Lung Cancer Test Less Effective in Areas Where Infectious Lung Disease is More Common

“A new analysis of published studies found that FDG-PET technology is less accurate in diagnosing lung cancer versus benign disease in regions where infections like histoplasmosis or tuberculosis are common. Misdiagnosis of lung lesions suspicious for cancer could lead to unnecessary tests and surgeries for patients, with additional potential complications and mortality.

“Histoplasmosis and other fungal diseases are linked to fungi that are often concentrated in bird droppings and are found in soils.

“The study by investigators at Vanderbilt University and the Tennessee Valley Healthcare System-Veterans Affairs was led by Vanderbilt first author Stephen Deppen, Ph.D., and principal investigator Eric Grogan, M.D., MPH, and appeared in the Sept. 24 issue of JAMA.

“Positron emission tomography (PET) combined with fludeoxyglucose F18 (FDG) is currently recommended for the noninvasive diagnosis of lung nodules suspicious for lung cancer. To estimate FDG-PET diagnostic accuracy, the authors reviewed lung cancer abstracts published in a 14 year period and included 70 studies in the meta-analysis. The studies included 8,511 nodules, 60 percent of which were malignant.”

Less Costly to Screen for and Treat Early-Stage Lung than to Treat Late-Stage Lung Cancer

“The average cost to screen high-risk individuals for developing lung cancer with low-dose computed tomography (LDCT) plus the average cost of curative intent treatment, like surgery, is lower than the average cost to treat advanced stage lung cancer, which quite rarely results in a cure.

“The National Lung Cancer Screening Trial (NLST) has previously shown that LDCT screening of people at high-risk for lung cancer reduces lung cancer mortality by 20%, thus many organizations including the United States Preventative Services Task Force (USPSTF) have recommend LDCT screening for these individuals. It is thought that if lung cancer is detected at an early stage with screening that it can be cured and the consequences of this are a significant reduction in lung cancer mortality, as the 5-year survival rate for early-stage disease is 54%, and a reduction in the need for expensive and toxic treatments for advanced late-stage lung cancer, which seldom results in a cure as reflected by a 5-year survival rate of 4%. However, in the US 8.6 million people meet the high-risk criteria, which could equate to a significant screening cost.

“The Pan-Canadian Early Detection Study prospectively examined the costs for the resources used to screen annually, treat (if necessary), and follow for 2 years 2059 participants who had a 2% or greater risk of developing lung over 3 years as determined by a Web-based lung cancer risk prediction tool.”

Professional Recommendations Against Routine Prostate Cancer Screening Have Little Effect

“The effect of guidelines recommending that elderly men should not be routinely screened for prostate cancer ‘has been minimal at best,’ according to a new study led by researchers at Henry Ford Hospital.

“The study, published as a research letter online in JAMA Internal Medicine, focused on the use of PSA — prostate-specific antigen — to test for prostate cancer. ‘We found that the effect of the guidelines recommending against the routine screening of elderly men in particular has been minimal at best,’ says Jesse Sammon, D.O., a researcher at Henry Ford’s Vattikuti Urology Institute and lead author of the study.

“The researchers found an estimated 17 million men age 50 or older without a history of prostate cancer or prostate problems who reported undergoing PSA screening. Though credited with a significant improvement in 5-year cancer survival rates during the first decade after the FDA approved PSA testing of men without symptoms, its use for routine screening is controversial.

” ‘The concern is that the test often provides false-positives, leading subjects who do not have a prostate malignancy to undergo treatment they don’t need and suffer such side effects as impotence and urinary incontinence,’ says Dr. Sammon.

“Nearly three years ago, the debate led the U.S. Preventative Services Task Force to recommend against routine PSA screening in any age group.

” ‘But in the time since, nationwide patterns of PSA screening were largely unknown,’ says Dr. Sammon. ‘We sought to examine those patterns to determine the effects of the most recent USPSTF recommendation.’ “

Journal Maturitas Publishes Position Statement on Breast Cancer Screening

“Elsevier, a world-leading provider of scientific, technical and medical information products and services, today announced the publication of a position statement by the European Menopause and Andropause Society (EMAS) in the journal Maturitas on the topic of breast cancer screening.

“Breast cancer is the most prevalent cancer in women, with slightly more than ten percent developing the disease in Western countries. Mammography screening is a well-established method to detect breast cancer. However there are concerns about over diagnosis with population-based screening programmes.. Some tumors grow so slowly that they will not threaten the health of women during their lifetime. The women will die from another cause and thus it is argued that these tumors should not have been treated. Treatments can be invasive and painful, have major side-effects, especially in those with significant co-morbidities. While this is easy from an epidemiological standpoint, it is a dilemma for the treating physician dealing with individual women. It is virtually impossible to make the diagnosis of breast cancer and to predict the future behavior of that tumor. Thus individualization is proposed so that women may be categorized into ‘low to moderate’ and ‘high’ risk based on familial risk and the first screening mammogram so that further screening can be tailored.”

