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At least 109 records · Page 6Linked to original sources
PubMed2000

The significance of the free-to-complexed prostate-specific antigen (PSA) ratio in prostate cancer detection in patients with a PSA level of 4.1-10.0 ng/mL.

OBJECTIVE: To compare the ratio of free prostate specific antigen (fPSA), total PSA (tPSA) and complexed PSA (cPSA, measured using a novel immunoassay) with other variables used to detect prostate cancer in patients with intermediate serum PSA levels of 4.1-10.0 ng/mL. PATIENTS AND METHODS: From July 1997 to August 1998, 140 consecutive patients were assessed; all had intermediate serum PSA levels and/or abnormal findings on a digital rectal examination. All patients underwent transrectal ultrasonography (TRUS)-guided biopsy, and the prostate and transition zone volumes were determined by TRUS. Free and tPSA were measured using the Tandem-R assay (Hybritech Corp., San Diego, CA). PSA complexed with alpha1-antichymotrypsin (cPSA) was measured using an appropriate assay. The ability of cPSA, free-to-total PSA ratio (f/tPSA), free-to-complexed PSA ratio (f/cPSA), tPSA density of the whole prostate (PSAD), of the transition zone (tPSATZ), and cPSA density of the whole prostate (cPSAD) and of the transition zone (cPSATZ) to improve the power of PSA in detecting prostate cancer was evaluated using receiver operating characteristic (ROC) curves. Results Of the 140 patients, 126 had histologically confirmed benign disease and 14 had prostate cancer. The cPSA alone had better specificity for detecting prostate cancer than had tPSA alone but the difference was not significant. The area under the ROC curve for f/cPSA was larger than those for all other variables. With a 93% sensitivity for detecting prostate cancer, a f/cPSA threshold of 25% would result in fewer unnecessary biopsies (40% f/cPSA specificity) than with all other PSA variables. The difference in the resolution was significant between f/cPSA and tPSA, cPSA, tPSAD and tPSATZ, but not with f/tPSA, cPSAD or cPSATZ. In patients with a prostate volume of < 30 mL, the cPSATZ showed better specificity for prostate cancer than tPSA alone. CONCLUSION: Measuring the level of cPSA and its derivatives may provide better differentiation of prostate cancer and benign disease than tPSA alone in patients with a tPSA level of 4.1-10.0 ng/mL.

Aged↗
PubMed1989

Community programs. Breast cancer detection awareness.

The American Cancer Society initiated a major nationwide program to raise public and health professional awareness about the benefits of breast cancer detection, particularly screening mammography. Activities were carried out at the community level and attempted to develop local collaboration and participation. Barriers to use of screening, including cost, quality assurance, physician attitudes and practices, and women's knowledge, were addressed in communities across the United States. Early indications are that the program has made a major impact, contributing to the recent increase in the number of women who have had mammograms, the number of mammograms done in hospitals, the number of physicians who follow Society Guidelines for Mammography 0 (in Illinois, this rose from 15% in 1985 to 46% in 1987), and in the number of early breast cancers being diagnosed. The challenge remains to more broadly integrate breast cancer detection into health practice. The BCDA provides a valuable example to make this goal a reality.

Adult↗
PubMed1996

Cancer detection: how effective is public education?

The American Cancer Society has been educating the public about cancer detection methods since 1922. Originally, only two warning signs were published; however, for more than 40 years, there have been seven cancer warning signs. In an attempt to evaluate the public knowledge of cancer detection and prevention, this pilot study examined the attitudes, knowledge and behaviors of 172 laypersons. The instrument used consisted of four sections and was designed by the investigator and the graduate nursing research class. The first section contained 30 questions about the individual, health practices, and risk status in a forced-choice format. Ability to identify the seven cancer warning signals was the second section. Attitudes toward Cancer Detection methods were evaluated in a semantic differential format as the third section. The list section contained 24 Likert-formatted statements of beliefs about the importance of cancer detection. Before data analysis, a Cronbach's alpha was obtained on each scale and ranged from 0.8031 to 0.8897. Eighty nine (52%) of the respondents were women and 83 (48%) were men. The sample was 85% white, 11% African-American, and 4% other ethnic groups. Ninety-four percent of the population had some form of health insurance. Gender was not significantly related to scores on the Attitudes toward Cancer Detection or the Beliefs about Cancer Scale. Race was significantly related to scores on the Attitudes toward Cancer Detection Scale. Nineteen percent of the sample could not identify any of the cancer warning signs. The median number of warning signs correctly identified as warning signals was three. Thirty-two items were incorrectly listed as warning signs. Survival of cancer is linked with early detection. The inability to influence changes in knowledge and practices over the past 50 years is examined. Implications for nurses and teaching related to cancer warning signs are explored.

