Early Detection of Cancer: Past, Present, and Future

2015 ◽  
pp. 57-65 ◽  
Author(s):  
Joshua D. Schiffman ◽  
Paul G. Fisher ◽  
Peter Gibbs
Keyword(s):  
Cancer Screening ◽  
Circulating Tumor Dna ◽  
Screening Tests ◽  
Current Status ◽  
Screening Methods ◽  
Clinical Consequence ◽  
Curative Intent ◽  
High Risk Populations ◽  
Early Tumor ◽  
The Cost

Screening in both healthy and high-risk populations offers the opportunity to detect cancer early and with an increased opportunity for treatment and curative intent. Currently, a defined role for screening exists in some cancer types, but each screening test has limitations, and improved screening methods are urgently needed. Unfortunately, many cancers still lack effective screening recommendations, or in some cases, the benefits from screening are marginal when weighed against the potential for harm. Here we review the current status of cancer screening: we examine the role of traditional tumor biomarkers, describe recommended imaging for early tumor surveillance, and explore the potential of promising novel cancer markers such as circulating tumor cells (CTC) and circulating tumor DNA. Consistent challenges for all of these screening tests include limited sensitivity and specificity. The risk for overdiagnosis remains a particular concern in screening, whereby lesions of no clinical consequence may be detected and thus create difficult management decisions for the clinician and patient. If treatment is pursued following overdiagnosis, patients may be exposed to morbidity from a treatment that may not provide any true benefit. The cost-effectiveness of screening tests also needs to be an ongoing focus. The improvement of genomic and surveillance technologies, which leads to more precise imaging and the ability to characterize blood-based tumor markers of greater specificity, offers opportunities for major progress in cancer screening.

Neonatal Screening for Cystic Fibrosis: Position Paper

PEDIATRICS ◽  
1983 ◽  
Vol 72 (5) ◽  
pp. 741-745 ◽  
Author(s):  
◽  
Lynn M. Taussig ◽  
Thomas F. Boat ◽  
Delbert Dayton ◽  
Norman Fost ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Newborn Screening ◽  
Neonatal Screening ◽  
Task Force ◽  
Genetic Disorder ◽  
Clinical Manifestations ◽  
Screening Tests ◽  
Current Status ◽  
Screening Methods ◽  
Asymptomatic Patients

Neonatal screening represents the search for a disorder in a general newborn population. The purpose of screening may be to improve the health of the affected infant, to provide counseling, or for research. Screening tests have been widely accepted for conditions such as phenylketonuria, hypothyroidism, and other metabolic conditions. Cystic fibrosis (CF) is the most common lethal genetic disorder among the white population (with a lower incidence among blacks), and thus there has been interest in screening newborns for CF1 However, proposals emanating from this interest have remained controversial.2-4 The recent development of a relatively simple test—the dried blood immuno-reactive trypsinogen (IRT) assay—has increased this interest.5-12 Besides considering technical reliability and validity of newborn screening methods, it is crucial that all other aspects of screening (including medical, ethical, psychosocial, and economic aspects) be rigorously examined before implementing mass screening.13-15 To address these issues the Cystic Fibrosis Foundation convened a Task Force on Neonatal Screening. Although the Task Force considered the current status of the IRT test, it focused on the generally accepted criteria for newborn screening, summarized in the Table,14 and the relationship of these criteria to the present state of knowledge related to CF. The issues identified by the Task Force, are summarized in this paper, and recommendations are presented at the conclusion. EFFECTIVENESS OF PRESYMPTOMATIC TREATMENT Evidence suggesting that the initiation of treatment before clinical manifestations of CF first appear improves prognosis has been controversial. Whereas some studies have yielded supportive data,16 others have not.4 There are no generally accepted treatment protocols for use in symptomatic or asymptomatic patients.

scholarly journals Cervical Cancer Screening Programs in Europe: The Transition Towards HPV Vaccination and Population-Based HPV Testing

Viruses ◽  
2018 ◽  
Vol 10 (12) ◽  
pp. 729 ◽  
Author(s):  
Andreas Chrysostomou ◽  
Dora Stylianou ◽  
Anastasia Constantinidou ◽  
Leondios Kostrikis
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Hpv Vaccination ◽  
Screening Method ◽  
Population Based ◽  
Screening Tests ◽  
Screening Methods ◽  
Hpv Testing ◽  
Screening Programs

