New trial suggests that younger women could benefit from annual screening

Breast Cancer Now | February 2019| New trial suggests that younger women could benefit from annual screening

A leading charity has funded research that found evidence that indicates women aged 35-39 at a moderate or high risk of developing breast cancer, could benefit from annual screening.

Professor Gareth Evans, who led the trial funded by Breast Cancer Now, looked at whether screening these women through annual mammograms could pick up tumours earlier. The study found that when tumours were picked up through screening, most were smaller in size, and were less likely to have spread to lymph nodes, compared to women who weren’t screened.

In total 2,899 women aged 35-39 at moderate or high risk of breast cancer due to their family history were offered annual screening across 34 UK centres between 2006 and 2015.

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In total, 50 breast cancers were detected (in 49 women), of which 35 were invasive tumours. Of the 35 invasive breast cancers, 80% (28/35) were detected by screening when the tumour was 2cm or smaller in size, and only 20% (7/35) had spread to the patients’ lymph nodes.

While the researchers acknowledge that further research to fully understand the risks and benefits of screening this group. However, detecting breast cancer early gives women the best possible chance of survival, and we would like the upcoming review of NHS cancer screening to consider these results and to review services offered to women with a family history of breast cancer.

Breast Cancer Now today called for the upcoming review of NHS cancer screening programmes to include an assessment of family history services across the country, and to set out the health economic evidence required to consider extending screening to women aged 35-39 at moderate or high risk due to their family history (Source: Breast Cancer Now).

Breast Cancer Now Annual screening detects breast cancers earlier for women aged 35-39 with a family history, major UK trial finds

See also:

University of Manchester Annual screening detects breast cancers earlier for women aged 35-39 with a family history

In the news:

BBC News Breast cancer: Scan younger women at risk, charity says

BMJ Research News: Persistent sore throat may be a warning sign for laryngeal cancer, study suggests

Mayor, S. | 2019| Persistent sore throat may be a warning sign for laryngeal cancer, study suggests|BMJ364 | doi: https://doi.org/10.1136/bmj.l435

Persistent sore throat, particularly when combined with other apparently low risk symptoms, is a previously overlooked clinical risk factor for cancer of the larynx, a UK case control study in UK general practice has found.

Study author Willie Hamilton of the University of Exeter Medical School said:

“This research matters. When the National Institute for Health and Care Excellence (NICE) guidance for cancer investigation was published there was no evidence from GP practices to guide this—nor to inform GPs.”

“These results expand current NICE guidance by identifying new symptom combinations that are associated with laryngeal cancer. They may help GPs to select more appropriate patients for referral,” suggested the research group.

Diagnostic delay is one of the main predictors of poor prognosis in laryngeal cancer. An earlier UK study of 28 cancers showed it had the fifth longest delay in primary care referral.

Current NICE guidelines suggest urgent referral for patients with persistent unexplained hoarseness or lump or neck lump but these were based on consensus rather than primary care evidence.

The new study, funded by the National Institute for Health Research, compared 806 patients diagnosed with laryngeal cancer between 2000 and 2009 with 3559 controls matched for age, sex, and practice.

The study’s findings showed that 10 symptoms were significantly associated with being diagnosed with laryngeal cancer.  74%  (595 of 806) of the patients had at least one of these symptoms recorded at a primary consultant in the year before their diagnosis.

Similar to findings from secondary care, hoarseness was the commonest of the 10 features, with a positive predictive value of 2.7%.

But several symptom combinations not currently mentioned in the NICE guidance gave positive predictive values greater than 3%, which is the threshold for urgent referral.

Recurrent sore throat with hoarseness gave a positive predictive value of 12%, while positive predictive values for sore throat plus recurrent dyspnoea or dysphagia were both 4.1%. Sore throat plus otalgia was also high risk, with a positive predictive value of 3% (Source: BMJ).

