Deirdre Fuller, Oncology Roundtable
The U.S. Preventive Services Task Force (USPSTF) just released a draft recommendation for annual lung screening in high-risk individuals. This decision is a major step in advancing the acceptance of low-dose CT screening and securing insurance coverage for high-risk patients.
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Lauren Stentz, Oncology Roundtable
Physicians should find significantly more polyps during screening colonoscopies than national benchmarks suggest, according to a recent Mayo Clinic study. With the increasing prevalence of high-definition colonoscopy technology, Mayo researchers believe that national standards need to be reevaluated.
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Our colleagues at the Imaging Performance Partnership recently posted an article summarizing the results of a Journal of Medical Screening review of European studies on service screening for breast cancer.
Researchers uncovered a significant mortality benefit from screening, upending skeptical studies and reports published over the past few months.
In case you didn’t see the article, we've reposted it below.
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My colleague Nicholas Bartz from the Imaging Performance Partnership recently wrote a nice summary and analysis of the results from the NCI's National Lung Screening Trial, and I wanted to pass it along:
In October 2010 the National Cancer Institute announced a premature end to its National Lung Screening Trial after finding that low-dose CT screening of high-risk participants was associated with a 20 percent mortality reduction. Now, as the first formal report of that trial appears in the New England Journal of Medicine, both the trial's researchers and outside parties are raising questions as to whether CT lung screening is ready to be implemented on a broad scale.
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My colleagues in Technology Insights just reported on yet another conflicting study on mammography that I wanted to share:
A new study published in the British Medical Journal is reigniting the debate over mammography as a screening tool. Lead author Dr. Phillipe Autier looked at historical data from 1980 to 2006 to determine the impact of screening mammography on breast cancer-related mortality in six European countries. The greatest decrease in mortality over this 26 year period was seen in women ages 40 to 49. However, there was not a correlation between decreases in mortality and the availability of screening mammography in these countries. Accordingly, the authors have concluded that there is no impact on breast cancer mortality as a result of screening mammography. Rather, the authors infer that improved treatments for breast cancer and efficiencies in healthcare are more likely responsible for this decrease.
This and other studies published on the efficacy of screening mammography seem at odds with new recommendations from the American College of Obstetrics and Gynecology (ACOG). This week, ACOG released updated guidelines recommending screening mammography annually for all women over 40. ACOG revised its earlier recommendations of annual screening at 50 due to new evidence that more aggressive tumors have shorter sojourn times (time from detection to symptoms) in women under 50, and that reductions in mortality due to screening are similar for women in their 40s and 50s. ACOG emphasizes the importance of communicating the risk of false positives to women receiving screening mammography as this risk increases with more frequent imaging. This high false positive rate is also referenced in the widely-discussed USPSTF guidelines from 2009 that recommend biennial screening at age 50.
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Vanderbilt's Ingram Cancer Center recently launched a new online tool designed to help physicians interpret genetic test results. According to the press release:
With just a few clicks, users can get up-to-date information on the clinical significance of specific mutations."
Here's how it works: A doctor receives tumor profiling results from the lab that show a mutation in a specific gene. The doctor remembers a little about the gene, but hasn't seen that result very often, as it is relatively uncommon.
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With the promising initial results reported from the National Lung Screening Trial in November (previously covered here), enthusiasm around the promise of CT screening for lung cancer has begun to grow. Compounding this trend is a smaller study, recently published in the journal Lung Cancer (and discussed here), which concludes that the use of CT scans can reduce mortality in regular smokers by as much as 64% over a six year period. The study examined the lung cancer mortality rate for a cohort of 8,000 regular smokers who underwent CT screening, comparing the results to two unscreened cohorts. While the degree of efficacy varied by the cohort being compared and statistical method used, every iteration of the analysis showed a reduction in the rate of lung cancer deaths from 36-64% in those undergoing CT screening, collaborating similar results reported from the NLST.
Despite the growing evidence of its efficacy, questions still abound with respect to how CT should be used to screen for lung cancer. The lack of clear guidelines for when and how often screenings should be performed, the propensity for the screenings to yield false positives, and the current lack of reimbursement all suggest that it may be some time before CT screening for lung cancer becomes standard of care. With that said, in an era when discussions of appropriateness seem to consistently identify scans that do not need to be performed, CT scanning for lung cancer may ultimately emerge as one instance in which appropriateness means ordering more scans, not fewer.
My colleague Brian Maher from Technology Insights recently wrote the following article on breast imaging technologies that I thought would be of interest:
Each year, after reviewing high-impact publications and findings from major clinical conferences, my research team and I like to reflect on the key imaging technology trends we've seen across the past year, and forecast how many of these trends will impact the provision of imaging services in the future.
One trend which continues to amaze us is the ever-increasing number of modalities which can be deployed at various stages in the breast cancer imaging pathway. From screening to diagnosis, from staging and pre-surgical planning to treatment monitoring, over a dozen different modalities are jockeying for position. Presently, 2D digital mammography, ultrasound, and breast MRI are considered to be "must have" technologies, representing the accepted clinical standards for various indications. However, while each of these modalities has a distinct and validated role in the care pathway, they also have their respective shortcomings, which are clinical and/or operational in nature.
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