Cancer Surveillance
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PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0256514
Andria Hadjipanteli ◽  
Petros Polyviou ◽  
Ilias Kyriakopoulos ◽  
Marios Genagritis ◽  
Natasa Kotziamani ◽  

Purpose Limited work has been performed for the implementation of digital breast tomosynthesis (DBT) in breast cancer surveillance imaging. The aim of this study was to investigate the differences between two different DBT implementations in breast cancer surveillance imaging, for patients with a personal history of breast cancer. Method The DBT implementations investigated were: (1) 2-view 2D digital mammography and 2-view DBT (2vDM&2vDBT) (2) 1-view (cranial-caudal) DM and 1-view (mediolateral-oblique) DBT (1vDM&1vDBT). Clinical performance of these two implementations was assessed retrospectively using observer studies with 118 sets of real patient images, from a single imaging centre, and six observers. Sensitivity, specificity and area under the curve (AUC) using the Jack-knife alternative free-response receiver operating characteristics (JAFROC) analysis were evaluated. Results Results suggest that the two DBT implementations are not significantly different in terms of sensitivity, specificity and AUC. When looking at the two main different lesion types, non-calcifications and calcifications, and two different density levels, no difference in the performance of the two DBT implementations was found. Conclusions Since 1vDM&1vDBT exposes the patient to half the dose of 2vDM&2vDBT, it might be worth considering 1vDM&1vDBT in breast cancer surveillance imaging. However, larger studies are required to conclude on this matter.

BMJ ◽  
2021 ◽  
pp. n2020
NAJ Ryan ◽  
T Snowsill ◽  
E McKenzie ◽  
KJ Monahan ◽  
D Nebgen

2021 ◽  
Vol 108 (Supplement_6) ◽  
L E Spyropoulou ◽  
M Li ◽  
D Curley ◽  
E Martin ◽  
G Wynn ◽  

Abstract Introduction Whilst daily living has adapted to the “new normal” during Covid-19, colorectal cancer pathways are yet to be revised to reflect this transformation. Government advice to stay at home, hospital avoidance and reduced healthcare access, may be masking a significant proportion of population at risk. We aim to identify changes in colorectal cancer target pathways. Method All cancer referrals during the initial Covid-19 period were retrospectively analysed, recording type and date of first clinic and investigation, MDT discussion and decision to treat dates. A comparison was made with referral and treatment data from the same referral period in 2019. Results 338 referrals were received during March-April 2020, compared to 542 in 2019, indicating a 37.6% decrease. A high proportion of patients were reviewed by telephone clinic (63.4%) rather than face-to-face (23.8%), representing a significant shift in practice. An increasing number of patients were initially investigated by CT(40.2%) instead of endoscopy (37.8%). 51(15.5%) patients were not investigated, with COVID-19 being the commonest reason. 25 patients were diagnosed with colorectal cancer, of which 8(32.0%) breached the investigation and 13(52.0%) the treatment date, both usually postponed due to the pandemic. There was a 66.7% reduction in surgical management compared to 2019. Conclusions Two-week wait pathways are strained in the era of Covid-19. As the fight against the global pandemic continues, patients are mostly seen virtually and receive non-gold standard investigation. With fewer patient presentations and elective surgeries, it is important to continue colorectal cancer surveillance and timely treatment, considering possible alternative pathways.

2021 ◽  
Vol 108 (Supplement_6) ◽  
N Rees ◽  
M Okocha

Abstract Aim The aim of this quality improvement project is to assess our centre’s compliance to current NICE guidelines regarding annual mammogram follow-up for every breast cancer patient for 5 years and to elucidate any mechanisms that may optimise the efficiency of this surveillance process. Method We prospectively reviewed individual radiology requests following all wire-guided wide local excisions (WG-WLE), wide local excisions (WLE) and mastectomies undertaken at Bristol Breast Centre, a large tertiary referral centre, from January 2017-August 2020. Results Over the almost 4-year audit period, 1,885 operations were carried out. Specifically, 401 operations were performed from January 2017-June 2017, 677 from July 2017-January 2019 and 807 from February 2019-August 2020. Compliance to NICE guidelines was 95%, 100% and 95% from January 2017-June 2017, July 2017-January 2019 and February 2019-August 2020, respectively. Interestingly, compliance rates from February 2019-August 2020 varied according to the type of operation carried out; compliance was 97%, 94% and 91% for WG-WLE, WLE and mastectomy, respectively. This appears to result from the corresponding number of tardy radiological requests that were made following each of the three procedures. Specifically, the proportion of database requests filed in excess of one month post-operatively for each procedure type were 8%, 10% and 21% for WG-WLE, WLE and mastectomy, respectively. Conclusions Efficient annual mammographic surveillance depends on prompt post-operative radiological requests. Such database requests should ideally be enacted less than one month post-operatively. We suggest the adoption of an automatic electronic prompt could facilitate more effective post-operative mammogram surveillance.

2021 ◽  
pp. OP.21.00226
Florian R. Schroeck ◽  
A. Aziz Ould Ismail ◽  
Grace N. Perry ◽  
David A. Haggstrom ◽  
Steven L. Sanchez ◽  

PURPOSE: For many patients with cancer, the frequency of surveillance after primary treatment depends on the risk for cancer recurrence or progression. Lack of risk-aligned surveillance means too many unnecessary surveillance procedures for low-risk patients and not enough for high-risk patients. Using bladder cancer as an example, we examined whether practice determinants differ between Department of Veterans Affairs sites where risk-aligned surveillance was more (risk-aligned sites) or less common (need improvement sites). METHODS: We used our prior quantitative data to identify two risk-aligned sites and four need improvement sites. We performed semistructured interviews with 40 Veterans Affairs staff guided by the Tailored Implementation for Chronic Diseases framework that were deductively coded. We integrated quantitative data (risk-aligned site v need improvement site) and qualitative data from interviews, cross-tabulating salient determinants by site type. RESULTS: There were 14 participants from risk-aligned sites and 26 participants from need improvement sites. Irrespective of site type, we found a lack of knowledge on guideline recommendations. Additional salient determinants at need improvement sites were a lack of resources (“the next available without overbooking is probably seven to eight weeks out”) and an absence of routines to incorporate risk-aligned surveillance (“I have my own guidelines that I've been using for 35 years”). CONCLUSION: Knowledge, resources, and lack of routines were salient barriers to risk-aligned bladder cancer surveillance. Implementation strategies addressing knowledge and resources can likely contribute to more risk-aligned surveillance. In addition, reminders for providers to incorporate risk into their surveillance plans may improve their routines.

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