New guidelines for cancer detection create stir.
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Present status of thermography, ultrasound and mammography in breast cancer detection.
Various biophysical methods have been utilized in the diagnosis of breast cancer. To date the best results have been obtained with x-ray mammography. Ultrasound and thermography have great appeal as non-destructive techniques but, in the present state of development, are of limited use. The spatial resolution presently obtainable in ultrasonograms is inadequate for the detection of subclinical cancer and thermography is also of questionable reliability. While an overall true positive rate of 70% to 75% may be anticipated with thermography, the bulk of false negatives would seem to occur in those tumors most amenable to therapy, i.e., subclinical cancers. The "false positive" rate of thermography is also excessive, but would be acceptable for establishing a high risk group if true positive rates could be improved. At present thermography finds its greatest use as an adjunct to mammography and physical examination; it should not be used as the sole modality in a screening program. The efficacy of mammography can be readily demonstrated but the propriety of its use as a screening device has been questioned. This is primarily related to the possible carcinogenic effect of radiation at diagnostic levels. Although the carcinogenic effect is unproven, the dose in radiologic procedures should be kept to a minimum consistent with adequate images. The present state of the art would indicate that the risk, if any, is minimal as contrasted with the natural incidence of breast cancer and the results of early diagnosis and treatment.
Adult↗
Light scanning versus mammography in breast cancer detection.
Transillumination light scanning of the breast was compared with screen-film mammography in a prospective study of 1,110 women referred to an outpatient imaging department. Each method was interpreted independently of the other but with knowledge of physical examination findings. Of 24 biopsy-proved cancers, 14 (58%) were detected with light scanning and 21 (88%) with mammography. The 77 false-positive light scan examinations were attributed to technical factors and the inability of light scanning to distinguish malignant from benign conditions on the basis of imaging features. Of the ten false-negative light scan examinations, two were retrospectively reclassified as positive, but light scans in the other eight cases remained normal in appearance. The authors conclude that transillumination light scanning is not competitive with mammography as a screening method for breast cancer detection. furthermore, they were unable to identify a select subpopulation of women who might benefit from light scanning as an adjunct to mammography.
Biopsy↗
Adenoma residua in colorectal cancer. A study of 34 colorectal cancers detected by an immunological occult blood test.
A retrospective histological study was made searching for adenoma remnants in 34 colorectal cancer specimens detected by the quantitative and human Hb-specific immunological FECA-EIA test for occult blood in the faeces. As a control group, 34 colorectal cancer preparations from routine hospital material were studied in a similar manner. A difference was found between these materials, 12 out of 34 study cancers showing adenoma residua compared with only two in the control group. Even if a proportion of colorectal cancers is apparently not associated with adenomas, it is suggested that the existence of adenoma remnants is a sign of biologically early tumour development and consequently, it might correlate with a favourable prognosis.
Aged↗
Invasion of the seminal vesicles by prostatic cancer: detection with transrectal sonography.
Endorectal sonography provides a potential means of detecting seminal vesicle invasion by prostatic cancer that is too subtle for diagnosis by digital rectal examination. To assess this application of sonography, we examined 300 patients with transrectal sonography of the prostate and seminal vesicles followed by histologic examination of the seminal vesicles from core biopsies and/or prostatectomy specimens. Of the 38 patients with histologically proved seminal vesicle invasion by prostatic cancer, 35 (92%) had an abnormal appearance of the seminal vesicles on sonography. Of 167 patients with prostatic cancer without histologic evidence of seminal vesicle involvement, sonograms showed abnormal seminal vesicles in 42 (25%). In 95 patients with histologically normal prostates and seminal vesicles, sonograms showed abnormal seminal vesicles in 11 (12%). The sonographic findings correlating best with tumor invasion of the seminal vesicles were hyperechogenicity and a combination of two or more of the following abnormalities: cystic dilatation, asymmetry, enlargement, and anterior displacement. Our experience in these patients suggests that endorectal sonography can be useful in the detection of seminal vesicle involvement by prostatic cancer.
Genital Neoplasms, Male↗
Cancers induced and cancers detected in a mammography screening programme.
The numbers of cancers which might be induced in a breast screening programme are compared with the numbers detected. The induction rate is estimated from reports of breast cancer in various groups exposed to high radiation doses, and also from International Commission on Radiological Protection risk estimates. An apparent discrepancy between these two approaches is discussed and removed. Detection rates are based on preliminary results in Edinburgh, and greatly exceed the induction rate. Whether such an excess is maintained if an X-ray grid requiring a higher dose is used on younger age groups is discussed.
Adolescent↗
Canadian National Breast Screening Study: 1. Breast cancer detection and death rates among women aged 40 to 49 years.
