Krebsfrüherkennung

Scientific evidence for the effectiveness of early detection and screening in cancer has been established in randomized clinical trials for three malignancies: cervix, breast, and colon cancer. In cervix cancer incidence and mortality can be reduced. In breast and colon cancer early detection and screening can only reduce mortality. The German guidelines currently in use for cancer screening have adapted these results. Some of the United States guidelines are less restrictive, leading to an increased incidence of some tumor entities such as prostate cancer. The clinical significance still needs to be established. The theoretical potential for reducing cancer mortality by screening measures is estimated to be 3–6%. However, it is to be expected that improvements in detection methods and better organization of screening program structures will increase the proportion of lives saved by screening measures.     

Nonbreast cancer incidence,treatment received and outcomes: Are there differences in breast screening attendees versus nonattendees?

While reductions in breast cancer mortality have been evident since the introduction of population-based breast screening in women aged 50–74 years, participation in cancer screening programs can be influenced by several factors, including health system and those related to the individual. In our study, we compared cancer incidence and mortality for several cancer types other than breast cancer, noncancer mortality and patterns of treatment amongst women who did and did not participate in mammography screening. All women aged 50–65 years enrolled on the Queensland Electoral Roll in 2000 were included. The study population was then linked to records from the population-based breast screening program and private fee-for-service screening options to establish screened and unscreened cohorts. Diagnostic details for selected cancers and cause of death were obtained from the Queensland Oncology Repository. We calculated incidence rate ratios and hazard ratios comparing screened and unscreened cohorts. Among screened compared to unscreened women, we found a lower incidence of cancers of the lung, cervix, head and neck and esophagus and an increase in colorectal cancers. Cancer mortality (excluding breast cancer) was 35% lower among screened compared to unscreened women and they were also about 23% less likely to be diagnosed with distant disease. Screened compared to unscreened women were more likely to receive surgery and less likely to receive no treatment. Our study adds further to the population data examining outcomes among women participating in mammography screening.     

Cervical Cancer Prevention and Early Detection; The Role of Nurse and Midwives

Worldwide 31% of cancers in women are in the breast or uterine cervix. Cancer of the uterine cervix is one of the ‍leading causes of cancer death among women. The estimated new cancer cervix cases per year is 500.000 of which ‍79% occur in the developing countries, where it is consistently the leading cancer and there are in excess of 233.000 ‍deaths from the disease. The major risk factors for cervical cancer include early age at first intercourse, multiple ‍sexual partners, low socioeconomic status, HSV, HPV infection, cigarette smoking and extended use of oral ‍contraceptives. Well organized and applied public education and mass screening programmes can substantially ‍reduce the mortality from cervical cancer and the incidence of invasive disease in the population. Women who are ‍health conscious are more likely to have used screening services (mammogram, pap-smear test) and performed ‍breast-self examination and genital hygiene. There are both opportunities and burdens for nurses and midwives ‍working in primary health care settings. This is a prime example of a role of public education in cancer prevention ‍with reference to population-based cancer screening programs. ‍     

Validation of proposed prostate cancer biomarkers with gene expression data: a long road to travel

Biomarkers are important for early detection of cancer, prognosis, response prediction, and detection of residual or relapsing disease. Special attention has been given to diagnostic markers for prostate cancer since it is thought that early detection and surgery might reduce prostate cancer-specific mortality. The use of prostate-specific antigen, PSA (KLK3), has been debated on the base of cohort studies that show that its use in preventive screenings only marginally influences mortality from prostate cancer. Many groups have identified alternative or additional markers, among which PCA3, in order to detect early prostate cancer through screening, to distinguish potentially lethal from indolent prostate cancers, and to guide the treatment decision. The large number of markers proposed has led us to the present study in which we analyze these indicators for their diagnostic and prognostic potential using publicly available genomic data. We identified 380 markers from literature analysis on 20,000 articles on prostate cancer markers. The most interesting ones appeared to be claudin 3 (CLDN3) and alpha-methysacyl-CoA racemase highly expressed in prostate cancer and filamin C (FLNC) and keratin 5 with highest expression in normal prostate tissue. None of the markers proposed can compete with PSA for tissue specificity. The indicators proposed generally show a great variability of expression in normal and tumor tissue or are expressed at similar levels in other tissues. Those proposed as prognostic markers distinguish cases with marginally different risk of progression and appear to have a clinically limited use. We used data sets sampling 152 prostate tissues, data sets with 281 prostate cancers analyzed by microarray analysis and a study of integrated genomics on 218 cases to develop a multigene score. A multivariate model that combines several indicators increases the discrimination power but does not add impressively to the information obtained from Gleason scoring. This analysis of 10 years of marker research suggests that diagnostic and prognostic testing is more difficult in prostate cancer than in other neoplasms and that we must continue to search for better candidates.     

