How Common is Overdiagnosis of Lung Cancer with Low Dose CT Screening?

MedicalResearch.com Interview with:
“CT Scan” by frankieleon is licensed under CC BY 2.0Dr. Bruno Heleno MD PhD

Assistant Professor | Professor Auxiliar
NOVA Medical School | Faculdade de Ciências Médicas
Universidade Nova da Lisboa 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Danish Lung Cancer Screening Trial (DLCST) is a randomized controlled trial which enrolled 4104 participants (aged 50-70 years; current or former smokers; ≥20 pack years; former smokers must have quit <10 years before enrollment) to either 5 rounds of screening for lung cancer with low-dose CT-scans or to no screening.

After 10 years of follow-up, there was a 2.10 percentage points lung cancer absolute risk increase with low-dose CT-screening. Overdiagnosis, i.e. the detection of cancer that would not progress to symptoms or death, was estimated at 67.2% of the screen-detected cancers.

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Lung Cancer Risk Drops Almost 40% Within 5 Years of Quitting Smoking

MedicalResearch.com Interview with:
Hilary Tindle, MD, MPH

“Used Cigarette Butts” by Indi Samarajiva is licensed under CC BY 2.0Associate Professor of Medicine and theWilliam Anderson Spickard, Jr., MD Chair in Medicine
Founding Director of ViTAL, the Vanderbilt Center for Tobacco, Addiction and Lifestyle
Division of Internal Medicine & Public Health and Vanderbilt Ingram Cancer Center (VICC)

MedicalResearch.com: What is the background for this study?

Response: Lung cancer is the most common cause of cancer related death for men and women ,and cigarette smoking is responsible for almost 9 of our every 10 lung cancers in the US. Lung cancer screening can reduce the risk of death from lung cancer by about 20% or even higher if screening is combined with quitting smoking.

We know that lung cancer risk is lower in people who quit smoking, compared to those who continue to smoke, but it was not clear how quickly this risk drops after quitting. Most prior studies on this subject assessed smoking status (current, former, never) at relatively few timepoints. By asking about smoking more frequently (every couple of years), we can get a better picture of a person’s true exposure to cigarette smoke and take into account periods where someone may have smoked more, less, or even quit altogether. Some people may start and stop multiple times over their lifetime.

Another question was exactly how long the risk of lung cancer stays elevated after quitting smoking. Again, by asking about smoking multiple times over someone’s lifetime, we get a better picture of how long they were truly smoke free.

MedicalResearch.com: What are the main findings?

  •  We analyzed data from the Framingham Heart Study Original and Offspring cohorts (almost 9000 people total) to study the risk of lung cancer after quitting smoking, and to determine if the risk of lung cancer ever goes back to that of someone who has never smoked (termed a “never smoker”). Study participants were followed for a median of almost 30 years, and were asked about smoking every 2-4 years.
  • We focused on heavier smokers, who had smoked more than 21 pack-years. (A “pack-year” is a way to quantify how much someone has been exposed to cigarette smoke. Pack years are the product of years of smoking times the amount smoked. For example, someone who smoked 1 pack of cigarettes per day for 20 years would have 20 pack years. Another person who smoked 2 packs per day for 10 years would also have 20 pack years.) As expected, the risks of lung cancer were highest among current smokers, followed by former smokers, followed by never smokers.
  • Compared to never smokers, former smokers had higher lung cancer risk: about 12 times higher within 10 years since quitting (YSQ), about 7 times higher from 10-15 YSQ, about 6 times higher from 15-25 YSQ, and over 3 times higher even after 25 YSQ.
  • Compared to current smokers, former smokers had lower lung cancer risk: 39% lower within 5 YSQ, which continued to drop over time.
  • Among all former smokers, about 4 in 10 lung cancers occurred after more than 15 YSQ, which is beyond the window of eligibility for current screening guidelines.

In the future, after additional study, guidelines may decide to extend the window of lung cancer screening beyond 15 YSQ. However, additional modeling studies are likely needed before making that determination. For now, anyone who qualifies for lung cancer screening based on age, pack years, and years since quitting, should have it.

MedicalResearch.com: What should readers take away from your report?

Response: If you currently smoke cigarettes, now is a great time to quit. The results of this study show that lung cancer risk drops almost 40% within 5 years since quitting, compared to people who continue to smoke.

If you already quit smoking, congratulations on taking that major step.