OBJECTIVES: To evaluate the efficacy of the combination of annual screening with mammography, physical examination of the breasts and the teaching of breast self-examination in reducing the rate of death from breast cancer among women aged 40 to 49 years on entry. DESIGN: Individually randomized controlled trial. SETTING: Fifteen urban centres in Canada with expertise in the diagnosis and treatment of breast cancer. PARTICIPANTS: Women with no history of breast cancer and no mammography in the previous 12 months were randomly assigned to undergo either annual mammography and physical examination (MP group) or usual care after an initial physical examination (UC group). The 50,430 women enrolled from January 1980 through March 1985 were followed for a mean of 8.5 years. DATA COLLECTION: Derived from the participants by initial and annual self-administered questionnaires, from the screening examinations, from the patients' physicians, from the provincial cancer registries and by record linkage to the Canadian National Mortality Data Base. Expert panels evaluated histologic and death data. MAIN OUTCOME MEASURES: Rates of referral from screening, rates of detection of breast cancer from screening and from community care, nodal status, tumour size, and rates of death from all causes and from breast cancer. RESULTS: Over 90% of the women in each group attended the screening sessions or returned the annual questionnaires, or both, over years 2 to 5. The characteristics of the women in the two groups were similar. Compared with the Canadian population, the participants were more likely to be married, have fewer children, have more education, be in a professional occupation, smoke less and have been born in North America. The rate of screen-detected breast cancer on first examination was 3.89 per 1000 in the MP group and 2.46 per 1000 in the UC group; more node-positive tumours were found in the MP group than in the UC group. During years 2 through 5 the ratios of observed to expected cases of invasive breast cancer were 1.26 in the MP group and 1.02 in the UC group. Of the women with invasive breast cancer through to 7 years, 191 and 157 women in the MP and UC groups respectively had no node involvement, 55 and 43 had one to three nodes involved, 47 and 23 had four or more nodes involved, and 38 and 49 had an unknown nodal status. There were 38 deaths from breast cancer in the MP group and 28 in the UC group. The ratio of the proportions of death from breast cancer in the MP group compared with those in the UC group was 1.36 (95% confidence interval 0.84 to 2.21). The survival rates were similar in the two groups. The highest survival rate occurred among women whose cancer had been detected by mammography alone. CONCLUSION: The study was internally valid, and there was no evidence of randomization bias. Screening with yearly mammography and physical examination of the breasts detected considerably more node-negative, small tumours than usual care, but it had no impact on the rate of death from breast cancer up to 7 years' follow-up from entry.
Adult↗
Loss of heterozygosity at the ACTBP2 locus in lung cancer detected on Elchrom precast Spreadex gels.
One of the most important goals in the continuous struggle against cancer is early detection of the disease by a simple method that can be used in routine laboratory practice. According to several recent reports, early detection may be achieved by monitoring alterations at several microsatellite loci containing tri- and tetranucleotide repeats. The method relies on comparison of the intensity of allele bands in cancer tissue, plasma, and lymphocytes of a patient. Microsatellite instability is typically detected by labeling the DNA with a radioactive probe or a fluorescent dye followed by electrophoresis on 20-40-cm-long denaturing polyacrylamide gels. In this study, we show that loss of heterozygosity at the ACTBP2 locus in lung cancer patients can be detected using the Elchrom electrophoresis system and just 4-cm-long precast Spreadex gels.
Actins↗
Prognosis of breast cancers detected in women receiving hormone replacement therapy.
OBJECTIVE: To determine the influence of hormone replacement therapy (HRT) on various prognostic factors of breast cancer (BC). METHODS: A multi-centre case-control study was conducted, in which a comparison was made of the differences between various histological and biological clinical variables of BC detected in 121 women undergoing HRT at the time of diagnosis, and those cancers detected in 121 women of similar age not undergoing HRT. The variables were also analysed in function of the type of HRT and the length of time treated. RESULTS: The tumours detected in patients receiving HRT presented significantly lower tumoural stages, a lower degree of affected axillary lymph node dissemination, and a greater percentage of well-differentiated tumours and positive estrogen receptors than those detected in women not under HRT. Most of these results due principally to those patients who were undergoing CONCLUSIONS: Although the better prognosis of tumours detected in women receiving HRT may be due largely to their diagnosis at earlier stages, there is an increasing body of data leading one to think that these tumours present certain histological and biological characteristics that make such cancers less aggressive.
Breast Neoplasms↗
The challenge of early breast cancer detection among immigrant and minority women in multicultural societies.
