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PubMed1996

Training in early cancer detection and anxiety in adolescent males: a preliminary report.

Because of concerns about increasing anxiety in a population that is at relatively low risk for developing cancer, some investigators have recommended that training in testicular self-examination (TSE) not be provided to adolescent males. However, empirical findings documenting a link between training in cancer detection and increased anxiety in adolescent males are lacking. In this preliminary study, we assessed whether training in TSE was actually associated with elevated state anxiety in two samples of adolescent males (29 ninth graders and 30 college underclassmen). For both groups, anxiety scores were well within normal limits at postassessment, indicating that a purported cost of the procedure may in fact not exist.

Adolescent↗
PubMed2004

[Histological diagnosis after Pap smears detecting cancer or high-grade lesion of the cervix].

OBJECTIVE: The aim of the study is to analyze the histological-cytological correlations for Pap smears having detected cancer or high-grade squamous intra-epithelial lesion (HSIL) of the cervix. PATIENTS AND METHOD: The study about 311 women is retrospective. The average age is 36.4 years. Group 1 (histological diagnosis of high-grade or invasive lesion) includes 244 women (77.5%). Group 2 (histological diagnosis other than high-grade or invasive lesion) includes 37 women (11.9%) with a presumed diagnosis of HSIL. Group 3 (absence of histological follow-up) includes 30 women (9.6%) with a presumed diagnosis of HSIL. RESULTS: In group 1, the presumed cytological diagnosis is HSIL in 229 cases, squamous carcinoma in 11 cases and adenocarcinoma in two cases. In this group, the average delay between the Pap smear and the first histology is equal to two months. It is longer than 6 months in seven cases. The diagnosis of cancer or high-grade lesion is confirmed histologically on a first biopsy of the cervix in 196 cases, a second or a third biopsy in 10 cases, an endocervical curettage in six cases and a surgical specimen in 32 cases. In the group 2, the histological diagnosis is normal-benign in 14 cases (presumed cytological false positives) and condyloma-CIN 1 in 23 cases (presumed overevaluations). DISCUSSION AND CONCLUSION: Results highlight benefits of interactive exchanges between clinicians and pathologists, and the necessity of review of discordant cases by several pathologists in due time, with written comments and coding of the conclusions of the review. Histological follow-up is late or not done in some women.

Adolescent↗
PubMed2005

Clinical utility of human glandular kallikrein 2 within a neural network for prostate cancer detection.

OBJECTIVE: To assess, using artificial neural networks (ANNs), human glandular kallikrein 2 (hK2), prostate-specific antigen (PSA), and percentage free/total PSA (f/tPSA), for discriminating between prostate cancer and benign prostatic hyperplasia (BPH). MATERIAL AND METHODS: Serum samples from 475 patients with prostate cancer (n = 347) or BPH (n = 128) within the PSA range of 1-20 ng/mL were analysed for tPSA, fPSA and hK2 (research assay, Toronto, Canada). Data were analysed in the ranges of 1-4, 2-4, 4-10, and 2-20 ng/mL tPSA. Back-propagation ANN models with the variables PSA, f/tPSA, and hK2, hK2/fPSA and hK2/(f/tPSA) were constructed. The diagnostic validity was evaluated by receiver-operating characteristic (ROC) curve analysis. RESULTS: Whereas the median concentration of hK2 was not significantly different between patients with BPH or prostate cancer in any of the tPSA ranges, the f/tPSA, hK2/fPSA and hK2/(f/tPSA), and the hK2-based ANN outputs were always significantly different between patients with prostate cancer or BPH. Using ROC curve comparison, all variables were significantly better than hK2 in all ranges. The hK2-based ANN performed better than f/tPSA except in the 4-10 ng/mL tPSA range. At 90% and 95% sensitivity, the hK2-based ANN was also significantly better than f/tPSA in the 1-4 ng/mL tPSA range. hK2/(f/tPSA) achieved equal results to the hK2-based ANN except in the range 2-20 ng/mL tPSA. CONCLUSIONS: The hK2-based ANN improves the outcome of f/tPSA but not hK2/(f/tPSA) in almost all analysed subgroups. When comparing the results at 90% and 95% sensitivity the hK2-based ANN only performed significantly better than f/tPSA in the lowest tPSA range. Only in lower tPSA ranges do hK2-based ANNs show an advantage for further improving prostate cancer detection.

