Prostate Screening: Combining MRI with Conventional Prostate Surveillance Effective, Study Suggests

“Initial results from the Göteborg randomised screening trial indicates that using MRI (Magnetic Resonance Imaging) alongside conventional prostate cancer screening seems to offer improved cancer detection and can help avoid unnecessary biopsies.

“Prostate cancer is the third most common male cancer in Europe, accounting for over 92,000 deaths in 2012 (9% of male deaths). Screening for prostate cancer is a controversial issue, with until recently, little clear evidence that existing screening procedures, using PSA (to be followed by biopsies), were effective. In general, either the screening has tended to miss many cancers, or to give false positives, meaning that many men are subject to invasive testing and perhaps treatment which was just not necessary.

“The Göteborg Trial is the Swedish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC), which is the largest randomized prostate cancer screening trial in the world. In 2014 results from this trial showed a significant mortality reduction with prostate-specific antigen (PSA) screening for men aged 55-69 years of age. Now new work, presented at the European Association of Urology Conference in Madrid, shows that using MRI may further improve the accuracy of prostate cancer screening. This research has been awarded the EAU’s First Prize for the Best Abstract by a Resident.”


ABCD Rules for Diagnosis of Melanoma Reviewed

“The American Academy of Dermatology Ad Hoc Task Force for the ABCDEs of Melanoma, chaired by Hensin Tsao, MD, PhD, reviewed the mnemonic for early detection of melanoma and determined it has strengths and weaknesses.

“The ABCDE mnemonic includes A = asymmetry, B = border, C = color, D = diameter and E = evolving. The individual ABCDE criteria display sensitivities of 57%, 57%, 65%, 90% and 84%, and specificities of 72%, 71%, 59%, 63% and 90%, respectively, when used by dermatologists for diagnosing melanoma.

“The reviewers specifically looked at the use of the diameter (D) criterion and whether it should be revised to include melanomas smaller than 6 mm. They reported that studies have found melanomas smaller than 6 mm ranged from 2.2% to 22% of the lesions biopsied. The task force members added that small diameter might not be indicative of early melanoma and invasiveness.

“They also reviewed alternate mnemonics for subtypes of melanoma, including ABCDEF for subungual melanoma, and additional ABCD criteria for pediatric melanoma. Other detection tools for early melanoma, including the Glasgow seven-point checklist, were reviewed.

“ ‘Although the diagnostic accuracy of ABCDEs has been verified in clinical practice and are a useful tool when used by dermatologists, to our knowledge, no randomized clinical trial has been performed to demonstrate that using the ABCDE criteria improves the ability to perform early detection by the public,’ the task force concluded. ‘Further research will be important to determine if the ABCDE criteria should be altered or set aside in favor of a newer paradigm.’ ”


Breast Cancer Survivors May Have Higher Thyroid Cancer Risk

“Women who survive breast cancer may have a higher-than-average risk of developing thyroid cancer in the next several years, a new study suggests.

“Looking at government data on over 700,000 U.S. women treated for breast cancer, researchers found that the women had a higher-than-normal risk of developing thyroid cancer—particularly within five years of the breast cancer diagnosis.

“The study results suggest that breast cancer survivors should have ‘vigilant screening’ for thyroid cancer in the first five years after their diagnosis, said the study’s lead author, Dr. Jennifer Hong Kuo, a surgeon at Columbia University Medical Center in New York City.”


Decision Aid Including Information on Overdetection Increases Informed Choice in Breast Screening and Reduces Intention to Be Screened

“In a study reported in The Lancet, Hersch et al found that use of a decision aid containing information on overdetection in breast cancer screening was associated with an increased rate of informed choice regarding screening, a reduced rate of positive attitudes toward screening, and reduced intention to be screened.

“In the community-based trial conducted in New South Wales, Australia, 879 women aged 48 to 50 years who had not had mammography in the past 2 years and did not have a personal or strong family history of breast cancer were randomly assigned between January 2014 and July 2014 to receive an intervention decision aid including evidence-based explanatory and quantitative information on overdetection, breast cancer mortality reduction, and false-positives (n = 440) or a control decision aid including information on breast cancer mortality reduction and false-positives (n = 439). The primary outcome was informed choice, defined as adequate knowledge and consistency between attitudes and screening intentions. Participants were interviewed via telephone at 3 weeks after randomization. The primary outcome was analyzed in all women who completed all follow-up interview questions.

“Among the two cohorts, 21 women in the intervention group and 20 in the control group were lost to follow-up, and 10 and 11 did not answer all interview questions. Among 409 women in the intervention group and 408 in the control group, 99 vs 63 (24% vs 15%, difference = 9%, P = .0017) were considered to have made an informed choice regarding screening. Compared with the control group, significantly more women in the intervention group met the threshold for adequate overall knowledge (29% vs 17%, difference = 12%, P < .0001), significantly fewer expressed positive attitudes toward screening (69% vs 83%, difference = 14%, P < .0001), and significantly fewer intended to be screened (74% vs 87%, difference = 13%, P < .0001).”