Breast Cancer Screening in Over-70s 'May Lead to Overdiagnosis'

“Involving much older women in breast cancer screening programs may “lead to overdiagnosis and overtreatment” claim experts, following a study on a Netherlands-based national program that screened women up to age 75.

“As people in Western societies are living longer, it is expected that in the coming years there will be an increase in the proportion of older women with breast cancer – the largest contributor to death from cancer in women worldwide.

“Older women with breast cancer are at increased risk for adverse outcomes and side effects from breast cancer treatment, and studies have shown that risk of death from breast cancer increases with age.

“Although doctors have assumed that screening programs could diagnose breast cancer at an earlier stage in older women and therefore improve prognosis, no strong evidence exists for the benefits of this.

“However, although some guidelines recommend breast cancer screening with mammography for women up until the age of 75, randomized trials investigating the success of these guidelines have rarely included women over the age of 60.”

Some Cancer Experts See 'Overdiagnosis,' Question Emphasis on Early Detection

“The surge of cancer screening in the U.S. has increased the detection of precancerous lesions that are often low-risk. Some experts now argue that cancer is being overdiagnosed. WSJ’s Monika Auger reports.

“Early detection has long been seen as a powerful weapon in the battle against cancer. But some experts now see it as double-edged sword.

“While it’s clear that early-stage cancers are more treatable than late-stage ones, some leading cancer experts say that zealous screening and advanced diagnostic tools are finding ever-smaller abnormalities in prostate, breast, thyroid and other tissues. Many are being labeled cancer or precancer and treated aggressively, even though they may never have caused harm.

“As a result, these experts say, many people may be undergoing surgery, radiation, chemotherapy and other treatments unnecessarily, sometimes with lifelong side effects.”

Expertise, Preventive Care Important to Stop Ovarian Cancer

“You’ve heard the saying, “If it isn’t broke, don’t fix it.”

“However, in the case of certain cancers, such as ovarian cancer, you might not know it needs to be fixed because you don’t know something is wrong.

” ‘The symptoms for ovarian cancer more often come at the later stages, and we really don’t have an effective screening protocol for the general population besides genetic carriers of the BRCA mutation,’ says Thomas Herzog, MD, professor in the division of gynecologic oncology at the University of Cincinnati (UC), clinical director of the UC Cancer Institute and UC Health gynecologic oncologist. ‘This is why it is so important to know your risks and to seek the best care possible if you are affected by this type of cancer.’ “

New Recommendations Needed for Melanoma Screening

“Citing a 1-year pilot skin cancer-screening program in Germany, three dermatologists recommended that federal health officials make new recommendations for melanoma screening.

Under the national screening program that took place in Schleswig-Holstein, Germany, from 2003 to 2004, people 20 years or older with statutory health insurance were eligible for skin examination, according to an editorial by June K. Robinson, MD, and colleagues.

“If the nondermatologist found a suspicious lesion, the patient was then referred to a dermatologist.

“The program resulted in an increase in melanoma and nonmelanoma incidence of approximately 30%, as well as lower mortality rates than the unscreened regions, for the first time since 1980. As a result of the screenings, the mortality rate in Northern Germany decreased by 50%. The program also led to more early and small melanomas being detected, with nearly 90% of lesions detected being less than 1 mm in depth, according to the authors.”

Lasker Award-Winner Urges Wider Genetic Tests for Cancer

“An American scientist Monday was awarded a top prize for discovering the location of the BRCA1 gene for breast cancer, and used the occasion to call for wider genetic testing of women.

“Mary-Claire King was given the Lasker-Koshland Special Achievement Award in Medical Science for her lifetime of work. The award is among the top honors in the field of science, and is often called the “American Nobel.”

“In an article published in the Journal of the American Medical Association to coincide with the award, King said more genetic testing should be done to catch inherited cancers before it is too late.

” ‘Based on our 20 years’ experience working with families with cancer-predisposing mutations in BRCA1 and BRCA2, it is time to offer genetic screening of these genes to every woman, at about age 30, in the course of routine medical care,’ she wrote.

” ‘To identify a woman as a carrier only after she develops cancer is a failure of cancer prevention,’ said King, a professor of genome sciences at the University of Washington School of Medicine in Seattle.”