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In the news:

BBC News Persistent sore throat ‘can be cancer sign’

Faecal immunochemical tests versus colonoscopy for post-polypectomy surveillance: an accuracy, acceptability and economic study

Atkin, W., et al | 2019|Faecal immunochemical tests versus colonoscopy for post-polypectomy surveillance: an accuracy, acceptability and economic study| Health Technology Assessment| Vol.23| 01| https://doi.org/10.3310/hta23010

 

A study which recruited male and female patients (aged between 60-72) from the Bowel Screening Programme between 30 January 2012 to 30 December 2013,  finds that annual faecal immunochemical testing, with colonoscopy in positive cases, was generally acceptable to patients and would be cost-saving compared to three-yearly colonoscopy, although it has lower sensitivity, resulting in missed lesions.

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Plain English Summary 

Bowel cancer typically develops from lesions called adenomas. Although common, most adenomas do not develop into cancer. Adenomas detected during a bowel examination, called a colonoscopy, are usually removed during this procedure. However, even after adenoma removal, some patients are still at greater risk of bowel cancer.

Depending on the number and size of adenomas found, patients are invited for a colonoscopy after 1, 3 or 5 years. Most of these additional colonoscopies will not detect cancer and they are expensive, often uncomfortable and can harm the bowel.

Both bowel cancer and adenomas can cause bleeding in the bowel. This study examined whether or not a test for blood in stool, completed at home [known as the faecal immunochemical test (FIT)], could be used instead of colonoscopy to monitor patients following adenoma removal. Colonoscopy would then be offered only to those who had a positive FIT result, indicating blood in the stool.

This study invited individuals for annual FITs for 3 years who, as part of the Bowel Cancer Screening Programme, had one or two large adenomas or three or four small adenomas removed. If a FIT detected blood in the stool at any of the tests, these individuals were immediately offered a colonoscopy. If a FIT did not detect blood in the stool at any test, these individuals were offered a colonoscopy 3 years after their adenomas were removed, as were participants who did not return their second or third FIT.

The study demonstrated that an annual FIT could identify 85 of every 100 cancers and 57 of every 100 patients with adenomas if repeated over 3 years. Annual FITs were considerably cheaper than colonoscopy after 3 years. Participants reported that the FIT was easy to use and provided reassurance. However, some were concerned that the FIT would not be as effective as colonoscopy.

Abstract

Background

In the UK, patients with one or two adenomas, of which at least one is ≥ 10 mm in size, or three or four small adenomas, are deemed to be at intermediate risk of colorectal cancer (CRC) and referred for surveillance colonoscopy 3 years post polypectomy. However, colonoscopy is costly, can cause discomfort and carries a small risk of complications.

Objectives

To determine whether or not annual faecal immunochemical tests (FITs) are effective, acceptable and cost saving compared with colonoscopy surveillance for detecting CRC and advanced adenomas (AAs).

Design

Diagnostic accuracy study with health psychology assessment and economic evaluation.

Setting

Participants were recruited from 30 January 2012 to 30 December 2013 within the Bowel Cancer Screening Programme in England.

Participants

Men and women, aged 60–72 years, deemed to be at intermediate risk of CRC following adenoma removal after a positive guaiac faecal occult blood test were invited to participate. Invitees who consented and returned an analysable FIT were included.

Intervention

We offered participants quantitative FITs at 1, 2 and 3 years post polypectomy. Participants testing positive with any FIT were referred for colonoscopy and not offered further FITs. Participants testing negative were offered colonoscopy at 3 years post polypectomy. Acceptibility of FIT was assessed using discussion groups, questionnaires and interviews.

Main outcome measures

The primary outcome was 3-year sensitivity of an annual FIT versus colonoscopy at 3 years for detecting advanced colorectal neoplasia (ACN) (CRC and/or AA). Secondary outcomes included participants’ surveillance preferences, and the incremental costs and cost-effectiveness of FIT versus colonoscopy surveillance.

