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Kohaar I, Hodges N, Srivastava S. Biomarkers in Cancer Screening: Promises and Challenges in Cancer Early Detection. Hematol Oncol Clin North Am 2024:S0889-8588(24)00046-7. [PMID: 38782647 DOI: 10.1016/j.hoc.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Cancer continues to be one the leading causes of death worldwide, primarily due to the late detection of the disease. Cancers detected at early stages may enable more effective intervention of the disease. However, most cancers lack well-established screening procedures except for cancers with an established early asymptomatic phase and clinically validated screening tests. There is a critical need to identify and develop assays/tools in conjunction with imaging approaches for precise screening and detection of the aggressive disease at an early stage. New developments in molecular cancer screening and early detection include germline testing, synthetic biomarkers, and liquid biopsy approaches.
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Affiliation(s)
- Indu Kohaar
- Cancer Biomarkers Research Group, Division of Cancer Prevention, National Cancer Institute, NIH, 9609 Medical Center Drive, NCI Shady Grove Building, Rockville, MD 20850, USA
| | - Nicholos Hodges
- Cancer Biomarkers Research Group, Division of Cancer Prevention, National Cancer Institute, NIH, 9609 Medical Center Drive, NCI Shady Grove Building, Rockville, MD 20850, USA
| | - Sudhir Srivastava
- Cancer Biomarkers Research Group, Division of Cancer Prevention, National Cancer Institute, NIH, 9609 Medical Center Drive, NCI Shady Grove Building, Rockville, MD 20850, USA.
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2
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Rubinstein WS, Patriotis C, Dickherber A, Han PKJ, Katki HA, LeeVan E, Pinsky PF, Prorok PC, Skarlupka AL, Temkin SM, Castle PE, Minasian LM. Cancer screening with multicancer detection tests: A translational science review. CA Cancer J Clin 2024. [PMID: 38517462 DOI: 10.3322/caac.21833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 03/23/2024] Open
Abstract
Multicancer detection (MCD) tests use a single, easily obtainable biospecimen, such as blood, to screen for more than one cancer concurrently. MCD tests can potentially be used to improve early cancer detection, including cancers that currently lack effective screening methods. However, these tests have unknown and unquantified benefits and harms. MCD tests differ from conventional cancer screening tests in that the organ responsible for a positive test is unknown, and a broad diagnostic workup may be necessary to confirm the location and type of underlying cancer. Among two prospective studies involving greater than 16,000 individuals, MCD tests identified those who had some cancers without currently recommended screening tests, including pancreas, ovary, liver, uterus, small intestine, oropharyngeal, bone, thyroid, and hematologic malignancies, at early stages. Reported MCD test sensitivities range from 27% to 95% but differ by organ and are lower for early stage cancers, for which treatment toxicity would be lowest and the potential for cure might be highest. False reassurance from a negative MCD result may reduce screening adherence, risking a loss in proven public health benefits from standard-of-care screening. Prospective clinical trials are needed to address uncertainties about MCD accuracy to detect different cancers in asymptomatic individuals, whether these tests can detect cancer sufficiently early for effective treatment and mortality reduction, the degree to which these tests may contribute to cancer overdiagnosis and overtreatment, whether MCD tests work equally well across all populations, and the appropriate diagnostic evaluation and follow-up for patients with a positive test.
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Affiliation(s)
- Wendy S Rubinstein
- Division of Cancer Prevention, US National Cancer Institute, Rockville, Maryland, USA
| | - Christos Patriotis
- Division of Cancer Prevention, US National Cancer Institute, Rockville, Maryland, USA
| | - Anthony Dickherber
- Center for Strategic Scientific Initiatives, US National Cancer Institute, Rockville, Maryland, USA
| | - Paul K J Han
- Division of Cancer Control and Population Sciences, US National Cancer Institute, Rockville, Maryland, USA
| | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Rockville, Maryland, USA
| | - Elyse LeeVan
- Division of Cancer Prevention, US National Cancer Institute, Rockville, Maryland, USA
| | - Paul F Pinsky
- Division of Cancer Prevention, US National Cancer Institute, Rockville, Maryland, USA
| | - Philip C Prorok
- Division of Cancer Prevention, US National Cancer Institute, Rockville, Maryland, USA
| | - Amanda L Skarlupka
- Division of Cancer Prevention, US National Cancer Institute, Rockville, Maryland, USA
| | - Sarah M Temkin
- National Institutes of Health Office of Research on Women's Health, Bethesda, Maryland, USA
| | - Philip E Castle
- Division of Cancer Prevention, US National Cancer Institute, Rockville, Maryland, USA
- Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Rockville, Maryland, USA
| | - Lori M Minasian
- Division of Cancer Prevention, US National Cancer Institute, Rockville, Maryland, USA
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3
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Etzioni R, Gulati R, Patriotis C, Rutter C, Zheng Y, Srivastava S, Feng Z. Revisiting the standard blueprint for biomarker development to address emerging cancer early detection technologies. J Natl Cancer Inst 2024; 116:189-193. [PMID: 37941446 PMCID: PMC10852609 DOI: 10.1093/jnci/djad227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/07/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023] Open
Abstract
Novel liquid biopsy technologies are creating a watershed moment in cancer early detection. Evidence supporting population screening is nascent, but a rush to market the new tests is prompting cancer early detection researchers to revisit the standard blueprint that the Early Detection Research Network established to evaluate novel screening biomarkers. In this commentary, we review the Early Detection Research Network's Phases of Biomarker Development (PBD) for rigorous evaluation of novel early detection biomarkers and discuss both hazards and opportunities involved in expedited evaluation. According to the PBD, for a biomarker-based test to be considered for population screening, 1) test sensitivity in a prospective screening setting must be adequate, 2) the shift to early curable stages must be meaningful, and 3) any stage shift must translate into clinically significant mortality benefit. In the past, determining mortality benefit has required lengthy randomized screening trials, but interest is growing in expedited trial designs with shorter-term endpoints. Whether and how best to use such endpoints in a manner that retains the rigor of the PBD remains to be determined. We discuss how computational disease modeling can be harnessed to learn about screening impact and meet the needs of the moment.
