Promising Advances in Early Cancer Detection

Early detection is key in the fight against cancer. Since most therapy is focused around treating cells at the site of origin, it is important to detect cancerous cells as early as possible, before it has had the chance to metastasize. Therefore, having testing procedures to detect cancer at initial onset is vital to successfully eliminate the disease.

The most effective screening test would possess attributes such as being non-invasive, safe, reliable and inexpensive. The Pap smear developed in the 1930s was one of the first screening tests available for cervical cancer, and has since become routine for women during yearly pelvic exams. This procedure is inexpensive and relatively non-invasive although it may be uncomfortable for some. However, the reliability is scrutinized due to the incident of false positives where cells are wrongly diagnosed as cancerous. This screening procedure requires subjective analysis by a cytologist reading hundreds of samples a day, at this point, human error becomes inevitable. Despite the shortcomings, most would agree that they would elect to take the test.

Other diagnostic procedures include imaging techniques, endoscopy, and biopsy. Imaging techniques, such as x-ray and MRI, are not invasive like endoscopy and biopsies, but most of these techniques are only effective at later stages in cancer development for obvious reasons. Many of these procedures are used as a final definitive screen in diagnosis because they do carry some patient risk.

The field of biomarker screening in biological fluids such as blood and urine has really become the focal point of cancer research for early detection. The routinely used prostate-specific antigen (PSA) and Cancer Antigen CA-125 screens measure individual biomarkers. Although these are good screening tools, the new wave of biomarker screening is focused on forms of testing that can cover a broad spectrum of cancer types in one analysis.

Exosome Diagnostics is researching & developing a newly discovered cancer cell fragment called exosomes. Tumors shed exosomes into the blood supply and these exosomes carry genetic material and proteins that can reveal the type and progression of the cancer.

ONCOblotR Labs has a Laboratory Developed Test that is a blood test for cancer. The test uses a protein screening method and focuses on ENOX2 protein expressed only by cancer cells. These proteins are shed into the circulation and can be detected in the blood. Different cancers produce a different type of ENOX2 protein that is identified by the ONCOblotR Test. Therefore, the origin of the cancer can be detected. Both of these revolutionary tests can detect cancer very early, even before clinical symptoms are presented.

The future of screening and diagnostic testing looks promising and provides another valuable tool to fight cancer. These early detection capabilities are especially promising for those types that can only be detected at later stages when clinical symptoms arise and survival rates are low. Tests such ONCOblotR and Exosome Diagnostics' RNA tests are limitless. These procedures are high- throughput and all-encompassing so new cancer types will be added as additional markers are found. As research continues in the area of high-throughput biomarker screening, early detection will certainly save millions of lives.

Cheri M. Turman, PhD. - Cheri completed her bachelor's degree in chemistry with a minor in biology and a master's degree in chemistry specializing in biotechnology from Stephen F. Austin State University. She received her doctorate at The University of Texas Health Science Center at Houston and MD Anderson Cancer Center specializing in biochemistry and molecular biology. Cheri consults with ONCOblotR Labs, which offers the ONCOblotR Test. To read more about ONCOblotR Labs, and their latest test for cancer visit their website at http://www.oncoblotlabs.com/ .

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Early Stage Testicular Cancer - Surveillance Is Best Follow-Up Strategy

Editor's Choice
Academic Journal
Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 17 May 2013 - 0:00 PDT Current ratings for:
Early Stage Testicular Cancer - Surveillance Is Best Follow-Up Strategy

A long-term study of men with stage I seminoma, a common form of testicular cancer, suggests that surveillance for cancer recurrence, rather than additional chemotherapy or radiation therapy, is sufficient for the vast majority of patients who have undergone successful surgery for their cancer.

In a new long-term study conducted in Denmark, researchers analyzed a national clinical database and found that 99.6% of patients who only underwent surveillance (following a successful surgery) were alive after 10 years of being diagnosed with testicular cancer.

Surveillance means carrying out routine CT scans, physical exams, chest X-ray exams, and blood tests for a period of five years after surgery.

In some countries, such as Denmark (where the study took place), the preferred follow-up strategy is surveillance alone. In the U.S. half of patients undergo either radiotherapy or chemotherapy as follow-up treatment, while the other half only receive surveillance.

There has been a recent increase in the number of patients undergoing surveillance alone in the U.S., a trend that will likely continue following this new finding.

Treatment options such as chemotherapy or radiotherapy can cause very harmful side effects, including a higher risk of secondary cancers (such as leukemia). Therefore, other follow-up strategies that don't incur such drastic risks, such as surveillance alone, are preferred.

