Supplemental Cancer Screening for Women With Dense Breasts: Guidance for Health Care Professionals.

Mammography is the standard for breast cancer screening. The sensitivity of mammography in identifying breast cancer, however, is reduced for women with dense breasts. Thirty-eight states have passed laws requiring that all women be notified of breast tissue density results in their mammogram report. The notification includes a statement that differs by state, encouraging women to discuss supplemental screening options with their health care professionals (HCPs). Several supplemental screening tests are available for women with dense breast tissue, but no established guidelines exist to direct HCPs in their recommendation of preferred supplemental screening test. Tailored screening, which takes into consideration the patient's mammographic breast density and lifetime breast cancer risk, can guide breast cancer screening strategies that are more comprehensive. This review describes the benefits and limitations of the various available supplemental screening tests to guide HCPs and patients in choosing the appropriate breast cancer screening.

Comparing the Cost-Effectiveness of Innovative Colorectal Cancer Screening Tests.

BACKGROUND: Colorectal cancer (CRC) screening with colonoscopy and the fecal immunochemical test (FIT) is underused. Innovative tests could increase screening acceptance. This study determined which of the available alternatives is most promising from a cost-effectiveness perspective. METHODS: The previously validated Microsimulation Screening Analysis-Colon model was used to evaluate the cost-effectiveness of screening with capsule endoscopy every 5 or 10 years, computed tomographic colonography every 5 years, the multi-target stool DNA test every 1 or 3 years, and the methylated SEPT9 DNA plasma assay (mSEPT9) every 1 or 2 years. We also compared these strategies with annual FIT screening and colonoscopy screening every 10 years. Quality-adjusted life-years gained (QALYG), number of colonoscopies, and incremental cost-effectiveness ratios were projected. We assumed a willingness-to-pay threshold of $100 000 per QALYG. RESULTS: Among the alternative tests, computed tomographic colonography every 5 years, annual mSEPT9, and annual multi-target stool DNA screening had incremental cost-effectiveness ratios of $1092, $63 253, and $214 974 per QALYG, respectively. Other screening strategies were more costly and less effective than (a combination of) these 3. Under the assumption of perfect adherence, annual mSEPT9 screening resulted in more QALYG, CRC cases averted, and CRC deaths averted than annual FIT screening but led to a high rate of colonoscopy referral (51% after 3 years, 69% after 5 years). The alternative tests were not cost-effective compared with FIT and colonoscopy. CONCLUSIONS: This study suggests that for individuals not willing to participate in FIT or colonoscopy screening, mSEPT9 is the test of choice if the high colonoscopy referral rate is acceptable to them.

Beneficios y "maleficios" del cribado. El sobrediagnóstico y la medicina anticipativa / Benefits and damages of Screening. Overdiagnosis and anticipatory medicine

Mucho han cambiado los resultados en el tratamiento del cáncer de mama desde la publicación de trabajos que recomendaban la realización de cribados para diagnosticar precozmente los tumores de mama. Los posteriores re-análisis, que mostraron errores en las evaluaciones, los avances en la terapia oncológica y la concienciación de profesionales y público, han demostrado la dudosa efectividad de esta medida y como contrapartida los riesgos dependientes por sobrediagnóstico y sobretratamiento. Por otra parte la falta de información e incluso la desinformación existente sobre el tema, han ocasionado una desorientación entre los posibles beneficiarios del procedimiento. Se les ha recomendado, por parte de organizaciones, plataformas, sociedades privadas y servicios de salud pública, un procedimiento ocultando daños importantes: físicos, psicológicos y económicos. Es fácil promover el examen de mamografía si la mayoría de las mujeres cree que previene o reduce el riesgo de contraer cáncer de seno y salva muchas vidas mediante la detección temprana de tumores agresivos. Desgraciadamente eso no es así. A la vista de ello, existen muchos detractores del cribado que vienen recomendando la información fiable y correcta y la indicación personal no tanto del cribado como de la exploración como procedimiento diagnóstico. Las mujeres deben discutir con sus médicos su propio perfil de riesgo, los posibles beneficios, daños y complejidades de la mamografía de detección, y tomar decisiones informadas sobre la realización del cribado. Definir qué mujeres se beneficiarían de un seguimiento debido a factores de riesgo definidos y aquellas que por el contrario corren más riesgos que beneficios. Un programa de salud pública que claramente no produce más beneficios que daños es difícil de justificar. Proporcionar información clara e imparcial, promover la atención adecuada y prevenir el sobrediagnóstico y el sobretratamiento sería la mejor opción

Treatment of breast cancer has changed markedly since the publication of papers recommending screening programs for early diagnosis. Posterior reevaluations demonstrated mistakes; advances in oncological therapy and better knowledge of the problem have demonstrated the doubtful efficacy of these procedures which, on the other hand have also side effects with risk of overdiagnosis and overtreatment. Misinformation confuses patients. This procedure has been recommended by many institutions without explaining possible important risks. It is very easy to promote mammograms if the majority feel that it reduces risk of breast cancer and saves many lives. Unfortunately this is not the case. At present there are many people against screening who are recommending explicit and precise explanations of the procedure as well as of the importance of physical examination. Women must discuss with their physicians their own risk, possible benefits and eventual risks and damages of mammograms and they must take informed decision about screening. Women should be classified in those with potential benefits of mammograms and those with more risks than benefits. A program which does not offer clearly more benefits than risks cannot be implemented by Public Heath institutions. Complete and impartial information, adequate attention and prevention of overdiagnosis and overtreatment would be the best option

Ethnic Disparities in Imaging Utilization at Diagnosis of Non-Small Cell Lung Cancer.

