Ground-breaking Lung Cancer Breath Test in Clinical Trial

What You Need to Know: Medical researchers are evaluating a revolutionary device which detects lung cancer in early stages by evaluating breath. It is hoped that the LuCID (Lung Cancer Indicator Detection) program will lead to a non-invasive method of diagnosing lung cancer in the early stages.

A clinical trial led by University of Leicester respiratory experts into a potentially ground-breaking ‘breath test’ to detect lung cancer is set to get underway at the Glenfield Hospital in Leicester (England). The device works by measuring volatile organic compounds (VOCs) at low concentrations in a patient’s breath and offers a cheaper and smaller alternative to existing detection technologies.

Study leader Dr Salman Siddiqui offers: “Lung cancer has one of the lowest 5-year survival rates of all cancers, however early diagnosis can greatly improve a patient’s prognosis. Current diagnostic procedures such as a chest X-ray, CT scan and bronchoscopy are costly and not without risks so the benefits of a non-invasive, cheaper alternative are clear.

My Take: Can’t wait. For now, if you have a significant history of cigarette smoking (for example, 1 pack per day for at least 30 years, or 2 ppd for 15 years), ask your health care provider if a screening CT scan might be appropriate for you. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minuteable now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: University of Leicester. “Ground-breaking lung cancer breath test in clinical trial.” ScienceDaily. ScienceDaily, 14 February 2015. <www.sciencedaily.com/releases/2015/02/150214201621.htm>.

Would A Lottery Ticket Tempt You to Get Colon Cancer Screening?

What You Need to Know: Convincing patients to do an often dreaded colon cancer screening test could just take a little extra nudge – like a chance to win $50. Patients who were told they had a 1-in-10 chance of winning $50 were more likely to complete home stool blood tests that help screen for colon cancer, according to a new study.

“Our study is another example of how modest financial incentives may go a long way in improving health behaviors and health care quality,” says author Jeffrey Kullgren, M.D., M.S. M.P.H. “Integrating a small lottery incentive into usual care is a low cost tool with potential to promote patients’ use of a service proven to saves lives by catching cancer early.”

Background: Officially called a fetal occult blood test, the home kit requires patients to take a sample of their bowel movement and mail it to a lab. The test helps detect hidden, microscopic blood in stool that may be an early sign of abnormal growths (polyps) or cancer in the colon. It is the least expensive way to screen for colon cancer and is recommended annually for people over the age of 50, but only about one-third of patients who are prescribed the home kit actually complete it.

The Study: Researchers wanted to see what price might help reverse the trend, looking at whether flat dollar amounts of up to $20, a chance to win $50 or raffle for $500 could be an effective incentive. The $50 lottery approach had the greatest impact, increasing the test completion rate by 20 percent. The study was done at the Philadelphia (USA) Veterans Affairs Medical Center among 1,549 patients who were prescribed the blood stool test.

“Fecal occult blood tests are inexpensive and an effective way to find colon cancer early and save lives. It’s up to the patient, however, to do this test at home and unfortunately completion rates are low,” says Kullgren, who is also a member of U-M’s Institute for Healthcare Policy and Innovation.

My Take: Low cost incentives may help us to improve our ability to prevent chronic diseases. This approach is worthy of more exploration in a number of health areas. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: University of Michigan Health System. “Need to encourage patients to screen for colon cancer? Try a lottery.” ScienceDaily. ScienceDaily, 17 November 2014. <www.sciencedaily.com/releases/2014/11/141117174330.htm>.

Mammograms: Are “Fancy” Ones Cost-Effective?

What You Need to Know: Mammograms are less accurate in women with dense breast tissue. About 10% of women have very dense breasts, while another 40% have some degree of breast density. Tomosynthesis (3D) mammograms appear to be more effective than standard mammograms for women with dense breasts. A new study suggests that tomosynthesis is also cost-effective.

