Breast screening programme

Breast Screening Programme, England 2018-19 | NHS Digital |  30 January 2020

Women between the ages of 50 and 70 are invited for regular breast screening (every three years) under a national programme. Screening is intended to reduce mortality by detecting breast cancer at an early stage when there is a better chance of successful treatment.

This report presents information about the NHS Breast Screening Programme in England in 2018-19 and includes data on women invited for breast screening, coverage, uptake of invitations, outcomes of screening and cancers detected.

The publication also features an online interactive dashboard to complement the existing publication resources.

Full report: Breast Screening Programme England, 2018-19 | NHS Digital

Further detail at NHS Digital

Colorectal cancer

Colorectal cancer | NICE guideline [NG151] | January 2020

This guideline covers managing colorectal (bowel) cancer in people aged 18 and over. It aims to improve quality of life and survival for adults with colorectal cancer through management of local disease and management of secondary tumours (metastatic disease).

Recommendations

This guideline includes recommendations on:

• prevention of colorectal cancer in people with Lynch syndrome
• information for people with colorectal cancer
• management of local disease
• molecular biomarkers to guide systemic anti-cancer therapy
• management of metastatic disease
• ongoing care and support

See also: Colorectal cancer (Quality Standard 20, updated from Aug 2012)

BMJ: CT screening in former or current smokers can significantly reduce mortality by almost a quarter

Mayor, S. |2020| Lung cancer: CT screening in former or current smokers significantly reduces mortality, study finds| BMJ  |368 |doi: https://doi.org/10.1136/bmj.m347

The findings of a large randomised controlled trial, now published in the NEJM, demonstrate that regular computed tomographic (CT) screening in current and former smokers reduces lung cancer mortality by around a quarter at 10 years.

The NELSON study included more than 13 000 men and 2 500 women aged between 50 and 74 from the Netherlands and Belgium. All of the subjects were current or former smokers, with a median smoking history of 38.0 pack years (interquartile range 29.7 pack years to 49.5 pack years) among male participants. Less than half  (44.9%) of the men in the study were former smokers.

Results showed that deaths from lung cancer were nearly a quarter (24%)  lower after 10 years of follow-up in men undergoing regular CT screening than in those not screened . Lung cancer deaths decreased from 3.3 deaths per 1000 person years in the control group to 2.5 deaths per 1000 person years in men who were screened (Source: Mayor, 2020).

Abstract

BACKGROUND

There are limited data from randomized trials regarding whether volume-based, low-dose computed tomographic (CT) screening can reduce lung-cancer mortality among male former and current smokers.

METHODS

A total of 13,195 men (primary analysis) and 2594 women (subgroup analyses) between the ages of 50 and 74 were randomly assigned to undergo CT screening at T0 (baseline), year 1, year 3, and year 5.5 or no screening. We obtained data on cancer diagnosis and the date and cause of death through linkages with national registries in the Netherlands and Belgium, and a review committee confirmed lung cancer as the cause of death when possible. A minimum follow-up of 10 years until December 31, 2015, was completed for all participants.

RESULTS

Among men, the average adherence to CT screening was 90.0%. On average, 9.2% of the screened participants underwent at least one additional CT scan (initially indeterminate). The overall referral rate for suspicious nodules was 2.1%. At 10 years of follow-up, the incidence of lung cancer was 5.58 cases per 1000 person-years in the screening group and 4.91 cases per 1000 person-years in the control group; lung-cancer mortality was 2.50 deaths per 1000 person-years and 3.30 deaths per 1000 person-years, respectively. The cumulative rate ratio for death from lung cancer at 10 years was 0.76 in the screening group as compared with the control group, similar to the values at years 8 and 9. Among women, the rate ratio was 0.67 at 10 years of follow-up, with values of 0.41 to 0.52 in years 7 through 9.

CONCLUSIONS

In this trial involving high-risk persons, lung-cancer mortality was significantly lower among those who underwent volume CT screening than among those who underwent no screening. There were low rates of follow-up procedures for results suggestive of lung cancer. (Funded by the Netherlands Organization of Health Research and Development and others; NELSON Netherlands Trial Register number, NL580. opens in new tab.)

Interested in this study? Ask the Library & Knowledge Service to provide you with a copy here

 

Cervical cancer could be eliminated says NHS England

Hundreds of lives will be spared every year in England thanks to a more sensitive cervical screening test rolled out as part of the NHS Long Term Plan | via NHS England

NHS experts said that there is “potential” to eliminate cervical cancer completely thanks to the change in primary test within the NHS Cervical Cancer Screening Programme, combined with the effectiveness of the HPV vaccine.

The new and more sensitive test now looks for traces of high risk Human Papillomavirus (HPV), which causes nearly all cases of cervical cancer. Any tests that are HPV positive are then checked for abnormal changes of the cervix.

HPV is a group of viruses with more than 100 types, but 14 types can cause cervical cancer as well as some head and neck cancers. It means that any sign of infection will be spotted at an earlier stage before it could potentially develop into cancer.