BACKGROUND: Prior research demonstrated statistically significant racial disparities related to lung cancer treatment and outcomes. We examined differences in initial imaging and survival between blacks, Hispanics, and non-Hispanic whites. METHODS: The linked Surveillance, Epidemiology, and End Results-Medicare database between 2007 and 2015 was used to compare initial imaging modality for patients with lung cancer. Participants included 28 881 non-Hispanic whites, 3123 black, and 1907 Hispanics, patients age 66 years and older who were enrolled in Medicare fee-for-service and diagnosed with lung cancer. The primary outcome was comparison of positron emission tomography (PET) imaging with computerized tomography (CT) imaging use between groups. A secondary outcome was 12-month cancer-specific survival. Information on stage, treatment, and treatment facility was included in the analysis. Chi-square test and logistic regression were used to evaluate factors associated with imaging use. Kaplan-Meier method and Cox proportional hazards regression were used to calculate adjusted hazard ratios and survival. All statistical tests were two-sided. RESULTS: After adjusting for demographic, community, and facility characteristics, blacks were less likely to undergo PET or CT imaging at diagnosis compared with non-Hispanic whites odds ratio (OR) = 0.54 (95% confidence interval [CI] = 0.50 to 0.59; P < .001). Hispanics were also less likely to receive PET with CT imaging (OR = 0.72, 95% CI = 0.65 to 0.81; P < .001). PET with CT was associated with improved survival (HR = 0.61, 95% CI = 0.57 to 0.65; P < .001). CONCLUSIONS: Blacks and Hispanics are less likely to undergo guideline-recommended PET with CT imaging at diagnosis of lung cancer, which may partially explain differences in survival. Awareness of this issue will allow for future interventions aimed at reducing this disparity.

Computer-assisted diagnosis of early esophageal squamous cell carcinoma using narrow-band imaging magnifying endoscopy.

BACKGROUND: We developed a computer-assisted diagnosis model to evaluate the feasibility of automated classification of intrapapillary capillary loops (IPCLs) to improve the detection of esophageal squamous cell carcinoma (ESCC). METHODS: We recruited patients who underwent magnifying endoscopy with narrow-band imaging for evaluation of a suspicious esophageal condition. Case images were evaluated to establish a gold standard IPCL classification according to the endoscopic diagnosis and histological findings. A double-labeling fully convolutional network (FCN) was developed for image segmentation. Diagnostic performance of the model was compared with that of endoscopists grouped according to years of experience (senior > 15 years; mid level 10 - 15 years; junior 5 - 10 years). RESULTS: Of the 1383 lesions in the study, the mean accuracies of IPCL classification were 92.0 %, 82.0 %, and 73.3 %, for the senior, mid level, and junior groups, respectively. The mean diagnostic accuracy of the model was 89.2 % and 93.0 % at the lesion and pixel levels, respectively. The interobserver agreement between the model and the gold standard was substantial (kappa value, 0.719). The accuracy of the model for inflammatory lesions (92.5 %) was superior to that of the mid level (88.1 %) and junior (86.3 %) groups (P < 0.001). For malignant lesions, the accuracy of the model (B1, 87.6 %; B2, 93.9 %) was significantly higher than that of the mid level (B1, 79.1 %; B2, 90.0 %) and junior (B1, 69.2 %; B2, 79.3 %) groups (P < 0.001). CONCLUSIONS: Double-labeling FCN automated IPCL recognition was feasible and could facilitate early detection of ESCC.

Type of breast cancer diagnosis, screening, and survival.

INTRODUCTION: Breast cancer screening is known to reduce mortality. In the present study, we analyzed the prevalence of breast cancers detected through screening, before and after introduction of an organized screening, and we evaluated the overall survival of these patients in comparison with women with an extrascreening imaging-detected breast cancer or those with palpable breast cancers. MATERIALS AND METHODS: We collected data about all women who underwent a breast operation for cancer in our department between 2001 and 2008, focusing on type of tumor diagnosis, tumor characteristics, therapies administered, and patient outcome in terms of overall survival, and recurrences. Data was analyzed by R (version 2.15.2), and P < .05 was considered significant. RESULTS: Among the 2070 cases of invasive breast cancer we considered, 157 were detected by regional mammographic screening (group A), 843 by extrascreening breast imaging (group B: 507 by mammography and 336 by ultrasound), and 1070 by extrascreening breast objective examination (group C). The 5-year overall survival in groups A, B, and C were, respectively, 99% (95% CI, 98%-100%), 98% (95% CI, 97%-99%), and 91% (95% CI, 90%-93%), with a significant difference between the first 2 groups and the third (P < .05) and a trend between groups A and B (P = .081). CONCLUSION: The diagnosis of invasive breast cancer with screening in our population resulted in a survival gain at 5 years from the diagnosis, but a longer follow-up is necessary to confirm this data.

TRICARE: changes included in the National Defense Authorization Act for Fiscal Year 2007; improvements to descriptions of cancer screening for women. Final rule.

The Department is publishing this final rule to implement section 703 of the National Defense Authorization Act (NDAA) for Fiscal Year 2007 (FY07), Public Law 109-364. Specifically, that legislation authorizes breast cancer screening and cervical cancer screening for female beneficiaries of the Military Health System, instead of constraining such testing to mammograms and Papanicolaou smears. The rule allows coverage for "breast cancer screening" and "cervical cancer screening" for female beneficiaries of the Military Health System, instead of constraining such testing to mammograms and Papanicolaou tests. This rule ensures new breast and cervical cancer screening procedures can be added to the TRICARE benefit as such procedures are proven to be a safe, effective, and nationally accepted medical practice. This amends the cancer specific recommendations for breast and cervical cancer screenings to be brought in line with the processes for updating other cancer screening recommendations. In response to public comment on the proposed rule, this final rule includes a clarification that the benefit encompasses screening based on Health and Human Services guidelines.