Latest News on Cancer Screening: Dec 2020

Latest News on Cancer Screening: Dec 2020

Colorectal cancer screening: Clinical guidelines and rationale

Evidence exists that reductions in colorectal cancer (CRC) mortality can be achieved through detection and treatment of early-stage CRCs and the identification and removal of adenomatous polyps, the precursor to these cancers. An expert, multidisciplinary panel was convened to review this evidence and to produce recommendations to guide clinicians and the public in making decisions regarding CRC screening and surveillance. As part of its review, the panel also commissioned a simulation model that estimates and compares the clinical consequences (benefits and major complications) of each screening approach. This guideline report presents the panel’s recommendations with respect to screening and surveillance in people at average risk for CRC and those at increased risk because of a family history of CRC or genetic syndromes or a personal history of adenomatous polyps, inflammatory bowel disease, or curative-intent resection of CRC. The cost- effectiveness of potential screening strategies was taken into account when preparing the recommendations. A summary of the evidence on each screening test’s performance, effectiveness, frequency, complications, ‘and patient acceptance is included. Also provided are suggestions for ways to increase compliance with the recommendations, questions for which additional research is needed, and the results of the simulation model on screening consequences. [1]

Enthusiasm for Cancer Screening in the United States

Context Public health officials, physicians, and disease advocacy groups have worked hard to educate individuals living in the United States about the importance of cancer screening.

Objective To determine the public’s enthusiasm for early cancer detection.

Design, Setting, and Participants Survey using a national telephone interview of adults selected by random digit dialing, conducted from December 2001 through July 2002. Five hundred individuals participated (women aged ≥40 years and men aged ≥50 years; without a history of cancer).

Main Outcome Measures Responses to a survey with 5 modules: a general screening module (eg, value of early detection, total-body computed tomography); and 4 screening test modules: Papanicolaou test; mammography; prostate-specific antigen (PSA) test; and sigmoidoscopy or colonoscopy.

Results Most adults (87%) believe routine cancer screening is almost always a good idea and that finding cancer early saves lives (74% said most or all the time). Less than one third believe that there will be a time when they will stop undergoing routine screening. A substantial proportion believe that an 80-year-old who chose not to be tested was irresponsible: ranging from 41% with regard to mammography to 32% for colonoscopy. Thirty-eight percent of respondents had experienced at least 1 false-positive screening test; more than 40% of these individuals characterized that experience as “very scary” or the “scariest time of my life.” Yet, looking back, 98% were glad they had had the initial screening test. Most had a strong desire to know about the presence of cancer regardless of its implications: two thirds said they would want to be tested for cancer even if nothing could be done; and 56% said they would want to be tested for what is sometimes termed pseudodisease (cancers growing so slowly that they would never cause problems during the persons lifetime even if untreated). Seventy-three percent of respondents would prefer to receive a total-body computed tomographic scan instead of receiving $1000 in cash.

Conclusions The public is enthusiastic about cancer screening. This commitment is not dampened by false-positive test results or the possibility that testing could lead to unnecessary treatment. This enthusiasm creates an environment ripe for the premature diffusion of technologies such as total-body computed tomographic scanning, placing the public at risk of overtesting and overtreatment. [2]

American Cancer Society Guidelines for Breast Cancer Screening: Update 2003

In 2003, the American Cancer Society updated its guidelines for early detection of breast cancer based on recommendations from a formal review of evidence and a recent workshop. The new screening recommendations address screening mammography, physical examination, screening older women and women with comorbid conditions, screening women at high risk, and new screening technologies. [3]

Breast Cancer Screening Awareness and Practice among Women in Sagamu Local Government Area, South-Western Nigeria: A Community Based Study

Introduction: Breast cancer is the leading female malignancy in the world and the second principal cause of cancer deaths in women worldwide. It has a poorer outcome among African-American women compared with the whites due to more advanced stage at presentation. This study therefore examines the factors influencing breast cancer screening awareness and practices among women in Ogun State, Western Nigeria.

Methods: This analytical cross-sectional study was conducted between April 22nd and13th May, 2013. A multi stage cluster sampling technique was used to select the participants into the study. One participant per each household was selected into the study. A semi- structured questionnaire was used to collect relevant information.

