologically confirmed diagnosis of breast cancer in the Breast Cancer Detection Demonstration Project (BCDDP). The relative five, eight, and 10-year survival rates were 88, 83, and 79 percent, respectively. Allowances were made for lead-time bias among cancers detected through screening, and the validity of the findings was supported by internal analyses, which showed that length-time bias was of little, if any, importance, and that any possible "overdiagnosis" of cancer cases was also of small relevance. In view of current interest in the value of screening women before age 50, intensive analyses were made comparing the BCDDP data for women in their 40s with women in their 50s. In terms of kinds of breast cancers found, modality of finding them, and survival rates once they have been found, the parallel results for the two groups show that screening was virtually as effective in the younger as in the older women. Some authorities are of the opinion that the benefits of mammography after age 50 are well documented, but at younger ages the evidence is still inconclusive. The findings in this study show there is no doubt of the very successful results of screening for breast cancer with mammography in younger as well as older women. In comparing relative five-year and eight-year survival rates for women with invasive breast cancers detected through screening in the BCDDP, with those for cases diagnosed in the National Cancer Institute's Surveillance, Epidemiology and End Results (NCI SEER) program from 1977 to 1982, it is seen that for individual subcategories by tumor size and nodal class, the survival rates are about the same. However, for overall invasive cancers, the five-year and eight-year survival rates were 87 and 81 percent, respectively, for the BCDDP compared with 74 and 65 percent for SEER. Thus the substantial gains in survival followed the large shift toward a high proportion of cancers being diagnosed and treated in more favorable stages through the screening accomplishments. With respect to the relative case fatality rates, the complements of the relative survival rates, the eight-year rate of 19 percent for the BCDDP versus that of 35 percent for SEER connotes 46 percent fewer women dying in the BCDDP group.

Adult↗
PubMed2006

African-American race is a predictor of prostate cancer detection: incorporation into a pre-biopsy nomogram.

OBJECTIVES: To construct a pre-biopsy predictive model incorporating several clinical variables, including African-American (AA) or Caucasian race, to predict the risk of prostate cancer detection on prostate biopsy, as traditionally AA men have had a higher incidence of prostate cancer than Caucasian men, but previous predictive tools for prostate cancer have not incorporated the effect of race. PATIENTS AND METHODS: We evaluated 9473 patients undergoing initial prostate biopsy at three equal-access healthcare institutes from 1993 to 2003. At each biopsy session, patient age, race, serum prostate-specific antigen level (PSA), digital rectal examination (DRE) findings, number of biopsy cores taken, year of biopsy, and pathological findings were recorded. A logistic regression model was constructed to evaluate predictors of cancer detection based on pre-biopsy variables. The model was internally validated using the bootstrap statistical method, and a nomogram was constructed. RESULTS: Prostate cancer was diagnosed in 1895 (33%) AA men and 991 (26%) Caucasians. AA men had a significantly higher mean serum PSA level than Caucasians, at 13.0 and 8.5 ng/mL, respectively (P < 0.001). The mean ages were similar between AA and Caucasian men (P = 0.23), but Caucasian men had a higher incidence of an abnormal DRE (P < 0.001). On multivariate analysis, age, race, year of biopsy, PSA level, DRE, and number of cores taken were all statistically significant (P < 0.001). Hazard ratios were (controlling for year of biopsy); age (1.30), Caucasian race (0.74), PSA level (1.47), DRE (1.75), and number of cores taken (1.19). The predicted model had a boot-strapped concordance index of 0.75. CONCLUSION: AA race remains an independent predictor of prostate cancer detection in men undergoing initial prostate biopsy. This nomogram is the first to individualise the risk by AA or Caucasian race in a predictive model for counselling men on their probability of having cancer at the time of their first biopsy.

Black or African American↗
PubMed2001

Prostate cancer detection in men with prior high grade prostatic intraepithelial neoplasia or atypical prostate biopsy.