Whether you currently smoke, or if you quit smoking within the last 15 years, talk to your doctor to see if you are eligible for lung cancer screening. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

 Response: We would like to see additional research from different groups to determine if the current lung cancer screening guidelines should potentially be altered to include those who quit more than 15 years ago. Again, this is a decision may require additional study, including an understanding of why some former smokers remain at elevated risk of lung cancer. Perhaps studying genetic variation could shed some light on this question.  

MedicalResearch.com: Is there anything else you would like to add?

Response: Yes, we would like to thank the NIH and particularly the NHLBI for supporting the Framingham Heart Study (FHS) and studies like it, and also to all the participants in the FHS for giving their information for decades, to the benefit of all Americans and the world. We consider studies such as the FHS to be “national treasures” in that they provide critical information for doctors and researchers to improve healthcare. The FHS is most often thought of as a cardiovascular dataset, but it also captures information on cancer. In the case of the current study, we re-analyzed information that was already collected, which is one of the efficient and low cost methods of conducting research. 

Citation:

 Hilary A Tindle, Meredith Stevenson Duncan, Robert A Greevy, Ramachandran S Vasan, Suman Kundu, Pierre P Massion, Matthew S Freiberg. Lifetime Smoking History and Risk of Lung Cancer: Results From the Framingham Heart Study. JNCI: Journal of the National Cancer Institute, 2018; DOI: 10.1093/jnci/djy041

 

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What Happened to Prostate Cancer Screening and Treatment After PSA Guidelines Changed?

MedicalResearch.com Interview with:

James T. Kearns, MD Clinical Fellow, Department of Urology University of Washington School of Medicine Seattle, WA 

Dr. Kearns

James T. Kearns, MD
Clinical Fellow, Department of Urology
University of Washington School of Medicine
Seattle, WA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The effects of the USPSTF recommendation against prostate cancer screening had not been fully characterized among a younger population, particularly with respect to downstream effects such as prostate biopsy, prostate cancer diagnosis, and treatment for prostate cancer.

We found that PSA testing decreased in the years surrounding the USPSTF recommendation, but we also found a larger proportionate decrease in prostate biopsy, prostate cancer diagnosis, and use of surgery or radiation for the treatment of prostate cancer.

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USPSTF: Men 70 and Older Should Not Be Screened for Prostate Cancer

MedicalResearch.com Interview with:

Alex Krist, M.D., M.P.H Professor of family medicine and population health Virginia Commonwealth University and Active clinician and teacher at the Fairfax Family Practice residency

Dr. Krist

Alex Krist, M.D., M.P.H
Professor of family medicine and population health
Virginia Commonwealth University and
Active clinician and teacher at the Fairfax Family Practice residency

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Prostate cancer is one of the most common cancers to affect men. However, the decision about whether to be screened is complex and personal. The U.S. Preventive Services Task Force reviewed the latest research on the benefits and harms of screening for prostate cancer using PSA-based testing, as well as evidence on treatment.

We found that men who are 55 to 69 years old should discuss the benefits and harms of screening with their doctor, so they can make the best choice for themselves based on their values and individual circumstances. Men age 70 and older should not be screened, as the benefits of screening diminish as men age and the harms are greater.

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Low-Intensity PSA-Based Screening Does Not Reduce Prostate Cancer Deaths

MedicalResearch.com Interview with:

Richard Martin Professor of Clinical Epidemiology Head of Section, Clinical Epidemiology & Public Health Population Health Sciences Bristol Medical School 

Prof. Martin

Richard Martin
Professor of Clinical Epidemiology
Head of Section, Clinical Epidemiology & Public Health
Population Health Sciences
Bristol Medical School 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Screening for prostate cancer using the PSA test aims to detect prostate cancer at an early stage, before symptoms develop, when treatment can be offered that may avoid the risks of advanced cancer or may extend life.

Evidence from a large European trial suggests that PSA screening at 2 to 4 yearly intervals could reduce prostate-cancer deaths by 20%. after 13 years of follow-up. However, there are problems with the accuracy of the PSA test and potential harmful consequences. In particular, using the PSA test to screen for prostate cancer results in some tested men being diagnosed with low-risk, harmless cancers that are unlikely to progress or require treatment.  This problem may be particularly exacerbated when using repeated PSA testing as a screening strategy.

