Ovarian cancer population screening and mortality after long-term follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial

Menon, U. et al | 2021 | Ovarian cancer population screening and mortality after long-term follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial | The Lancet | DOI:https://doi.org/10.1016/S0140-6736(21)00731-5

This trial recruited more than 500 000 post menopausal UK women aged between 50 and 74 years of age, 202 638 were recruited and randomly assigned, and 202 562 were included in the analysis: 50 625 (25·0%) in the MMS group, 50 623 (25·0%) in the USS group, and 101 314 (50·0%) in the no screening group

They undertook the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) to determine if population screening can reduce deaths due to the disease. We report on ovarian cancer mortality after long-term follow-up in UKCTOCS, and the findings suggest that screening did not significantly reduce ovarian and tubal cancer deaths, general population screening cannot be recommended.

Background

Ovarian cancer continues to have a poor prognosis with the majority of women diagnosed with advanced disease. Therefore, we undertook the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) to determine if population screening can reduce deaths due to the disease. We report on ovarian cancer mortality after long-term follow-up in UKCTOCS.

Methods

In this randomised controlled trial, postmenopausal women aged 50–74 years were recruited from 13 centres in National Health Service trusts in England, Wales, and Northern Ireland. Exclusion criteria were bilateral oophorectomy, previous ovarian or active non-ovarian malignancy, or increased familial ovarian cancer risk. The trial management system confirmed eligibility and randomly allocated participants in blocks of 32 using computer generated random numbers to annual multimodal screening (MMS), annual transvaginal ultrasound screening (USS), or no screening, in a 1:1:2 ratio. Follow-up was through national registries. The primary outcome was death due to ovarian or tubal cancer (WHO 2014 criteria) by June 30, 2020. Analyses were by intention to screen, comparing MMS and USS separately with no screening using the versatile test. Investigators and participants were aware of screening type, whereas the outcomes review committee were masked to randomisation group. This study is registered with ISRCTN, 22488978, and ClinicalTrials.gov, NCT00058032.

Findings

Between April 17, 2001, and Sept 29, 2005, of 1 243 282 women invited, 202 638 were recruited and randomly assigned, and 202 562 were included in the analysis: 50 625 (25·0%) in the MMS group, 50 623 (25·0%) in the USS group, and 101 314 (50·0%) in the no screening group. At a median follow-up of 16·3 years (IQR 15·1–17·3), 2055 women were diagnosed with tubal or ovarian cancer: 522 (1·0%) of 50 625 in the MMS group, 517 (1·0%) of 50 623 in the USS group, and 1016 (1·0%) of 101 314 in the no screening group. Compared with no screening, there was a 47·2% (95% CI 19·7 to 81·1) increase in stage I and 24·5% (−41·8 to –2·0) decrease in stage IV disease incidence in the MMS group. Overall the incidence of stage I or II disease was 39·2% (95% CI 16·1 to 66·9) higher in the MMS group than in the no screening group, whereas the incidence of stage III or IV disease was 10·2% (−21·3 to 2·4) lower. 1206 women died of the disease: 296 (0·6%) of 50 625 in the MMS group, 291 (0·6%) of 50 623 in the USS group, and 619 (0·6%) of 101 314 in the no screening group. No significant reduction in ovarian and tubal cancer deaths was observed in the MMS (p=0·58) or USS (p=0·36) groups compared with the no screening group.

Interpretation

The reduction in stage III or IV disease incidence in the MMS group was not sufficient to translate into lives saved, illustrating the importance of specifying cancer mortality as the primary outcome in screening trials. Given that screening did not significantly reduce ovarian and tubal cancer deaths, general population screening cannot be recommended.

Ovarian cancer population screening and mortality after long-term follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial

Royal College of Radiologists: Care is not just for the patient

Royal College of Radiologists | April 2021 | Care is not just for the patient

The RCR Support and Wellbeing Working Group has produced Care is not just for the patient to help our Fellows and members recognise burnout in themselves and each other, so that mitigating steps can be taken. We want to reduce the stigma associated with mental health problems and to empower and support our Fellows and members to start meaningful and productive conversations around how to manage and avoid stress. The report includes signposting to practical resources, hints and tips and real-life experiences of peers in the hope that these will provide tools to help bolster your wellbeing.  

Care is not just for the patient

Campaign Lung Cancer: See through the symptoms

EGFR Positive UK, ALK Positive UK, Ruth Strauss Foundation, Roy Castle Lung Cancer Foundation, Cancer Research UK, and Macmillan Cancer Support | nd | Lung cancer see through the symptoms

Six cancer charities: EGFR Positive UK, ALK Positive UK, Ruth Strauss Foundation, Roy Castle Lung Cancer Foundation, Cancer Research UK, and Macmillan Cancer Support have produced the campaign see through the symtpoms to raise awareness of lung cancer.

Photographs of patients, many of non-smokers or occasional smokers, who have been diagnosed with lung cancer, the campaign also highlights their symptoms prior to receiving their diagnosis. Source: Lung Cancer see through the symptoms

Lung cancer is the most common cause of cancer death in the UK, with only 16% of patients expected to survive more than five years, and over half being diagnosed with advanced metastatic disease. It can affect anyone, smokers and non-smokers alike, with lung cancer in never-smokers now the UK’s 8th most common cause of cancer-related death.

