Mistletoe for cancer?

Mistletoe extracts are widely used in the treatment of cancer. The results of clinical trials are however highly inconsistent. We therefore conducted a systematic review of all randomised clinical trials of this unconventional therapy. Eight databases were searched to identify all studies that met our inclusion/exclusion criteria. Data were independently validated and extracted by 2 authors and checked by the 3rd according to predefined criteria. Statistical pooling was not possible because of the heterogeneity of the primary studies. Therefore a narrative systematic review was conducted. Ten trials could be included. Most of the studies had considerable weaknesses in terms of study design, reporting or both. Some of the weaker studies implied benefits of mistletoe extracts, particularly in terms of quality of life. None of the methodologically stronger trials exhibited efficacy in terms of quality of life, survival or other outcome measures. Rigorous trials of mistletoe extracts fail to demonstrate efficacy of this therapy.     

Screening for cancer: what's new?

Setting up of screening programmes for cancers has been the result of evaluation studies but even more of the existence (or non existence) of national policies for cancer control. We know for sure that mammographic screening can reduce breast cancer mortality in women from age 50 onwards, smear screening has a favourable impact on cervical cancer mortality and incidence, and faecal blood testing in stools may reduce colon cancer mortality. Other questions, considered for a long time as settled, are coming back, either because new data are available, such as in screening for breast cancer before age 50, or because new screening methods are being proposed, such as for lung cancer. Finally, the recognition of populations at very high genetic risk makes necessary the search for answers for example for familial breast and/or ovarian cancer. Last but not least is the methodological challenge: how can we rapidly provide answers, which implies the need for new approaches, in addition to randomized controlled trials?