The CAP trial offered a one-off PSA test to men aged 50-69 years in the UK. The goal of this low-intensity, one-off PSA testing was to avoid unnecessary screening while still identifying men with high risk, aggressive cancers for whom screening and early detection can reduce morbidity and mortality. However, we found that after an average 10-years of follow-up, the PSA test still detected too many low-risk prostate cancers, while also missing cancers that did need treatment. After an average 10-years of follow-up, the group who had been screened had the same percentage of men dying from prostate cancer as those who had not been screened (0.29%).  Continue reading

Mammograms Reduce Mortality From Higher Grade Breast Cancers

MedicalResearch.com Interview with:

Prof-Stephen-Duffy.jpg

Prof. Duffy

Stephen W. Duffy
Professor of Cancer Screening
Wolfson Institute of Preventive Medicine,
Barts and The London School of Medicine and Dentistry
Queen Mary University of London

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The phenomenon of length bias, whereby screening has more chance of detecting slow growing tumours, has been known about for some years. This has led some colleagues to speculate that breast cancer screening only benefits those with slow-growing, less aggressive cancers, and does not reduce deaths from more aggressive, rapidly progressing cancers.

In this study, we addressed this question directly using data from a randomised trial of mammographic screening. We calculated the reduction in mortality from grade 1 (less aggressive), grade 2 (intermediate) and grade 3 (most aggressive) cancers, as a result of screening. We found that the greatest reduction in breast cancer mortality was from the aggressive, fast-growing grade 3 cancers, contrary to what had been suspected.  Continue reading

Fecal Testing Better At Detecting Colon Cancer Than Advanced Atypical Changes

MedicalResearch.com Interview with:

Anastasia Katsoula, MD MSc Aristotle University of Thessaloniki Greece 

Dr. Katsoula

Anastasia Katsoula, MD MSc
Aristotle University of Thessaloniki
Greece 

MedicalResearch.com: What is the background for this study?

Response: Early detection of colorectal cancer (CRC) has proven to be effective in reduction of cancer-related mortality. Fecal immunochemical testing (FIT) has been recently advocated for population-based screening for CRC in average-risk individuals due to its high accuracy and potential for adherence, based on results from previous systematic reviews and meta-analyses in average-risk populations. However, the potential role of FIT for screening of subjects at increased risk for CRC has not yet been elucidated, hence colonoscopy is currently the only recommended screening option for subjects at increased risk of CRC. We performed a systematic review and meta-analysis to explore the diagnostic accuracy of FIT for CRC or advanced neoplasia (AN) in patientswith personal or familial history of CRC, using colonoscopy as the reference standard.

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No Angelina Jolie Effect Found In Rates of Breast Cancer Screening

MedicalResearch.com Interview with:

Marco D. Huesch, MBBS, PhD Department of Radiology Milton S. Hershey Medical Center Hershey, PA 

Dr. Huesch

Marco D. Huesch, MBBS, PhD
Department of Radiology
Milton S. Hershey Medical Center
Hershey, PA  

MedicalResearch.com: What is the background for this study?

Response: Public health depends on coordinated actions between patients, payors and providers. Important preventative care and evidence-based screenings need to be understood and sought out by patients, need to be reimbursed by or subsidized by insurance plans, and offered and recommended by physicians and care team members.

Women’s breast health is a good example of how – in theory – all these come together and allow women to obtain regular screenings for breast cancer through mammograms. Yet it is commonly accepted that perhaps as many as 1 in 3 women are not adequately screened or are not screened at all.

In this study we hypothesized that a prominent global celebrity, Ms Angelina Jolie’s, highly public announcement of her own risk-reducing surgery to prevent breast cancer and her recommendation to women to understand whether they were at high risk might spur uptake of breast screenings at our institution.

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Many Older Adults Welcome A Stop To Cancer Screenings

MedicalResearch.com Interview with:

Nancy Schoenborn, MD Assistant Professor Division of Geriatric Medicine and Gerontology Johns Hopkins University School of Medicine

Nancy Schoenborn, MD
Assistant Professor
Division of Geriatric Medicine and Gerontology
Johns Hopkins University School of Medicine

MedicalResearch.com: What are the main findings?

Response: A lot of cancer screenings are not expected to save lives until up to 10 years later; however, the side effects of the test happen right away. Because of this, clinical guidelines have recommended against routine screening for those patients who will not live long enough to benefit but may experience the potential harm of the test in the short term. However, many patients with limited life expectancy still receive screening and clinicians are worried about how patients would react if they recommended that patients stop screening. This research is important because it is the first study that explores how patients think about the decision of stopping cancer screening and how patients want to talk to their doctors about this issue. Understanding patient perspectives would help improve screening practices and better align recommendations and patient preference.