Results

Of 8008 invitees, 5946 (74.3%) consented and returned a round 1 FIT. FIT uptake in rounds 2 and 3 was 97.2% and 96.9%, respectively. With a threshold of 40 µg of haemoglobin (Hb)/g faeces (hereafter referred to as µg/g), positivity was 5.8% in round 1, declining to 4.1% in round 3. Over three rounds, 69.2% (18/26) of participants with CRC, 34.3% (152/443) with AAs and 35.6% (165/463) with ACN tested positive at 40 µg/g. Sensitivity for CRC and AAs increased, whereas specificity decreased, with lower thresholds and multiple rounds. At 40 µg/g, sensitivity and specificity of the first FIT for CRC were 30.8% and 93.9%, respectively. The programme sensitivity and specificity of three rounds at 10 µg/g were 84.6% and 70.8%, respectively. Participants’ preferred surveillance strategy was 3-yearly colonoscopy plus annual FITs (57.9%), followed by annual FITs with colonoscopy in positive cases (31.5%). FIT with colonoscopy in positive cases was cheaper than 3-yearly colonoscopy (£2,633,382), varying from £485,236 (40 µg/g) to £956,602 (10 µg/g). Over 3 years, FIT surveillance could miss 291 AAs and eight CRCs using a threshold of 40 µg/g, or 189 AAs and four CRCs using a threshold of 10 µg/g.

Conclusions

Annual low-threshold FIT with colonoscopy in positive cases achieved high sensitivity for CRC and would be cost saving compared with 3-yearly colonoscopy. However, at higher thresholds, this strategy could miss 15–30% of CRCs and 40–70% of AAs. Most participants preferred annual FITs plus 3-yearly colonoscopy. Further research is needed to define a clear role for FITs in surveillance.

(Source: Health Technology Assessment (HTA)

 

The study can be read in full from HTA

£2.17m boost for pancreatic cancer research

University of Liverpool | 2018 | £2.17m boost for pancreatic cancer research

New research in progress at the University of Liverpool, has been awarded over £2 million by Cancer Research UK, to identify differences in blood samples from people with newly diagnosed diabetes, to people who will develop pancreatic cancer and those who will not. Approximately 50 per cent of all people with pancreatic cancer develop diabetes before their diagnosis. At the moment researchers lack a reliable way to distinguish pancreatic cancer-linked diabetes from normal type-2 diabetes, also known as diabetes mellitus.

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Now scientists at Liverpool will look for biomarkers (molecules in the blood samples) that could help them to identify people with a diabetes diagnosis who could benefit from further tests. The samples from participants will be stored in a biobank so they can be used in future studies to further research in this area (Source: University of Liverpool).

Read the full news story from University of Liverpool 

 

 

Nobel prize for medicine goes to cancer therapy

BBC News | October 2018 | Nobel prize for medicine goes to cancer therapy

Two immunologists, Prof Allison, of the University of Texas, and Prof Honjo, of Kyoto University, as the winners of this year’s Nobel Prize for Medicine. The pair will share the Nobel prize approximately $1.01 million or £775,000. The scientists have been awarded the prize in recognition of their discovery of how to fight cancer using the body’s immune system. Their award is significant as it is the first time in the prize’s history that the development of a cancer therapy has been recognised with a Nobel prize. 

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Accepting the prize, Tasuku Honjo told reporters: “I want to continue my research … so that this immune therapy will save more cancer patients than ever.”

