The gist: A recent research study explored the best screening strategy for people at high risk of developing melanoma. They found that regular full-body examinations along with dermoscopy and total-body photography helped diagnose patients earlier.
“In a study intended to help define optimal screening in individuals at high risk of melanoma, Moloney et al evaluated use of full-body examinations every 6 months along with dermoscopy and total-body photography for all patients and sequential digital dermoscopy imaging as indicated. The study, reported in JAMA Dermatology, showed a high diagnostic yield for new primary melanomas, particularly during the first 2 years of follow-up…
“This prospective observational study involved 311 very high-risk patients from the Sydney Melanoma Diagnostic Centre and Melanoma Institute Australia enrolled between February 2006 to February 2011 and followed for up to 5 years. Patients had to have a history of invasive melanoma and dysplastic nevus syndrome, history of invasive melanoma and at least three first-degree or second-degree relatives with melanoma, history of at least two primary invasive melanomas, or a CDKN2A or CDK4 mutation. Patients underwent full-body examination and total-body photography every 6 months, with sequential digital dermoscopy imaging every 3 or 6 months for equivocal lesions and excision of atypical lesions.”
“A few years ago women were usually told to get annual mammograms starting at age 40 and men were told that the PSA blood test for prostate cancer was a lifesaver. Now the U.S. Preventive Services Task Force, whose advice helps set government policy on screening tests, says that women should start breast cancer screening every two years at age 50 and that men can skip the PSA test. And the list of tinkers, tweaks, and about-faces on cancer screening keeps getting longer. For example:
“The American Gastroenterological Association warns that though colonoscopy saves lives from colorectal cancer, some people get tested more often than necessary, exposing themselves to unnecessary risks.
“A Medicare advisory panel in April said that the agency should not cover lung cancer screening even in high-risk people—contradicting earlier advice from the Task Force.
“A study published online in May by the journal Cancer found that cervical cancer may be more common than previously thought, especially in older women, prompting its authors to question advice that most women can stop Pap tests after age 65.
“Minnesota became the latest of more than a dozen states to pass a law requiring that women be told whether they have “dense breasts” after a mammogram—even though experts disagree on what’s best for women who get that news.
“Why is it all so complicated? We talked with experts, reviewed current research, and came up with our advice on the screening tests you need and those you don’t—at least for now.”
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“A strategy that limits CMS [Centers for Medicare and Medicaid Services] coverage of lung cancer screening to certified and comprehensive centers may be preferable to widespread coverage due to the potential harms associated with screening and a lack of data specific to the Medicare population, according to a commentary published today in Annals of Internal Medicine.
“ ‘It is essential that low-dose CT screening programs have the proper infrastructure in place to ensure standardized interpretation and reporting of CT results, a protocolized evaluation process for screen-detected nodules, and a coordinator to ensure patients receive evaluation in a timely and appropriate fashion,’ Renda Soylemez Wiener, MD, MPH, assistant professor of medicine in The Pulmonary Center of the Boston University School of Medicine, told HemOnc Today. ‘Through a process of certification of screening programs, CMS can ensure that Medicare beneficiaries undergoing low-dose CT screening have it done in a way that maximizes benefits and minimizes harms from lung cancer screening.’ “
“Monitoring patients at extreme risk with total-body photography (TBP) and sequential digital dermoscopy imaging (SDDI) assists with early diagnosis of primary melanoma, according to a study published online June 25 in JAMA Dermatology.
“Fergal J. Moloney, M.D., from the University of Sydney, and colleagues compared six-month full-body examination versus TBP in 311 patients (February 2006 to February 2011). Patients had either a history of invasive melanoma and dysplastic nevus syndrome, a history of invasive melanoma and at least three first-degree or second-degree relatives with prior melanoma, a history of at least two primary invasive melanomas, or a CDKN2A or CDK4 gene mutation.”
“Lung cancer causes more deaths in the US than the next three most common cancers combined. Now a new breathalyzer test, embedded with a ‘NaNose’ nanotech chip to literally ‘sniff out’ cancer tumors, has been developed by a team of international researchers. It may turn the tide by both accurately detecting lung cancer and identifying its stage of progression.”
“Recent reports have shown that colon cancer rates have fallen by 30 percent over the past decade, particularly in people over age 50, because of the effectiveness of colonoscopies and awareness efforts surrounding the condition.
“Martha Ferguson, MD, UC Cancer Institute physician, associate professor at the UC College of Medicine and UC Health Colon and Rectal surgeon, says that these numbers are promising but that there are still misconceptions that are causing people to forgo their colonoscopy.
” ‘Colonoscopies are recommended every 10 years for average-risk people beginning at age 50—earlier if there is a family history of colon cancer,’ Ferguson says. ‘However, some people think that a colonoscopy is going to be a miserable, painful test, and that isn’t the case.’ “
“More than 130 lawmakers are urging the Obama administration to expand coverage for a lung-cancer test under Medicare that could cost the program billons, calling the screening important for vulnerable seniors.
“In a letter to the Centers for Medicare and Medicaid Services, the lawmakers called for a timely decision on coverage for low-dose CT scans for older patients at higher risk of developing lung cancer.”
“Examination and review of several studies that evaluated patient-centered outcomes for individuals undergoing low-dose computed tomography (LDCT) screening for lung cancer found that screening does not appear to significantly influence overall health-related quality of life or result in long-term changes in anxiety or distress, but that positive results in the short-term, do increase distress levels.”
“Investigators of the COSMOS (Continuous Observation of SMOking Subjects) study show good compliance and patient survival outcomes using a 5-year low-dose computed tomography (LDCT) screening protocol in individuals at high-risk of developing lung cancer. This protocol had fewer patients requiring further diagnostic follow-up compared to other studies, including the National Lung Cancer Screening Trial (NLST), with a minimal number of incorrect diagnoses.”