Contents

Search

screening for cancer

Classification: - breath analysis - blood tests - Illumina is launching a new company 'Grail' to develop a blood test that will detect early-stage cancers in asymptomatic individuals [11] - Grail, will use DNA sequencing to look for genetic mutations that occur when cancer is first developing [11] - the goal is a blood test that will detect any cancer [11] - cell-free DNA in plasma using targeted error correction sequencing used to detect ~60 cancer-related genes in patients with early colorectal cancer, breast cancer, lung cancer, or ovarian cancer - 60-70% identification rate [16] - urine tests - 18-gene urine panel for high-grade prostate cancer - cell-free tumor DNA in urine may detect HPV+ oropharyngeal cancer [24] - urine biomarker panel (LYVE1, REG1B & TFF1) alone & in combination with plasma CA19-9 cab detect pancreatic adenocarcinoma up to 2 years prior to diagnosis [24] - other Indications: - recommended screening: a) screening for breast cancer b) screening for cervical cancer c) screening for colon cancer d) screening for skin cancer e) screening for lung cancer (high-risk) - screening not recommended: a) bladder cancer b) lung cancer c) ovarian cancer d) testicular cancer e) pancreatic cancer f) screening for prostate cancer g) leukemia [21] Interpretation: False positives common: - risk for having 1 false positive after 4 tests was 37% among men & 26% among women [3] (sigmoidoscopy among screening tests in this study) - risk for undergoing a false-positive-prompted invasive procedure after 4 tests was 17% among men & 12% among women Clinical significance: - meta-analysis suggest that colorectal cancer screening with sigmoidoscopy may extend life by ~3 months [23] - lifetime gain for other screening tests appears to be unlikely or uncertain [23] - neither colonoscopy nore fecal occult blood testing extend life [23] Notes: only 14% of cancers detected by recommended screening [20] - if prostate cancer is included, 25% of cancers detected by screening [20] Screening recommendations met in 62-88% of population; yet > 1/3 of cancers (for which screening is recommended) present at late stages [4] Overscreening of the elderly? [5,8] Elderly often prefer hearing [15]: "This test would not help you live longer" vs "You may not live long enough to benefit from this test." Patients rarely informed of risks for overdiagnosis & overtreatment when discussing cancer screening [6] Most cancer screening guidelines fail to provide details of both risks & benefits [12] Harms, including negative psychological consequences, overdiagnosis & false positives are rarely are quantified & reported by cancer screening trials [7] Only 60% of cancer screening trials report all-cause mortality [7] There appears to be some question as to whether cancer screening reduces overall mortality [10] - patients who are nonadherent to cancer screening recommendations also are likely to be nonadherent to chronic disease prevention & management [17] physician's order of cancer screening is higher at 8 AM at 5 PM [18] - 64% vs 48% for breast cancer screening - 37% vs 23% rof colon cancer screening patient completion of cancer sceening follows a similar pattern - 33% for breast screening completion for 8 AM appointment vs 18% for 5 PM appointment [18]

Related

malignant neoplasm (cancer)

Specific

breath test for cancer cancer-sniffing dog screening for breast cancer screening for cervical cancer screening for colon cancer screening for lung cancer screening for ovarian cancer screening for prostate cancer screening for skin cancer