Adult↗
PubMed1993

Breast cancer detection in an institution. Is mammography detrimental?

The poor results of the National Breast Screening Study of Canada regarding the screening of women aged 40-49 have been interpreted to suggest that mammography might be detrimental. Our comparison of women who had mammography and had their cancers detected by mammography with women who did not have mammography and had palpable cancers suggest that this is not the case. There is no detrimental effect; rather, the use of mammography results in an improvement in survival. The poor results of the National Breast Screening Study likely are due to the unbalanced allocation of women with advanced cancers to the screened group, the poor quality of the mammography in the trial, and an insufficient sample size.

Adult↗
PubMed2001

Invasive lobular carcinoma: sonographic features of cancers detected in a BreastScreen Program.

Sixty-two screen-detected invasive lobular carcinomas (ILC) were studied for sonographic, mammographic, clinical and histological findings. Ultrasound (US) features were compared with 60 invasive duct cancers (IDC). Size and axillary lymph node status in ILC were compared with all other cancers detected. In 41 ILC examined with US, 36 were found as masses (87.8% sensitivity; 95% CI 77.8-97.8%). Some US features of ILC and IDC differed: ILC were 9.94 times more likely to be hyperechoic (odds ratio, OR, 9.94; 95% CI 3.28-31.74) and 77% less likely to be taller than wide (OR 0.23; 95% CI 0.18-0.62). Thirty-three ILC showed typical malignant features of spiculate margins and acoustic shadowing. invasive lobular carcinomas had a greater mean diameter (20.4 mm; n = 60) than other invasive cancers (14.4 mm; n = 322) (P < 0.001). Ultrasound-guided needle biopsy was the method of diagnosis in 26 of 41 impalpable ILC (63%). Ultrasound has high sensitivity in characterizing screen-detected ILC, which may have atypical sonographic features including hyperechogenicity and a wider than tall shape. Ultrasound was an important contributor to diagnosis.

Australia↗
PubMed1994

Prostate cancer detection in BPH patients.

The first problem to be solved in the evaluation of BPH patients is surely the differential diagnosis with prostate carcinoma. We evaluated the impact of a combined approach for prostate cancer detection using DRE, PSA, TRUS and ultrasound-guided biopsy, determining the sensitivity and specificity of different tools, in order to obtain a diagnostic algorithm to be used for pretreatment differential diagnosis between prostate cancer and BPH.

Aged↗
PubMed1988

[Breast cancer detected by mass screening using physical examination alone].

In Tokushima prefecture, mass screening for breast cancer has been conducted using physical examination alone since 1970. Breast cancer was detected in 108 of 141,116 screened women up until 1986. The detection rate was 0.08% among total examinees, 0.12% among initial examinees, and 0.04% among subsequent examinees. Patients with breast cancer were divided into three groups. Group I consisted of 70 patients whose cancers were detected by initial screening examination. Group II consisted of 38 patients whose cancers were discovered by subsequent periodic screenings. Group III included "interval" patients, whose cancers were found in the interval within 2 years between a negative screening examination and the next screening; 19 patients were classified into this group. Serving as controls were 615 breast cancer patients who visited our outpatient clinic, independently of the screening program, during the same period as that of the mass screening. Of the 108 patients in Groups I and II, 51 patients (47%) had noticed a lump in the breast themselves by the time of the mass screening. The stage classification and nodal involvement showed significant differences between the mass screening group and the control group, but no significant differences among the three groups. The Group III cases (interval cases) were detected at an early stage, but some of these cases included patients with fast-growing tumors. When compared with cumulative survival curves according to age-matched case-control study, there was no significant difference between the patients whose tumors were detected in the mass screening and the controls.

Ambulatory Care↗
PubMed2000

Combined optical and fluorescence imaging for breast cancer detection and diagnosis.