Adult↗
PubMed2005

Early breast cancer detection.

Breast cancer is the commonest type of cancer among women in industrialized countries. The incidence of breast cancer increases rapidly with age during the reproductive years and then increases at a slower rate after about age 50 years, the average age of menopause. Preventive programmes and early diagnosis identify those risk factors associated to breast cancer, not all determined. Some of these risk factors act through hormonal mechanisms or are promoted by endocrine conditions. Many epidemiological studies have been carried out to identify risk factors for breast cancer. Breast cancer is a progressive neoplasia, that if diagnosed at an early stage has a higher rate of therapeutic success. It is of vital importance to precociously diagnose the tumor before reaching the palpable stage. This can be carried out by screening that allows the precocious diagnosis of hidden neoplasia and not clinically evident in asymptomatic women. Annual mammography and clinical examination should be carried out after 40 years of age in low risk women, who would be informed about its benefits, limitations and potential risks associated to regular screening. All women should be aware of the fact that the incidence rate is lower in younger women and increases with age. Mammographic screening of elderly women should be personalized to assure quality and life expectation. Healthy women can benefit from possible treatment and so should continue to undergo annual screening. On the other hand, if life expectation is limited to less than 3 years, because of functional limitations associated to multiple pathologies, annual screening is not advisable. Chronological age must not limit screening. Women that are considered at high risk for breast cancer can start screening at an earlier age, shorter screening intervals, and undergo other forms of screening apart from the physical examination and mammography (for example magnetic resonance). It is very important to identify those women at high risk. Future research will included the possibility to diagnose aggressive tumors and not, identify the ideal screening methods, to be aware of the impact of hormonal therapy on the mammary density, to determine the role of physical examination for diagnosis of cancer and to increase the efficiency of mammography.

Adult↗
PubMed2005

Serum tumor necrosis factor alpha receptors p55/p75 ratio and ovarian cancer detection.

OBJECTIVE: Early ovarian cancer detection is still very difficult and patients are mostly in advanced stages, with obvious influence on poor prognosis. METHOD: Fifty-one ovarian cancer patients and 16 healthy controls had the serum concentrations of TNF alpha receptor p55, p75 and CA-125 measured prospectively and preoperatively. RESULT: Mean concentrations of TNF alpha receptor p55, p75 and CA-125 in patients with ovarian cancer were higher than in controls. The ratios of p55 and p75 receptor in ovarian cancer and controls were 0.73+/-0.38 and 0.55+/-0.06 respectively. The areas under ROC curve in detecting malignancy (all FIGO stages) were 0.73, 0.65, 0.88 and 0.85 for p55, p75, p55/p75 ratio and CA-125 respectively. The areas under ROC curve in detecting stage I of ovarian cancer were 0.52, 0.60, 0.84 and 0.66 for p55, p75, p55/p75 ratio and CA-125 respectively. CONCLUSION: Serum TNF alpha p55/p75 ratio showed promising value in ovarian cancer detection.

CA-125 Antigen↗
PubMed1999

Prostate cancer detection: relationship to prostate size.