General

oncology screening

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16,. 17, 18. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015, 2018.
  2. Wolff T et al Screening for skin cancer: An update of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2009 Feb 3; 150:194. PMID: 19189909 http://www.ahrq.gov/clinic/uspstf09/skincancer/skincanart.htm - U.S. Preventive Services Task Force. Screening for skin cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2009 Feb 3; 150:188. PMID: 19189908 http://www.ahrq.gov/clinic/uspstf09/skincancer/skincanrs.htm - Petitti DB et al Update on the methods of the U.S. Preventive Services Task Force: Insufficient evidence. Ann Intern Med 2009 Feb 3; 150:199. PMID: 19189910 - corresponding NGC guideline withdrawn Dec 2014
  3. Croswell JM et al, Cumulative Incidence of False-Positive Results in Repeated, Multimodal Cancer Screening Ann Fam Med. 2009 May-Jun;7(3):212-22. PMID: 19433838 http://www.annfammed.org/cgi/content/full/7/3/212
  4. Henley SJ et al Surveillance of Screening-Detected Cancers (Colon and Rectum, Breast, and Cervix) --- United States, 2004--2006 Surveillance Summaries Morbidity and Mortality Weekly Report (MMWR) November 26, 2010 / 59(SS09);1-25 PMID: 21102407 http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5909a1.htm
  5. Bellizzi KM et al. Prevalence of cancer screening in older, racially diverse adults: Still screening after all these years. Arch Intern Med 2011 Dec 12/26; 171:2031. PMID: 22158573
  6. Wegwarth O and Gigerenze G Overdiagnosis and Overtreatment. Evaluation of What Physicians Tell Their Patients About Screening Harms. JAMA Intern Med. Published online October 21, 2013 PMID: 24145597 http://archinte.jamanetwork.com/article.aspx?articleid=1754987
  7. Heleno B et al. Quantification of harms in cancer screening trials: Literature review. PMID: 24041703 BMJ 2013;347:f5334 http://www.bmj.com/content/347/bmj.f5334
  8. Royce TJ et al Cancer Screening Rates in Individuals With Different Life Expectancies. JAMA Intern Med. Published online August 18, 2014 PMID: 25133746 http://archinte.jamanetwork.com/article.aspx?articleid=1897549 - van Hees F et al The Appropriateness of More Intensive Colonoscopy Screening Than Recommended in Medicare BeneficiariesA Modeling Study. JAMA Intern Med. Published online August 18, 2014 PMID: 25133641 http://archinte.jamanetwork.com/article.aspx?articleid=1897548 - Gross CP Cancer Screening in Older Persons. A New Age of Wonder. JAMA Intern Med. Published online August 18, 2014 PMID: 25133660 http://archinte.jamanetwork.com/article.aspx?articleid=1897541
  9. Wilt TJ, Harris RP, Qaseem A for the High Value Care Task Force of the American College of Physicians. Screening for Cancer: Advice for High-Value Care From the American College of Physicians. Ann Intern Med. 2015;162(10):718-725. PMID: 25984847 http://annals.org/article.aspx?articleid=2294149 - Harris RP, Wilt TJ, Qaseem A for the High Value Care Task Force of the American College of Physicians. A Value Framework for Cancer Screening: Advice for High-Value Care From the American College of Physicians. Ann Intern Med. 2015;162(10):712-717 PMID: 25984846 http://annals.org/article.aspx?articleid=2293237
  10. Prasad V, Lenzer J, Newman DH. Why cancer screening has never been shown to "save lives" - and what we can do about it. BMJ 2016;352:h6080 PMID: 26740343 http://www.bmj.com/content/352/bmj.h6080
  11. Orciari Herman A, Sadoughi S, Sofair A Single Blood Test to Detect All Cancers in the Works, Company Says Physician's First Watch, Jan 11, 2016 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - Reuters. Jan 10, 2016 Illumina, partners make $100 million bet to detect cancer via blood test. http://www.reuters.com/article/us-usa-healthcare-illumina-idUSKCN0UO0W920160111
  12. Young K, Fairchild DG, Di Francesco L Most Cancer Screening Guidelines Fail to Provide Details of Both Benefits and Risks. Physician's First Watch, Feb 24, 2016 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org reference to JNCI home page
