cancer

Information for patients about Lynch Syndrome, the most common cause of hereditary colorectal cancer and a number of other cancers. James W. Mold, MD, MPH

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This JAMA Patient Page describes Lynch syndrome, its risk factors and diagnosis, and its association with colorectal cancer and other specific cancers.

Author/s:

Kasey Hornbuckle, Cassandra D L Fritz

Breast Cancer Survivorship Guidelines

Rowan Hutchins — Sun, 08 Oct 2023 05:00:00 +0000

Date Added:

October 8, 2023

Journal/Publication:

Publisher:

ACS

Publication Date:

December 7, 2015

Issue:

Volume:

Pages:

URL:

Breast Cancer Survivorship Guidelines

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.3322/caac.21322

Keywords

breast cancer

cancer

cancer survivors

education of patients

PMID (1):

26642105

MeSH

breast neoplasms

Patient Advocacy

Guideline recommendations for patients who have survived breast cancer from the ACA and ASCO. James W. Mold, MD, MPH

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What Is the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline?

The Breast Cancer Survivorship Care Guideline is advice from the American Cancer Society and the American Society of Clinical Oncology to help doctors, nurses, and other health care professionals provide care for breast cancer survivors who have finished cancer treatment. The cancer survivorship care guideline addresses issues that can occur in breast cancer survivors after their treatment.

What Should I Know About Stopping Routine Cancer Screening?

Rowan Hutchins — Sun, 19 Mar 2023 05:00:00 +0000

Date Added:

March 19, 2023

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

March 13, 2023

URL:

What Should I Know About Stopping Routine Cancer Screening?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jamainternmed.2023.0088

Keywords

cancer

cancer screening

Neoplasms

PMID (1):

36912847

MeSH

early detection of cancer

Information for patients on when and why to stop getting screening tests for cancer. James W. Mold, MD, MPH

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Cancer screening tests are not perfect. Test results may suggest cancer when there is none (false-positive screen). They can also miss cancer even if it is present (false-negative screen). False-positive results can lead to emotional stress and more testing without improving health. Screening tests may also lead to overdiagnosis. Overdiagnosis is when screening tests find slow-growing forms of cancer that would never have caused symptoms or affected health if left undetected.

Author/s:

Zhang, Grace, Incze, Michael

Screening for Colorectal Cancer US Preventive Services Task Force Recommendation Statement

Saige Blanchard — Fri, 21 May 2021 05:00:00 +0000

Date Added:

May 21, 2021

Journal/Publication:

Journal of the American Medical Association

Publisher:

American Medical Association

Publication Date:

May 18, 2021

Issue:

Volume:

325

Pages:

1965-1977

URL:

Screening for Colorectal Cancer US Preventive Services Task Force Recommendation Statement

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2021.6238

Keywords

PMID (1):

34003218

MeSH

Colorectal Neoplasms

hereditary nonpolyposis

incidence

Mass Screening

intestinal polyposis

Updated USPSTF recommendations regarding CRC screening. James W. Mold, MD, MPH

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Abstract

Importance: Colorectal cancer is the third leading cause of cancer death for both men and women, with an estimated 52 980 persons in the US projected to die of colorectal cancer in 2021. Colorectal cancer is most frequently diagnosed among persons aged 65 to 74 years. It is estimated that 10.5% of new colorectal cancer cases occur in persons younger than 50 years. Incidence of colorectal cancer (specifically adenocarcinoma) in adults aged 40 to 49 years has increased by almost 15% from 2000-2002 to 2014-2016. In 2016, 26% of eligible adults in the US had never been screened for colorectal cancer and in 2018, 31% were not up to date with screening.

Objective: To update its 2016 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for colorectal cancer in adults 40 years or older. The review also examined whether these findings varied by age, sex, or race/ethnicity. In addition, as in 2016, the USPSTF commissioned a report from the Cancer Intervention and Surveillance Modeling Network Colorectal Cancer Working Group to provide information from comparative modeling on how estimated life-years gained, colorectal cancer cases averted, and colorectal cancer deaths averted vary by different starting and stopping ages for various screening strategies.

