Cancer screening in the United States, 2013: a review of current American Cancer Society guidelines, current issues in cancer screening, and new guidance on cervical cancer screening and lung cancer screening

Non-normal Screening Mammography Results, Lumpectomies, and Breast Cancer Reported by California Women, 2001-2009

BACKGROUND

Although screening mammography may contribute to decreases in breast cancer mortality in a population, it may also increase the risk of false positives, anxiety, and unnecessary and costly medical procedures in individuals. We report trends in self-reported non-normal screening mammography results, lumpectomies, and breast cancer in a representative sample of California women.

METHODS

Data were obtained from the 2001, 2005, and 2009 cross-sectional California Health Interview Surveys (CHIS) and weighted to the California population. CHIS employed a multistage sampling design to administer telephone surveys in 6 languages. Our study sample was restricted to women 40 years and older who reported a screening mammogram in the past 2 years. Sample sizes were 13,974 in 2001, 12,069 in 2005, and 15,552 in 2009. Women reporting non-normal results were asked whether they had an operation to remove the lump and, if so, whether the lump was confirmed as malignant.

FINDINGS

Between 2001 and 2009, the percent of California women who reported having been diagnosed with breast cancer was relatively stable. For each of the three age groups studied, the percentage of non-normal mammography results increased and the percentages of lumpectomies decreased and, for every woman reporting a diagnosis of breast cancer, three women reported a lumpectomy that turned out not to be cancer. This ratio was greater for younger women and less for older women.

CONCLUSIONS

Despite relatively constant rates of breast cancer diagnosis from 2001 to 2009, the percentage of non-normal mammography results increased and lumpectomies declined.

Beyond the mammography debate: a moderate perspective

After some decades of contention, one can almost despair and conclude that (paraphrasing) "the mammography debate you will have with you always." Against that sentiment, in this review I argue, after reflecting on some of the major themes of this long-standing debate, that we must begin to move beyond the narrow borders of claim and counterclaim to seek consensus on what the balance of methodologically sound and critically appraised evidence demonstrates, and also to find overlooked underlying convergences; after acknowledging the reality of some residual and non-trivial harms from mammography, to promote effective strategies for harm mitigation; and to encourage deployment of new screening modalities that will render many of the issues and concerns in the debate obsolete. To these ends, I provide a sketch of what this looking forward and beyond the current debate might look like, leveraging advantages from abbreviated breast magnetic resonance imaging technologies (such as the ultrafast and twist protocols) and from digital breast tomosynthesis-also known as three-dimensional mammography. I also locate the debate within the broader context of mammography in the real world as it plays out not for the disputants, but for the stakeholders themselves: the screening-eligible patients and the physicians in the front lines who are charged with enabling both the acts of screening and the facts of screening at their maximally objective and patient-accessible levels to facilitate informed decisions.

Shape-based Automatic Detection of Pectoral Muscle Boundary in Mammograms

The detection of the pectoral muscle boundary in the medio-lateral oblique view of mammograms is essential to improving the computer-aided diagnosis of breast cancer. In this study, a shape-based detection method is proposed for accurately extracting the boundary of the pectoral muscle in mammograms. A shape-based enhancement mask is applied to the mammogram and the initial boundary is then defined using morphological operators. The seed point is then detected on the initial boundary and the pectoral boundary is evolved from candidate points produced using a shape-based growth strategy. A cubic polynomial fitting function is implemented to obtain the final pectoral muscle boundary. The proposed method was applied to 322 mammograms from the mini Mammographic Image Analysis Society database. A 97.2 % acceptable rate from expert radiologists and assessment results based on the false positive rate, false negative rate, and Hausdorff distance demonstrate the robustness and effectiveness of the proposed shape-based detection method.

Cost-effectiveness analysis of a colonoscopy screening navigator program designed for Hispanic men

Although Hispanic men are at higher risk of developing colon cancer compared to non-Hispanic white men, colonoscopy screening among Hispanic men is much lower than among non-Hispanic white men. University Health System (UHS) in San Antonio, Texas, instituted a Colorectal Cancer Male Navigation (CCMN) Program in 2011 specifically designed for Hispanic men. The CCMN Program contacted 461 Hispanic men 50 years of age and older to participate over a 2-year period. Of these age-eligible men, 370 were screened for CRC after being contacted by the navigator. Using participant and program data, a Markov model was constructed to determine the cost-effectiveness of the CCMN Program. An average 50-year-old Hispanic male who participates in the CCMN Program will have 0.3 more quality-adjusted life-years (QALYs) compared to a similar male receiving usual care. Life expectancy is also predicted to increase by 6 months for participants compared to non-participants. The program results in net health care savings of $1,148 per participant ($424,760 for the 370 CCMN Program participants). The incremental cost-effectiveness ratio is estimated at $3,765 per QALY in favor of the navigation program. Interventions to reduce disparities in CRC screening across ethnic groups are needed, and this is one of the first studies to evaluate the economic benefit of a patient navigator program specifically designed for an urban population of Hispanic men. A colorectal cancer screening intervention which relies on patient navigators trained to address the unique needs of the targeted population (language barriers, transportation and scheduling assistance, colon cancer, and screening knowledge) can substantially increase the likelihood of screening and improve quality of life in a cost-effective manner.

Knowledge and practice of colorectal screening in a suburban group of Iraqi American women

Colorectal cancer (CRC) was the second most common cancer among women in 2008, accounting for 571,000 cases, and 9.4% of all cancer cases afflicting women worldwide. According to the World Health Organization (WHO) and the Iraqi National Cancer Registry (INCR), Iraq has seen a steady rise in CRC rates among its general population over the past several decades. Despite Iraq's increasing national incidence of CRC and the growth of the US' Iraqi immigrant population over the last 10 years, little remains known about the prevalence of CRC among the latter population, their knowledge of CRC and associated risk factors, or their behavioral intent and practices regarding CRC screening. The aims of this study were to (1) examine the knowledge of and adherence to National Cancer Institute screening recommendations for CRC among a population of Iraqi women living in the Washington D.C. Metropolitan Area and (2) test the efficacy of a one-time educational intervention conducted using linguistically and culturally appropriate materials to raise awareness of, and promote future adherence to, CRC screening methods. This descriptive study used a pre/post design with a 12-month follow-up. Following extensive dissemination of information regarding the study in the Iraqi American community in the study location, 50 women were initially recruited, of whom 32 participated in the study. The study's findings revealed that the participants generally had low baseline levels of CRC screening adherence and preventive knowledge that significantly improved after the intervention as demonstrated by pre- and post-assessments of knowledge and behavior. These findings could be used to raise awareness (1) among clinicians regarding the need for early detection and screening of and referral for CRC treatment among Iraqi American women and (2) among Iraqi American women about risk factors for this disease and the importance of early detection and screening. The study also highlights the need for a larger study of knowledge, attitudes, and perceptions among both this population and the clinicians who serve them.