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Widespread Thyroid Cancer Screening Likely Leads To Overdiagnosis and Overtreatment

MedicalResearch.com Interview with:

Dr. C. Seth Landefeld MD U.S. Preventive Services Task Force and  Chairman of the department of Medicine and Spencer Chair in Medical Science Leadership University of Alabama at Birmingham (UAB) School of Medicine

Dr. Landefeld

Dr. C. Seth Landefeld MD
U.S. Preventive Services Task Force and
Chairman of the department of Medicine and
Spencer Chair in Medical Science Leadership
University of Alabama at Birmingham (UAB) School of Medicine 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Thyroid cancer is rare in the United States, and the evidence shows that screening for it leads to an increase in new diagnoses without affecting the number of people who die from it. This is because screening people without signs or symptoms for thyroid cancer often identifies small or slow-growing tumors that might never affect a person during their lifetime.

After reviewing the evidence, the Task Force found little evidence on the benefits of screening for thyroid cancer and considerable evidence that treatment, which is often unnecessary, can cause significant harms. Additionally, in places where universal screening has been implemented, it hasn’t helped people live longer, healthier lives.

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Comparison of Posttransplant Dermatologic Diseases by Race

MedicalResearch.com Interview with:
Christina Lee Chung, MD, FAAD
Associate Professor of Dermatology
Director, Center for Transplant Patients
Drexel University College of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It’s long been recognized immunosuppressed organ transplant recipients are at significantly increased risk for skin cancer and other types of skin disease.

But despite advances to improve skin cancer prevention for these patients, little is known about how skin conditions affect African-American, Asian and Hispanic transplant recipients. This is problematic given that, according to the U.S. Department of Health and Human Services, more than half of the 120,000 Americans on the waiting list for organs identify as nonwhite.

We compared medical records of 412 organ transplant recipients — including 154 white patients and 258 nonwhite (black, Asian or Hispanic) — who were referred to the Drexel Dermatology Center for Transplant Patients between 2011 and 2016. As one of the only models of its kind in the country, the center provides post-transplant dermatological care to every patient who is transplanted by and/or followed by the Drexel University and Hahnemann University Hospital Transplant Programs. That means that every patient, regardless of race, is screened annually for skin cancer, which provided a unique dataset for us to analyze.

Two hundred eighty-nine transplant recipients exhibited malignant, infectious or inflammatory conditions during their evaluation, but their primary acute diagnoses differed greatly by race. In 82 white patients, skin cancer was the most common acute problem requiring attention at first visit. Black and Hispanic patients, by contrast, were most often diagnosed with inflammatory or infectious processes, such as fungal infections, warts, eczema, psoriasis, and rashes that required immediate medical attention.

Overall, squamous cell carcinoma in situ was the most common type of skin cancer diagnosed in each racial or ethnic group. But the location of the cancerous lesions again depended on the race of the patient. Most lesions in white and Asian patients occurred in sun-exposed areas of the body, like the scalp, neck, chest and back. For black patients, the lesions were primarily found in the groin.  Moreover, six of the nine lesions found on black patients tested positive for high-risk HPV strains, suggesting an association between the virus and skin cancer for African Americans.

We also provided questionnaires to 66 organ transplant recipients to find out more about the patients’ awareness of skin cancer prevention. Seventy-seven percent of white patients were aware their skin cancer risk was increased, compared to 68 percent of nonwhites. Only 11 percent of nonwhite patients reported having regular dermatologic examinations, compared to 36 percent of whites. Finally, 45 percent of white patients but only 25 percent of nonwhite reported knowing the signs of skin cancer.

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False Positive Mammograms Can Lead Women To Delay or Skip Next Exam

MedicalResearch.com Interview with:

Mammogram showing small lesion - Wikipedia

Mammogram showing small lesion
– Wikipedia

Firas Dabbous, PhD
Manager, Patient Centered Outcomes Research
Russell Institute for Research & Innovation
Advocate Lutheran General Hospital
Park Ridge, IL 

MedicalResearch.com: What is the background for this study?