Population: Asymptomatic adults 45 years or older at average risk of colorectal cancer (ie, no prior diagnosis of colorectal cancer, adenomatous polyps, or inflammatory bowel disease; no personal diagnosis or family history of known genetic disorders that predispose them to a high lifetime risk of colorectal cancer [such as Lynch syndrome or familial adenomatous polyposis]).

Evidence assessment: The USPSTF concludes with high certainty that screening for colorectal cancer in adults aged 50 to 75 years has substantial net benefit. The USPSTF concludes with moderate certainty that screening for colorectal cancer in adults aged 45 to 49 years has moderate net benefit. The USPSTF concludes with moderate certainty that screening for colorectal cancer in adults aged 76 to 85 years who have been previously screened has small net benefit. Adults who have never been screened for colorectal cancer are more likely to benefit.

Recommendation: The USPSTF recommends screening for colorectal cancer in all adults aged 50 to 75 years. (A recommendation) The USPSTF recommends screening for colorectal cancer in adults aged 45 to 49 years. (B recommendation) The USPSTF recommends that clinicians selectively offer screening for colorectal cancer in adults aged 76 to 85 years. Evidence indicates that the net benefit of screening all persons in this age group is small. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the patient's overall health, prior screening history, and preferences. (C recommendation).

Author/s:

Davidson, K. W., Barry, M. J., Mangione, C. M., Cabana, M., Caughey, A. B., Davis, E. M., Donahue, K. E., Doubeni, C. A., Krist, A. H., Kubik, M., Li, L., Ogedegbe, G., Owens, D. K., Pbert, L., Silverstein, M., Stevermer, J., Tseng, C., Wong, J. B.

Cancer Prevalence and Risk Stratification in Adults Presenting With Hematuria: A Population-Based Cohort Study

Devin Evans — Wed, 27 Jan 2021 06:00:00 +0000

Date Added:

January 27, 2021

Journal/Publication:

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

Publisher:

Mayo Clinic

Publication Date:

January 21, 2021

URL:

Cancer Prevalence and Risk Stratification in Adults Presenting With Hematuria: A Population-Based Cohort Study

Type:

Clinical Research Results

Format:

Article

DOI (1):

https://doi.org/10.1016/j.mayocpiqo.2020.12.001

Keywords

Carcinoma, Renal Cell

MeSH

Carcinoma, Renal Cell

Hematuria

Cystoscopy

cohort studies

Ethics Committees, Research

Kidney Neoplasms

This study documents the low prevalences of urinary tract cancers in patients presenting with either gross or microscopic hematuria. James W. Mold, MP

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Abstract

Objective

To calculate the prevalence of renal cell carcinoma (RCC), upper urinary tract urothelial carcinoma (UT-UC), and lower urinary tract urothelial carcinoma (LT-UC) in patients with gross asymptomatic microhematuria (AMH) and symptomatic microhematuria (SMH).

Patients and Methods

This study was a population-based retrospective descriptive study. The study was approved by both the Mayo Clinic Institutional Review Board and the Olmsted Medical Center Institutional Review Board, and the population used was Olmsted County residents. A total of 4453 patients who presented with an initial episode of hematuria from January 1, 2000, through December 30, 2010, were included. Of the 4453 patients (median age, 58 years; interquartile range, 44.6-73.3 years), 1487 (33.4%) had gross hematuria, 2305 (51.8%) had AMH, and 661 (14.8%) had SMH.

Results

In the 1487 patients with gross hematuria, the prevalence of RCC, UT-UC, and LT-UC was 1.3%, 0.8%, and 9.0%, respectively. In the 2305 patients with AMH, the prevalence of RCC, UT-UC, and LT-UC was 0.2%, 0.3%, and 1.6%, respectively. In the 661 patients with SMH, the prevalence of RCC, UT-UC, and LT-UC was 0.6%, 0.2%, and 0.3%, respectively. Age was the most relevant risk factor for any hematuria type.