OBJECTIVES: It has been suggested that the lower detection rate for cancer in large prostates is due to the smaller proportion of tissue sampled. To examine this hypothesis, we evaluated whole-mount radical prostatectomy specimens in which the volume of cancer had been determined. We correlated cancer volume to overall gland volume. In addition, we performed stochastic computer simulations of parasagittal sextant biopsies on the same group of radical prostatectomy specimens. We correlated the likelihood of a positive cancer biopsy simulation with tumor volume and gland size. METHODS: Six hundred seven tumor foci from 180 serially sectioned whole-mount prostatectomy specimens were mapped and digitized. Tumor volume was calculated by a step-section planimetry algorithm. Before sectioning, each gland was weighed. Systematic parasagittal sextant biopsies were computer simulated for each case. For each prostate, 40 simulations were performed, with random variations in biopsy location programmed for each run. Overall cancer detection by biopsy was considered positive if 90% of the 40 simulation runs were positive for cancer. Chi-square tests were used to evaluate statistical significance. RESULTS: Small-volume cancers (0.5 cc or less) were twice as frequent in large glands greater than 50 g (P = 0.03). These small-volume tumors comprised 33% (13 of 40) of cancers in prostates greater than 50 g, 16% (5 of 31) in glands less than 30 g, and 14% (15 of 109) in glands 30 to 50 g. The rate of positive sextant biopsy simulation was lower in glands greater than 50 g than in glands 50 g or less (48% versus 67%, P<0.03). Smaller cancers were much less likely to be detected in the simulations. The simulation detection rate for cancers 0.5 cc or less was 18% (6 of 33), compared with a detection rate of 73% (107 of 147) for cancers greater than 0.5 cc (P<0.00001). CONCLUSIONS: The observed lower cancer detection rate in large glands is a result of the higher proportion of low-volume cancers in these glands. This suggests that large prostates are more likely to be biopsied because of an elevated prostate-specific antigen value resulting from benign elements of the gland and not from a significant cancer. Increasing the number of cores solely to compensate for increased prostate size risks a disproportionate increased detection of small-volume tumors with a low clinical likelihood of progression.

Biopsy↗
PubMed2006

The effect of prior biopsy scheme on prostate cancer detection for repeat biopsy population: results of the 14-core prostate biopsy technique.

OBJECTIVES: To evaluate the diagnostic performance of 14-core repeat biopsy protocol and the impact of prior biopsy scheme on repeat prostate biopsy group. METHODS: 211 patients had repeat biopsy using 14-core protocol consisting of 10-core peripheral zone (classical sextant+4 lateral peripheral cores) and 4-core transitional zone (TZ) biopsies. The diagnostic yield was determined both in patients who had previously undergone sextant or 10-core biopsy protocol. RESULTS: Overall cancer detection rate was 25.6%. 14-core biopsy technique detected cancer in 36.1 and 18.7% of the patients who had a previous sextant biopsy and 10-core biopsy protocol, respectively (P = 0.005). Patients with and without high-grade prostatic intraepithelial neoplasia (HGPIN) in the previous sextant biopsy had 56.5 and 28.3% cancer detection rates on the subsequent extended biopsy, respectively (P = 0.017) Patients who had previous 10-core biopsy with and without HGPIN revealed 22.9 and 17.2% cancer detection rates, respectively (P = 0.465) Additional four lateral peripheral cores detected 33% (3/30) and 17% (4/24) of cancers in patients with previous sextant and 10-core biopsy, respectively. 3.7% of the patients had tumor only in the TZ and none of them had prior extended biopsy. CONCLUSIONS: The yield of extended 14-core repeat biopsy protocol was higher in patients with previous negative sextant biopsy compared to the patients with previous negative 10-core biopsy. HGPIN history found on previous sextant biopsy was a strong cancer predictor on repeat biopsy; same was not true for the patients with previous 10-core biopsy. The yield of lateral peripheral cores and TZ biopsies were lower in patients with prior negative extended biopsy.

Aged↗
PubMed1995

Barriers to effective skin cancer detection.