In this article, we present a novel approach that combines the best aspects of both endogenous optical imaging and exogenous fluorescent lifetime and yield imaging for breast cancer detection and diagnosis. Using this approach, spatial distributions of optical properties, fluorescence lifetime, and yield in tissue can be reconstructed from measured excitation and emission data at the surface of the breast tissue by regularized inverse algorithms. We show images from simulated data, as well as images from experimental data using tissue-like phantom materials in the laboratory.

Algorithms↗
PubMedDate not supplied

The quality improvement cycle (QIC) in clinical practice: colorectal cancer detection.

In adapting quality improvement techniques originally developed by industry to an HMO medical delivery system, Harvard Community Health Plan (HCHP) applied the Shewhart quality improvement cycle (QIC) to colorectal cancer detection. An initial increase in the number of members routinely tested led to a second QIC to improve consistency of clinical evaluation of members with positive fecal occult blood test results. The successful use of these QICs suggests that similar techniques have a role in improving basic clinical skills and in the evaluation and therapy of common clinical conditions.

Clinical Competence↗
PubMed1996

Analysis of percent free prostate-specific antigen (PSA) for prostate cancer detection: influence of total PSA, prostate volume, and age.

OBJECTIVES: To determine whether the use of the free-to-total PSA ratio (percent free PSA) could increase the specificity of PSA testing for prostate cancer detection in men with serum PSA concentrations between 4.0 and 10.0 ng/mL, and to assess the influence of total PSA, prostate volume, and age on percent free PSA. METHODS: Sera were obtained from 217 men with histologically confirmed diagnoses (139 prostate cancer, 78 benign). Free and total PSA concentrations were determined using Hybritech Tandem assays. RESULTS: Use of percent free PSA increased PSA specificity: 29% of negative biopsies would be spared while retaining 95% sensitivity. Percent free PSA increased with increasing age and prostate volume. Percent free PSA decreased as total PSA increased. A significant relation exists between percent free PSA and the probability of a positive biopsy; in this cohort, a patient with a low percent free PSA (< or = 10%) had a higher probability of cancer (63 +/- 9%) than a patient with a high percent free PSA (> or = 26%) (probability 2 +/- 3%). CONCLUSIONS: Percent free PSA may be used as an aid in distinguishing prostate cancer from benign disease in men with a total PSA between 4.0 and 10.0 ng/mL. Large prospective multicenter trials are required to develop consistent recommendations and determine the appropriate cutpoints and risk probabilities, controlling for total PSA, prostate volume, age, and biopsy history.

Adult↗
PubMed2004

Evaluation of CaDet, a computer-based clinical decision support system for early cancer detection: a comparison with the performance of clinicians.

Based on an analysis of the epidemiologic and clinical attributes of individual patients, the CaDet computer program presents physicians with data patterns that may require clinical attention with regard to early cancer detection. This study evaluated the performance of the program as a possible tool to aid clinicians in the latter. Patient data were obtained by a questionnaire from 160 healthy volunteers. Scored cancer alerts generated by the computer program in response to this data were evaluated in comparison to similar alerts provided by five expert internists who reviewed the same information in blinded fashion. The alert profiles generated by the computer for each of the patients examined were highly correlated to those provided by the clinicians. The computer's alert rate increased with the number of physicians who raised corresponding alerts (20%, 32%, 54%, 73% and 91%, respectively, for 1, 2, 3, 4 and 5 physicians, p < 0.0001) and with the overall weight assigned by the physicians to these alerts (22%, 56%, 84% and 90% for cumulative scores of 1-4, 5-8, 9-12 and 13 or more points, respectively, p < 0.0001). It is concluded that the CaDet computer program may have a role in improving early detection, pending the results of further clinical research.

Decision Support Systems, Clinical↗
PubMed2001

[Successful complete androgen blockade (CAB) therapy for prostatic cancer detected from multiple lung metastases: a case report].