Results: A total of 495 women were interviewed in this study, the mean age of the respondents was 36.45 years ranging from 19 to 63 years. Only 48.5% of respondents knew the commonest age group at risk of breast cancer and 59.4% knew breast cancer can be detected early. Majority [81.0%] were not aware of mammography and none of the respondents knew the age when regular screening should commence. One hundred percent of our respondents have never had mammography done for any reason whatsoever. Majority of respondents [85.0%] have never asked anyone about mammography. Predictors of awareness of mammography were marital status [O.R= 1.61, C.I=1.35-3.05], tertiary education [OR= 2.14 C.I=1.13-6.08] and Nuclear family structure [OR=1.83, C.I=1.13-3.74].

Conclusion: This study revealed a low level of awareness of mammography and mammographic screening. None of the respondents had ever undergone mammography. Public education and awareness programs should be developed to promote early detection and diagnosis in the prevention of breast cancer in women in Nigeria and other developing countries. [4]

Genotyping Human Papillomavirus in Women Attending Cervical Cancer Screening Clinic in Harare, Zimbabwe

Aim: To determine the prevalence of human papillomavirus genotypes in women attending a cervical cancer screening VIAC (visual inspection with acetic acid) clinic.

Study Design: Cross-sectional study.

Place and Duration of Study: VIAC clinic at Parirenyatwa Referral Hospital in Harare in Zimbabwe between February and April 2015.

Methodology: Sexually active women were recruited and they provided their socio-demographic data and self-collected vaginal swabs. HIV status of the participants was determined. DNA was extracted from the swabs using the standard phenol-chloroform method. HPV DNA was detected using the standard consensus MY09/11-GP5+/GP6+ nested polymerase chain reaction. Amplicons were sequenced and sequences analyzed using bioinformatics tools to identify the HPV genotypes.

Results: Sixty women were recruited. Their age ranged from 21-83 years, with a mean of 40.1 years. Most of the women were married and resided in the urban areas. Of the 60 participants, 50% (30/60) were HIV-positive. The prevalence of HPV genotypes in the study subjects was 56.7% (34/60). HPVs were most prevalent in women aged 30 years and below, and became less prevalent as the age increased. The predominant genotypes detected were HPV-16, -58, -52, -45, -18, -33, -51, -6, -81, -11, -70, -62, -32 and -40.

Conclusion: A number of HPV genotypes were detected in half of women tested. There was no significance association between risk-factors (parity, level of education, residence, history of STI, contraceptive use and sexual debut) and HPV infection. The findings of this study showed that consensus nested PCR and DNA sequencing could be used to detect HPV genotypes in women in cervical cancer screening programs. Although this method is sensitive, it is inefficient at detecting multiple HPV infections. [5]

Reference

[1] Winawer, S.J., Fletcher, R.H., Miller, L., Godlee, F., Stolar, M.H., Mulrow, C.D., Woolf, S.H., Glick, S.N., Ganiats, T.G., Bond, J.H. and Rosen, L., 1997. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology, 112(2), pp.594-642.

[2] Schwartz, L.M., Woloshin, S., Fowler Jr, F.J. and Welch, H.G., 2004. Enthusiasm for cancer screening in the United States. Jama, 291(1), pp.71-78.

[3] Smith, R.A., Saslow, D., Sawyer, K.A., Burke, W., Costanza, M.E., Evans III, W.P., Foster Jr, R.S., Hendrick, E., Eyre, H.J. and Sener, S., 2003. American Cancer Society guidelines for breast cancer screening: update 2003. CA: a cancer journal for clinicians, 53(3), pp.141-169.

[4] Amoran, O. E., Toyobo, T. O. and Fatugase, O. K. (2014) “Breast Cancer Screening Awareness and Practice among Women in Sagamu Local Government Area, South-Western Nigeria: A Community Based Study”, Current Journal of Applied Science and Technology, 4(16), pp. 2320-2332. doi: 10.9734/BJAST/2014/9050.

[5] Matuvhunye, T., Mandishora, R. S., Chin’ombe, N., Chakafana, G., Mbanga, J., Zumbika, E. and Pedersen, B.- (2016) “Genotyping Human Papillomavirus in Women Attending Cervical Cancer Screening Clinic in Harare, Zimbabwe”, Microbiology Research Journal International, 16(6), pp. 1-9. doi: 10.9734/BMRJ/2016/28481.

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