Response: When women are told that there is something abnormal on their screening mammogram that can cause stress and worry while undergoing additional testing, even when they are later told that there is nothing wrong. We wanted to know if receiving a false positive screening mammogram would cause women to think twice before getting their next screening mammogram, and maybe delay coming back for their next screen. This is important because patients who have a false positive experience may have higher chance to develop breast cancer at a later point in time. Therefore, it is important to understand their screening patterns to better educate and inform them about the importance of adhering to mammography guidelines and emphasize the importance of returning on schedule for their next screens.

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Cost Effectiveness of Lung Cancer Screening Requires Careful Patient Selection

MedicalResearch.com Interview with:
Kevin ten Haaf MSc

Scientific researcher, Public Health
Erasmus Medical Center
Rotterdam

MedicalResearch.com: What is the background for this study?

Response: Lung cancer screening is currently recommended in the United States, for persons aged 55 through 80 who smoked at least 30 pack-years (the average number of cigarettes smoked per day multiplied by the number of years the person has smoked) and who currently smoke or have quit within the last 15 years. Other countries, such as Canada, are investigating the feasibility of implementing lung cancer screening policies.

However, the cost-effectiveness of lung cancer screening in a population-based setting is uncertain. Concerns have been raised on the feasibility of implementing lung cancer screening policies, especially with regards to the potential costs. In this study, the benefits, harms and costs of implementing lung cancer screening in the province of Ontario, Canada were assessed.

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Annual CT Lung Cancer Screening Among Former Smokers Remains Underutilized

MedicalResearch.com Interview with:

Ahmedin Jemal, DVM, PHD Vice President, Surveillance and Health Services Research American Cancer Society, Inc. 250 Williams St. Atlanta, GA 30303

Dr. Ahmedin Jemal

Ahmedin Jemal, DVM, PHD
Vice President, Surveillance and Health Services Research
American Cancer Society, Inc.
250 Williams St.
Atlanta, GA 30303

MedicalResearch.com: What is the background for this study?

Response: In December 2013, the United States Preventive Services Task Force (USPSTF) recommended annual screening for lung cancer with low dose computed tomography (LDCT) for current or former heavy smokers who quit within the past 15 years.

A previous study estimated that only 2-4% of heavy smokers received LDCT for lung cancer screening in 2010 in the United States. We sought to determine whether lung cancer screening among high risk smokers increased in 2015, following the USPSTF recommendation in 2013.

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Multifaceted Interventions Improve Cancer Screening Among Marginalized Groups

MedicalResearch.com Interview with:

Sheila F. Dunn, MD, MSc Scientist, Women's College Research Institute Director, Family Practice Health Centre Staff Physician, Department of Family and Community Medicine Women's College Hospital Associate Professor, Department of Family and Community Medicine University of Toronto

Dr. Sheila Dunn

Sheila F. Dunn, MD, MSc
Scientist, Women’s College Research Institute
Director, Family Practice Health Centre
Staff Physician, Department of Family and Community Medicine
Women’s College Hospital
Associate Professor, Department of Family and Community Medicine
University of Toronto

MedicalResearch.com: What is the background for this study?

Response: Despite organized cervical and breast cancer screening programs, inequities in screening remain. In Ontario, women who are newcomers, especially those of South Asian and East Asian origin, have much lower screening rates than Canadian-born women.

In order to address these inequities the CARES program used a multi-faceted community-based intervention to increase knowledge and promote cervical and breast cancer screening among newcomer and otherwise marginalized women in Toronto, Ontario, Canada. We reached out to women in the target groups through a network of community agencies. Women attended group educational sessions co-led by peers who spoke their language. Access to screening was facilitated through group screening visits, a visit health bus and on-site Pap smears. Administrative data were used to compare screening after the education date for CARES participants with a control group matched for age, screening status and area of residence.

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Comprehensive Lung Cancer Screening Is Complex Task With Many False Positives

MedicalResearch.com Interview with:

Dr-Linda-Kinsinger.jpg

Dr. Linda Kinsinger

Linda Kinsinger, MD, MPH
National Center for Health Promotion and Disease Prevention
U.S. Department of Veterans Affairs
NW Washington DC 20420

MedicalResearch.com: What is the background for this study? 

Response: The U.S. Preventive Services Task Force recommends annual lung cancer screening with low-dose computed tomography (LDCT) for current and former heavy smokers ages 55 to 80.