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Affiliation(s)
- Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Roman Gulati
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Christos Patriotis
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Carolyn Rutter
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Yingye Zheng
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Sudhir Srivastava
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Ziding Feng
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
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4
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Guerra CE, Sharma PV, Castillo BS. Multi-Cancer Early Detection: The New Frontier in Cancer Early Detection. Annu Rev Med 2024; 75:67-81. [PMID: 37729031 DOI: 10.1146/annurev-med-050522-033624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
The new generation of cancer early detection tests holds remarkable promise for revolutionizing and changing the paradigm of cancer early detection. Dozens of cancer early detection tests are being developed and evaluated. Some are already commercialized and available for use, most as a complement to and not in place of existing recommended cancer screening tests. This review evaluates existing single- and multi-cancer early detection tests (MCEDs), discussing their performance characteristics including sensitivity, specificity, positive and negative predictive values, and accuracy. It also critically looks at the potential harms that could result from these tests, including false positive and negative results, the risk of overdiagnosis and overtreatment, psychological and economic harms, and the risk of widening cancer inequities. We also review the large-scale, population-based studies that are being launched in the United States and United Kingdom to determine the impact of MCEDs on clinically relevant outcomes and implications for current practice.
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Affiliation(s)
- Carmen E Guerra
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Prateek V Sharma
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | - Brenda S Castillo
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA;
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5
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Kensler KH, Johnson R, Morley F, Albrair M, Dickerman BA, Gulati R, Holt SK, Iyer HS, Kibel AS, Lee JR, Preston MA, Vassy JL, Wolff EM, Nyame YA, Etzioni R, Rebbeck TR. Prostate cancer screening in African American men: a review of the evidence. J Natl Cancer Inst 2024; 116:34-52. [PMID: 37713266 PMCID: PMC10777677 DOI: 10.1093/jnci/djad193] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Prostate cancer is the most diagnosed cancer in African American men, yet prostate cancer screening regimens in this group are poorly guided by existing evidence, given underrepresentation of African American men in prostate cancer screening trials. It is critical to optimize prostate cancer screening and early detection in this high-risk group because underdiagnosis may lead to later-stage cancers at diagnosis and higher mortality while overdiagnosis may lead to unnecessary treatment. METHODS We performed a review of the literature related to prostate cancer screening and early detection specific to African American men to summarize the existing evidence available to guide health-care practice. RESULTS Limited evidence from observational and modeling studies suggests that African American men should be screened for prostate cancer. Consideration should be given to initiating screening of African American men at younger ages (eg, 45-50 years) and at more frequent intervals relative to other racial groups in the United States. Screening intervals can be optimized by using a baseline prostate-specific antigen measurement in midlife. Finally, no evidence has indicated that African American men would benefit from screening beyond 75 years of age; in fact, this group may experience higher rates of overdiagnosis at older ages. CONCLUSIONS The evidence base for prostate cancer screening in African American men is limited by the lack of large, randomized studies. Our literature search supported the need for African American men to be screened for prostate cancer, for initiating screening at younger ages (45-50 years), and perhaps screening at more frequent intervals relative to men of other racial groups in the United States.