Since the beginning of December, every part of the country has had the new way of screening in place. There are 2,500 new cases of cervical cancer in England every year but research says that a quarter of those could be prevented with this new way of testing.

The introduction is part of the NHS Long Term Plan’s ambitions to catch tens of thousands more cancers earlier, when it is easier to treat and the chance of survival is higher.

Full detail “Potential to eliminate” cervical cancer in England thanks to NHS Long Term Plan  | NHS England

Multi-disciplinary team meetings: cancer care

This guidance sets out how Multi-Disciplinary Teams (MDTs) can provide the most effective clinical management by focussing on patients with the most complex needs | NHS England | NHS Improvement

This guidance has been developed to enable cancer multi-disciplinary teams (MDTs) to respond to the changing landscape in cancer care, as recognised in the NHS Long Term Plan and the Independent Cancer Taskforce Report.

The guidance sets out how MDT Meetings (MDTMs) can continue to provide effective clinical management by remaining focussed on discussion of those patient cases which require full multidisciplinary input. This approach aims to support MDTMs in three ways:

• Firstly, it should help to ensure there is adequate time for discussion of cases where it is  needed, by allowing more focus on complex cases in the MDTM.
• Secondly, streamlining should ensure that valuable diagnostic and clinical time is used most effectively by creating more flexibility in management of the MDTM.
• Thirdly, the policy will increase the transparency and consistency of care by agreeing the treatment or care any patient should expect to receive across Cancer Alliances.

Streamlining Multi-Disciplinary Team Meetings – Guidance for Cancer Alliances | NHS England | NHS Improvement

Ovarian cancer disease profile

Disease profile in England: Incidence, mortality, stage and survival for ovary, fallopian tube and primary peritoneal carcinomas |  Public Health England

This report provides a detailed insight into the status of ovarian cancer in England.  It is the first report from the Cancer Audit Feasibility Pilot project which runs for two years and includes details of disease incidence, mortality and survival.

National bowel cancer audit annual report

National Bowel Cancer Audit Annual Report 2019 | The Healthcare Quality Improvement Partnership

Image source: https://www.hqip.org.uk/

This tenth report of the audit includes data on over 30,000 patients diagnosed with bowel cancer between 01 April 2017 and 31 March 2018.  For the first time, indicators of return to theatre and robotic surgery are reported and the measure of adjuvant chemotherapy for stage III colon cancer is reported at trust/hospital level in England. The report discusses several key findings for care pathways, surgical care, survival, rectal cancer and National Cancer Registry data.

Full report at HQIP

Amount and intensity of leisure-time physical activity and lower cancer risk

Matthews, C. E. et al. | Amount and Intensity of Leisure-Time Physical Activity and Lower Cancer Risk | Journal of Clinical Oncology | published online December 26th 2019.

Purpose
To determine whether recommended amounts of leisure-time physical activity (ie, 7.5-15 metabolic equivalent task [MET] hours/week) are associated with lower cancer risk, describe the shape of the dose-response relationship, and explore associations with moderate- and vigorous-intensity physical activity.

Methods
Data from 9 prospective cohorts with self-reported leisure-time physical activity and follow-up for cancer incidence were pooled. Multivariable Cox regression was used to estimate adjusted hazard ratios (HRs) and 95% CIs of the relationships between physical activity with incidence of 15 types of cancer. Dose-response relationships were modeled with restricted cubic spline functions that compared 7.5, 15.0, 22.5, and 30.0 MET hours/week to no leisure-time physical activity, and statistically significant associations were determined using tests for trend (P < .05) and 95% CIs (< 1.0).

Results
A total of 755,459 participants (median age, 62 years [range, 32-91 years]; 53% female) were followed for 10.1 years, and 50,620 incident cancers accrued. Engagement in recommended amounts of activity (7.5-15 MET hours/week) was associated with a statistically significant lower risk of 7 of the 15 cancer types studied, including colon (8%-14% lower risk in men), breast (6%-10% lower risk), endometrial (10%-18% lower risk), kidney (11%-17% lower risk), myeloma (14%-19% lower risk), liver (18%-27% lower risk), and non-Hodgkin lymphoma (11%-18% lower risk in women). The dose response was linear in shape for half of the associations and nonlinear for the others. Results for moderate- and vigorous-intensity leisure-time physical activity were mixed. Adjustment for body mass index eliminated the association with endometrial cancer but had limited effect on other cancer types.

Conclusion
Health care providers, fitness professionals, and public health practitioners should encourage adults to adopt and maintain physical activity at recommended levels to lower risks of multiple cancers.

Full document available at Journal of Clinical Oncology

Testicular cancer: one cycle of chemo just as effective

Cullen, M., et al |2020|The 111 Study: A Single-arm, Phase 3 Trial Evaluating One Cycle of Bleomycin, Etoposide, and Cisplatin as Adjuvant Chemotherapy in High-risk, Stage 1 Nonseminomatous or Combined Germ Cell Tumours of the Testis|European Urology|

European Urology has published a paper based on a study that looked at the efficacy of one cycle of chemotherapy for patients with testicular cancer rather than two.  While standard treatment in Europe involves two cycles of chemotherapy the researchers of this trial  show that one cycle has few adverse effects and comparable outcomes
to those seen with two cycles. 