A sociological view of the barriers experienced by women from traditional cultures, both in their native countries and as immigrants and minorities in multicultural western societies, in preventive health care generally and in breast screening specifically, is essential not only to understand patterns of late-stage diagnosis, but also to design successful interventions and programs. Breast cancer is a unique disease, as its name ties together a multisymbolic organ of the female anatomy and a potentially fatal affliction, the treatment of which commonly is a body-mutilating procedure (mastectomy). Because of its special nature, breast cancer is shrouded in fears, myths, and connotations reaching far beyond the objective clinical understanding of the disease. Many women do not use available breast-screening services and present with advanced symptoms. To help women detect and treat breast cancer early, health care providers and policymakers should try to understand their predicaments and the factors influencing their decisions. Structural barriers include such socioeconomic factors as poor health insurance, distance to medical facilities, and inability to take time off from work, while organizational barriers include difficulty in navigating complex health care systems and interacting with medical staff. Psychological and sociocultural barriers include poor health motivation, denial of personal risk, fatalism, mistrust of cancer treatments, and the fear of becoming a burden on family members. These barriers can often preclude proactive breast screening or rapid response to symptoms, even when breast cancer awareness is rather high. Moreover, in many traditional societies, especially Muslim ones, women's decisions and actions are controlled by men, and men may be unaware of or disapprove of breast screening. This article discusses several approaches to lowering the described barriers, including specially tailoring educational programs that dispel cancer myths, involving men in breast cancer detection efforts, implementing cultural competence training for mainstream health care providers, and recruiting minority health care professionals to enable better outreach to their coethnics.
Breast Neoplasms↗
Breast MR imaging in women at high-risk of breast cancer. Is something changing in early breast cancer detection?
In the last few years, several papers have addressed the introduction of contrast-enhanced MR imaging for screening women at high risk for breast cancer. Taking in consideration five prospective studies, on 3,571 screened women with hereditary predisposition to the disease and 9,652 rounds, we found that 168 patients were diagnosed with breast cancer (155 screen-detected, eight interval, and five cancers excluded from analysis) with a detection rate per year of 1.7%. These cancers were small (49% equal to or less than 10 mm in diameter) but aggressive, 82% being invasive and 49% with histologic grade 3; however, only 19% of these invasive cancers were associated with nodal involvement. The pooled sensitivity was 16% for clinical breast examination, 40% for mammography, 43% for ultrasound, and 81% for MR. The positive predictive value (calculated on the basis of the number of invasive diagnostic procedures due to false positives) was 33%, 47%, 18%, and 53%, respectively. Aim of the present article is to present the historical development of MR imaging of breast tumors that made this application theoretically and technically possible, to explain what strategic problems we face in the presence of a hereditary predisposition to the disease, to review the main results of the published studies, and to outline open problems and future perspectives.
Breast Neoplasms↗
Long-term survival of patients with gallbladder cancer detected during or after laparoscopic cholecystectomy.
Little evidence is available regarding long-term survival of patients with gallbladder cancer that is discovered at the time of laparoscopic cholecystectomy (LC). Therefore the present study was performed to evaluate long-term outcomes of this disease. Of 1546 patients who underwent LC for benign gallbladder disease between January 1992 and January 2002, 8 patients (0.5%) had cancers that were found during or after LC. The median follow-up period was 55 months (range: 36-142 months). The gallbladder was resected without perforation in all cases. During surgery there was a suspicion of malignancy in 6 of 8 cases. Frozen section analysis showed that 2 had TNM stage Tis tumors, 2 had T1a tumors, and 2 had T2 tumors. Two patients with T2 tumors were immediately converted to extended cholecystectomy. The final pathology revealed another 2 tumors, and demonstrated that 3 patients had Tis tumors, 3 had T1a tumors, and 2 had T2N0M0 tumors. None of the patients underwent additional surgery. All patients survived with no evidence of recurrence during the median follow-up of 55 months. In conclusion, before and during LC, we have not overlooked T2 or more advanced tumor, which requires additional procedures for curative resection. This might result in good survival. We consider that an intensive preoperative work-up and meticulous inspection of the opened gallbladder should be mandatory to detect gallbladder cancer in patients who undergo LC. At present, this is not routinely practiced.
Adult↗
Dietary fibre and risk of colorectal cancer in the Breast Cancer Detection Demonstration Project (BCDDP) follow-up cohort.