BACKGROUND: In response to the dramatic rise in melanoma incidence, numerous health care specialists have encouraged primary care providers to increase skin cancer detection efforts. Although primary care providers currently find more melanomas than do dermatologists, many detection opportunities are missed. In addition, primary care providers occasionally incorrectly reassure patients about specific lesions. Nevertheless, there is little evidence that efforts to detect skin cancer are growing. This paper discusses barriers to skin cancer detection and potential ways to increase screening. METHODS: Methods involve the review of the medical literature and the author's synthesis of this information. RESULTS: The principle barriers to skin cancer detection are that it is a low priority in primary care, that the majority of exams do not result in significant findings, and that many providers lack expertise to adequately identify high risk lesions. Lack of reimbursement for preventive care, inadequate time for complete skin exams, and distraction by other health problems also play a role in limiting skin cancer detection efforts. CONCLUSIONS: Relying on primary care-based skin cancer detection as the only means to increase skin cancer identification is an unwise policy. Approaches that may be able to increase skin cancer prevention and detection include increased (1) collaboration between skin cancer specialists and experts in primary care, (2) focus on providers of pediatric care, (3) advocacy for reimbursement of preventive health care, (4) educational efforts for the public to request skin exams, and (5) education directed to providers in high risk areas.

Clinical Competence↗
PubMed2004

Effect of peripheral biopsies in maximising early prostate cancer detection in 8-, 10- or 12-core biopsy regimens.

OBJECTIVE: To assess the cancer detection rate per individual core biopsy in a 12-core protocol and develop an optimal biopsy regimen for detecting early prostate cancer. PATIENTS AND METHODS: The study included 445 new patients who had a 12-core transrectal ultrasonography (TRUS)-guided prostatic biopsy over a 40-month period. The 12- core biopsy protocol included parasagittal sextant and six peripheral biopsies. The cancer detection rate per individual core was evaluated to give an optimal biopsy protocol. RESULTS: Prostate cancer was detected in 142 patients (31.9%). Parasagittal sextant biopsy would have failed to detect 40 (28.2%) of the cancers. Among the various possible biopsy protocols, the optimum 10-core biopsy strategy excluding the parasagittal mid-zone biopsies from the 12-core protocol achieved a cancer detection rate of 98.6%. CONCLUSION: The cancer detection rate increased from 71.8% for parasagittal sextant biopsies to 88.7% by adding peripheral basal biopsies (8-biopsy protocol); 98.6% of cancers in the series would have been detected with a 10-biopsy strategy omitting the parasagittal mid-zone biopsies. Thus we recommend a 10-core protocol incorporating six peripheral biopsies in patients with elevated age- specific prostate-specific antigen levels (2.6-10.0 ng/mL) for maximising cancer detection.

Adult↗
PubMed2003

The relationship of prostate gland volume to extended needle biopsy on prostate cancer detection.

PURPOSE: We investigated the relationship between prostate volume and cancer detection by needle biopsy, and determined the effect of an increased number of cores on the sampling error of needle biopsy on large prostate glands. MATERIALS AND METHODS: The study cohort included 750 consecutive patients who underwent first time transrectal ultrasound guided prostate needle biopsy from January 1995 to August 2001. Prostate volumes were divided into quartiles (13 to 34, 34.1 to 45, 45.1 to 64 and 64.1 to 244 cc). Multivariate analysis controlling for age, prostate specific antigen (PSA) and biopsy indication was performed to determine the effect of the number of cores and prostate volume on prostate cancer detection. RESULTS: Patients diagnosed with prostate cancer were older (p = 0.0035) and had higher PSA levels (p = 0.0002) than those with no cancer on biopsy. Decreasing cancer detection rates were seen with increasing prostate volume (p = 0.0074). The OR of detection for each additional core was 0.99 (95% CI 0.93, 1.06), suggesting that increasing the number of biopsy cores did not increase the rate of prostate cancer detection. Multivariate analysis revealed that patients with larger prostates had the same, or possibly lower, cancer detection rate as the number of biopsy cores was increased. Patients with larger prostates were older (p <0.0001), had higher PSA levels (p <0.0001) and were even more likely to have undergone biopsy for increased PSA rather than abnormal digital rectal examination alone (p <0.0001). CONCLUSIONS: Our study suggests that the lower cancer detection rate for men with large prostates may be due to a decrease in the use of increased serum PSA for prostate cancer detection in larger prostates in addition to other factors such as sampling error. Increased serum PSA levels in cases of larger prostates, although a risk factor for prostate cancer warranting biopsy, may also be due to nonmalignant sources such as benign prostatic hyperplasia.

Age Factors↗
PubMed2003

Annual screening for oral cancer detection.