Ultrasound Lags behind MRI for Supplemental Breast Cancer Screening

“Cancer screening of women with dense breast tissue is a subject of great interest to both the medical community and the press. Dense parenchyma reduces the sensitivity of mammography to half that of fatty breasts. Approximately 40% of women 40 years of age or older have dense breast tissue, making supplemental breast cancer screening essential.

“Although supplemental screening via ultrasound is unaffected by breast density, is not associated with ionizing radiation, and does not require IV contrast material, acceptance of this modality has lagged.

“According to Ellen B. Mendelson, professor of radiology at Northwestern University Feinberg School of Medicine, and Wendie A. Berg, professor of radiology at Magee-Womens Hospital of UPMC, a significant factor is lack of available intensive training opportunities.

” ‘The most common alternative screening modality, MRI, cannot be used with women who have pacemakers or other devices, severe claustrophobia, or renal insufficiency,’ say Drs. Mendelson and Berg. To realize ultrasound’s potential to increase the number of cancers detected, intensive training programs need to be put in place for physician performers and interpreters for both handheld and automated breast ultrasound systems.’ “


New Health Care Delivery Model for Prostate Cancer Care Results in Better Patient Outcomes

“A comprehensive, population-based regional health care management program for men with prostate cancer who are members of Kaiser Permanente Southern California has led to improved outcomes, according to a Kaiser Permanente study published today in the journal Urology Practice.

” ‘While is the second-leading cause of cancer death among men, providing high quality care for men living with prostate cancer presents a challenge,’ said study lead author Ronald K. Loo, MD, regional chief of urology, Southern California Permanente Medical Group. ‘Increased survival rates have made prostate cancer similar to other chronic conditions, which means we need ongoing management strategies that span the natural history and clinical course of the disease.’ ”

“Kaiser Permanente Southern California developed the prostate cancer care program in 2003. It is focused on screening and prevention, shared decision making for treatment following diagnosis and care improvement for men with localized and advanced disease.”


Better Informed Women Less Likely to Want a Breast Mammogram

“Women who understand the risk of over-detection and over-diagnosis associated with mammography screening have lower intentions to have a breast screening test, according to a new Lancet study.

” ‘Mammography screening can reduce breast cancer deaths but most women are unaware that inconsequential disease can also be detected by screening, leading to over-diagnosis and overtreatment,’ says study author, Prof Kirsten McCaffery of the University of Sydney.

“Over-detection and over-diagnosis refers to the diagnosis and treatment of breast cancer that would not have presented clinically during a woman’s lifetime.

“Such a diagnosis, and the resulting overtreatment, can harm women physically and emotionally.”


Physicians Promote Screening Strategies for Those at High-Risk for Melanoma

“Melanoma, the most deadly type of skin cancer, was to blame for approximately 9,700 deaths in 2014. And with the number of melanoma cases increasing each year, it is believed that the disease could become one of the most common types of cancer in the United States by 2030. Promoting and developing national screening strategies may help to reduce deaths due to melanoma. According to Vernon K. Sondak, M.D., chair of the Department of Cutaneous Oncology at Moffitt Cancer Center, ‘it is time to embrace the opportunity to decrease melanoma mortality through risk-stratified education and screening.

“The U.S. Surgeon General recently issued a call to action to prevent skin cancer. However, screening for melanoma currently is not supported by U.S. Preventive Services Task Force skin cancer screening guidelines. The U.S. Preventive Services Task Force has expressed several concerns regarding population-wide screening for skin cancer, including uncertainty whether screening would reduce deaths, having patients undergo unnecessary tissue biopsies and the cost associated with screening individuals who have a low-risk for developing skin cancer.

“In a clinical review published in the Feb. 10 issue of The Journal of the American Medical Association, Moffitt physicians, Sondak and L. Frank Glass, M.D., described data from an Australian melanoma screening study that supports more extensive high-risk population-based screening programs. The Australian researchers gave extensive skin screenings every six months to 311 people who had an increased risk of developing melanoma. They detected 75 melanomas over an average follow-up period of three and a half years, but this was not associated with an excessive number of unnecessary biopsies.”


"Lung-RADS" Criteria Could Help Reduce False-Positives in Lung Cancer Screening

The gist: New criteria could keep CT scan screening tests from indicating that a person has lung cancer, when they really do not. So called “false-positives” can lead to unnecessary medical procedures and distress. The Lung-RADS criteria may lower the rate of false-positive screening tests. However, there are concerns that Lung-RADS might delay diagnosis for people with true lung cancer. 

“The use of Lung Imaging Reporting and Data System criteria during interpretation of low-dose CT scan results may yield lower false-positive results than observed in the National Lung Screening Trial, according to results of a retrospective study.

“However, the Lung Imaging Reporting and Data System (Lung-RADS) criteria — developed by the American College of Radiology — also were associated with reduced sensitivity.

“ ‘The findings suggest that the implementation of Lung-RADS can substantially reduce the false-positive rate in CT screening for lung cancer,’ William C. Black, MD, study author and professor of radiology at the Dartmouth-Hitchcock Medical Center, told HemOnc Today. ‘However, the findings also suggest that the diagnosis of some lung cancers may be delayed with the implementation of Lung-RADS. Whether this delay will substantively reduce the effectiveness of CT screening is unknown and will have to be further studied.’ “