Breast cancer can return 20 years after treatment

Risk of certain breast cancers coming back remains for at least 20 years after treatment | New England Journal of Medicine | Story via Cancer Research UK

Research, carried out by The Early Breast Cancer Trialists’ Collaborative Group collected data from more than 60,000 women who had been diagnosed with hormone sensitive breast cancer (usually called oestrogen receptor positive or ER+ breast cancer) between 1976 and 2011.

All of the patients were given a type of anti-oestrogen therapy for five years as part of their treatment. At the five year mark the women had no signs that their breast cancer had come back and treatment ended.

The figures, published in the New England Journal of Medicine show that out of the women included in the study, 11,000 had their cancer come back in another part of the body such as the bone, liver and lung in the 15 years after stopping treatment. They also showed that the risk of cancer coming back remained the same year on year from when they stopped taking the anti-oestrogen drugs to 15 years later.

Full story at Cancer Research UK

Full reference: Pan, H. et al. (2017) 20-Year Risks of Breast-Cancer Recurrence after Stopping Endocrine Therapy at 5 YearsNew England Journal of Medicine.

 

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HPV jab reduces number of smear tests needed over lifetime

Researchers say three cervical screenings could offer same benefit to women given the human papillomavirus (HPV) vaccine as the 12 currently offered. | International Journal of Cancer | Cancer Research UK

Women who have been given the human papillomavirus (HPV) vaccine may only need three cervical screenings in their lifetime, a study has said. Researchers found that smear tests at the ages of 30, 40 and 55 could offer the same benefit to vaccinated women as the 12 currently offered.

The results are based on how the HPV vaccine and the improved cervical screening programme will work best together. The new programme called HPV primary testing is set to be introduced in England by December 2019. It means that cervical samples are tested for HPV but only checked for abnormal cells if the virus is found. The current test checks for abnormalities first, which is less efficient.

The Cancer Research UK-funded team at Queen Mary University of London said that cutting the number of screenings for vaccinated women could save the NHS time and money.

Full reference: Landy et al. |What cervical screening is appropriate for women who have been vaccinated against high risk HPV? A simulation study. | International Journal of Cancer

See also:

Cervical screening coverage rates in England fall

This report presents information about the NHS Cervical Screening Programme in England in 2016-17. It includes data on the call and recall system, on screening samples examined by pathology laboratories and on referrals to colposcopy clinics | NHS Digital

Key Facts:

• At 31 March 2017, the percentage of eligible women (aged 25 to 64) who were recorded as screened adequately within the specified period was 72.0 per cent. This compares with 72.7 per cent at 31 March 2016 and 75.4 per cent at 31 March 2012.

• A total of 4.45 million women aged 25 to 64 were invited for screening in 2016-17, representing an increase of 5.6 per cent from 2015-16 when 4.21 million women were invited.

• In total, 3.18 million women aged 25 to 64 years were tested in 2016-17, an increase of 2.9 per cent from 2015-16 when 3.09 million women were tested.

• Of samples submitted by GPs and NHS Community Clinics, 94.8 per cent of test results were returned Negative.

• 8.8 per cent of patients did not attend colposcopy appointments and gave no prior warning.

Full detail at NHS Digital: Cervical Screening Programme, England – 2016-17

Radiation risk with digital mammography in breast screening

This review estimates the risks and benefits of breast screening in terms of deaths due to radiation-induced cancers and lives saved by digital mammography in the NHS Breast Screening Programme in England.

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A radiation risk model, patient dose data and data from national screening statistics were used to estimate the number of deaths due to radiation induced breast cancers in the NHSBSP in England. The breast cancer mortality reduction in the invited population due to screening, and the percentage of women diagnosed with symptomatic breast cancer who die from that cancer, were collated from the literature. The number of lives saved due to screening was calculated.

The main findings are that:

  • the risk of a radiation-induced cancer for a woman attending full field digital mammographic screening (2 views) by the NHSBSP is between 1 in 49,000 to 1 in 98,000 per visit
  • if a woman attends all 7 screening examinations between the ages of 50 to 70, the risk of a radiation-induced cancer is between 1 in 7,000 to 1 in 14,000
  • it is estimated that about 400 to 800 cancers are detected by the NHSBSP for every cancer induced
  • the mortality benefit of screening exceeds the radiation-induced detriment by about 150:1 to 300:1
  • for the small proportion of women with breasts thicker than 90mm who receive higher radiation doses, the benefit will exceed the risk by about 100:1 to 200:1

Full report at Public Health England

New two-year progress report on delivering the cancer strategy 2015-2020

NHS England’s National Cancer Programme Progress Report (2016-17) shows that the NHS is on track to transform cancer services by 2020/21 | NHS England

NHS England’s two-year progress report shows significant progress has been made towards delivering world-class cancer services in England. Improvements include a £130m investment (over 2016/18) in new and upgraded radiotherapy equipment and £200m over two years to accelerate rapid diagnosis and enhance patients’ quality of life.

The report describes progress across the field including:

  • Modernisation of radiotherapy equipment throughout the country.
  • New models of care introduced to ensure cancer is diagnosed earlier and improve survival.
  • Establishment of Cancer Alliances across the country to bring together clinical leaders, healthcare workers, patients and charities for better coordination of care.

Full document: Achieving World-Class Cancer Outcomes: A Strategy for England 2015-2020

Cancer screening: informed consent

Public Health England has updated the Cancer Screening: Informed consent guidelines.

These guidelines give commissioners, providers and healthcare professionals in cancer screening information on consent to screening and procedures.

The document covers information and advice on:

  • breast screening
  • cervical screening
  • bowel cancer screening
  • mental capacity and consent

It also provides several template letters for patients withdrawing from programmes.

Changes to cancer waiting times system and dataset

NHS England is planning changes to the cancer waiting times (CWT) system and dataset, which will come into effect from April 2018.

The changes are part of a programme of work to implement the new 28 day faster diagnosis standard by 2020. The CWT system enables CCGs to monitor and manage pathways of care for cancer patients. An information standards notice published on 28 September sets out the forthcoming changes, and an updated guidance document for CWT standards will be published later this year.

Further detail available via NHS Digitial