Decisional outcomes following use of an interactive web-based decision aid for prostate cancer screening

Informed decision-making tools are recommended for men considering prostate cancer screening. We evaluated the extent to which use of an interactive, web-based decision aid was associated with decisional and screening outcomes. Participants (N = 253) were 57 (7.0) years old and completed telephone interviews at baseline, 1 month, and 13 months post-baseline. Tracking software captured minutes spent on the website (median = 33.9), sections viewed (median = 4.0/5.0), testimonials viewed (median = 4.0/6.0), and values clarification tool (VCT) use (77.3 %). In multivariable analyses, all four website use variables were positively associated with increased knowledge (p's < 0.05). Complete VCT use and number of informational sections were positively associated with greater decisional satisfaction (p's < 0.05). Decisional conflict and screening behavior were not associated with measures of website use. Increased use of informational content and interactive elements were related to improved knowledge and satisfaction. Methods to increase utilization of interactive website components may improve informed decision-making outcomes.

Screening for melanoma

Although melanoma is a deadly cancer that is rising in incidence, the USA does not have uniform guidelines for melanoma screening. Screening for melanoma requires no specialized equipment and has little associated morbidity. However, screening has the greatest impact when performed among patients with the highest risk for melanoma incidence and mortality. Screening lower-risk patients may result in prohibitively high costs, unnecessary biopsies of benign lesions, and decreased access to a dermatologic specialist for patients who are actually at a higher risk. We advocate targeting melanoma screening efforts toward those patients at high risk of developing and dying from melanoma, as well as toward those at-risk patients who are least likely to detect their own melanoma.

Triple-negative breast cancer: what is known about it?

Triple-negative breast cancer (TNBC) is considered a rare diagnosis. This malignancy targets a specific population of women and has risk factors differing from those of other breast cancers. TNBC exhibits distinct pathologic features that result in aggressive metastasis and poor prognosis. Pathologically, TNBC cancer cells are characterized by negative receptors for progesterone and estrogen and by the lack of over-expression of human epidermal growth factor receptor 2, which limits chemotherapeutic treatment options for women with TNBC. Nurses can assist in early detection by offering patient education about the little known risk factors for TNBC. Psychosocial issues can overwhelm patients diagnosed with breast cancer. This article provides suggestions for nurses as they guide women who are experiencing an atypical breast cancer diagnosis with an uncertain prognosis and limited treatment options.

Curcuma zedoaria (Berg.) Rosc. essential oil and paclitaxel synergistically enhance the apoptosis of SKOV3 cells

Curcuma zedoaria (Berg.) Rosc. essential oil (CZEO) is the major component of Curcuma zedoaria (Berg.) Rosc., a traditional medicine with antitumor activity. Paclitaxel (PTX) is a first-line chemotherapeutic agent used to treat patients with ovarian cancer. These compounds directly target nuclear DNA, in order to suppress or inhibit tumor cell growth. The present study aimed to determine the synergistic antitumor effects of CZEO and PTX on the SKOV3 human ovarian cancer cell line. SKOV3 cells were treated with CZEO, PTX or a combination of the two and cell viability was detected using cell counting kit-8. In addition, flow cytometry was used to determined cell apoptosis as well as for cell cycle analysis. The morpho-logical changes of apoptosis were assessed using Hoechst 33342 staining and the expression levels of apoptotic pathway proteins, including caspase-3 and poly (ADP-ribose) polymerase (PARP), were quantified using western blot analysis. The cell viability assay indicated that either of these compounds alone or in combination suppressed the growth of SKOV3 cells. Furthermore, flow cytometric analysis indicated that treatment with a combination of CZEO and PTX resulted in increased inhibition of proliferation and induction of apoptosis of SKOV3 cells, as compared with treatment with either of the compounds alone. In addition, the protein expression levels of caspase-3 were increased following treatment with a combination of CZEO and PTX. The results of the present study suggested that CZEO and PTX synergistically enhanced the inhibition of SKOV3 proliferation, and the possible underlying mechanism may be the induction of cell apoptosis and cell cycle arrest. This therefore indicated that PTX supplemented with CZEO may be an effective treatment strategy to decrease the dose and toxicity of PTX.

Screening for cancer: when to stop?: A practical guide and review of the evidence

Deciding when to stop cancer screening in older adults is a complex challenge that involves multiple factors: individual health status and life expectancy; risks and benefits of screening, which vary with age and comorbidity; and individual preferences and values. This article examines current cancer screening practices and reviews the risks and benefits of cancer screening for colorectal, breast, lung, prostate, and cervical cancer, particularly in older individuals and those with multiple comorbidities. Tools for estimating life expectancy are reviewed, and a practical framework is presented to guide discussions on when the harms of screening likely outweigh the benefits.