Most oral cancer and oral mucosal screening programs initiated in the past 20 years have been limited to a single examination of the population under study. Age specific, annual oral mucosal screening examination as a part of general health screening has been in operation in Tokonama city, Japan, from 1986. From 1996 the same target population aged 40 years and older has been invited for screening. The program coverage extended to 26% of the city population. During 1995-1998, out of 9536 attendees who participated in a general health and oral mucosal screening program in Tokoname city 6340 subjects (66.5%) re-attended at least for one further screening examination. There was no difference in the attendance for two annual mucosal examinations between male (67.0%) and female (66.2%) subjects. Three thousand nine hundred thirty-five subjects attended oral screening all 3 years (1996-1999) and the overall show-up rate for three consecutive examinations was 61%. During September-October 1996, 42 volunteer dentists carried out 6705 mouth examinations among those aged 40 years and older at the Municipal Center. One oral cancer was detected in 1996, in a subject free of any mucosal disease in the previous year. Among the screen-negative cases in 1996, 78% re-attended for screening in 1997 and 79% re-attended in the subsequent year. In the cohort that re-attended screening (1996-1998), oral mucosal pathology detected in three consecutive screenings included 18 leukoplakias, 24 with oral lichen planus and 343 other benign mucosal lesions. The number of subjects who complied to return and who remained disease-free over the 3-year period amounted to 3860, 59% of the disease-free subjects seen in 1996. A regular smoker was less likely to attend oral cancer screening in the three consecutive years of follow-up (odds ratio: 0.832, 95% CI 0.701-0.988). Satisfactory participation can be obtained for annual oral mucosal screening in Japan: this allows detection of new lesions, including oral cancer and leukoplakia (a surrogate marker of cancer risk). The number of new oral cancers detected in the program was too low to determine the optimal frequency for oral cancer screening but new oral leukoplakias were found on annual re-screening: the data indicate that the interval between two screens for this population should not be greater than 12 months.

Adult↗
PubMed1998

[Feature of screening-detected cancer and progress of treatment--esophageal cancer].

The recent increase in the detection of esophageal mucosal cancer has been changing the direction of treatment. The rate of esophageal cancer detection in mass screening by X-ray is 0.008%, which is 1/13 that of gastric cancer. Moreover, the rate by endoscopy is higher; the former is 0.1% and the later is 0.6%. Further, endoscopic screening using iodine staining for a high risk group like alcoholism has 3.6% detectability on esophageal cancer and 1.7% on gastric cancer. The rate of cancer-detection of upper intestinal organs comes to 5.35% in all. Most of the esophageal cancer detected by endoscopy is mucosal cancer, which is treatable by endoscopic mucosal resection (EMR). The result of the treatment is 100% 5 year-survival in cases of m1 and 2 esophageal cancer. EMR of esophagus-preserving treatment is truly effective for patients. Endoscopic examination using iodine staining for the high risk group is excellent for mass screening of esophageal cancer.

Adult↗
PubMedDate not supplied

The early detection research network surface-enhanced laser desorption and ionization prostate cancer detection study: A study in biomarker validation in genitourinary oncology.

Prostate-specific antigen (PSA) screening has led to a dramatic increase in prostate cancer detection with a concurrent stage migration. Although the test has revolutionized prostate cancer detection by identifying disease that is potentially curable in the majority of men, only 25% of men receiving test results of PSA > 4 ng/ml will have prostate cancer and many men receiving a normal PSA will have disease, including high-grade disease. There is a need for improved biomarkers for detecting prostate cancer. One such method of cancer detection is surface-enhanced laser desorption and ionization (SELDI). The Early Detection Research Network (EDRN) validation study for SELDI for prostate cancer is described. In a three-stage study, the portability and reproducibility of the technique will be determined; the predictive algorithm will be refined in a multi-institutional case-control population; followed by ultimate validation in the context of a prospective trial with complete disease ascertainment. The unique aspect of the EDRN SELDI validation study is the novel use of two groups of cancer cases: those cases with higher-risk disease (Gleason > or = 7) and those cases with lower-risk disease (Gleason < or = 6). This study will allow the first evaluation of a predictive algorithm that includes prognosis in disease screening. The EDRN SELDI prostate cancer biomarker validation study is a rigorous evaluation of a new detection method for prostate cancer. The methodologies used for this evaluation will prove useful for guiding future biomarker studies in this challenging disease.