However, clinicians have questioned the practical aspects of implementing lung cancer screening. VA provides care for 6.7 million Veterans each year, mostly older men – many of whom are current or former smokers – thus the implementation of a lung cancer screening program for VA patients would require substantial resources. In order to understand the feasibility and implications of this for patients and clinical staff, VA implemented a three-year Lung Cancer Screening Demonstration Project (LCSDP) in eight geographically-diverse VA hospitals. Investigators identified 93,033 primary care patients at eight sites who were assessed on screening criteria, of whom 2,106 patients were screened between July 2013 and June 2015.

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Stool DNA Tests (Cologuard ) Increases Colon Cancer Screening and Detection Among Previously Noncompliant Patients

MedicalResearch.com Interview with:

Dr. Mark Prince MD USMD Health System Arlington, TX 76017

Dr. Mark Prince

Dr. Mark Prince MD
USMD Health System
Arlington, TX 76017

MedicalResearch.com: What is the background for this study?

Response: This 12-month retrospective study conducted to determine the screening compliance rates for a noninvasive multitarget stool DNA (mt-sDNA) screening test (Cologuard) for colon cancer among a cohort of nearly 400 average-risk Medicare patients who had previously not complied with recommended screening. These were patients who had never had a colonoscopy, had been more than ten years since last colonoscopy, or had been more than one year since last stool testing for occult blood.

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ACA Medicare Changes Increased Diagnosis of Early-Stage Colorectal Cancer Among Seniors.

MedicalResearch.com Interview with:

Nengliang “Aaron” Yao PhD Assistant professor Department of Public Health Sciences University of Virginia

Dr. Nengliang Yao

Nengliang “Aaron” Yao PhD
Assistant professor
Department of Public Health Sciences
University of Virginia

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The ACA made several changes in Medicare that could increase the use of cancer screening and thus lead to more early cancer diagnoses. This includes waiving patient cost-sharing for screening, waiving patient cost-sharing for one wellness visit per year, and paying bonuses to physicians for doing more work in a primary care setting.

We studied how effective those changes were in facilitating more early diagnoses of breast and colorectal cancers. We found that the changes had no effect on early breast cancer diagnoses (likely because costs and other access barriers for mammograms were already low), but increased the number of early colorectal cancer diagnoses by 8 percent.

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Breast and Prostate Cancer Screenings Have Similar Potential for OverDiagnosis

MedicalResearch.com Interview with:
Karsten Juhl Jørgensen, MD, Dr. MedSci
The Nordic Cochrane Centre
Rigshospitalet, Copenhagen 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our systematic Cochrane review of the original randomised breast screening trials showed substantial conflict between their estimates of the benefit. Some trials showed a large benefit, others none or a small benefit. This difference was related to the design of the trials.

The most optimistic trials were those with suboptimal randomisation.

The main findings of our current study support those of the most rigorously performed randomised trials: breast screening does not fulfill its fundamental premise, which is to reduce the occurrence of late stage disease. This means a mortality reduction is unlikely and that use of less invasive surgery due to breast screening is also unlikely.

However, we did find very substantial increases in early stage breast cancer, which persisted over our 17 year observation period. This means that breast screening likely leads to substantial overdiagnosis of breast cancers that would otherwise not have caused health problems during a woman’s lifetime. We estimate that 1 in 3 breast cancers detected in a screened population is likely overdiagnosed.

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ACA: Screening Disparities Fall For Mammograms But Not Colonoscopies

MedicalResearch.com Interview with:

Dr. Gregory Cooper, MD Program Director, Gastroenterology, UH Cleveland Medical Center Co-Program Leader for Cancer Prevention and Control, UH Cleveland Medical Center Professor, Medicine, CWRU School of Medicine Co-Program Leader for Cancer Prevention and Control UH Seidman Cancer Center

Dr. Gregory Cooper

Dr. Gregory Cooper, MD
Program Director, Gastroenterology
UH Cleveland Medical Center
Co-Program Leader for Cancer Prevention and Control, UH Cleveland Medical Center
Professor, Medicine, CWRU School of Medicine
Co-Program Leader for Cancer Prevention and Control
UH Seidman Cancer Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Affordable Care Act, among other features, removed out of pocket expenses for approved preventive services, and this may have served as a barrier to cancer screening in socioeconomically disadvantaged individuals. If so, then the gap in screening between socioeconomic groups should narrow following the ACA.

The main findings of the study were that although in the pre-ACA era, there were disparities in screening, they narrowed only for mammography and not colonoscopy.