Conclusion

This unique cohort study reported that the prevalence of RCC or UC in patients with AMH and SMH was low, especially in the young cohort, and a large number of intense work-ups, such as cystoscopy and computed tomography urography, currently conducted could be omitted if stratified by hematuria type and age.

Author/s:

Takeuchi, Mitsuru, McDonald, Jennifer S., Takahashi, Naoki, Frank, Igor, Thompson, R. H., King, Bernard F., Kawashima, Akira

Association between vitamin D supplementation and mortality: systematic review and meta-analysis

Brian Desmarais — Mon, 30 Sep 2019 13:33:28 +0000

Date Added:

September 30, 2019

Journal/Publication:

BMJ

Publication Date:

August 12, 2019

URL:

Association between vitamin D supplementation and mortality: systematic review and meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1136/bmj.l4673

Keywords

cancer

cancer mortality

vitamin D

Vitamin D3 supplimentation

MeSH

cardiovascular diseases

Outcome Assessment (Health Care)

Vitamin D3 supplementation appears to reduce cancer-related mortality. It is a little hard to tell whether it works regardless of initial 25OH VitD levels as this analysis suggests. James W. Mold, MD, MPH

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Abstract

OBJECTIVE:

To investigate whether vitamin D supplementation is associated with lower mortality in adults.

DESIGN:

Systematic review and meta-analysis of randomised controlled trials.

DATA SOURCES:

Medline, Embase, and the Cochrane Central Register from their inception to 26 December 2018.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES:

Randomised controlled trials comparing vitamin D supplementation with a placebo or no treatment for mortality were included. Independent data extraction was conducted and study quality assessed. A meta-analysis was carried out by using fixed effects and random effects models to calculate risk ratio of death in the group receiving vitamin D supplementation and the control group.

MAIN OUTCOME MEASURES:

All cause mortality.

RESULTS:

52 trials with a total of 75 454 participants were identified. Vitamin D supplementation was not associated with all cause mortality (risk ratio 0.98, 95% confidence interval 0.95 to 1.02, I2=0%), cardiovascular mortality (0.98, 0.88 to 1.08, 0%), or non-cancer, non-cardiovascular mortality (1.05, 0.93 to 1.18, 0%). Vitamin D supplementation statistically significantly reduced the risk of cancer death (0.84, 0.74 to 0.95, 0%). In subgroup analyses, all cause mortality was significantly lower in trials with vitamin D3 supplementation than in trials with vitamin D2 supplementation (P for interaction=0.04); neither vitamin D3 nor vitamin D2 was associated with a statistically significant reduction in all cause mortality.

CONCLUSIONS:

Vitamin D supplementation alone was not associated with all cause mortality in adults compared with placebo or no treatment. Vitamin D supplementation reduced the risk of cancer death by 16%. Additional large clinical studies are needed to determine whether vitamin D3 supplementation is associated with lower all cause mortality.

STUDY REGISTRATION:

PROSPERO registration number CRD42018117823.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Author/s:

Zhang, Y., Fang, F., Tang, J., Jia, L., Feng, Y., Xu, P., Faramand, A.

Effects of Aspirin on Risks of Vascular Events and Cancer According to Bodyweight and Dose: Analysis of Individual Patient Data from Randomised Trials

Jeffrey Wilson — Tue, 28 Aug 2018 19:33:50 +0000

Date Added:

September 26, 2018

Journal/Publication:

Lancet

Publisher:

Elsevier

Publication Date:

August 4, 2018

Issue:

10145

Volume:

392

Pages:

387-399

URL:

Effects of Aspirin on Risks of Vascular Events and Cancer According to Bodyweight and Dose: Analysis of Individual Patient Data from Randomised Trials

Type:

Meta-analyses, Reviews, and Guidelines, Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/S0140-6736(18)31133-4

Keywords

aspirin

cardiovascular events

cancer

PMID (1):

30017552

MeSH

disease, cardiovascular

aspirin

Neoplasms

This analysis of multiple large aspirin trials found that 81mg of aspirin was only effective for reducing the risk of cardiovascular events in patients weighing less than 70kg. Doses >325mg were effective in those weighing more than 70kg. While not definitive, this study suggests that aspirin’s effect is dose dependent. That may explain some of the contradictory findings from the various published trials.