The Study: To investigate whether tomosynthesis would be a clinically effective and cost-effective approach, researchers from Fred Hutchinson Cancer Center (Seattle, USA) used an established breast cancer simulation model to compare biennial screening with digital mammography plus tomosynthesis with mammography only for women 50 to 74 years old. Their model considered costs from the federal (USA) payer perspective, and used a lifetime horizon.

Findings: Adding the second test would result in an incremental cost per quality-adjusted life year (QALY) gained of US$53,893, the researchers found. (Less than US$100,000 per QALY is considered cost-effective.)

For every 2,000 women screened, over 12 rounds of screening, one breast cancer death would be avoided. Adding tomosynthesis to digital mammography would also avoid 405 false-positives for every 1,000 women screened, over 12 rounds of screening.

Tomosynthesis involves taking lower-dose mammography “slices” of the breast using a rotating gantry, and combining them into a loop, author Dr. Christopher Lee explained. “It does require either a new mammography unit or an add-on to an existing mammography unit,” he said. “Most places could just add on a part to their existing digital mammography unit and be able to conduct tomosynthesis, but it is an up-front institutional cost and that is not factored into our analysis.”

Ultrasound for supplemental screening would result in more false positives, while screening magnetic resonance imaging would be prohibitively expensive, the researcher noted.

While research is still in the very early stages, Dr. Lee said, it’s possible that the mammography/tomosynthesis approach might be beneficial for all women, not only those with dense breasts. “This may apply to all women, but we did not study that in this particular analysis,” he said.

He and his colleagues conclude: “Our analysis, conducted by using currently available data, provides women, physicians, payers, and policymakers in the United States with much-needed information regarding the comparative effectiveness of combined mammography and tomosynthesis screening relative to mammography screening alone. Our results suggest that biennial combined screening for women aged 50-74 years with dense breasts is a cost-effective approach from a federal payer perspective if priced appropriately (below a threshold combined screening cost of $226 vs $139 for digital mammography alone) and if interpretive performance metrics of improved specificity are met in routine practice.”

I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

SOURCE: http://bit.ly/1wFJqpE; Radiology 2014.

Breath Temperature: Can We Tell if You Have Lung Cancer?

What You Need to Know: The temperature of exhaled breath could be used to diagnose lung cancer. Results of a recent study demonstrate that patients with lung cancer have a higher breath temperature than those without. The temperature also increases with the number of years a person had smoked and the stage of their lung cancer.

Background: Many research teams have been looking at the possibility of using breath tests for a number of cancers. This is the first study looking at breath temperature as a marker in lung cancer.

The Study: The research, presented at the European Respiratory Society (ERS) International Congress in Munich, suggests that testing the temperature of breath could be a simple and noninvasive method to either confirm or reject the presence of lung cancer. The researchers enrolled 82 people in the study who had been referred for a full diagnostic test after an x-ray suggested the presence of lung cancer. 40 patients received a positive diagnosis, while 42 patients had the diagnosis rejected. Researchers measured the temperature of exhaled breath in all patients using a breath thermometer device, known as an X-Halo device.

Results: Patients with lung cancer had a higher breath temperature than those without. Breath temperature also increased with the number of years a person had smoked and the stage at which their lung cancer had developed. The researchers also identified a cut-off value in the measurement of temperature, which they proved could identify lung cancer with a high level of accuracy.

Professor Giovanna Elisiana Carpagnano, lead author of the study from the University of Foggia, Italy, said: “Our results suggest that lung cancer causes an increase in the exhaled temperature. This is a significant finding and could change the way we currently diagnose the disease. If we are able to refine a test to diagnose lung cancer by measuring breath temperature, we will improve the diagnostic process by providing patients with a stress-free and simple test that is also cheaper and less intensive for clinicians.”

My Take: Exciting. But not ready for general use. So: 1) Don’t smoke; 2) If you smoke, quit; 3) if you have a 30 pack-year history of cigarette use (fro example, 1 pack per day for 30 years, or 2 packs per day for 15), ask your healthcare provider whether you may be a candidate for a low-dose screening CT scan. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: European Lung Foundation. “Breath temperature test could identify lung cancer.” ScienceDaily. ScienceDaily, 8 September 2014. <www.sciencedaily.com/releases/2014/09/140908083738.htm>.