Benign breast diseases in breast cancer screening programs in Italy (2000-2001)

AIMS AND BACKGROUND: Screening mammography has been shown to be effective in reducing breast cancer mortality in several randomized clinical trials. One major side effect of screening is the diagnosis of benign breast disease (BBD), which is considered as a nonprogressive lesion, except for a small percentage of lesions considered at high risk. We present data referring to service screening programs active in Italy in 2000 and 2001 and participating in the national survey carried out by the Italian Group for Mammography Screening (GISMa). METHODS: To all centers participating in the GISMa National Survey, we submitted a questionnaire regarding the service screening protocol and main indicators of performance of the local program in the years 2000 and 2001. RESULTS: A total of 657 detected BBD cases, registered by 23 Italian breast cancer screening centers in women 50 to 69 years of age, are included in this study. The BBD detection rate was 2.5 per 1000 at the first screening test and 1.05 per 1000 at repeated tests. The benign/malignant ratio was 0.34 at the first and 0.22 at the repeated test. CONCLUSIONS: Detection of BBD occurred frequently in breast screening programs, and prognostic implications should be further investigated. Women should be individually informed at screening, and with greater detail at the moment of the recall for assessment, of the implications of BBD detection and receive the necessary, also psychological, counseling to avoid the possible harm related to breast cancer screening.     

How Effective Is Mammography as a Screening Tool?

Purpose of Review

Screening mammography has been shown to be an effective tool in the early diagnosis of breast cancer in average-risk women. Because the results of mortality reduction take time to become evident, the effectiveness of screening requires monitoring of quality indicators to determine the functioning of a population-based screening program. It is important to understand the goals of a population-based screening program to balance the risks and benefits of screening mammography and to determine the effectiveness of the program.

Recent Findings

In Canada, breast cancer screening has been shown to be highly effective at reducing breast cancer mortality by 40%. Using the Canadian screening program as an example of population-based screening, quality indicators of screening mammography and recent performance will be reviewed to assess overall effectiveness of the program.

Summary

Screening mammography as a population-based program is an effective tool in the early diagnosis of breast cancer in average-risk women, showing a 40% reduction in breast cancer mortality.

     

Clinical significance of hTERC and C-Myc genes amplification in a group of Egyptian patients with cancer cervix

Background: Cervical cancer is the second most common cancer in women worldwide after breast cancer. Cervical cancer is a preventable disease. The implementation of cervical cancer screening programs has greatly decreased the morbidity and mortality, as precancerous lesions and early invasive cervical cancer could be detected and treated effectively. The detection of hTERC gene amplification was suggested as a possible diagnostic marker for use in routine cytological screening. Objectives: The present study was designed to detect genomic gains of the hTERC and C-MYC genes using FISH technique and to investigate the relationship between genes amplification and the clinical data of the patients. Patients and Methods: The current study was carried out on twelve cases with cervical cancer at different grades (three cases were grade I, six cases were grade II and three cases were grade III). Interphase FISH analysis using LSI probe, Cervical Cancer probe hTERC (3q26) & C-MYC (8q24), was successfully performed on 12 patients with cancer cervix. Results: Interphase FISH analysis revealed positive hTERC gene amplification in all cases of cancer cervix (100%). However C-MYC gene amplification was detected in four cases only (33.3%). Statistical analysis of the data revealed significant correlation between hTERC amplification and grading. Also, there was significant correlation between C-MYC amplification and grading and highly significant correlation between C-MYC amplification and hTERC amplification. On the other hand hTERC and C-MYC genes amplification showed an inverse correlation with the ages of the patients. Conclusion: The present study highlights the importance of using hTERC and C-MYC genes FISH probes for cases with cancer cervix or pre-malignant lesions as a sensitive technique. This method provides an easy and effective applicable approach which helps in the diagnosis and prognosis, as an increased copy number is associated with a more advanced grade that could be detected in the early stages of the disease. Keywords: Cancer cervix, Telomerase, hTERC amplification.     