Mette Sakso Mortensen, MD, a PhD student at the Department of oncology at the Copenhagen University Hospital in Copenhagen, Denmark, said:

"To our knowledge, this study is the largest to address this issue in patients with stage I seminoma, and with the longest follow-up. Now we have solid proof that surveillance is safe and appropriate for most patients with this particular cancer.

We also characterized key prognostic factors for relapse, which can help us identify high-risk patients who may need adjuvant therapy instead of surveillance. However, in general, seminoma stage I patients can safely be followed on a surveillance program."

A total of 1,822 men with stage I seminoma, who underwent successful surgery were followed on a five year surveillance program. The researchers were able to follow the patients for an average of 15.4 years.

19.5 percent of the patients experienced a relapse, of whom 216 received radiotherapy while 136 received chemotherapy and only 3 underwent surgery.

The 10-year-cancer-specific survival rate was 99.6 percent, which translates into four men dying out of every 1,000 who underwent surveillance alone.

The risk of relapse increased among patients whose tumor size was bigger than 1.5 inches and spread to lymphatic vessels or blood, as well as those whose levels of a blood marker called human chorionic gonadotropin were high.

Even though testicular cancer is quite rare among the general population, it is the most common solid tumor among young men. Approximately 4,000 people will be diagnosed with stage I seminoma this year in the U.S.

ASCO President-Elect Clifford A. Hudis, MD, said:

"This important study is one of several recent reminders that sometimes "less is more? in patient care. Opting for surveillance spares patients, most of whom are young men, from the harmful side effects of chemotherapy and radiation without diminishing their chances for a long and healthy life."

Scientists at UC Davis found that frequent CT scanning for testicular cancer surveillance was associated with secondary malignancies.

Written by Joseph Nordqvist
Copyright: Medical News Today
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Single-dose Radiation in Early Breast Cancer

A single dose of radiotherapy delivered at the time of surgery may be an effective alternative to external beam radiation delivered over several weeks among selected patients with early breast cancer. Findings of this international Phase III trial were published in The Lancet.

Treatment for early-stage breast cancer often involves breast conserving surgery (lumpectomy), which may be followed by radiation therapy to decrease risk of recurrence. ?Two methods of delivering radiation include:

External beam radiation: High-energy rays are delivered to the breast from a machine outside the body over several weeks. Single dose intraoperative therapy: One dose of radiation is delivered at the time of surgery.

To compare the outcomes of a single dose of targeted radiotherapy delivered at the time of surgery with those of external beam radiation delivered over several weeks, researchers evaluated the two approaches in more than 2,000 women with early breast cancer. Participants were aged 45 or older. Approximately half the patients received a single dose of radiotherapy at the time of surgery, and approximately half received external beam radiation over several weeks. All women underwent breast-conserving surgery.

At four years outcomes of both approaches were similar: There were six local recurrences in the targeted radiation group compared with five in the external beam radiation group. As well, both groups experienced similar side effects and frequency of side effects.

It appears that among some patients with early breast cancer, a single dose of radiotherapy at the time of surgery may be an effective alternative to several weeks of external beam radiation therapy. The researchers caution, however, that these findings may not apply to all patients with early breast cancer, as this study evaluated only women who were 45 or older and considered appropriate candidates for breast-conserving surgery.? In addition, the follow-up remains too short to draw definitive conclusions. It will be important to see if there is any change in the results over time.

Reference: ?Vaidya JS, Joseph DJ, Tobias, JS, et al. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. The Lancet [early online publication]. June 5, 2010.

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Many Breast Cancer Patients Taking Adjuvant Hormonal Therapy Stop Treatment Early

Less than half of early-stage breast cancer patients with hormone-sensitive disease completed the full dose and schedule of their hormonal therapy treatment. These findings were recently published in the Journal of Clinical Oncology.[1]

The majority of breast cancers are hormone receptor-positive. These cancers are stimulated to grow by the circulating female hormones estrogen and/or progesterone. Treatment of hormone receptor-positive breast cancer often involves hormonal therapies that suppress or block the action of estrogen. These therapies include tamoxifen as well as agents known as aromatase inhibitors. Tamoxifen acts by blocking estrogen receptors, whereas aromatase inhibitors suppress the production of estrogen in postmenopausal women.?

Possible side effects of aromatase inhibitors include joint pain, decreased bone density, hot flashes, and vaginal dryness. Tamoxifen is associated with some side effects similar to symptoms of menopause, which include hot flashes, irregular menstrual periods and vaginal discharge or bleeding. Not all women will experience these symptoms. There is a small increase in the number of blood clots in individuals taking tamoxifen. In addition, tamoxifen appears to increase a woman’s risk of developing uterine cancer, though the risk is less than 1% over a 5-year course of treatment.?