Biomarkers, Tumor↗
PubMed1997

Prostatic asymmetry as a risk factor for prostatic carcinoma: serial prostate-specific antigen monitoring and cancer detection.

OBJECTIVE: To compare the rates of cancer detection in men with a normal, asymmetric, or suspicious prostate on digital rectal examination (DRE) initially and after 3 years of serial monitoring of prostate specific antigen (PSA) level. PATIENTS AND METHODS: Prostatic 'asymmetry' was defined as asymmetric growth of the lateral lobes of the prostate without induration or nodules, as assessed by a DRE. The study included 963 men with no clinical evidence of prostate cancer and whose serum PSA levels were monitored at 4 month intervals. Prostatic biopsy was recommended if the PSA level became persistently abnormal (> 4ng/mL) or increased by > 20% after having been initially abnormal. Cancer detection rates were compared among groups categorized by the initial DRE findings and serum PSA level. RESULTS: On comparing groups with suspicious and normal DREs, and abnormal with normal PSA levels both, as expected, were associated with a statistically significant increase in cancer detection. However, an asymmetric prostate did not carry an increased risk of detecting prostate cancer when compared with a normal prostate, regardless of PSA level. CONCLUSIONS: An asymmetric prostate does not appear to be an independent risk factor for detecting prostate cancer. Therefore, an asymmetric prostate with no abnormality in PSA level should not mandate prostatic biopsy, or even an increase in monitoring frequency above the presently recommended annual interval.

Aged↗
PubMed1997

Clinicopathological features of prostate cancer detected by transrectal ultrasonography-guided systematic six-sextant biopsy.

BACKGROUND: The objectives of this study were to compare the efficacy of 3 modalities (prostate-specific antigen (PSA) assay, digital rectal examination (DRE), and transrectal ultrasonography (TRUS)) in detecting prostate cancer which was pathologically confirmed by TRUS-guided systematic six-sextant biopsy, and to investigate the relationship between the number of positive cores and several clinicopathological parameters. METHODS: Between 1992 and 1994, 297 males (155 from a mass screening program and 142 identified as outpatients) with a mean age of 71 years, underwent examinations including PSA determination, DRE, TRUS and systematic six-sextant biopsy, and/or additional directed biopsy. RESULTS: Prostate cancer was detected in 93 men. The sensitivity level of the PSA assay was significantly higher (85%) than that of either DRE or TRUS. Patients with an abnormal DRE or TRUS, elevated PSA levels, and those in the T3-T4 category or with moderate to poorly-differentiated adenocarcinomas had more positive biopsy cores (P < 0.05). Also, the relationships of both the number of positive biopsy cores and tumor grade to bone metastasis were significant (P < 0.01). Of 209 hypoechoic areas identified by transrectal ultrasonography, 42% were cancerous, and of 427 isoechoic areas, 12% were cancerous. The percentage of positive biopsy cores with hypoechoic areas was 86% in the subjects with a PSA > 10 ng/mL, but low (9%) in subjects with a PSA < or = 4 ng/mL, and the percentage of negative biopsy cores with a normal TRUS was high (98%) in subjects with a PSA of < or = 4 ng/mL, but lower (67%) in subjects with a PSA > 10 ng/mL. CONCLUSION: The serum PSA assay was more useful than either DRE or TRUS in detecting prostate cancer. The percentage of bone metastasis increased concomitant with the number of positive biopsy cores, and the positive biopsy rate of hypoechoic areas positively correlated with the PSA level.

Aged↗
PubMed1996

Asymptomatic colorectal cancer detected by screening.