间期乳腺癌的研究进展及预防策略

乳腺癌筛查可以显著降低患者的死亡率,国内现有的筛查方案具有一定的卫生经济学价值,但高成本方案有待权衡.间期乳腺癌的发生率是衡量乳腺癌筛查方案敏感与否的重要指标,因此成为乳腺癌筛查研究中的热点和焦点.本文将在间期乳腺癌流行病学、临床特点、病理生物学特点以及患者预后等方面进行综述,重点探讨间期乳腺癌的危险因素及预防策略.     

Conundrums in screening for cancer

Screening for cancer has to be carefully organized for maximum effectiveness, and introduced in full understanding of the natural history of the disease. There are major potential harms as well as benefits from screening. The current state of art for breast, cervix and prostate cancer screening is reviewed, only for breast and cervix are policies of screening in the population justified.     

Lung cancer screening

The result of a lung cancer screening program should be fewer lung cancer-specific deaths in the screened population. studies evaluating chest imaging as a screening tool for lung cancer have not shown a reduction in lung cancer-specific mortality to date. The ability of institutions using chest imaging to meet the criteria for successful screening programs has also been debated. Contentious issues include the presence of an overdiagnosis bias, the ability to find preclinical disease at a curable point in time, the amount of pseudodisease identified, and the cost-effectiveness of screening programs. Current guidelines remain vague as randomized trials are being completed and technologic advances are occurring. The ultimate face of a successful lung cancer screening program is yet to be defined.     

Carcinoma-associated mucin serum markers CA M26 and CA M29: efficacy in detecting and monitoring patients with cancer of the breast, colon, ovary, endometrium and cervix

Two recently developed monoclonal antibody (MAb)-based anti-mucin assays, CA M26 and CA M29, were studied in 250 cancer patients and compared to 3 well-established marker tests, viz., CA 125, CA 15.3 and SCC, in order to assess their clinical usefulness as serum tumor markers. Pre-treatment sera were obtained from patients with predominantly low-stage epithelial malignancies comprising 200 adenocarcinomas (of the ovary, endometrium, breast and large intestine) and 50 squamous-cell carcinomas (of the uterine cervix). Pretreatment sera of 50 patients with benign ovarian tumors were included to evaluate levels in benign disease, CA M26 and CA M29 cut-off levels were established in 89 healthy controls. In patients with adenocarcinomas, overall positivity for CA M29 was 24%, ranging from 10% in breast cancer to 60% in ovarian cancer. Overall positivity was highest for CA 125 (30%) and lowest for CA M26 (18%) with CA M29 (24%) being similar to CA 15.3 (25%). In adenocarcinomas the combined CA M26-CA M29 assays equalled results obtained with the CA 125-CA 15.3 combination (33% vs. 36%). Elevation of 2 or more markers was highly indicative of advanced disease (p less than 0.025). A majority of positive patients showed either CA M26 or CA M29 elevations, indicating that both antibodies detect distinct epitopes. After adjustment for tumor site and stage, the profile of CA M26 as a single marker differed significantly from the profiles of CA 125 and of CA M29. CA M26 was frequently (32%) elevated in patients with squamous-cell carcinoma of the cervix and CA M26 levels were often independently elevated. CA M26 seems to be valuable as an additional marker in breast cancer and perhaps as a new marker in cervical cancer. CA M29 may be useful in ovarian cancer in addition to CA 125.     

Prevention and early detection of cancer

The axiom that prevention is better than cure is especially true for a serious disease such as cancer for which therapy is expensive and seldom fully effective. However, it is only for some cancers that the major determinants are known and for which primary prevention programs are likely to result in substantial reduction in incidence. Past efforts at primary prevention have not been very successful where avoidance of cancer determinants involves changing pleasurable personal habits or has major economic effects. Control of the disease is now largely based on therapy. Because successful therapy is influenced by the stage of the disease at diagnosis there is increasing interest in early detection through the application of various screening techniques. Only some of these have been demonstrably effective in reducing cancer mortality. The introduction of any mass screening program should be based on an assessment of its costs, risks, and effectiveness in reducing mortality from the disease.     