BACKGROUND: The hypothesis that increased intake of dietary fibre lowers the risk of colorectal cancer (CRC) has recently been weakened by results from cohort and intervention studies that did not detect such an association. We investigated the association between dietary fibre intake and risk of CRC in a cohort of women that prospectively answered a food frequency questionnaire (FFQ). METHODS: We studied 45 491 women in the Breast Cancer Detection Demonstration Project (BCDDP) follow-up cohort. A 62-item FFQ was administered from 1987 and 1989 to assess dietary intake. Participants received follow-up questionnaires (in 1992-1995 and 1995-1998) on which they reported incident cancers. Cases were also identified through searches of the National Death Index and state cancer registries. Cox proportional hazard regression was used to generate risk ratios and 95% CI for quintiles of total fibre intake and fibre subtypes. RESULTS: During a mean follow-up time of 8.5 years we identified 487 colorectal cancer cases. The 10th and 90th percentiles of dietary fibre intake were 5.4 g and 18.2 g respectively. For total fibre we observed no association with colorectal cancer (fifth versus first quintile, RR = 0.94, 95% CI: 0.71-1.23). Analyses by subgroup of fibre and by anatomical subsite did not reveal any stronger inverse associations. CONCLUSIONS: Within a cohort of older women characterized by a relatively low fibre intake, there was little evidence that dietary fibre intake lowers the risk of colorectal cancer.
Breast Neoplasms↗
Prostate cancer: the role of transrectal ultrasound and its impact on cancer detection and management.
With the advent of higher-frequency transducers as well as Doppler technologies, TRUS has become a valuable tool in the detection and management of prostate cancer. When combined with the other risk identifiers, an informed patient, and an experienced operator, it cannot only reduce the number of missed cancers by effective targeting of biopsies, but also reduce the number of unnecessary biopsies.
Biopsy↗
The role of nuclear medicine in breast cancer detection: functional breast imaging.
Mammography remains the imaging modality of choice in detection of early, nonpalpable breast cancer. Scintimammography using SPECT, however, may prove to be a very useful adjunct to a nondiagnostic or difficult mammogram. Further prospective studies have to be designed so that the specific clinical applications of this technique are more defined. As with any new imaging procedure, special care to obtain high-quality scintimammographic studies and sufficient training of staff to perform and interpret the imaging are necessary.
Breast Neoplasms↗
Automated interpretation of protein subcellular location patterns: implications for early cancer detection and assessment.
Fluorescence microscopy is a powerful tool for analyzing the subcellular distributions of proteins, but that power has not been fully utilized because most analysis of those distributions has been done by visual examination. This limitation can be overcome using automated pattern recognition methods widely used in other fields. This article summarizes work demonstrating that automated systems can recognize the patterns of major organelles in both two- and three-dimensional images of cultured cells, and that these systems can distinguish similar patterns better than visual examination. The basis for these systems are sets of Subcellular Location Features that capture the essence of subcellular patterns without being sensitive to the extensive variation that occurs in the size, shape, and orientation of cells in microscope images. These features can also be used to make sensitive, statistical comparisons of the distribution of a protein between two conditions, such as in the presence and absence of a drug. The possible use of automated pattern analysis methods for improving detection of abnormal cells in cancerous or precancerous tissues is also discussed.
Automation↗
Three-year findings of an early lung cancer detection feasibility study with low-dose spiral computed tomography in heavy smokers.
BACKGROUND: Low-dose spiral computed tomography (sCT) showed a four-fold increase in the detection rate in high-risk subjects and a higher percentage of stage I lung cancer in comparison with chest X-ray. However, there is a considerable discrepancy among studies in the percentage of lung nodules, overall lung cancer and stage I detection rate. SUBJECTS AND METHODS: From April to December 2001, 520 asymptomatic volunteers aged >or=55 years with a history of cigarette smoking >or=20 pack-years and no previous cancer were enrolled to receive an annual sCT of the chest for five consecutive years. RESULTS: Seventy three per cent were male, median age was 59 years and 91% were current smokers. At baseline, nodules >or=5 mm were detected in 114 (22%) undergoing sCT; the size of lung nodules ranged from 5 to 9.9 mm in 81.5% of the cases. Five (1%) cases of lung cancer were detected. In two additional cases a pathological diagnosis of atypical adenomatous hyperplasia was made. Three new cases of lung cancer were detected in the second and third year of the study. One interval case was detected during the third year. CONCLUSIONS: Despite some promising data, convincing evidence from ongoing randomized trials is needed to support the routine use of sCT as a recommended tool for screening of lung cancer.
Aged↗
A simple histochemical assay to detect cancer cells.
Oxygen insensitivity of cancer cells and oxygen sensitivity of non-cancer cells in the histochemical assay of glucose-6-phosphate dehydrogenase (G6PD) activity enables detection of cancer cells in unfixed cell smears or cryostat sections of biopsies. The assay is based on reduction of the tetrazolium salt neotetrazolium. It is a cheap assay that is easy to perform. It takes only 30 min at the most. The test discriminates between adenomas and carcinomas of colon and rectum with a certainty higher than 80% and is the best prognosticator of survival of colorectal cancer patients. Pancreatic cancer can be discriminated from pancreatitis with 100% certainty. Therefore, the assay is an excellent tool for the pathologist to provide additional information in difficult cases of diagnosis of cancer and for prognosis.
Colonic Neoplasms↗