Global cancer statistics, 2012

Cancer constitutes an enormous burden on society in more and less economically developed countries alike. The occurrence of cancer is increasing because of the growth and aging of the population, as well as an increasing prevalence of established risk factors such as smoking, overweight, physical inactivity, and changing reproductive patterns associated with urbanization and economic development. Based on GLOBOCAN estimates, about 14.1 million new cancer cases and 8.2 million deaths occurred in 2012 worldwide. Over the years, the burden has shifted to less developed countries, which currently account for about 57% of cases and 65% of cancer deaths worldwide. Lung cancer is the leading cause of cancer death among males in both more and less developed countries, and has surpassed breast cancer as the leading cause of cancer death among females in more developed countries; breast cancer remains the leading cause of cancer death among females in less developed countries. Other leading causes of cancer death in more developed countries include colorectal cancer among males and females and prostate cancer among males. In less developed countries, liver and stomach cancer among males and cervical cancer among females are also leading causes of cancer death. Although incidence rates for all cancers combined are nearly twice as high in more developed than in less developed countries in both males and females, mortality rates are only 8% to 15% higher in more developed countries. This disparity reflects regional differences in the mix of cancers, which is affected by risk factors and detection practices, and/or the availability of treatment. Risk factors associated with the leading causes of cancer death include tobacco use (lung, colorectal, stomach, and liver cancer), overweight/obesity and physical inactivity (breast and colorectal cancer), and infection (liver, stomach, and cervical cancer). A substantial portion of cancer cases and deaths could be prevented by broadly applying effective prevention measures, such as tobacco control, vaccination, and the use of early detection tests.

Barriers related to non-adherence in a mammography breast-screening program during the implementation period in the interior of São Paulo State, Brazil

Mammography is the best exam for early diagnosis of breast cancer. Developing countries frequently have a low income of mammography and absence of organized screening. The knowledge of vulnerable population and strategies to increase adherence are important to improve the implementation of an organized breast-screening program. A mammography regional-screening program was implemented in a place around 54.238 women, aged 40–69 years old. It was proposed to perform biannual mammography free of cost for the women. We analyze the first 2 years of the implementation of the project. Mammography was realized in 17.964 women. 42.1% of the women hadn’t done de mammography in their lives and these women were principally from low socio-economic status (OR = 2.99), low education (OR = 3.00). The best strategies to include these women were mobile unit (OR = 1.43) and Family Health Program (OR = 1.79). The incidence of early breast tumors before the project was 14.5%, a fact that changed to 43.2% in this phase. Multivariate analysis showed that the association of illiterate and the mobile unit achieve more women who had not performed mammography in their lives. The strategies to increase adherence to mammography must be multiple and a large organization is necessary to overpass the barriers related to system health and education.

The role of tentative decisions and health concepts in assessing information about mammography screening

Breast cancer awareness campaigns and screening programs are important public health issues. In order to deepen women's knowledge about mammography screening, a balanced presentation of arguments is considered to be relevant. Yet, little is known about how women process this information and assess pro and contra arguments, which, in turn, can be embedded in different health paradigms. The aim of this experimental study was to determine the impact of both women's pre-formed, tentative decisions about whether to participate in mammography screening and of their individual health concepts on their assessment of different arguments about mammography screening. The results showed that women who would tend at the outset to participate in mammography screening rated information about advantages as more relevant than information about disadvantages--in contrast to women who did not intend to participate. In addition, the greater the fit was between women's individual health concepts and the health concept presented in the arguments, the more they considered the information presented to be relevant. We conclude that presenting balanced information about mammography screening does not guarantee balanced processing of that information. Health professionals need to be aware of people's prior beliefs and of the health paradigm in which information is embedded.

Proteomics in translational cancer research: biomarker discovery for clinical applications

This special focus issue of Expert Review of Proteomics invites key opinion leaders to report their recent findings and views on the important topic of translating potential proteomic biomarkers to clinically useful, regulator-approved biomarkers: a challenging journey. The issue also highlights the difficulties associated with and the way forward in the discovery of proteomic cancer biomarkers for clinical applications, as well as presenting recent original research in the field.

Behavioral economics: "nudging" underserved populations to be screened for cancer

Persistent disparities in cancer screening by race/ethnicity and socioeconomic status require innovative prevention tools and techniques. Behavioral economics provides tools to potentially reduce disparities by informing strategies and systems to increase prevention of breast, cervical, and colorectal cancers. With an emphasis on the predictable, but sometimes flawed, mental shortcuts (heuristics) people use to make decisions, behavioral economics offers insights that practitioners can use to enhance evidence-based cancer screening interventions that rely on judgments about the probability of developing and detecting cancer, decisions about competing screening options, and the optimal presentation of complex choices (choice architecture). In the area of judgment, we describe ways practitioners can use the availability and representativeness of heuristics and the tendency toward unrealistic optimism to increase perceptions of risk and highlight benefits of screening. We describe how several behavioral economic principles involved in decision-making can influence screening attitudes, including how framing and context effects can be manipulated to highlight personally salient features of cancer screening tests. Finally, we offer suggestions about ways practitioners can apply principles related to choice architecture to health care systems in which cancer screening takes place. These recommendations include the use of incentives to increase screening, introduction of default options, appropriate feedback throughout the decision-making and behavior completion process, and clear presentation of complex choices, particularly in the context of colorectal cancer screening. We conclude by noting gaps in knowledge and propose future research questions to guide this promising area of research and practice.

Lung Cancer Biomarkers

Lung cancer is the most frequently occurring cancer in the world and continually leads in mortality among cancers. The overall 5-year survival rate for lung cancer has risen only 4% (from 12% to 16%) over the past 4 decades, and late diagnosis is a major obstacle in improving lung cancer prognosis. Survival of patients undergoing lung resection is greater than 80%, suggesting that early detection and diagnosis of cancers before they become inoperable and lethal will greatly improve mortality. Lung cancer biomarkers can be used for screening, detection, diagnosis, prognosis, prediction, stratification, therapy response monitoring, and so on. This review focuses on noninvasive diagnostic and prognostic biomarkers. For that purpose, our discussion in this review will focus on biological fluid-based biomarkers. The body fluids include blood (serum or plasma), sputum, saliva, BAL, pleural effusion, and VOC. Since it is rich in different cellular and molecular elements and is one of the most convenient and routine clinical procedures, serum or plasma is the main source for the development and validation of many noninvasive biomarkers. In terms of molecular aspects, the most widely validated ones are proteins, some of which are used in the clinical sector, though in limited accessory purposes. We will also discuss the lung cancer (protein) biomarkers in clinical trials and currently in the validation phase with hundreds of samples. After proteins, we will discuss microRNAs, methylated DNA, and circulating tumor cells, which are being vigorously developed and validated as potential lung cancer biomarkers. The main aim of this review is to provide researchers and clinicians with an understanding of the potential noninvasive lung cancer biomarkers in biological fluids that have recently been discovered.