Organization and Evaluation of Performance Indicators of a Breast Cancer Screening Program in Meknes-Tafilalt Region,Morocco

Objective: The benefits of screening and early detection of breast cancer, including reduced morbidity and mortality, have been well-reported in the literature. In 2011, a breast cancer screening program was launched in Meknes-Tafilalt region of Morocco. The aim of this study was to evaluate the early performance indicators of this program. Materials and Methods: This retrospective evaluative study was conducted between April 2012 and December 2014, in Meknes-Tafilalt region of Morocco. Several performance indicators of the breast cancer screening program were calculated: the compliance rate, the positivity rate, the referral rate, the cancer detection rate and the organizational indicators. Results: During 2012-2014, a total of 184,951 women participated in the breast cancer screening program. The compliance rate was 26%, the positive rate was 3.3%, the referral rate was 36.7%, and the cancer detection rate was 1.2 per 1,000 women. The median time between the date of clinical breast examination and the date of biopsy (or cyto-puncture) was 36 days. The median time between the date of positive mammography and the date of biopsy (or cyto-puncture) was 6 days. The median time between the date of clinical breast examination and the date of the first received treatment was 61 days. Conclusions: The program needs better monitoring, as well as implementation of quality assurance tools to improve performance in our country.     

Breast cancer screening among females in Iran and recommendations for improved practice: a review

Breast cancer is the second most common cancer amongst women, in Iran comprising 21.4% of female cancers. There are several screening modalities for breast cancer including breast self-examination, clinical breast examination and mammography. This research reviews the literature surrounding the implementation of these screening approaches in the Islamic Republic of Iran. After initial results produced approximately 208 articles, a total of 96 articles were included because they specifically addressed epidemiological characteristics of breast cancer, culture, religion, health seeking behavior, screening programs and the health system in Iran. Literature showed that breast self-examination and clinical breast examination were most common as there is no population-based mammography screening program in Iran. Additionally, most women appear to obtain information through the mass media. Results also indicate that Islamic beliefs and preventative medicine are very much aligned and can be used to promote breast cancer screening in Iran. These results highlight that there is a need for aggressive preventative measures focusing on breast self examination and gradually moving towards national mammography programs in Iran ideally disseminated through the media with government support.     

Biomarkerforschung in der Krebsfrüherkennung

For reliable early cancer diagnosis the establishment of good screening programs is indispensable. The quality and success of such programs are strongly dependent on the excellence of the biomarkers used. Therefore, intensive research is being performed on the development and establishment of such new markers. Circulating tumor cells which can be found in the bloodstream of cancer patients are especially important in the detection and management of metastatic disease. Additionally, the analysis of cell-free circulating DNA in the serum of patients displays a new potential marker for the detection of minimal residual tumor disease. Cell-free circulating DNA can also be used to improve existing early cancer screening programs. Recent publications also show that new protein markers can be developed which might be added to existing screening approaches in the near future.     

Efficient test for cancer antigens: decreased levels of cancer antigen in serum after excision of breast tumor

Monoclonal antibody technology has developed new serum marker tests which may offer advantages in the follow up of cancer patients. In breast cancer detection among symptomatic patients MCA and CA 15-3 monoclonals at best reach a sensitivity of about 0.45 at a specificity level of 0.90. We have tested these monoclonal tests (MCA and CA 15-3) by applying them to detect the postoperative decrease of marker levels in the serum among women with breast cancer or benign breast disease. The CA 15-3 postoperative decrease test (5% decrease) reached slightly higher diagnostic sensitivity (0.70) and efficiency (0.83) than the MCA postoperative decrease test (sensitivity 0.65, efficiency 0.80). The combined MCA and CA 15-3 decrease tests had a sensitivity of 0.85 and an efficiency of 0.90 at 5% decrease level. The postoperative decrease test is far superior to normal marker tests in breast cancer detection, especially when several sensitive markers are used. A 35% or larger decrease in serum levels of MCA or CA 15-3 after surgery was 100% specific for breast cancer, and detected 43% of all cancer cases. Although such a test cannot be used for screening, it could be valuable in special diagnostic situations.     

A stochastic model for predicting the mortality of breast cancer

Consider a cohort of women, identified by year of birth, some of whom will eventually be diagnosed with breast cancer. A stochastic model is developed for predicting the U.S. breast cancer mortality that depends on advances in therapy and dissemination of mammographic screening. The predicted mortality can be compared with the same cohort having usual care with no screening program and absence of modern therapy, or a cohort in which only a proportion participate in a screening program and have modern therapy. The model envisions that a woman may be in four health states: i.e., 1) no disease or breast cancer that cannot be diagnosed (S0), 2) preclinical state (Sp), 3) clinical state (Sc), and 4) disease-specific death (Sd). The preclinical disease refers to breast cancer that is asymptomatic but that may be diagnosed with a special exam. The clinical state refers to symptomatic disease diagnosed under usual care. One of the basic assumptions of the model is that the disease is progressive; i.e., the transitions for the first three states are S0-->Sp-->Sc. The other basic assumption is that any reduction in mortality associated with earlier diagnosis is due to a stage shift in diagnosis; i.e., early diagnosis results in a larger proportion of earlier stage patients. The model is used to predict changes in female breast cancer mortality in the U.S. women for 1975-2000. The model is general and may predict mortality for other chronic diseases that satisfy the two basic assumptions.     