PURPOSE: We used clinical variables to predict prostate cancer detection on re-biopsy among patients diagnosed with high grade prostatic intraepithelial neoplasia (PIN) or atypia on initial prostate biopsy. MATERIALS AND METHODS: A total of 45 men with atypia and 43 with high grade PIN were eligible for our study. Clinical variables were tested with univariate and multivariate logistic regression to predict who would have cancer on re-biopsy. We also calculated the odds of detecting cancer with various repeat sampling strategies and determined whether the location of initial atypia or high grade PIN is correlated to that of cancer on re-biopsy. RESULTS: Of the patients in the atypia and high grade PIN groups 51% had cancer on re-biopsy. Cancer was diagnosed significantly earlier in the high grade PIN than in the atypia cohort (average 7.5 versus 22.9 months, respectively, p = 0.005). Multivariate logistic modeling showed that digital rectal examination and patient age were independent predictors of cancer in atypia, whereas no variables were significantly predictive for high grade PIN. Of cancers in the atypia and high grade PIN 65% and 74%, respectively, would have been detected if re-biopsy was focused only at the initial site of disease. CONCLUSIONS: Men with atypia or high grade PIN merit close followup because 50% will have cancer on re-biopsy as will those who are older with an abnormal digital rectal examination. Although re-biopsy should focus primarily on the original site of atypia or high grade PIN, cancer detection significantly increases with the sampling of adjacent sites.

Aged↗
PubMed2006

Contrast-enhanced sonography for prostate cancer detection in patients with indeterminate clinical findings.

OBJECTIVE: The purpose of our study was to evaluate the usefulness of contrast-enhanced sonography for prostate cancer detection in patients with an indeterminate prostate-specific antigen (PSA) level (4-10 ng/mL) and negative findings on digital rectal examination. SUBJECTS AND METHODS: Forty-eight patients underwent gray-scale, color Doppler, and contrast-enhanced sonography examinations and then sonographically guided biopsy. Contrast-enhanced sonography was performed using Levovist at a mechanical index of 1.1-1.4. The performances of the three methods for cancer detection were compared according to biopsy site and patient. RESULTS: Sensitivity by biopsy site was greater on contrast-enhanced sonography (68%) than on gray-scale (39%) and color Doppler (41%) sonography (p > or = 0.05), whereas the specificity and overall accuracy by biopsy site (82% and 77% for gray-scale sonography, 84% and 79% for color Doppler sonography, and 83% and 81% for contrast-enhanced sonography, respectively) were not different for the three methods (p > 0.05). The concordance score for sonography and biopsy results by patient was not different for gray-scale (6.4 +/- 1.8), color Doppler (6.3 +/- 0.6), and contrast-enhanced sonography (6.5 +/- 0.7) (p = 0.281). CONCLUSION: Contrast-enhanced sonography could improve only the sensitivity for cancer detection in analysis by biopsy site but did not improve the overall performance of sonography in patients with an indeterminate PSA level and negative digital rectal examination.

Aged↗
PubMed1996

Early cancer detection programmes for women at high risk for breast and ovarian cancer: a proposal of practical guidelines.

Women from families with multiple breast and/or ovarian cancers may be at increased risk to develop breast/ovarian cancer themselves. Due to personal experience with family members having these diseases they are anxious and ask for specific prophylactic measurements or treatment. The detection of two susceptibility genes, BRCA1 and BRCA2, has given insight into the genetic background of part of the familial breast/ovarian cancer syndromes. This has led to an increased demand in genetic counselling, testing, and early cancer detection programmes. Prospective data from early cancer detection programmes in this high risk population are yet not available. Based on data from epidemiological risk studies, breast and ovarian screening programmes and follow up data from breast cancer trials recommendations for an early cancer detection programme have been summarized. At the present these recommendations are tested in a prospective trial.

Adult↗
PubMed2005

Prostate cancer detection in men with prostate specific antigen 4 to 10 ng/ml using a combined approach of contrast enhanced color Doppler targeted and systematic biopsy.

PURPOSE: Transrectal gray scale ultrasound guided biopsy is the standard method for diagnosing prostate cancer (PC). Improved cancer detection with ultrasound contrast agents is related to better detection of tumor vascularity. We evaluated the impact of a combined approach of contrast enhanced, color Doppler targeted biopsy (CECD) and systematic biopsy (SB) for the PC detection rate in men with prostate specific antigen (PSA) 4.0 to 10 ng/ml. MATERIALS AND METHODS: We examined 380 screening volunteers with a total PSA of 4.0 to 10 ng/ml (percent free PSA less than 18). CECD was always performed before SB. Another investigator blinded to contrast enhanced findings performed 10 SBs. The cancer detection rate for the CECD, SB and combined approaches was assessed. RESULTS: PC was detected in 143 of 380 patients (37.6%, mean total PSA 6.2 ng/ml). The PC detection rate for CECD and for SB was 27.4% and 27.6%, respectively. The overall cancer detection rate with the 2 methods combined was 37.6%. For targeted biopsy cores the detection rate was significantly better than for SB cores (32.6% vs 17.9%, p <0.01). CECD in a patient with cancer was 3.1-fold more likely to detect PC than SB. CONCLUSIONS: CECD allows for the detection of lesions that cannot be found on gray scale ultrasound or SB. CECD allows for assessment of neovascularity associated with PC. However, the combined use of CECD and SB allows for maximal detection of PC with a detection rate of 37.6% in our patients with PSA 4 to 10 ng/ml.