A comparison of web-based versus print-based decision AIDS for prostate cancer screening: participants' evaluation and utilization

BACKGROUND

Patient decision aids facilitate informed decision making for medical tests and procedures that have uncertain benefits.

OBJECTIVE

To describe participants' evaluation and utilization of print-based and web-based prostate cancer screening decision aids that were found to improve decisional outcomes in a prior randomized controlled trial.

DESIGN

Men completed brief telephone interviews at baseline, one month, and 13 months post-randomization.

PARTICIPANTS

Participants were primary care patients, 45-70 years old, who received the print-based (N = 628) or web-based decision aid (N = 625) and completed the follow-up assessments.

MAIN MEASURES

We assessed men's baseline preference for web-based or print-based materials, time spent using the decision aids, comprehension of the overall message, and ratings of the content.

KEY RESULTS

Decision aid use was self-reported by 64.3 % (web) and 81.8 % (print) of participants. Significant predictors of decision aid use were race (white vs. non-white, OR = 2.43, 95 % CI: 1.77, 3.35), higher education (OR = 1.68, 95 % CI: 1.06, 2.70) and trial arm (print vs. web, OR = 2.78, 95 % CI: 2.03, 3.83). Multivariable analyses indicated that web-arm participants were more likely to use the website when they preferred web-based materials (OR: 1.91, CI: 1.17, 3.12), whereas use of the print materials was not significantly impacted by a preference for print-based materials (OR: 0.69, CI: 0.38, 1.25). Comprehension of the decision aid message (i.e., screening is an individual decision) did not significantly differ between arms in adjusted analyses (print: 61.9 % and web: 68.2 %, p = 0.42).

CONCLUSIONS

Decision aid use was independently influenced by race, education, and the decision aid medium, findings consistent with the 'digital divide.' These results suggest that when it is not possible to provide this age cohort with their preferred decision aid medium, print materials will be more highly used than web-based materials. Although there are many advantages to web-based decision aids, providing an option for print-based decision aids should be considered.

Opportunities and challenges for the use of large-scale surveys in public health research: a comparison of the assessment of cancer screening behaviors

Large-scale surveys that assess cancer prevention and control behaviors are a readily available, rich resource for public health researchers. Although these data are used by a subset of researchers who are familiar with them, their potential is not fully realized by the research community for reasons including lack of awareness of the data and limited understanding of their content, methodology, and utility. Until now, no comprehensive resource existed to describe and facilitate use of these data. To address this gap and maximize use of these data, we catalogued the characteristics and content of four surveys that assessed cancer screening behaviors in 2005, the most recent year with concurrent periods of data collection: the National Health Interview Survey, Health Information National Trends Survey, Behavioral Risk Factor Surveillance System, and California Health Interview Survey. We documented each survey's characteristics, measures of cancer screening, and relevant correlates; examined how published studies (n = 78) have used the surveys' cancer screening data; and reviewed new cancer screening constructs measured in recent years. This information can guide researchers in deciding how to capitalize on the opportunities presented by these data resources.

Health messaging to individuals who perceive ambiguity in health communications: the promise of self-affirmation

The perception that extant health messages about risk factors for a disease are ambiguous can be associated with greater anxiety and reduced interest in taking precautionary action. In this experiment, 247 female alcohol consumers who perceived varying degrees of ambiguity in current cancer prevention messages read an unambiguous article about the documented link between alcohol consumption and breast cancer. Before reading the article, half were given the opportunity to self-affirm by reflecting on an important value-a technique previously shown to enhance receptivity to threatening messages. The authors found that self-affirmation increased message acceptance among those who perceived relatively higher levels of ambiguity in cancer communications. Also, the relation between perceived ambiguity and risk perception became positive among self-affirmed participants, suggesting they had become less defensive. Self-affirmation may be an effective technique to use when delivering health communications to audiences who perceive a lack of consistency in prevention messages.

The impact of breast cancer knowledge and attitudes on screening and early detection among an immigrant Iranian population in southern California

Few studies explored factors influencing breast cancer screening and early detection behaviors among immigrant Iranian women residing in the USA. Using a cross-sectional survey, a convenience sample of 319 Iranian American women was selected to investigate the impact of breast cancer knowledge and attitude on screening. A self-administered questionnaire assessed breast cancer screening knowledge, attitude, and mammography use (ever, previous year, and future intention). 79 % of the women in the study reported ever receiving at least one mammogram and 74 % received a mammogram in the past year. Personal attitude had an independent significant effect on: mammography use in the last year, ever use of mammography, and future intention to screen. Knowledge and morality-induced attitude influenced screening behavior but not significantly. Interventions targeting breast cancer screening among immigrant Iranian women in the USA should focus on enhancing personal attitudes in order to influence actual screening behavior.

An intergenerational approach to prostate cancer education: findings from a pilot project in the southeastern USA

African Americans (AA) are more likely to develop and die from cancer than any other racial or ethnic group. This study assessed older and younger/middle-aged African-American (AA) men's (1) knowledge and attitudes about prostate cancer (PrCA) and PrCA screening, (2) participation in clinical research, and (3) health and cancer-related decision making. Twenty-eight AA men (14 older, mean age 59.8; 14 younger/middle age, mean age 30.4) received a PrCA education program and completed pre/post-education program surveys, as well as qualitative post-education interviews. Younger/middle-aged men were more knowledgeable about PrCA and PrCA screening than older men. Older men reported being invited to participate in a clinical trial more often than younger men but were more likely to report that participation in clinical trials was risky and they did not plan to participate in medical research in the future. Younger/middle-aged men were more willing to participate in a clinical trial in the future and reported fewer barriers to participation in clinical research. There is potential for using intergenerational communication strategies with older/younger AA male dyads in PrCA interventions.

Association between nonalcoholic fatty liver disease and colorectal adenoma: a systemic review and meta-analysis

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is considered to be a hepatic manifestation of metabolic syndrome (MetS) and the most common chronic liver disease worldwide. The association between NAFLD and colorectal adenoma has been investigated in multiples studies but the results have been conflicting. We performed a systematic review and meta-analysis to evaluate this in asymptomatic patients who underwent screening colonoscopy.