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Is Skin Cancer Screening Cost Effective?

MedicalResearch.com Interview with:
Isabelle Hoorens, MD, PhD

Department of Dermatology
Ghent University Hospital
Ghent, Belgium

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In this study we questioned whether a population-based screening for skin cancer is cost-effective.

In addition we compared the cost-effectiveness of two specific screening techniques. The first technique, a lesion-directed screening being a free-of-charge skin cancer check of a specific lesion meeting 1 or more of the following criteria: ABCD rule (asymmetry, border irregularity, color variation, and diameter >6 mm), “ugly duckling” sign, new lesion lasting longer than 4 weeks, or red nonhealing lesions.

The second screening technique consisted of a systematic total body examination in asymptomatic patients. A clinical screening study was performed in Belgium in 2014. Continue reading

Patients and Partners Not Embarrassed To Do Skin Cancer Examinations On Each Other

MedicalResearch.com Interview with:

June K. Robinson, MD Research Professor of Dermatology Northwestern University Feinberg School of Medicine Department of Dermatology Chicago, IL 60611

Dr. June Robinson

June K. Robinson, MD
Research Professor of Dermatology
Northwestern University Feinberg School of Medicine
Department of Dermatology
Chicago, IL 60611

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This is a secondary finding from a randomized controlled trial of a structured skills training program for melanoma patients and their skin check partners.

The pairs learned and performed skin self-examination for the early detection of melanoma. They continued to perform skin checks for 2 years and trained pairs identified more early melanoma (melanoma in situ and Stage 1A melanoma) than controls.

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Screening for Colorectal Cancer Issues Evolve For Patients and Physicians

MedicalResearch.com Interview with:

David Lieberman MD Professor of Medicine Chief, Division of Gastroenterology and Hepatology Oregon Health and Science University L461 Portland, OR 97239

Dr. David Lieberman

David Lieberman MD
Professor of Medicine
Chief, Division of Gastroenterology and Hepatology
Oregon Health and Science University
Portland, OR 97239

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: New guidelines for colorectal cancer (CRC) screening from the USPSTF were published in June 2016. They recommended any of 8 different screening programs.

The purpose of this review was to highlight elements not included in the USPSTF report:
1. Elements of informed decision making associated with each program
2. Quality metrics for each program
3. Recommendations for higher than average risk individuals

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Prevent Cancer Foundation Tool Compares Screening Coverage By Major Health Insurers

MedicalResearch.com Interview with:

Carolyn R. Aldigé

Carolyn R. Aldigé

Carolyn R. Aldigé
President of the Prevent Cancer Foundation

MedicalResearch.com: What is the background for this tool? What types of cancers are covered under this comparison tool?

Response: The coverage tool compares screening coverage by the 30 largest health insurers in the U.S. Consumers can use the tool to see their insurance plans’ policies on coverage of screening tests for breast, cervical, colorectal, lung and prostate cancers.

MedicalResearch.com: What are some of the differences in insurance coverage of screening tests?

Response: There is a sizable variation in what insurance plans cover, partly a result of differing screening guidelines from three leading organizations. Though insurance plans are required to cover screenings recommended by the United States Preventive Services Task Force (USPSTF) without a co-pay, many will choose to cover other screening tests as well—but which guidelines do they follow? This is confusing to both patients and providers.

Breast cancer screening is an area where we see big differences in insurance coverage. All 30 plans cover 2D mammography, but only 13 plans cover 3D mammography (tomosynthesis).

Colorectal cancer screening coverage also differs. While almost all plans cover colonoscopy, CT colonography, flexible sigmoidoscopy, and FIT and FOBT screening tests, there are differences in coverage of stool-based DNA tests.

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One Stop Cancer Screening May Increase Participation Rates

MedicalResearch.com Interview with:

Dr. Amanda Bobridge University of South Australia Adelaide

Dr. Amanda Bobridge

Dr. Amanda Bobridge
University of South Australia
Adelaide

MedicalResearch.com: What is the background for this study?

Response: Despite cancer screening being demonstrated to reduce cancer morbidity and mortality, current participation in established screening programs is variable. In Australia, the participation rates range from 37% for bowel cancer (FOBT) screening to 57% for cervical cancer screening.

This study aimed to determine the barriers to and enablers for cancer screening and whether the target population for screening would support the concept of combined cancer screening (all screening offered at the same time at the same location).

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