FAST MRI: A 3-minute MRI for Breast Cancer Screening

What You Need to Know: An MRI screening protocol for breast cancer that takes just 3 minutes is as good as a regular MRI that takes 21 minutes, and more accurate than digital mammography, according to a proof-of-concept study published in the August 1 issue of the Journal of Clinical Oncology.

What: The accelerated MRI was as good as regular MRI for detecting 11 invasive breast cancers that had escaped detection on regular mammography, report Christiane A. Kuhl, MD, and colleagues from the University Hospital of Aachen in Bonn, Germany.

“MRI is the technique of the future [for screening]. Ionizing radiation is not involved. Compared with digital mammography, it is highly sensitive, and overdiagnosis is less of a problem, contrary to current notions,” Dr. Kuhl told Medscape Medical News.

How: Dr. Kuhl’s team “stripped down MRI to the essential part that makes for fast acquisition,” she explained. For the 3-minute protocol, the radiologist reads the first postcontrast subtracted (FAST) and maximum-intensity projection images; for the full diagnostic protocol, all the images are read. The screening accuracy of the accelerated MRI is similar to that of a full diagnostic MRI, she added.

The accelerated protocol “is a huge step forward in breast cancer screening,” writes Elizabeth A. Morris, MD, chief of breast imaging services at the Memorial Sloan Kettering Cancer Center in New York City, in an accompanying editorial. “Data clearly demonstrate that FAST breast MRI could be the standard for breast cancer screening: it is safe, does not induce cancers, and can find more cancers than mammography,” she explains.

The study consisted of 443 asymptomatic women at mild to moderate risk for breast cancer. They had all undergone digital mammography, and the women with dense or extremely dense breasts had also undergone ultrasound screening, all with negative results. The women then underwent MRI screening, which identified 11 breast cancers — 7 invasive cancers and 4 ductal carcinoma in situ. The identification of these 11 cancers provided an additional cancer yield of 18.3 per 1000.

My Take: Though not ready for general use, fast MRI is promising. In the screening setting, the investigators achieved a high detection rate. They accomplished this without a high false-positive rate, suggesting that we may have a quality screening test. The negative predictive value (the test says no cancer, when there really is no cancer) was 99.8%. Currently, I believe that 3D (tomosynthesis) mammograms represent the best technology for screening women at average risk. If you have a high risk for breast cancer, ask about risk-reducing methods (including tamoxifen), and whether you should add MIR to your mammogram routine. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

References: http://www.medscape.com/viewarticle/830245; 2014 August 1 issue of the Journal of Clinical Oncology.

Here We Go Again: The Great Mammogram Debate

mammograms mediolateral views

A comprehensive review of 50 year’s worth of international studies assessing the benefits and harms of mammography screening suggests that the benefits of the screening are often overestimated, while harms are underestimated. The authors report that the best estimate of the reduction in mortality from breast cancer due to annual screening for women overall is about 19 percent. For women in their 40s, the reduction in risk was about 15 percent, and for women in their 60s, about 32 percent. But how much a woman benefits depends on her underlying risk of breast cancer.

Background: The American Cancer Society estimates that about 40,000 U.S. women will die of breast cancer this year. In 2009, based on evidence that the benefit-risk ratio for mammography screening is higher among women over 50 and with less frequent screening, the U.S. Preventive Services Task Force (USPSTF) reversed its previous recommendation of mammography every one to two years beginning at age 40, and recommended routine screening every two years starting at age 50, the researchers noted. The recommendations remain controversial among the general public and the medical community. Recent evidence suggests that use of mammography in the U.S. has not changed following the updated recommendations.

“What I tell my patients is that the mammogram is not a perfect test,” said Nancy Keating, co-author of the report, associate professor of Health Care Policy at HMS and associate professor of medicine at Brigham and Women’s. “Some cancers will be missed, some people will die of breast cancer regardless of whether they have a mammogram, and a small number of people that might have died of breast cancer without screening will have their lives saved.”