METHODS

We searched the literatures of all languages from PubMed, EMBASE and the Cochrane library from January 1, 1980 through July 15, 2014. Combined and subgroup analyses stratified by study designs, study locations, characteristics of adenoma (location, size, number, and advanced adenoma) were performed.

RESULTS

Four cross-sectional and one cohort studies with a total of 6,263 subjects were included in the meta-analysis. NAFLD was significantly associated with colorectal adenoma [pooled odds ratio (OR) 1.74, 95% confidence interval (CI): 1.53-1.97]. The association was more significant in Asian population (pooled OR =1.77, 95% CI: 1.52-2.05, n=3 studies), compared to European/North American population (pooled OR =1.42, 95% CI: 0.75-2.67, n=2 studies). NAFLD was significantly associated with the number of colorectal adenoma (pooled OR =1.78, 95% CI: 1.10-2.86, n=2 studies), but not the location, size, or presence of advanced adenoma.

CONCLUSIONS

Our results suggest NAFLD is significantly associated with the presence of colorectal adenoma in asymptomatic patients undergoing screening colonoscopy. This finding provides additional risk stratifications for applying colorectal cancer (CRC) screening strategies. However, more studies of western population are needed to further investigate the ethnic disparity.

Predictors of repeat participation in the NHS bowel cancer screening programme

OBJECTIVES

Most types of population-based cancer screening require repeat participation to be effective. This study investigated predictors of repeat participation in the NHS Bowel Cancer Screening Programme (BCSP).

METHODS

The BCSP in England offers biennial colorectal cancer screening using a guaiac fecal occult blood test (gFOBt) from age 60-74 years. This analysis included 62,081 individuals aged 60-64 years at the time of the first invitation (R1). The main outcome was repeat participation at their second (R2) or third (R3) invitation. Behavioural measures derived from screening records included late return of the gFOBt kit, compliance with follow-up investigations and previous screening participation. Other potential predictors of repeat participation included results of individual test kit analysis (normal, weak positive, strong positive, spoilt) and the definitive result of the gFOBt screening episode (normal or abnormal). Age, sex and socioeconomic deprivation were also recorded.

RESULTS

Overall repeat uptake was 86.6% in R2 and 88.6% in R3. Late return of the test kit was consistently associated with lower uptake (R2: 82.3% vs 88.6%, P<0.001; R3: 84.5% vs 90.5%, P<0.001). A definitive abnormal gFOBt result in the previous screening episode was a negative predictor of repeat uptake (R2: 61.4% vs 86.8%, P<0.001; R3: 65.7% vs 88.8%, P<0.001). Weak positive (R2: 76.9% vs 86.8%, P<0.001; R3: 81.7% vs 88.8%, P<0.05) and spoilt test kits (R2: 79.0% vs 86.6%, NS; R3: 84.2% vs 92.2%, P<0.05) were associated with lower repeat uptake, but were not consistently independent predictors in all invitation rounds or subgroups. Among those with a definitive abnormal gFOBt result, noncompliance with follow-up in a previous screening episode was also associated with lower repeat uptake (R2: 24.3% vs 67.1%, P<0.001; R3: 43.2% vs 69.9%, P<0.001).

CONCLUSIONS

Behavioural markers and test results from previous screening episodes have been implicated in subsequent gFOBt uptake.

Assessing breast cancer risk in a primary care setting

Individuals who are given a preventive exam by a primary care provider are more likely to agree to cancer screening. The provider recommendation has been identified as the strongest factor associated with screening utilization. This article provides a framework for breast cancer risk assessment for an advanced practice registered nurse working in primary care practice.

Screening, early detection, education, and trends for melanoma: current status (2007-2013) and future directions: Part II. Screening, education, and future directions

New evidence has accumulated over the past several years that supports improved melanoma outcomes associated with both clinician and patient screening. Population-based and workplace studies conducted in Australia and the Unites States, respectively, have shown decreases in the incidence of thick melanoma and overall melanoma mortality, and a year-long statewide screening program in Germany has shown a nearly 50% reduction in mortality 5 years after the screening ended. Current melanoma screening guidelines in the United States are inconsistent among various organizations, and therefore rates of both physician and patient skin examinations are low. As policymaking organizations update national screening recommendations in the United States, the latest research reviewed in part II of this continuing medical education article should be considered to establish the most effective recommendations. Patient and provider education will be necessary to ensure that appropriate patients receive recommended screening.

miR-429 inhibits migration and invasion of breast cancer cells in vitro

Accumulating evidence indicates that microRNAs (miRNAs) are involved in regulating cancer invasion and metastasis, and an increasing number of research demonstrates that miRNAs can promote or inhibit cell motility depending on genetic background of different cancers and the microenvironment. In the present study, we established an in vivo bone metastasis model of breast cancer by injecting MDA-MB-231 cells into the left ventricle of nude mice, and then screened the differentially expressed miRNAs between parental and bone-metastatic MDA-MB-231 cells using miRNA array. The results revealed that decreased expression of miR-429 was probably involved in negatively regulating bone metastasis of breast cancer cells. On the other hand, overexpression of miR-429 in MDA-MB-231 cells remarkably suppressed invasion in vitro. We identified ZEB1 and CRKL as potential targets of miR-429 by analyzing combined results from in silico search and global expression array of the same RNA samples. Immunoblot assay confirmed that miR-429 reduced their expression at protein level. Taken together, our results offer an opportunity for further understanding of the recondite mechanisms underlying the bone metastasis of breast cancer.

Breast cancer in female survivors of Wilms tumor: a report from the national Wilms tumor late effects study

BACKGROUND

The standard treatment of pulmonary metastases in patients with Wilms tumor (WT) includes 12-gray radiotherapy (RT) to the entire chest. To the authors' knowledge, the risk of breast cancer (BC) in a large cohort of female survivors of WT has not previously been reported.

METHODS

A total of 2492 female participants in National Wilms Tumor Studies 1 through 4 (1969-1995) were followed from age 15 years through the middle of 2013 for incident BC. The median age at the time of last contact was 27.3 years. The authors calculated cumulative risk at age 40 years (CR40), hazard ratios (HR) by Cox regression, standardized incidence ratios (SIRs) relative to US population rates, and 95% confidence intervals (95% CIs).