Estrogen replacement therapy in women at increased risk for breast cancer

Summary The topic of estrogen replacement (ERT) after the onset of menopause remains controversial and charged with considerable emotion within both the medical community and the lay public. This is especially true for women at increased risk for breast cancer as well as those who reach menopause after the diagnosis of this disease. ERT clearly protects postmenopausal women from the morbidity and mortality of cardiovascular disease and osteoporosis, and it alleviates vasomotor and genitourinary symptoms. However, there remains uncertainty whether and for which subgroups of women these benefits may be offset by a potential increased risk for breast cancer.With screening programs, breast cancer is being diagnosed at an earlier stage; with improved therapy, survival rates are improving. Adjuvant chemotherapy is increasingly incorporated in the treatment program of localized disease and accelerates the arrival of menopause. Thus, more and younger women with excellent survival prognosis will develop early menopause after treatment for early breast cancer. For these women, the decision regarding ERT is likely to affect the quality and quantity of their life for several decades. It is important to weigh the relative risks and benefits of ERT for each individual woman in order to develop a meaningful health maintenance plan.     

Brustkrebs-Früherkennung in Deutschland

The guideline Early Detection of Breast Cancer in Germany aims to assist physicians, healthy women, and patients in decision making with recommendations based on evidence and formal consensus regarding the diagnostic chain of health care for early detection of breast cancer. This guideline updates the previous version of 2003. The guideline is a precondition to establishing an effective and efficient national early breast cancer detection program in accordance with the requirements of the European Council and the World Health Organization for cancer control programs. The core imaging technique of an early detection program is mammography, whether used for screening or diagnosis. Breast health care outcomes can be improved by embedding this imaging technology in a quality-assured diagnostic chain. The guideline comprises areas of present scientific and medical knowledge, based on evidence and consensus and covering all multidisciplinary aspects of the diagnostic chain, including clinical history taking, risk consultation and communication, breast health awareness, physical breast examination, breast imaging, interventional guided biopsy, excision biopsy, and breast pathology. The guideline provides formal measures as quality indicators to ensure resource availability, process quality, and outcome of the diagnostic chain. Early detection of breast cancer is presently the most promising chance for optimizing diagnosis and treatment of breast cancer in order to reduce mortality and morbidity while improving survivors’ quality of life. The aim is to detect breast cancer as a noninvasive disease or an invasive disease at an early stage, with a 5-year survival rate of more than 90% with adequate treatment. Detecting more noninvasive breast cancer might even help reduce the incidence. Within the scope of secondary prevention, early detection offers the chance of cure at an early disease stage by less intensive treatment.     

Breast cancer incidence after the introduction of mammography screening: what should be expected?

BACKGROUND: A prevalence peak is expected in breast cancer incidence when mammography screening begins, but afterward the incidence still may be elevated compared with prescreening levels. It is important to determine whether this is due to overdiagnosis (ie, the detection of asymptomatic disease that would otherwise not have arisen clinically). In the current study, the authors examined breast cancer incidence after the introduction of mammography screening in Denmark. METHODS: Denmark has 2 regional screening programs targeting women ages 50 years to 69 years. The programs were initiated in 1991 and 1993, respectively. No screening takes place in the 13 other Danish regions. Data regarding incident breast cancers detected between 1979 and 2001 were retrieved from the Danish Cancer Registry for each screening region and for the rest of Denmark, and time trends in rates for women ages 50 years to 69 years were compared. From 1 program, individual screening data were used to analyze breast cancer incidence in women who were never screened, those who were screened for the first time, or those who previously were screened. RESULTS: The incidence of breast cancer was found to have increased regardless of screening. In the screening regions, a marked prevalence peak was observed, and the incidence hereafter was compatible with the level indicated by the 95% confidence limits for the regression curves for the rates in the prescreening period, taking into account the artificial ageing in the program, the influx of newcomers, and variations in the data. Women who had undergone previous screening were found to have the same incidence of breast cancer as women who were never screened. CONCLUSIONS: The data from the current study do not provide evidence of overdiagnosis of invasive breast cancer in the 2 Danish screening programs or, if overdiagnosis was found to occur, it was only of limited magnitude.