Cervical cancer is the fourth most frequently occurring cancer in women around the world and can affect them during their reproductive years. Since the development of the Papanicolaou (Pap) test, screening has been essential in identifying cervical cancer at a treatable stage. With the identification of the human papillomavirus (HPV) as the causative agent of essentially all cervical cancer cases, HPV molecular screening tests and HPV vaccines for primary prevention against the virus have been developed. Accordingly, comparative studies were designed to assess the performance of cervical cancer screening methods in order to devise the best screening strategy possible. This review critically assesses the current cervical cancer screening methods as well as the implementation of HPV vaccination in Europe. The most recent European Guidelines and recommendations for organized population-based programs with HPV testing as the primary screening method are also presented. Lastly, the current landscape of cervical cancer screening programs is assessed for both European Union member states and some associated countries, in regard to the transition towards population-based screening programs with primary HPV testing.

scholarly journals Prostate Cancer Screening in the Workplace

AAOHN Journal ◽  
1998 ◽  
Vol 46 (8) ◽  
pp. 379-384 ◽  
Author(s):  
Claire Snyder ◽  
Peggy N. Schrammel ◽  
Claudia B. Griffiths ◽  
Robert I. Griffiths
Keyword(s):  
Prostate Cancer ◽  
Cancer Screening ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Screening Tests ◽  
Test Results ◽  
Total Cost ◽  
Screening Programs ◽  
Psa Testing ◽  
The Cost

Recognition of the mortality and morbidity associated with prostate cancer has resulted in employer based screening programs. This retrospective cohort study identified the employer costs of prostate cancer screening and referrals due to abnormal test results. The subjects were 385 men enrolled in a workplace screening program at a single employer between 1993 and 1995. Screening consisted of digital rectal examination (DRE) annually for enrolled employees aged 40 years and older, plus annual prostate specific antigen (PSA) testing for those 50 and older, and those 40 and older and considered at high risk. Data related to the health care and lost productivity costs of screening and referrals for abnormal test results were collected and analyzed. The total cost of screening was $44,355, or approximately $56 per screening encounter (788 DREs; 437 PSAs). Abnormal screening tests resulted in 52 referrals. Upon further evaluation, 42% were found to have an enlargement, 29% a node, and 12% benign prostatic hyperplasia. Only one malignancy was found. The total cost of additional referrals was $31,815, or 42% of the cost of screening plus referrals. As the cost per screening encounter was low, prostate cancer screening in the workplace is an efficient alternative.

Impact of Medicaid reimbursement and eligibility policies on receipt of cancer screening.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6514-6514
Author(s):  
Michael T. Halpern ◽  
Melissa A. Romaire ◽  
Susan G. Haber ◽  
Florence K. Tangka ◽  
Susan A. Sabatino ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Screening Test ◽  
Prostate Cancer Screening ◽  
Screening Tests ◽  
Screening Methods ◽  
Medicaid Reimbursement ◽  
Pap Tests ◽  
Medicaid Eligibility ◽  
Eligibility Requirements ◽  
To Receive

6514 Background: State Medicaid programs cover receipt of cancer screening services. However, coverage of cancer screening tests does not guarantee access to these services. Medicaid beneficiaries are less likely to be screened for cancer and more likely to present with advanced stage cancers. State-specific variations in Medicaid program eligibility requirements and reimbursements for medical services may affect cancer screening rates among Medicaid enrollees. This study examined how eligibility and reimbursement policies affected receipt of breast, cervical, colorectal, and prostate cancer screening. Methods: We examined 2007 Medicaid data for individuals age 21-64 enrolled in fee-for-service Medicaid for at least 4 months from 46 states and the District of Columbia. We examined the association of state-specific Medicaid cancer screening test and office visit reimbursements, income and financial asset eligibility requirements, physician copayments, and frequency of Medicaid eligibility renewal on receipt of cancer screening. Analyses used multivariate logistic regressions with generalized estimating equations to control for correlation between beneficiaries within a state. Results: Increased Medicaid screening test reimbursements were significantly associated with small increases in receipt of colonoscopy, mammograms, and PSA tests. Increased reimbursements for office visits were associated with increased receipt of colonoscopy, FOBT, Pap tests, and mammograms. Greater asset thresholds for Medicaid eligibility increased the likelihood of all screening tests except FOBT. Beneficiaries in states requiring more frequent (<12 month) renewal of Medicaid eligibility were more likely to receive FOBT, PSA, or mammograms, but less likely to receive Pap tests. Conclusions: Increasing Medicaid reimbursement rates and asset policies was generally associated with increases in cancer screening. As proposed Medicaid eligibility expansions will almost certainly increase the number of enrollees in this program, it is crucial to provide adequate reimbursements and develop eligibility policies to promote cancer screening and thereby increase early cancer detection among this underserved population.