RESULTS

The numbers of survivors with invasive BC divided by the numbers at risk were 16 of 369 (CR40, 14.8% [95% CI, 8.7-24.5]) for women who received chest RT for metastatic WT, 10 of 894 (CR40, 3.1% [95% CI, 1.3-7.41]) for those who received only abdominal RT, and 2 of 1229 (CR40, 0.3% [95% CI, 0.0-2.3]) for those who received no RT. The SIRs for these 3 groups were 27.6 (95% CI, 16.1-44.2) based on 5010 person-years (PY) of follow-up, 6.0 (95% CI, 2.9-11.0) based on 13,185 PY of follow-up, and 2.2 (95% CI, 0.3-7.8) based on 13,560 PY of follow-up, respectively. The risk was high regardless of the use of chest RT among women diagnosed with WT at age ≥10 years, with 9 of 90 women developing BC (CR40, 13.5% [95% CI, 5.6-30.6]; SIR, 23.6 [95% CI, 10.8-44.8] [PY, 1463]).

CONCLUSIONS

Female survivors of WT who were treated with chest RT had a high risk of developing early BC, with nearly 15% developing invasive disease by age 40 years. Current guidelines that recommend screening only those survivors who received ≥20 Gy of RT to the chest might be reevaluated.

Academic College of Emergency Experts in India's INDO-US Joint Working Group and OPUS12 Foundation Consensus Statement on Creating A Coordinated, Multi-Disciplinary, Patient-Centered, Global Point-of-Care Biomarker Discovery Network

Biomarker science brings great promise to clinical medicine. This is especially true in the era of technology miniaturization, rapid dissemination of knowledge, and point-of-care (POC) implementation of novel diagnostics. Despite this tremendous progress, the journey from a candidate biomarker to a scientifically validated biomarker continues to be an arduous one. In addition to substantial financial resources, biomarker research requires considerable expertise and a multidisciplinary approach. Investigational designs must also be taken into account, with the randomized controlled trial remaining the “gold standard”. The authors present a condensed overview of biomarker science and associated investigational methods, followed by specific examples from clinical areas where biomarker development and/or implementation resulted in tangible enhancements in patient care. This manuscript also serves as a call to arms for the establishment of a truly global, well-coordinated infrastructure dedicated to biomarker research and development, with focus on delivery of the latest discoveries directly to the patient via point-of-care technology.

Berberine reverses epithelial-to-mesenchymal transition and inhibits metastasis and tumor-induced angiogenesis in human cervical cancer cells

Metastasis is the most common cause of cancer-related death in patients, and epithelial-to-mesenchymal transition (EMT) is essential for cancer metastasis, which is a multistep complicated process that includes local invasion, intravasation, extravasation, and proliferation at distant sites. When cancer cells metastasize, angiogenesis is also required for metastatic dissemination, given that an increase in vascular density will allow easier access of tumor cells to circulation, and represents a rational target for therapeutic intervention. Berberine has several anti-inflammation and anticancer biologic effects. In this study, we provided molecular evidence that is associated with the antimetastatic effect of berberine by showing a nearly complete inhibition on invasion (P < 0.001) of highly metastatic SiHa cells via reduced transcriptional activities of matrix metalloproteinase-2 and urokinase-type plasminogen activator. Berberine reversed transforming growth factor-β1-induced EMT and caused upregulation of epithelial markers such as E-cadherin and inhibited mesenchymal markers such as N-cadherin and snail-1. Selective snail-1 inhibition by snail-1-specific small interfering RNA also showed increased E-cadherin expression in SiHa cells. Berberine also reduced tumor-induced angiogenesis in vitro and in vivo. Importantly, an in vivo BALB/c nude mice xenograft model and tail vein injection model showed that berberine treatment reduced tumor growth and lung metastasis by oral gavage, respectively. Taken together, these findings suggested that berberine could reduce metastasis and angiogenesis of cervical cancer cells, thereby constituting an adjuvant treatment of metastasis control.

International screening and early detection of breast cancer: resource-sensitive, age- and risk-specific guidelines

SUMMARY 

In this article we review the evidence and current controversies surrounding screening and early detection of breast cancer, from the initially positive age-specific randomized trials of the 1970s and 1980s, to the 2009 USPSTF recommendations, 2013 interpretation of SEER data, 2014 Canadian Study updates, and BHGI resource-sensitive guidelines, as well as the few reports available from emerging countries. We will also discuss the burden of breast cancer in low- and middle- income countries with rising incidence rates and advanced stages at presentation, the need for increasing awareness and downstaging of disease. We will discuss the data putting it in perspective for general guidelines for the international scene, and suggest adoption of evidence-based resource-sensitive and risk-specific guidelines, with less reliance on broad age-specific guidelines.

In 2014, can we do better than CA125 in the early detection of ovarian cancer?

Ovarian cancer is a lethal gynecologic malignancy with greater than 70% of women presenting with advanced stage disease. Despite new treatments, long term outcomes have not significantly changed in the past 30 years with the five-year overall survival remaining between 20% and 40% for stage III and IV disease. In contrast patients with stage I disease have a greater than 90% five-year overall survival. Detection of ovarian cancer at an early stage would likely have significant impact on mortality rate. Screening biomarkers discovered at the bench have not translated to success in clinical trials. Existing screening modalities have not demonstrated survival benefit in completed prospective trials. Advances in high throughput screening are making it possible to evaluate the development of ovarian cancer in ways never before imagined. Data in the form of human “-omes” including the proteome, genome, metabolome, and transcriptome are now available in various packaged forms. With the correct pooling of resources including prospective collection of patient specimens, integration of high throughput screening, and use of molecular heterogeneity in biomarker discovery, we are poised to make progress in ovarian cancer screening. This review will summarize current biomarkers, imaging, and multimodality screening strategies in the context of emerging technologies.