The researchers estimated that among 10,000 women in their 40s who undergo annual mammography for 10 years, about 190 will be diagnosed with breast cancer. Of those 190, the researchers estimate that about 5 will avoid death from breast cancer due to screening. About 25 of the 190 would die of breast cancer regardless of whether they have a mammogram or not. The rest will survive, thanks largely to advances in breast cancer treatment.

However, according to Keating, the chief harm associated with mammography is the risk of overdiagnosis. This is the diagnosis of cancers that never would have become clinically evident during a woman’s lifetime, either because the cancer never grew or because the patient died first of another cause. While it is impossible with current techniques to know which cancers we could safely observe and which need to be treated, the review cites findings that roughly 19 percent of women who are diagnosed based on findings from a mammogram are overdiagnosed. That means that roughly 36 of the 190 women who received annual mammography for 10 years and were diagnosed with breast cancer would receive unnecessary surgery, chemotherapy or radiotherapy.

My Take: I suspect that this study underestimates the benefits of mammograms, given the study includes results obtained with ancient techniques from decades ago! Still, most women at average risk overestimate the benefits of mammograms. I think that in the future, we will do a much better job of individualizing screening recommendations, incorporating risk factors such as breast density, age, family history, personal history, and perhaps race. Much of the controversy regarding mammograms today has to do with the fact that we have to screen so many to save a life. But what is the “right” ratio of screened to saved? That is a more challenging societal question.

I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

References: 1. Lydia E. Pace, Nancy L. Keating. A Systematic Assessment of Benefits and Risks to Guide Breast Cancer Screening Decisions. JAMA, 2014; 311 (13): 1327 DOI: 10.1001/jama.2014.1398; 2. Harvard Medical School. “The mammography dilemma: 50 years of analysis.” ScienceDaily. ScienceDaily, 1 April 2014. <www.sciencedaily.com/releases/2014/04/140401162150.htm>.

 

Mammograms: What’s A Gal To Do?

mammograms radiology tech examines

The issue of potential harms from mammography has been aired again, this time in a New York Times op-ed piece declaring that the false alarms in breast cancer screening “are a problem that needs to be fixed.”

The op-ed article was based (and broke the embargo by a few hours) on a commentary published online December 30 in JAMA Internal Medicine, which accompanied a small prospective study of a decision aid to help women to get a better handle on the benefits and risks.

The Study: Women 75 years and older, who were given a decision aid pamphlet outlining the risks and benefits of breast cancer screening. They reported being better informed about the potential tradeoffs and appeared to feel less conflicted about their ultimate choices, report Mara A. Schonberg, MD, MPH, and colleagues from Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, Massachusetts.

In the commentary, H. Gilbert Welch, MD, MPH, and Honor J. Passow, PhD, from the Geisel School of Medicine at Dartmouth University in Hanover, New Hampshire, estimate that of 1000 US women aged 50 years who are screened annually for a decade, 0.3 to 3.2 will be spared from dying of breast cancer, 490 to 670 will have at least 1 false-positive result, and 3 to 14 will be overdiagnosed and overtreated.

Is that acceptable? Read the response of the authors to these findings:

Dr. Welch says that a “screening program that falsely alarms about half the population is outrageous” and that “[w]hether you blame the doctors or the system or the malpractice lawyers, it’s a problem that needs to be fixed.”

So what can we do?

“Our suspicion is that the top priority for most women would be to have a more precise estimate of the benefit in the current treatment era. It has been 50 years since a randomized trial of screening mammography has been done in the United States. Given the exposure of tens of millions American women to this intervention, perhaps we are due for a second look,” they write.

My Take: 42 of the 45 women said that they found the decision aid helpful, and 43 said they would recommend it to others. This is a step forward. Looking ahead, we need to do a better job of individualizing screening recommendations to the individual, optimally with some input from the person regarding their tolerance for risk (unnecessary biopsies, for example versus cancer risk). I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: JAMA Intern Med. Published online December 30, 2013.