Adult↗
PubMed2005

Breast cancer detective: a computer game to teach breast cancer screening to Native American patients.

BACKGROUND: Few computer based information resources about breast cancer screening are interactive or are culturally appropriate for Native American patient education. METHODS: An interactive computer game was designed by modifications to a previously developed game for medical students about breast cancer screening. RESULTS: "Breast Cancer Detective-Native Patient Version" incorporates problem-based learning and competitive play and has culturally relevant graphics, situations, and language for patients. CONCLUSIONS: The computer game is targeted for Native American health care, designed to improve compliance with breast screening in this underserved population and improve cultural awareness for health care students and providers.

Breast Neoplasms↗
PubMed2000

Breast density as a predictor of mammographic detection: comparison of interval- and screen-detected cancers.

BACKGROUND: Screening mammography is the best method to reduce mortality from breast cancer, yet some breast cancers cannot be detected by mammography. Cancers diagnosed after a negative mammogram are known as interval cancers. This study investigated whether mammographic breast density is related to the risk of interval cancer. METHODS: Subjects were selected from women participating in mammographic screening from 1988 through 1993 in a large health maintenance organization based in Seattle, WA. Women were eligible for the study if they had been diagnosed with a first primary invasive breast cancer within 24 months of a screening mammogram and before a subsequent one. Interval cancer case subjects (n = 149) were women whose breast cancer occurred after a negative or benign mammographic assessment. Screen-detected control subjects (n = 388) were diagnosed after a positive screening mammogram. One radiologist, who was blinded to cancer status, assessed breast density by use of the American College of Radiology Breast Imaging Reporting and Data System. RESULTS: Mammographic sensitivity (i.e., the ability of mammography to detect a cancer) was 80% among women with predominantly fatty breasts but just 30% in women with extremely dense breasts. The odds ratio (OR) for interval cancer among women with extremely dense breasts was 6.14 (95% confidence interval [CI] = 1.95-19.4), compared with women with extremely fatty breasts, after adjustment for age at index mammogram, menopausal status, use of hormone replacement therapy, and body mass index. When only those interval cancer cases confirmed by retrospective review of index mammograms were considered, the OR increased to 9.47 (95% CI = 2.78-32.3). CONCLUSION: Mammographic breast density appears to be a major risk factor for interval cancer.

Adult↗
PubMed2001

Cancers detected and induced, and associated risk and benefit, in a breast screening programme.

Current cancer detection rates and dose levels in the UK Breast Screening Programme are used to compare numbers of cancers detected with numbers predicted to be induced by the screening process itself. Numbers of those detected are shown to exceed those induced by a large margin for women aged over 50 years. The associated benefit/risk ratio is also considered. For younger women this margin is progressively reduced but remains positive at least down to age 40 years, and possibly beyond. Women both with and without a family history of breast cancer are considered. Some implications for familial breast screening programmes are discussed. Some caution may be required before annual screening of women below the age of 35 years.

Adult↗
PubMed1990

Screening mammography: increasing the effort toward breast cancer detection.

Mammography is the only modality with the potential for detecting a breast cancer while it is non-palpable and at a stage of high curability. Early detection of breast cancer is important because survival is directly related to tumor size and lymph node status, and prognosis is best for small lesions without axillary node metastasis. Many studies have indicated that screening mammography is tremendously underused. This article focuses on the effectiveness of mammography and the importance of detecting a breast cancer at an early stage. Health care providers have a responsibility to inform their clients about the benefits of mammography. In addition, women need to be taught breast self-examination and undergo regular clinical breast examinations by a health care professional. The American Cancer Society guidelines for screening breast cancer are given.