Early investigation and referral is the key to improving outcomes. Early diagnosis saves lives. The charities have produced a list of resources for primary healthcare staff and their patients.

Symptoms of lung cancer include a persistent cough, breathlessness, recurrent chest infection, back or shoulder pain, fatigue, hoarseness, or swelling in the face or neck. If you see persistent or unexplained symptoms, please consider chest X-rays or referral on the Lung Cancer Pathway.

In then news:

Guardian GPs urged to be more alert in diagnosing lung cancer in non-smokers

NHS England: NHS to offer new drug that halves the risk of cancer returning

NHS England| 7 May 2021 | NHS to offer new drug that halves the risk of cancer returning

NHS England has announced the roll out of an innovative world-leading treatment that halves the risk of lung cancer patients suffering a return of the disease after undergoing treatment.

In a trial of the drug – the first of its kind – around nine out of ten patients treated, remained alive and disease-free after two years – compared to more than four in ten who hadn’t received the new therapy.

Around 100 patients in England with a rare form of cancer will initially have access to the drug, called Osimertinib, with many more expected to benefit this year.

Lung cancer is the most common cause of cancer death in the UK, accounting for one in five of all cancer deaths. Osimertinib is the first treatment for patients with non-small cell lung cancer whose tumours have a specific type of genetic mutation, to be licensed for use in patients who have just had surgery (Source: NHS England).

Full details are available from NHS England

Risk of colorectal cancer in first degree relatives of patients with colorectal polyps: nationwide case-control study in Sweden

Song, M., Emilsson, L., Roelstraete, B., & Ludvigsson, J. F. | 2021| Risk of colorectal cancer in first degree relatives of patients with colorectal polyps: nationwide case-control study in Sweden| BMJ |  373 | n877| doi:10.1136/bmj.n877

Risk of colorectal cancer in first degree relatives of patients with colorectal polyps: nationwide case-control study in Sweden

This case-control study uses data from a Swedish database, in order to assess family history of colorectal polyps and risk of colorectal cancer (CRC).

What is already known on this topic

• Endoscopic screening reduces the incidence of and mortality from colorectal cancer (CRC) by removal of precursor lesions—namely, colorectal polyps
• A family history of CRC is an established risk factor for CRC
• Individuals with a history of advanced colorectal polyps are at higher risk of developing CRC

What this study adds

• Individuals with at least two first degree relatives with polyps or a first degree relative with polyps diagnosed at a young age, most of whom are not yet recommended for early screening according to existing guidelines, are at an increased risk of CRC, particularly early onset disease, and they might benefit from early screening
• Compared with the advanced histology of polyps, the higher number of first degree relatives with polyps and younger age at polyp diagnosis seemed to be more predictive of CRC risk in family members

Abstract

Objective To assess the risk of colorectal cancer (CRC) in first degree relatives (parents and full siblings) of patients with precursor lesions (polyps) for CRC.

Design Case-control study.

Setting Linkage to the multi-generation register and gastrointestinal ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) histopathology cohort in Sweden.

Participants 68 060 patients with CRC and 333 753 matched controls.

Main outcome measures Multivariable adjusted odds ratios of CRC according to the number of first degree relatives with a colorectal polyp and the histology of polyps and age at diagnosis in first degree relatives. Subgroup analysis was also performed according to age at CRC diagnosis and evaluated the joint association of family history of colorectal polyps and family history of CRC.

Results After adjusting for family history of CRC and other covariates, having a first degree relative with a colorectal polyp (8.4 per cent (5742/68 060) in cases and 5.7 per cent (18 860/333 753) in controls) was associated with a higher risk of CRC (odds ratio 1.40, 95 per cent confidence interval 1.35 to 1.45). The odds ratios ranged from 1.23 for those with hyperplastic polyps to 1.44 for those with tubulovillous adenomas. To better put this risk in perspective, the age specific absolute risk of colon and rectal cancers was estimated according to family history of polyps based on the 2018 national CRC incidence in Sweden. For example, the absolute risk of colon cancer in individuals aged 60-64 years with and without a family history of colorectal polyp was, respectively, 94.3 and 67.9 per 100 000 for men and 89.1 and 64.1 per 100 000 for women. The association between family history of polyps and CRC risk was strengthened by the increasing number of first degree relatives with polyps (more than or equal to 2 first degree relatives: 1.70, 1.52 to 1.90, P less than 0.001 for trend) and decreasing age at polyp diagnosis (less than 50 years: 1.77, 1.57 to 1.99, P less than 0.001 for trend). A particularly strong association was found for early onset CRC diagnosed before age 50 years ( less than or equal to 2 first degree relatives: 3.34, 2.05 to 5.43, P equal to 0.002 for heterogeneity by age of CRC diagnosis). In the joint analysis, the odds ratio of CRC for individuals with two or more first degree relatives with polyps but no CRC was 1.79 (1.52 to 2.10), with one first degree relative with CRC but no polyps was 1.70 (1.65 to 1.76), and with two or more first degree relatives with both polyps and CRC was 5.00 (3.77 to 6.63) (P less than 0.001 for interaction).

Conclusions After adjusting for family history of CRC, the siblings and children of patients with colorectal polyps are still at higher risk of CRC, particularly early onset CRC. Early screening for CRC might be considered for first degree relatives of patients with polyps.

Risk of colorectal cancer in first degree relatives of patients with colorectal polyps: nationwide case-control study in Sweden