Multiple roles of toll-like receptor 4 in colorectal cancer

Toll-like receptor (TLR) signaling has been implicated in the inflammatory responses in intestinal epithelial cells (IECs). Such inflammatory signals mediate complex interactions between commensal bacteria and TLRs and are required for IEC proliferation, immune response, repair, and homeostasis. The upregulation of certain TLRs in colorectal cancer (CRC) tissues suggests that TLRs may play an essential role in the prognosis of chronic and inflammatory diseases that ultimately culminate in CRC. Here, we provide a comprehensive review of the literature on the involvement of the TLR pathway in the initiation, progression, and metastasis of CRC, as well as inherited genetic variation and epigenetic regulation. The differential expression of TLRs in epithelial cells has also been discussed. In particular, we emphasize the physiological role of TLR4 in CRC development and pathogenesis, and propose novel and promising approaches for CRC therapeutics with the aid of TLR ligands.

Realizing the Promise of Social Psychology in Improving Public Health

The theories, phenomena, empirical findings, and methodological approaches that characterize contemporary social psychology hold much promise for addressing enduring problems in public health. Indeed, social psychologists played a major role in the development of the discipline of health psychology during the 1970s and 1980s. The health domain allows for the testing, refinement, and application of many interesting and important research questions in social psychology, and offers the discipline a chance to enhance its reach and visibility. Nevertheless, in a review of recent articles in two major social-psychological journals ( Personality and Social Psychology Bulletin and Journal of Personality and Social Psychology), we found that only 3.2% of 467 studies explored health-related topics. In this article, we identify opportunities for research at the interface of social psychology and health, delineate barriers, and offer strategies that can address these barriers as the discipline continues to evolve.

Secondary malignancies in pediatric cancer survivors: perspectives and review of the literature

With continuing improvements in the successful treatment of pediatric malignancies, long term survivors of pediatric cancers and their providers are faced with new oncologic issues regarding long-term morbidities. As pediatric cancer survivors have matured into adulthood, the development of secondary malignancies has become a significant issue for these patients. Whether a consequence of treatment for the patient's original cancer, such as chemotherapy, ionizing radiation, or hematopoietic stem cell transplantation, secondary malignancies now present patients and providers with new challenges regarding treatment, surveillance and counseling. We review the major risk factors for secondary malignancies in pediatric cancer survivors, with particular emphasis on important molecular and cytogenetic risk factors, both inherited and acquired. We conclude with a discussion of recommendations for surveillance and counseling of these patients.

Large-scale profiling of metabolic dysregulation in ovarian cancer

Ovarian cancer is the leading cause of death in gynecologic malignancies. Profiling of endogenous metabolites has potential to identify changes caused by cancer and provide inspiring insights into cancer metabolism. To systematically investigate ovarian cancer metabolism, we performed metabolic profiling of 448 plasma samples related to epithelial ovarian cancer (EOC) based on ultra-performance liquid chromatography mass spectrometry in both positive and negative modes. These unbiased metabolomic profiles could well distinguish EOC from benign ovarian tumor (BOT) and uterine fibroid (UF). Fifty-three metabolites were identified as specific biomarkers for EOC, and this is the first report of piperine, 3-indolepropionic acid, 5-hydroxyindoleacetaldehyde and hydroxyphenyllactate as metabolic biomarkers of EOC. The AUC values of these metabolites for discriminating EOC from BOT/UF and early-stage EOC from BOT/UF were 0.9100/0.9428 and 0.8385/0.8624, respectively. Meanwhile, our metabolites were able to distinguish early-stage EOC from late-stage EOC with an AUC of 0.8801. Importantly, analysis of dysregulated metabolic pathways extends our current understanding of EOC metabolism. Metabolic pathways in EOC patients are mainly characterized by abnormal phospholipid metabolism, altered l-tryptophan catabolism, aggressive fatty acid β-oxidation and aberrant metabolism of piperidine derivatives. Together, these metabolic pathways provide a foundation to support cancer development and progression. In conclusion, our large-scale plasma metabolomics study yielded fundamental insights into dysregulated metabolism in ovarian cancer, which could facilitate clinical diagnosis, therapy, prognosis and shed new lights on ovarian cancer pathogenesis.

Patient opinions on prostate cancer screening are swayed by the United States Preventative Services Task Force recommendations

OBJECTIVE

To survey patient opinions on prostate cancer (PCa) screening in light of the United States Preventive Services Task Force recommendation against its use.

METHODS

We conducted a survey of all-comers to urology and primary care clinics. Participants provided demographic information and responded to a 5-item questionnaire regarding their opinions on screening before and after reading opposing position statements.

RESULTS

The overall response rate was 48%. After excluding incomplete questionnaires, 54 surveys were available for analysis. Patients were predominantly white, middle-aged and older, college-educated men with middle-to-upper-middle-class incomes who were seen at urology clinics. Patients rated their "pre" level of understanding of screening recommendations as good or very good (52%), okay (30%), and poor (19%). After reading the information sheets, good or very good understanding of screening recommendations improved (65%; P = .05), and agreement with the importance of screening remained high (80%). However, nearly 20% of patients expressed a more neutral or less favorable attitude toward the risk-benefit ratio of screening (P = .09). Agreement that men should undergo screening, that screening helps detect cancer, and that screening saves lives remained high, regardless of the exposure.

CONCLUSION

Overall, patients favor PCa screening, but heightened awareness of the current controversy raises concerns about its potential harms. PCa screening is a complex issue, and insight into changing public opinion will be crucial to our future discussions with patients who are wrestling with the decision whether to undergo screening.

Hydrophilic interaction liquid chromatography as second dimension in multidimensional chromatography with an anionic trapping strategy: application to prostate-specific antigen quantification

Liquid chromatography (LC) coupled with tandem mass spectrometry (MS-MS) in selected reaction monitoring mode (SRM) has become a widely used technique for the quantification of protein biomarkers in plasma and has already proven to give similar results compared to the conventional immunoassays. To improve the lack of insufficient sensitivity for quantification of low abundance protein, we propose a new two dimensional liquid chromatography (2D-LC-SRM) method for the quantitation of prostate specific antigen (PSA) in human plasma. The method centers on anion exchange cartridge between reversed-phase chromatography and hydrophilic interaction liquid chromatography (HILIC) in an on-line arrangement. The use of the anionic cartridge allows an easier online transfer of the analytes between both dimensions. Moreover, it provides an additional selectivity since the more basic peptides are not retained on this support. This setup has been applied to the quantification of prostate specific antigen (PSA) protein in plasma on a previous generation of mass spectrometer, which enabled a limit of quantification (LOQ) of 1ng/mL without any upfront immuno-depletion or intense off-line fractionation before the SRM analysis. The obtained LOQ is compatible with the required sensitivity for the clinically relevant plasma-based PSA tests.