scholarly journals 92 – Comparing the Cost-Effectiveness of New Colorectal Cancer Screening Tests

2019 ◽  
Vol 156 (6) ◽  
pp. S-21
Author(s):  
Elisabeth F. Peterse ◽  
Reinier Meester ◽  
Lucie de Jonge ◽  
Fernando Alarid-Escudero ◽  
Ann G. Zauber ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Screening Tests ◽  
Cancer Screening Tests ◽  
The Cost

scholarly journals Attributes, Performance, and Gaps in Current & Emerging Breast Cancer Screening Technologies

2019 ◽  
Vol 15 (2) ◽  
pp. 122-131
Author(s):  
Hina M. Ismail ◽  
Christopher G. Pretty ◽  
Matthew K. Signal ◽  
Marcus Haggers ◽  
J. Geoffrey Chase
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Early Detection ◽  
Breast Cancer Screening ◽  
Screening Tests ◽  
Screening Methods ◽  
Extensive Literature ◽  
Screening Programs ◽  
Detection Techniques ◽  
Wide Range

Background:Early detection of breast cancer, combined with effective treatment, can reduce mortality. Millions of women are diagnosed with breast cancer and many die every year globally. Numerous early detection screening tests have been employed. A wide range of current breast cancer screening methods are reviewed based on a series of searchers focused on clinical testing and performance. </P><P> Discussion: The key factors evaluated centre around the trade-offs between accuracy (sensitivity and specificity), operator dependence of results, invasiveness, comfort, time required, and cost. All of these factors affect the quality of the screen, access/eligibility, and/or compliance to screening programs by eligible women. This survey article provides an overview of the working principles, benefits, limitations, performance, and cost of current breast cancer detection techniques. It is based on an extensive literature review focusing on published works reporting the main performance, cost, and comfort/compliance metrics considered.Conclusion:Due to limitations and drawbacks of existing breast cancer screening methods there is a need for better screening methods. Emerging, non-invasive methods offer promise to mitigate the issues particularly around comfort/pain and radiation dose, which would improve compliance and enable all ages to be screened regularly. However, these methods must still undergo significant validation testing to prove they can provide realistic screening alternatives to the current accepted standards.

Cancer screening tests in France: First results of EDIFICE study

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6092-6092 ◽  
Author(s):  
X. Pivot ◽  
D. Serin ◽  
Y. Coscas ◽  
F. Eisinger ◽  
O. Rixe ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Colorectal Cancer ◽  
Cancer Screening ◽  
Representative Sample ◽  
Prostate Cancer Screening ◽  
Digital Rectal Examination ◽  
Screening Tests ◽  
First Results ◽  
Nationwide Observational Study ◽  
The Cost

6092 Background: The EDIFICE study was the first which aimed to allow better understanding of population’s adhesion in France to the screening tests available for the 4 most frequent cancers: breast, colorectal, prostate and lung. Methods: This nationwide observational study was carried out in France from January 18th to February 2nd, 2005 among a representative sample of 1,504 subjects aged between 40 and 75 years and a representative sample of 600 general practitioners (GPs). Information collected about participating subjects included socio-demographic characteristics, attitude towards cancer screening and actual experience of cancer screening, and about GPs’ medical practice regarding screening. Results: A striking result observed is that screening for colorectal cancer that USPSTF rates as an “A” Recommendation (strongly recommended) deserves less attention: reported rate 25% than prostate cancer screening (either with digital rectal examination and/or PSA): reported rate 36%. In the same way, GPs’ are recommended more often prostate cancer screening (58%) than colorectal cancer screening (18%). Another key result of that EDIFICE national representative survey is the high attendance rate of women at mammography screening. Conclusion: With respect to the cost of such programs, utilization must be monitored and compared among different countries/organization. Additional data will be presented about reasons to do or not cancer screening and about regularity of screening. [Table: see text] No significant financial relationships to disclose.