PURPOSE: Colorectal cancer screening has become prevalent. To discuss the efficacy of screening, we studied the characteristic of asymptomatic colorectal cancer detected by screening. METHODS: This is a retrospective review of patients with colorectal cancer treated at our institution. During the past 20 years, 96 of 1,046 cases of colorectal cancer were asymptomatic and detected by screening. Sixty-one of these cases were detected in the recent five years. The initial screening procedures were fecal occult blood test in 51 cases, sigmoidoscopy or colonoscopy in 18, barium enema in 9, and other tests in 18. RESULTS: Thirteen lesions (14 percent) were smaller than 1.0 cm and 32 (33 percent) were 1-2 cm in size. There were 34 Tis, 21 T1, and 8 T2 tumors. Of the 55 Tis or T1 lesions, 14 showed nonpolypoid growth (5 flat-elevated, 7 flat-elevated with depression, 1 flat, 1 depressed), and 12 of these were detected on endoscopy. Thirty-four cases were TNM Stage 0, 25 were Stage I, 16 were Stage II, 12 were Stage III, and 9 were Stage IV. Sixty-one percent of those detected by screening were in either Stage 0 or Stage I compared with 16 percent in the symptomatic group. Cumulative five-year disease-free survival rates were 100 percent for both Stage 0 and Stage I, 94 percent for Stage II, and 52 percent for Stage III. Overall cumulative five-year survival rate was 87 percent for those detected by screening, compared with 57 percent in symptomatic patients. CONCLUSIONS: Asymptomatic cancers detected by screening were at a less advanced stage. In particular, many nonpolypoid early cancers were detected by endoscopic screening.

Aged↗
PubMed2005

Baseline chest radiograph for lung cancer detection in the randomized Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial.

BACKGROUND: The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial was initiated in 1992 to examine cause-specific mortality reduction from screening for these four cancers in men and women. We report lung cancer detection results of the baseline screening round. METHODS: Of the 154,942 participants enrolled, who were aged 55-74 years with no history of PLCO cancers, 77,465 were randomly assigned to the intervention arm. Current or former smokers and never smokers in this arm received an initial single-view posterior-anterior chest radiograph. RESULTS: In the initial screen, 5991 (8.9%, 95% confidence interval [CI] = 8.7% to 9.2%) of radiographs were suspicious for lung cancer: 8.2% (95% CI = 7.9% to 8.5%) for women and 9.6% (95% CI = 9.3% to 10.0%) for men. Rates were highest for older age groups and for smokers. Among those 5991 participants with a positive screen, 206 (3.4%, 95% CI = 3.0% to 3.9%) underwent biopsy examination, 126 (61.2%, 95% CI = 54.5% to 67.8%) of whom were diagnosed with lung cancer within 12 months of the screen (59 in women and 67 in men). The positive predictive value was 2.1% (95% CI = 1.7% to 2.5%), and 1.9 lung cancers were detected per 1000 screens. Among these cancers, 44% (95% CI = 35% to 52%) were stage I non-small-cell lung cancer. High rates of lung cancer were found in current smokers (6.3 per 1000 screens) and in former smokers who had smoked within the past 15 years (4.9 per 1000 screens). The lung cancer detection rate among never smokers was 0.4 per 1000 screens; this group accounted for 11% (95% CI = 5.6% to 16.6%) of the cancers identified. CONCLUSIONS: In the baseline screen, nearly half the cancers were stage I. Whether this experience results in a reduction in lung cancer mortality is yet to be seen.

Adenocarcinoma↗
PubMed1995

Non-parametric estimation of the post-lead-time survival distribution of screen-detected cancer cases.

The goal of screening programmes for cancer is early detection and treatment with a consequent reduction in mortality from the disease. Screening programmes need to assess the true benefit of screening, that is, the length of time of extension of survival beyond the time of advancement of diagnosis (lead-time). This paper presents a non-parametric method to estimate the survival function of the post-lead-time survival (or extra survival time) of screen-detected cancer cases based on the observed total life time, namely, the sum of the lead-time and the extra survival time. We apply the method to the well-known data set of the HIP (Health Insurance Plan of Greater New York) breast cancer screening study. We make comparisons with the survival of other groups of cancer cases not detected by screening such as interval cases, cases among individuals who refused screening, and randomized control cases. As compared with Walter and Stitt's model, in which they made parametric assumptions for the extra survival time, our non-parametric method provides a better fit to HIP data in the sense that our estimator for the total survival time has a smaller sum of squares of residuals.

Breast Neoplasms↗