International variation in lung cancer mortality rates and trends among women

BACKGROUND

There is no recent comprehensive global analysis of lung cancer mortality in women. We describe contemporary mortality rates and trends among women globally.

METHODS

We used the World Health Organization's Cancer Mortality Database covering 65 populations on six continents to calculate age-standardized (1960 Segi world standard) lung cancer death rates during 2006 to 2010 and annual percent change in rates for available years from 1985 to 2011 and for the most recent five data years by population and age group (30-49 and 50-74 years).

RESULTS

Lung cancer mortality rates (per 100,000) among young women (30-49 years) during 2006 to 2010 ranged from 0.7 in Costa Rica to 14.8 in Hungary. Rates among young women were stable or declining in 47 of 52 populations examined. Rates among women 50 to 74 years ranged from 8.8 in Georgia and Egypt to 120.0 in Scotland. In both age groups, rates were highest in parts of Europe (Scotland, Hungary, Denmark) and North America and lowest in Africa, Asia, and Latin America. Rates in older women were increasing for more than half (36/64) of populations examined, including most countries in Southern, Eastern, and Western Europe and South America.

CONCLUSIONS

Although widespread reductions in lung cancer in young women provide evidence of tobacco control success, rates continue to increase among older women in many countries.

IMPACT

More concentrated efforts to initiate or expand tobacco control programs in these countries globally will be required to attenuate the future lung cancer burden. Cancer Epidemiol Biomarkers Prev; 23(6); 1025-36. ©2014 AACR.

Potential overuse of screening mammography and its association with access to primary care

BACKGROUND

Cancer screening in individuals with limited life expectancy increases the risk of diagnosis and treatment of cancer that otherwise would not have become clinically apparent.

OBJECTIVE

To estimate screening mammography use in women with limited life expectancy, its geographic variation, and association with access to primary care and mammographic resources.

METHODS

We assessed screening mammography use in 2008-2009 in 106,737 women aged 66 years or older with an estimated life expectancy of <7 years using a 5% national sample of Medicare beneficiaries. Descriptive statistics were used to estimate the screening mammography utilization, by access to primary care.

RESULTS

Among women with a life expectancy of <7 years, 28.5% received screening mammography during 2008-2009. The screening rates were 34.6% versus 20.5% for women with and without an identifiable primary care physician, respectively. The screening rates were higher among women who saw >1 generalist physician and who had more visits to generalist physicians. There was substantial geographic variation across the United States, with an average rate of 39.5% in the hospital referral regions (HRRs) in the top decile of screening versus 19.5% in the HRRs in the bottom decile. The screening rates were higher among HRRs with more primary care physicians (r=0.14, P=0.02), mammography facilities (r=0.12, P=0.04), and radiologists (r=0.22, P<0.001).

CONCLUSIONS

Substantial proportions of women with limited life expectancy receive screening mammography. Results presented sound a cautionary note that greater access to primary care and mammographic resources is also associated with higher overuse.

Examining connections between screening for breast, cervical and prostate cancer and colorectal cancer screening

AIM

To compare participation in breast, cervical and prostate cancer screening with colorectal cancer (CRC) screening.

MATERIALS & METHODS

This random digit-dialed survey includes participants (aged 50-75 years) from South Carolina (USA). Past participation information in fecal occult blood test, flexible sigmoidoscopy, colonoscopy, mammography, clinical breast examination, Pap test, prostate-specific antigen and digital rectal examination was obtained.Adjusted odds ratios are reported.

RESULTS

Among European-American women, any cervical or breast cancer screening was associated with adherence to any CRC screening. Among African-American women, mammography was associated with adherence to any CRC screening. Digital rectal examination and prostate-specific antigen tests were associated with adherence to any CRC screening test among all men.

CONCLUSION

Future research should explore approaches inclusive of cancer screening recommendations for multiple cancer types for reduction of cancer screening disparities.

Younger age distribution of cervical cancer incidence among survivors of pediatric and young adult cancers

BACKGROUND

Pediatric and young adult (PAYA) cancer survivors may have an earlier onset of chronic diseases compared with the general population. We compared the age at cervical cancer diagnosis between PAYA cancer survivors and females in the general US population.

METHODS

We used longitudinal data from 9 population-based registries of the Surveillance, Epidemiology, and End Results program collected between 1973 and 2010. PAYA cancer survivors were females diagnosed with any cancer before age 30 years, survived at least 5 years post-diagnosis, and were subsequently diagnosed with invasive cervical cancer (n=46). The general US population comprised females who were diagnosed with invasive cervical cancer as the primary malignancy (n=26,956). We estimated the difference in median age at diagnosis (ß₅₀) and bootstrap 95% confidence limits (CL) of invasive cervical cancer after adjustment for year of diagnosis and race.

RESULTS

The median age at diagnosis of invasive cervical cancer was 33 years for female PAYA cancer survivors and 40 years for females in the general US population (ß50=-7.0, 95% CL: -11, -3.2). Similar differences were observed across subgroups of stage and histologic subtype of invasive cervical cancer.

CONCLUSION

Our results suggest that PAYA cancer survivors are diagnosed with invasive cervical cancer at a substantially younger age compared with females without a prior cancer diagnosis in the general US population. This issue warrants further study, and could have implications for determining age at initiation or frequency of cervical cancer screening if younger age at diagnosis is attributable to an underlying biological phenomenon.

Cancer screening in the older adult: issues and concerns

Making individual recommendations for cancer screening in older adult patients may be difficult and time consuming, because of the need to incorporate complex issues of life expectancy, health status, risks and benefits, and individual values and wishes. In this article, current recommendations and related risks and benefits are summarized. Specific issues and concerns are addressed, with suggestions for strategies to assist older adults in making screening decisions.

Screening strategies for colorectal cancer in asymptomatic adults

This article provides an update for the primary care community on the evidence and recommendations for colorectal cancer screening in the adult population without symptoms at average and increased risk, excluding patients with high-risk genetic syndromes. The current and possible new screening strategies are reviewed, along with clinical wisdom related to the implementation of each method.