Due to the duration of treatment with adjuvant hormonal therapy as well as possible side effects of treatment, patient adherence and continuation of therapy for the full duration can be challenging. According to the results of a study conducted in Ireland, many women who begin taking tamoxifen for the adjuvant treatment of breast cancer discontinue use (without switching to another hormonal therapy) before completing five years of treatment.[2] In this study, older and younger patients were more likely to discontinue treatment as well as patients with additional health problems. Results from another study indicated that noncompliance with tamoxifen is common and results in significantly increased risk of recurrence.[3] Medication adherence is very important in order to reduce risk of cancer recurrence or mortality. Researchers recently conducted a study in early-stage breast cancer patients receiving tamoxifen and/or an aromatase inhibitor in order to better understand adherence and continuation issues in this patient population.

In the current study, researchers evaluated pharmacy records of 8,769 Stage I-III hormone-sensitive breast cancer patients. Forty-three percent were undergoing hormonal therapy with tamoxifen, 26% with an aromatase inhibitor, and 30% with both tamoxifen and an aromatase inhibitor (sequentially). From the pharmacy records, hormonal therapy prescriptions and dates of refill were analyzed in order to determine rates of therapy discontinuation and adherence. The researchers were also able to analyze factors associated with suboptimal hormonal therapy dose or schedule from the pharmacy data. Of the 8,769 patients evaluated in this study, only 49% completed adjuvant hormonal therapy at the full dose and schedule. Factors associated with stopping treatment early included younger or older age as well as the presence of additional medical problems (comorbidites). Lumpectomy versus mastectomy was also associated with stopping treatment early. Factors associated with completing therapy included Asian race and being married. Treatment with chemotherapy and radiation in addition to hormonal therapy was also associated with completing hormonal therapy.?

These researchers concluded that “interventions to improve adherence and continuation of hormonal therapy are needed, especially for younger women.” This study confirms findings of other studies evaluating hormonal therapy adherence issues. Strategies to improve patient adherence to treatment schedules and doses are critical to improve recurrence rates, especially for oral therapy like adjuvant hormonal therapy. It is critical for breast cancer patients who are undergoing treatment with adjuvant hormonal therapy to understand the risks and benefits of treatments as well as to understand the risks of stopping treatment early.?

References:

[1] Hershman DL, Kushi LH, Shao T, et al. Early Discontinuation and Nonadherence to Adjuvant Hormonal Therapy in a Cohort of 8,769 Early-Stage Breast Cancer Patients. Journal of Clinical Oncology. [early online publication]. June 28, 2010.

[2] Barron TI, Connolly R, Bennett K, Feely J, Kennedy MJ. Early discontinuation of tamoxifen: a lesson for oncologists. Cancer [early online publication]. January 22, 2007.

[3] Ma AMT, Barone J, Wallis AE, et al. Noncompliance with adjuvant radiation, chemotherapy, or hormonal therapy in breast cancer patients. American Journal of Surgery. 2008;196:500-504.

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Diagnosis of Early Breast Cancer Doesn’t Shorten Life Expectancy of Older Women

Among women age 67 or older, a diagnosis of ductal carcinoma in situ (DCIS) or Stage I breast cancer doesn’t appear to worsen survival; survival is similar to that of older women without breast cancer. Diagnosis of more advanced breast cancer, however, is linked with worse survival. These results were published in the Journal of Clinical Oncology.

Older women are a rapidly expanding segment of the U.S. population. The incidence of breast cancer increases with age, but it’s been uncertain how a diagnosis of breast cancer (particularly early-stage breast cancer) affects life expectancy among older women.

To explore the impact of a breast cancer diagnosis on the survival of older women, researchers conducted a study among more than 64,000 women who had been diagnosed with breast cancer at age 67 or older. Survival in these women was compared with survival in a group of similarly aged women without breast cancer. In the analysis, the researchers accounted for the other health problems, prior mammography use, and sociodemographic variables.??

Women who were diagnosed with DCIS or Stage I breast cancer and received standard treatment had similar survival to women without breast cancer. The most common cause of death among women with DCIS or Stage I breast cancer was cardiovascular disease. Women with Stage II or higher breast cancer had shorter survival than women without breast cancer. Risk of death was 50% higher among women with Stage II breast cancer, three-times higher among women with Stage III breast cancer, and close to 10-times higher among women with Stage IV breast cancer. The survival differences between women with advanced breast cancer and women without breast cancer decreased with age.

These results suggest that among older women, a diagnosis of DCIS or Stage I breast cancer does not shorten life expectancy.

Reference: Shonberg MA, Marcantonio ER, Ngo L, Li D, Silliman RA, McCarthy EP. Causes of death and relative survival of older women after a breast cancer diagnosis. Journal of Clinical Oncology. Early online publication March 14, 2011.

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