  13. Fenton JJ, Cai Y, Weiss NS et al Delivery of cancer screening: how important is the preventive health examination? Arch Intern Med. 2007 Mar 26;167(6):580-5. PMID: 17389289 Free PMC Article
  14. Smith RA, Andrews KS, Brooks D et al Cancer screening in the United States, 2017: A review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin. 2017 Feb 7 PMID: 28170086 Free Article http://onlinelibrary.wiley.com/doi/10.3322/caac.21392/full
  15. Schoenborn NL, Lee K, Pollack CE et al Older Adults' Views and Communication Preferences About Cancer Screening Cessation. JAMA Intern Med. Published online June 12, 2017. PMID: 28604917 http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2630754 - Torke AM Talking to Patients About Cancer Screening Cessation. JAMA Intern Med. Published online June 12, 2017 PMID: 28604923 http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2630750
  16. Phallen J, Sausen M, Adleff V et al Direct detection of early-stage cancers using circulating tumor DNA. Science Translational Medicine. 16 Aug 2017: 9(403):eaan2415 PMID: 28814544 http://stm.sciencemag.org/content/9/403/eaan2415
  17. Pierre-Victor D, Pinsky PF. Association of nonadherence to cancer screening examinations with mortality from unrelated causes: A secondary analysis of the PLCO cancer screening trial. JAMA Intern Med 2018 Dec 28 PMID: 30592477 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2719426 - Grady D, Parks M. Why is nonadherence to cancer screening associated with increased mortality? JAMA Intern Med 2018 Dec 28 PMID: 30592474 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2719419
  18. Hsiang EY, Mehta SJ, Small DS et al Association of Primary Care Clinic Appointment Time With Clinician Ordering and Patient Completion of Breast and Colorectal Cancer Screening. JAMA Netw Open. 2019;2(5):e193403. May 10 PMID: 31074811 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2733171 - Liss DT, Linder JA Decision Fatigue, Running Late, and Population Health Management - Screening Out of Time. JAMA Netw Open. 2019;2(5):e193402. May 10 PMID: 31074806 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2733166
  19. American College of Physicians Low-value cancer screening may be commonly provided to older U.S. adults. ACP Internist Weekly. Preventive care. August 17, 2021. https://acpinternist.org/weekly/archives/2021/08/17/4.htm
  20. Nelson R Screening Tests Diagnose About 14% of All Cancers. Medscape. December 20, 2022 https://www.medscape.com/viewarticle/985896 - NORC. University of Chicago Only 14% of Cancers Are Detected Through a Preventive Screening Test. https://www.norc.org/PDFs/GRAIL/State-Specific%20PCDSs%20chart%201213.pdf
  21. NEJM Knowledge+ Hematology
  22. Berry DA. Failure of researchers, reviewers, editors, and the media to understand flaws in cancer screening studies: application to an article in Cancer. Cancer. 2014 Sep 15;120(18):2784-91. PMID: 24925345 Free Article
  23. Bretthauer M, Wieszczy P, Loberg M et al Estimated Lifetime Gained With Cancer Screening Tests. A Meta-Analysis of Randomized Clinical Trials. JAMA Intern Med. Published online August 28, 2023. PMID: 37639247 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2808648
  24. Stewart J Urine Tests Could Be 'Enormous Step' in Diagnosing Cancer. Medscape. May 21, 2024 - Tosoian JJ, Zhang Y, Xiao L et al Development and Validation of an 18-Gene Urine Test for High-Grade Prostate Cancer. JAMA Oncol. 2024 Apr 18. . PMID: 38635241 https://jamanetwork.com/journals/jamaoncology/fullarticle/2817657 - Bhambhani C, Kang Q, Hovelson DH et ak ctDNA transiting into urine is ultrashort and facilitates noninvasive liquid biopsy of HPV+ oropharyngeal cancer. JCI Insight. 2024 Feb 8;9(6):e177759. PMID: 38516891 PMCID: PMC11018327 Free PMC article. https://insight.jci.org/articles/view/177759 - Debernardi S, Blyuss O, Rycyk D et al Urine biomarkers enable pancreatic cancer detection up to 2 years before diagnosis. Int J Cancer. 2023 Feb 15;152(4):769-780. PMID: 36093581 PMCID: PMC9789171 Free PMC article.