Abstract
Background: Standard management in the UK for high-risk stage 1 nonseminoma germ cell tumours of the testis (NSGCTT) is two cycles of adjuvant bleomycin, etoposide (360 mg/m2 ), and cisplatin (BE360P) chemotherapy, or surveillance.
Objective: To test whether one cycle of BE500P achieves similar recurrence rates to two cycles of BE360P.
Design, setting, and participants: A total of 246 patients with vascular invasion–positive stage 1 NSGCTT or combined seminoma + NSGCTT were centrally registered in a single-arm prospective study.
Intervention: One cycle comprising bleomycin 30000 IU on days 1, 8, and 15, etoposide 165 mg/m2 on days 1–3, and cisplatin 50 mg/m2 on days 1–2, plus antibacterial and granulocyte colony stimulating factor prophylaxis.
Outcome measurements and statistical analysis: The primary endpoint was 2-yr malignant recurrence (MR); the aim was to exclude a rate of 5%. Participants had regular imaging and tumour marker (TM) assessment for 5 yr.
Results and limitations: The median follow-up was 49 mo (interquartile range 37–60). Ten patients with rising TMs at baseline were excluded. Four patients had MR at 6, 7, 13, and 27 mo; all received second-line chemotherapy and surgery and three remained recurrence-free at 5 yr. The 2-yr MR rate was 1.3% (95% confidence interval 0.3–
3.7%). Three patients developed nonmalignant recurrences with localised teratoma differentiated, rendered disease-free after surgery. Grade 3–4 febrile neutropenia occurred in 6.8% of participants.
Conclusions: BE500P is safe and the 2-yr MR rate is consistent with that seen following two BE360P cycles. The 111 study is the largest prospective trial investigating one cycle of adjuvant BE500P in high-risk stage 1 NSGCTT. Adoption of one cycle of BE500P as standard would reduce overall exposure to chemotherapy in this young population.
Patient summary: Removing the testicle fails to cure many patients with high-risk primary testicular cancer  since undetectable cancers are often present elsewhere. A standard additional treatment in Europe is two cycles of chemotherapy to eradicate these. This trial shows one cycle has few adverse effects and comparable outcomes
to those seen with two cycles

 

The 111 Study: A Single-arm, Phase 3 Trial Evaluating One Cycle of  Bleomycin, Etoposide, and Cisplatin as Adjuvant Chemotherapy in 
High-risk, Stage 1 Nonseminomatous or Combined Germ Cell
Tumours of the Testis

In then news:

BBC News Testicular cancer: ‘Kinder’ chemotherapy is ‘just as effective’

International evaluation of an AI system for breast cancer screening

McKinney, S. M., et al. |2020| International evaluation of an AI system for breast cancer screening| Nature| 577|(7788)| P. 89-94.

An international team of researchers including experts from Imperial College London trained and tested an artificial intelligence (AI) system screening using a simulation of the double-reading process that is used in the UK.  29000 mammography images were used to demonstrate that the AI system was able to correctly identify cancers from the images with a similar degree of accuracy to expert radiologists, and holds the potential to assist clinical staff in practice. 

The authors of the paper found that the computer algorithm (AI system) maintained non-inferior performance and reduced the workload of the second reader by 88%. This robust assessment of the AI system paves the way for clinical trials to improve the accuracy and efficiency of breast cancer screening (Source: Imperial College London). 

Full press release from Imperial College London Artificial intelligence could help to spot breast cancer

Screening mammography aims to identify breast cancer at earlier stages of the disease, when treatment can be more successful1. Despite the existence of screening programmes worldwide, the interpretation of mammograms is affected by high rates of false positives and false negatives2. Here we present an artificial intelligence (AI) system that is capable of surpassing human experts in breast cancer prediction. To assess its performance in the clinical setting, we curated a large representative dataset from the UK and a large enriched dataset from the USA. We show an absolute reduction of 5.7%and 1.2% (USA and UK) in false positives and 9.4% and 2.7% in false negatives. We provide evidence of the ability of the system to generalize from the UK to the USA. In an independent study of six radiologists, the AI system outperformed all of the human readers: the area under the receiver operating characteristic curve (AUC-ROC) for the AI system was greater than the AUC-ROC for the average radiologist by an absolute margin of 11.5%. We ran a simulation in which the AI system participated in the double-reading process that is used in the UK, and found that the AI system maintained non-inferior performance and reduced the workload of the second reader by 88%. This robust assessment of the AI system paves the way for clinical trials to improve the accuracy and efficiency of breast cancer screening.

Paper: International evaluation of an AI system for breast cancer screening

In the news:

BBC |  AI ‘outperforms’ doctors diagnosing breast cancer

BMJ |  AI system outperforms radiologists in first reading of breast cancer screening, study claims