Prostatic cancer is rarely diagnosed by detection of lung metastases. We report a case of prostatic cancer in a 73-year-old man detected by abnormalities in chest X-ray and serum prostate specific antigen (PSA) level. He was initially admitted to our hospital due to elevation of PSA level. On the first transperineal prostatic needle biopsy, prostatic cancer was not detected and he was followed. Seven months after the first biopsy, chest X-ray revealed multiple abnormal nodules in the lung fields bilaterally and PSA level was again elevated. A second prostatic biopsy and whole-body examination were performed, and he was diagnosed with moderately differentiated prostatic adenocarcinoma with multiple lung metastases. Complete androgen blockade therapy was performed immediately. Two months after the beginning of treatment, PSA level was normalized and the multiple lung metastases had completely disappeared. There has been no evidence of recurrence or PSA relapse 24 months after detection of the prostatic cancer. This is the 26th case of prostatic cancer diagnosed in Japan following detection of multiple lung metastases.

Adenocarcinoma↗
PubMed2003

Early lung-cancer detection with spiral CT and positron emission tomography in heavy smokers: 2-year results.

BACKGROUND: Low-dose spiral CT of the chest effectively detects early-stage lung cancer in high-risk individuals. The high rate of benign nodules and issues of making a differential diagnosis are critical factors that currently hamper introduction of large-scale screening programmes. We investigated the efficacy of repeated yearly spiral CT and selective use of positron emission tomography (PET) in a large cohort of high-risk volunteers. METHODS: We enrolled 1035 individuals aged 50 years or older who had smoked for 20 pack-years or more. All patients underwent annual low-dose CT, with or without PET, for 5 years. Lesions up to 5 mm were deemed non-suspicious and low-dose CT was repeated after 12 months (year 2). FINDINGS: By year 2, 22 cases of lung cancer had been diagnosed (11 at baseline, 11 at year 2). 440 lung lesions were identified in 298 (29%) participants, and 95 were recalled for high-resolution contrast CT. PET scans were positive in 18 of 20 of the identified cancer cases. Six patients underwent surgical biopsy for benign disease because of false-positive results (6% of recalls, 22% of invasive procedures). Complete resection was achieved in 21 (95%) lung cancers, 17 (77%) were pathological stage I (100% at year 2), and the mean tumour size was 18 mm. There were no interval lung cancers in the 2.5 years of follow-up (average time on study from randomisation to last contact), although 19 individuals were diagnosed with another form of cancer (two deaths and 17 non-fatal admissions). INTERPRETATION: Combined use of low-dose spiral CT and selective PET effectively detects early lung cancer. Lesions up to 5 mm can be checked again at 12 months without major risks of progression.

Aged↗
PubMed1989

Transrectal ultrasonography. Early experience with use as prostate cancer detection tool.

Two hundred forty asymptomatic males, aged fifty-five to seventy years, underwent transrectal ultrasound of the prostate as part of a screening examination in conjunction with The National Prostate Cancer Detection Project (NPCDP). Nineteen prostate adenocarcinomas were detected, eight of which were nonpalpable. Fifteen of these patients had pathologic Stage B, 2 had microscopic Stage C (seminal vesicle involvement), and 2 had Stage D2 (bone) disease. While the activity and treatment of the eight nonpalpable lesions remain in question, the diagnosis certainly was made only with this type of examination. The use of transrectal ultrasound as a screening tool must continue to be prospectively evaluated in a multicenter trial.

Adenocarcinoma↗
PubMed1998

Early prostate cancer detection and potential for surgical cure in men with poorly differentiated tumors.

OBJECTIVES: Long-term cure after radical prostatectomy has been reported for men with organ-confined poorly differentiated prostate cancer. However, organ-confined rates have been disappointingly low, ranging from 8% to 18% in earlier series, which have consisted primarily of patients not screened for prostate-specific antigen (PSA). Recently, it has been our impression that a greater number of patients with poorly differentiated tumors have had organ-confined disease than earlier reports would have led us to predict. METHODS: To test this hypothesis, we reviewed the results of surgical staging in men with poorly differentiated tumors (Gleason score 8 to 10) entered into our prospective data base between August 1992 and June 1996. RESULTS: Of 109 men undergoing operation during the study period, 64 underwent exploration for planned radical prostatectomy with no previous therapy and comprise the study cohort. In 92%, the initial presentation was an elevated PSA level (median 10.8 ng/mL). We observed an organ-confined rate of 30% and found preoperative PSA levels of 10 ng/mL or less to be a significant predictor of organ-confined disease (45% versus 17%, P = 0.016, chi-square test). On preliminary follow-up (median 31 months), 84% of men with organ-confined tumors are free of PSA relapse, similar to that seen in 233 men with organ-confined moderately differentiated tumors undergoing operation during the study period (P = 0.12, log-rank test). CONCLUSIONS: Early prostate cancer detection, as reflected by PSA levels of 10 ng/mL or less, is associated with a higher organ-confined rate in men with poorly differentiated tumors. On preliminary follow-up, PSA relapse rates were lower in men with pathologically confirmed, organ-confined, poorly differentiated disease.