Prof Allison said: “It’s a great, emotional privilege to meet cancer patients who’ve been successfully treated with immune checkpoint blockade. They are living proof of the power of basic science, of following our urge to learn and to understand how things work.”(Source:BBC News)

See also:

The Guardian James P Allison and Tasuku Honjo win Nobel prize for medicine

Financial Times Cancer researchers win Nobel Medicine Prize

Reuters Nobel Prize in medicine awarded for groundbreaking cancer research

Oral drug treatment helps protect cancer patients from potentially deadly DVT and pulmonary embolism

University of Warwick| May 2018 |Oral drug treatment helps protect cancer patients from potentially deadly DVT and pulmonary embolism

Patients with a diagnosis of cancer are at high risk of developing blood clots. 20 per cent of cancer patients will develop venous thromboembolism (VTE) – either deep vein thrombosis (DVT) or pulmonary embolism (PE). This is due to a number of factors including immobility (if in bed poorly), pancreatic and gastric tumours, and chemotherapy. Because VTE can be life-threatening, blood thinners are used to shrink existing clots and prevent others from forming.

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Currently, international guidelines recommend cancer patients are injected with an anticoagulant (a low molecular weight heparin) to treat and prevent recurrence of VTE. Now scientists from the University of Warwick suggest that taking a tablet a day can help treat cancer patients for a potentially deadly condition.  The results of a large trial run at the University’s  Medical School called ‘select-d’ indicate that a daily tablet could be a beneficial alternative for treating VTE in selected patients, and  that prescribing the oral drug rivaroxaban (Xarelto) significantly reduced venous thromboembolism recurrence among patients with cancer and VTE

 

Lead researcher Professor Annie Young said,

“Clinicians were already adopting the oral drug into practice for non-cancer patients and now they have data from this study to indicate that this form of treatment is an alternative option for many cancer patients who have a clot.” ( Source: University of Warwick).

The full, unedited press release is available from University of Warwick 

6 in 7 women offered Tamoxifen choose not to take it

University of Leeds | April 2018 |Women at increased cancer risk shun preventative tamoxifen therapy

A study published in Breast Cancer Research and Treatment  shows that only 1 in 7 women who were offered Tamoxifen due to a familial history of cancer decided to take it. This new research sought to highlight that women eligible to take the drug were electing not to, it also aimed to explore the reasons behind such decisions. Researchers also found that patients consulted informal networks such as friends and family before making a decision about whether to take Tamoxifen (via University of Leeds) .

Whether the participants had children also had an impact on the decision, the scientists found those with children were more likely to take the drug. One participant explained that taking the drug might affect her ability to care for her children and parents, so decided not to take it.

The study was conducted in collaboration with scientists at the University Hospitals Southampton, University College London, Queen Mary University, University of Leeds and Northwestern University. The research was funded by Cancer Research UK and Yorkshire Cancer Research.

 

Abstract

Purpose Uptake of preventive therapy for women at increased breast cancer risk in England is unknown following the introduction of UK clinical guidelines in 2013. Preventive therapy could create socioeconomic inequalities in cancer incidence if it is more readily accepted by particular socio-demographic groups. In this multicentre study, we investigated uptake of tamoxifen and evaluated socio-demographic and clinical factors associated with initiation. We explored women’s experiences of treatment decision-making using qualitative interview data.
Methods Between September 2015 and December 2016, women (n=732) attending an appointment at one of 20 centres in England to discuss breast cancer risk were approached to complete a survey containing socio-demographic details and nul-
liparity. Of the baseline survey respondents (n equal to 408/732, 55.7% response rate), self-reported uptake of tamoxifen at 3-month follow-up was reported in 258 (63.2%). Sixteen women participated in semi-structured interviews.
Results One in seven (38/258=14.7%) women initiated tamoxifen. Women who had children were more likely to report use of tamoxifen than those without children (OR=5.26; 95%CI: 1.13–24.49, p=0.035). Interview data suggested that women weigh up risks and benefits of tamoxifen within the context of familial commitments, with exposure to significant other’s beliefs and experiences of cancer and medication a basis for their decision.

Conclusions Uptake of tamoxifen is low in clinical practice. There were no socio-demographic differences in uptake, suggesting that the introduction of breast cancer preventive therapy is unlikely to create socioeconomic inequalities in cancer incidence. Women’s decision-making was influenced by familial priorities, particularly having children.

The full article can be downloaded here