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BACKGROUND:

A one-dose-fits-all approach to use of aspirin has yielded only modest benefits in long-term prevention of cardiovascular events, possibly due to underdosing in patients of large body size and excess dosing in patients of small body size, which might also affect other outcomes.

METHODS:

Using individual patient data, we analysed the modifying effects of bodyweight (10 kg bands) and height (10 cm bands) on the effects of low doses (≤100 mg) and higher doses (300-325 mg or ≥500 mg) of aspirin in randomised trials of aspirin in primary prevention of cardiovascular events. We stratified the findings by age, sex, and vascular risk factors, and validated them in trials of aspirin in secondary prevention of stroke. Additionally, we assessed whether any weight or height dependence was evident for the effect of aspirin on 20-year risk of colorectal cancer or any in-trial cancer.

RESULTS:

Among ten eligible trials of aspirin in primary prevention (including 117 279 participants), bodyweight varied four-fold and trial median weight ranged from 60·0 kg to 81·2 kg (p<0·0001). The ability of 75-100 mg aspirin to reduce cardiovascular events decreased with increasing weight (pinteraction=0·0072), with benefit seen in people weighing 50-69 kg (hazard ratio [HR] 0·75 [95% CI 0·65-0·85]) but not in those weighing 70 kg or more (0·95 [0·86-1·04]; 1·09 [0·93-1·29] for vascular death). Furthermore, the case fatality of a first cardiovascular event was increased by low-dose aspirin in people weighing 70 kg or more (odds ratio 1·33 [95% CI 1·08-1·64], p=0·0082). Higher doses of aspirin (≥325 mg) had the opposite interaction with bodyweight (difference pinteraction=0·0013), reducing cardiovascular events only at higher weight (pinteraction=0·017). Findings were similar in men and women, in people with diabetes, in trials of aspirin in secondary prevention, and in relation to height (pinteraction=0·0025 for cardiovascular events). Aspirin-mediated reductions in long-term risk of colorectal cancer were also weight dependent (pinteraction=0·038). Stratification by body size also revealed harms due to excess dosing: risk of sudden death was increased by aspirin in people at low weight for dose (pinteraction=0·0018) and risk of all-cause death was increased in people weighing less than 50 kg who were receiving 75-100 mg aspirin (HR 1·52 [95% CI 1·04-2·21], p=0·031). In participants aged 70 years or older, the 3-year risk of cancer was also increased by aspirin(1·20 [1·03-1·47], p=0·02), particularly in those weighing less than 70 kg (1·31 [1·07-1·61], p=0·009) and consequently in women (1·44 [1·11-1·87], p=0·0069).

INTERPRETATION:

Low doses of aspirin (75-100 mg) were only effective in preventing vascularevents in patients weighing less than 70 kg, and had no benefit in the 80% of men and nearly 50% of all women weighing 70 kg or more. By contrast, higher doses of aspirin were only effective in patients weighing 70 kg or more. Given that aspirin's effects on other outcomes, including cancer, also showed interactions with body size, a one-dose-fits-all approach to aspirin is unlikely to be optimal, and a more tailored strategy is required.

Author/s:

Rothwell, Peter M., Cook, Nancy R., Gaziano, J. Michael, Price, Jacqueline F., Blech, Jill F. F., Roncaglioni, Maria Carla, Morimoto, Takeshi, Mehta, Ziyah