Adult↗
PubMed2000

Comparison of percent free PSA, PSA density, and age-specific PSA cutoffs for prostate cancer detection and staging.

OBJECTIVES: Various methods have been proposed to increase the specificity of prostate-specific antigen (PSA), including age-specific PSA reference ranges, PSA density (PSAD), and percent free PSA (%fPSA). In this multicenter study, we compared these methods for their utility in cancer detection and their ability to predict pathologic stage after radical prostatectomy in patients with clinically localized, Stage T1c cancer. METHODS: Seven hundred seventy-three men (379 with prostate cancer, 394 with benign prostatic disease), 50 to 75 years old, from seven medical centers were enrolled in this prospective blinded study. All subjects had a palpably benign prostate, PSA 4.0 to 10.0 ng/mL, and a histologically confirmed diagnosis. Hybritech's Tandem PSA and free PSA assays were used. RESULTS: %fPSA and age-specific PSA cutoffs enhanced PSA specificity for cancer detection, but %fPSA maintained significantly higher sensitivities. Age-specific PSA cutoffs missed 20% to 60% of cancers in men older than 60 years of age. %fPSA and PSAD performed equally well for detection (95% sensitivity) if cutoffs of 25% fPSA or 0.078 PSAD were used. The commonly used PSAD cutoff of 0.15 detected only 59% of cancers. %fPSA and PSAD also produced similar results for prediction of the post-radical prostatectomy pathologic stage. Patients with cancer with higher %fPSA values (greater than 15%) or lower PSAD values (0.15 or less) tended to have less aggressive disease. CONCLUSIONS: The results of this study demonstrated that cancer detection (sensitivity) is significantly higher with %fPSA than with age-specific PSA reference ranges. %fPSA and PSAD provide comparable results, suggesting that %fPSA may be used in place of PSAD for biopsy decisions and in algorithms for prediction of less aggressive tumors since the determination of %fPSA does not require ultrasound.

Age Factors↗
PubMed1992

The relationship between the clinical presentation and spread of colon cancer in 315 consecutive patients. A significant trend of earlier cancer detection from 1982 through 1988 at a university hospital.

We systematically analyzed the relationship between 47 clinicoepidemiologic parameters and stage of colon cancer in 315 patients who underwent colon cancer surgery from 1982 through 1988 at the Robert Johnson University Hospital. A history of hemorrhoids was correlated with early cancer, possibly because of earlier self-referral (odds ratio = 18.2; chi 2 = 10.4; degrees of freedom = 1; p less than 0.001). However, anemia was correlated with advanced cancer (odds ratio = 0.21; chi 2 = 13.7; degrees of freedom = 1; p less than 0.0002). Anemia may result from chronic bleeding due to a longstanding cancer. Prior studies have suggested that intensive screening programs may produce earlier colon cancer detection; this study demonstrated for all patients at a medical center a significant trend from 1982 through 1988 of detecting colon cancer at an earlier pathologic stage and with a better differentiated histologic grade (for first half of study period 44.4% had Dukes' stage A or B cancer, second half of study period 58.6% had Dukes' stage A or B cancer; odds ratio = 0.56; chi 2 = 5.8; degree of freedom = 1; p less than 0.02). Possible explanations for this phenomenon are earlier self-referral because of increased patient awareness of cancer warning signs, and earlier physician detection because of greater use of colonoscopy and polypectomy and because of increased screening and surveillance. This earlier detection may herald a future significant decrease in colon cancer mortality at this hospital because prognosis is closely related to cancer stage. Further studies are required to determine if this is part of a national trend.

Adult↗
PubMed2006

Computerized analysis of tissue density effect on missed cancer detection in digital mammography.

This paper presents a study of the analysis of breast density in missed cancer cases and the effect of tissue density on cancer detection. A total of 100 missed cancer cases were collected. The breast density tissue was segmented with a statistical-based method. A set of tests was then applied to examine: (1) the differences in density between the mammograms at the detected stage and that at missed stage; (2) the density difference between the cancerous mammograms and their contra-lateral normal mammograms in the missed cancer cases; (3) the effect of breast density on CAD cancer detection. The results demonstrate that breast density is an important factor affecting not only radiologist's reading but also CAD performance. In order to improve early detection of breast cancer, a special effort should be directed to the high dense breast cases in CAD system design.

Breast Neoplasms↗