Adult↗
PubMed1994

Relative sensitivity and specificity of serum prostate specific antigen (PSA) level compared with age-referenced PSA, PSA density, and PSA change. Data from the American Cancer Society National Prostate Cancer Detection Project.

BACKGROUND: Different indexes that may enhance the early detection capability of prostate specific antigen (PSA) have been proposed. In addition to the indexes relating to the normal PSA level, there are data suggesting the usefulness of the PSA level relative to prostate gland volume (PSA density), age-referenced PSA level, and PSA change. Little research comparing the sensitivity and specificity of these measures in the same population has been reported. METHODS: All subjects were participants in the American Cancer Society National Prostate Cancer Detection Project. Specificity was studied in 2011 men without prostate cancer, and sensitivity was determined for 171 men with prostate cancer. RESULTS: Prostate specific antigen change showed the highest specificity (96.4%), and PSA density the lowest (85.3%). The most sensitive index was PSA density, which was positive for 74.7% of the 171 cases of known cancer. A PSA change of more than 0.75 ng/ml per year was the least sensitive index (54.8%). Sensitivity and specificity varied in a narrow range. Improved performance in specificity was achieved only with the loss of sensitivity. CONCLUSIONS: None of the alternative indexes commonly used in general early detection practice demonstrated particular advantage when compared with the normal PSA concentration, defined as no more than 4.0 ng/ml.

Adult↗
PubMed2005

Breast cancer detection using mammary ductoscopy.

Mammary ductoscopy (MD) has been used as a tool to evaluate the breast for cancer for over 10 years. MD allows the direct visualization of the duct lumen, providing a more targeted approach to the diagnosis of disease arising in the ductal system, since the lesion can be visualized and samples collected in the area of interest. Initial studies of MD evaluated women with pathologic spontaneous nipple discharge (PND), while more recent reports are also using MD to assess women without PND for the presence of breast cancer. Cytologic assessment of MD is highly specific but less sensitive in the detection of breast cancer. Nonetheless, a MD sample from a breast with PND may rarely undergo cytologic review and be interpreted as consistent with malignancy, only later to undergo surgical resection demonstrating benign pathology. For this reason, PND specimens interpreted as malignant on cytologic review require histopathologic confirmation prior to instituting therapy. Additional sample evaluation using image or molecular analysis may improve the sensitivity and specificity of MD in breast cancer detection.

Breast Neoplasms↗
PubMed1990

American Cancer Society's Breast Cancer Detection Awareness Program: the 1988 middle Tennessee experience.

In an effort to augment public awareness of the benefits of screening mammography and to encourage the use of screening mammograms, the Tennessee Division of the American Cancer Society initiated the Breast Cancer Detection Awareness Program in March 1988. As a result of the initiative, 3,473 women telephoned for information, and 3,123 were found to be eligible for a screening mammogram. Of the 2,248 mammograms actually obtained, 1,764 (78%) were interpreted as normal, whereas 484 (22%) were classified as abnormal. Of the 484 women with abnormal mammograms, 277 (57%) were advised to have follow-up mammograms and 57 (12%) had excisional biopsy. The 55 biopsies reported showed benign changes in 83.6% and malignancy in 16.4%. Thus, nine malignancies were discovered from 2,248 screening mammograms (four malignancies per 1,000 mammograms). No malignancies were found in women between 35 and 39 years old.

Adult↗