The cost-effectiveness of improving cancer screening compliance.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6057-6057
Author(s):  
Michael S. Broder ◽  
Irina Yermilov ◽  
Clifford Y. Ko ◽  
Melinda Maggard Gibbons ◽  
Eunice Chang ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cancer Screening ◽  
Drug Treatment ◽  
Cost Effective ◽  
Quality Measures ◽  
Sensitivity Analyses ◽  
Screening Tests ◽  
Life Years ◽  
The Cost ◽  
Screening Measures

6057 Background: Expensive treatments and a growing number of cancer patients have resulted in increased spending on cancer care. Within a framework we developed for measuring the value of quality improvement (QI), we describe the cost-effectiveness of improving compliance with cancer screening measures compared to other quality measures. Methods: We used our framework to examine 18 Healthcare Effectiveness Data and Information Set (HEDIS) 2010 quality measures, synthesize related cost-effectiveness (CE) data and describe measure-specific QI-adjusted incremental cost-effectiveness ratios (ICERs). For each measure we: 1) quantified current compliance; 2) reviewed literature for ICERs; 3) estimated per-person steady state cost and quality-adjusted life years (QALYs); 4) estimated affected population size; 5) estimated the cost of QI; and 6) calculated QI-adjusted ICERs at full compliance, defined as 95%. We assumed per-person QI costs did not change with compliance and varied this in sensitivity analyses. We compared QI-adjusted ICERs for 3 cancer screening measures to the remaining measures. Results: Published ICERs for the cancer screening measures were $43,180/QALY (breast), $5,102/QALY (cervix) and $15,173/QALY (colon) and for other measures from $195/QALY (drug treatment) to $35,616/QALY (flu shots). Incorporating QI costs for cancer screening measures gave QI-adjusted ICERs of $64,549/QALY (breast), $15,463/QALY (cervix) and $22,991/QALY (colon), respectively. Incorporating QI costs for all 18 measures resulted in QI-adjusted ICERs from $195/QALY (drug treatment) to $9,075,868/QALY(antidepressant management), with a median of $15,463/QALY. Reaching 95% compliance with the 3 cancer measures would cost $5.1 billion and add 160,000 QALYs ($32,640/QALY) and with all 18 measures would cost $13.4 billion and add 5.8 million QALYs ($2,313/QALY). Conclusions: Improving compliance with cancer screening may be cost-effective at a threshold of $50k/QALY, although improving care on all HEDIS measures may be even more cost-effective. Accurate assessment of the cost of increasing cancer screening requires integration of both the cost-effectiveness of the screening tests and the cost of the QI programs needed to change practice.

scholarly journals Assessment of Circulating Copy Number Variant Detection for Cancer Screening

2016 ◽  
Author(s):  
Bhuvan Molparia ◽  
Eshaan Nichani ◽  
Ali Torkamani
Keyword(s):  
Cancer Screening ◽  
Copy Number ◽  
Early Stage ◽  
Point Mutations ◽  
Health Benefit ◽  
High Sensitivity ◽  
Copy Number Variant ◽  
Circulating Tumor Dna ◽  
Detection Methods ◽  
Screening Methods

ABSTRACTCurrent high-sensitivity cancer screening methods suffer from false positive rates that lead to numerous unnecessary procedures and questionable public health benefit overall. Detection of circulating tumor DNA (ctDNA) has the potential to transform cancer screening. Thus far, nearly all ctDNA studies have focused on detection of tumor-specific point mutations. However, ctDNA point mutation detection methods developed to date lack either the scope or sensitivity necessary to be useful for cancer screening, due to the extremely low (<1%) ctDNA fraction derived from early stage tumors. We suggest that tumor-derived copy number variant (CNV) detection is theoretically a superior means of ctDNA-based cancer screening for many tumor types, given that, relative to point mutations, each individual tumor CNV contributes a much larger number of ctDNA fragments to the overall pool of circulating DNA. Here we perform an in silico assessment of the potential for ctDNA CNV-based cancer screening across many common cancers.

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