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Affiliation(s)
- Kevin H Kensler
- Department of Population Health Sciences, Weill Cornell Medical Center, New York, NY, USA
| | - Roman Johnson
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Faith Morley
- Department of Population Health Sciences, Weill Cornell Medical Center, New York, NY, USA
| | - Mohamed Albrair
- Department of Global Health, University of Washington, Seattle, WA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Barbra A Dickerman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Roman Gulati
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Sarah K Holt
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Hari S Iyer
- Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Adam S Kibel
- Department of Urology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jenney R Lee
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Mark A Preston
- Department of Urology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jason L Vassy
- VA Boston Healthcare System, Boston, MA, USA
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Erika M Wolff
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Yaw A Nyame
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Timothy R Rebbeck
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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6
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Klein EA, Madhavan S, Beer TM, Bettegowda C, Liu MC, Hartman AR, Hackshaw A. Dying To Find Out: The Cost of Time at the Dawn of the Multicancer Early Detection Era. Cancer Epidemiol Biomarkers Prev 2023; 32:1003-1010. [PMID: 37255363 PMCID: PMC10390858 DOI: 10.1158/1055-9965.epi-22-1275] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/21/2023] [Accepted: 05/09/2023] [Indexed: 05/17/2023] Open
Abstract
Cancer is a significant burden worldwide that adversely impacts life expectancy, quality of life, health care costs, and workforce productivity. Although currently recommended screening tests for individual cancers reduce mortality, they detect only a minority of all cancers and sacrifice specificity for high sensitivity, resulting in a high cumulative rate of false positives. Blood-based multicancer early detection tests (MCED) based on next-generation sequencing (NGS) and other technologies hold promise for broadening the number of cancer types detected in screened populations and hope for reducing cancer mortality. The promise of this new technology to improve cancer detection rates and make screening more efficient at the population level demands the development of novel trial designs that accelerate clinical adoption. Carefully designed clinical trials are needed to address these issues.
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Affiliation(s)
- Eric A. Klein
- GRAIL, Inc, and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Tomasz M. Beer
- Exact Sciences Corporation and OHSU Knight Cancer Institute, Portland, Oregon
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, United Kingdom
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7
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Sasieni P, Smittenaar R, Hubbell E, Broggio J, Neal RD, Swanton C. Modelled mortality benefits of multi-cancer early detection screening in England. Br J Cancer 2023; 129:72-80. [PMID: 37185463 PMCID: PMC10307803 DOI: 10.1038/s41416-023-02243-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Screening programmes utilising blood-based multi-cancer early detection (MCED) tests, which can detect a shared cancer signal from any site in the body with a single, low false-positive rate, could reduce cancer burden through early diagnosis. METHODS A natural history ('interception') model of cancer was previously used to characterise potential benefits of MCED screening (based on published performance of an MCED test). We built upon this using a two-population survival model to account for an increased risk of death from cfDNA-detectable cancers relative to cfDNA-non-detectable cancers. We developed another model allowing some cancers to metastasise directly from stage I, bypassing intermediate tumour stages. We used incidence and survival-by-stage data from the National Cancer Registration and Analysis Service in England to estimate longer-term benefits to a cohort screened between ages 50-79 years. RESULTS Estimated late-stage and mortality reductions were robust to a range of assumptions. With the least favourable dwell (sojourn) time and cfDNA status hazard ratio assumptions, we estimated, among 100,000 screened individuals, 67 (17%) fewer cancer deaths per year corresponding to 2029 fewer deaths in those screened between ages 50-79 years. CONCLUSION Realising the potential benefits of MCED tests could substantially reduce late-stage cancer diagnoses and mortality.
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Affiliation(s)
- Peter Sasieni
- Comprehensive Cancer Centre, King's College London, Guy's Campus, Great Maze Pond, London, SE1 1UL, UK.
| | | | | | - John Broggio
- NHS Digital, 7 and 8 Wellington Place, Leeds, West Yorkshire, LS1 4AP, UK
| | - Richard D Neal
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Charles Swanton
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, WC1E 6DD, UK
- Cancer Evolution and Genome Instability Laboratory, Francis Crick Institute, London, NW1 1AT, UK
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8
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Hudnut AG, Hubbell E, Venn O, Church TR. Modeled residual current cancer risk after clinical investigation of a positive multicancer early detection test result. Cancer 2023; 129:2056-2063. [PMID: 36943898 DOI: 10.1002/cncr.34747] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 03/23/2023]
Abstract
BACKGROUND Positive results of a multi-cancer early detection (MCED) test require confirmatory diagnostic workup. Here, residual current cancer risk (RR) during the process of diagnostic resolution, including situations where the initial confirmatory test does not provide resolution, was modeled. METHODS A decision-tree framework was used to model conditional risk in a patient's journey through confirmatory diagnostic options and outcomes. The diagnostic journey assumed that cancer signal detection (a positive MCED test result) had already led to a transition from screening to diagnosis and began with an initial positive predictive value (PPV) from the positive result. Evaluation of a most probable (top) predicted cancer signal origin (CSO) and then a second-most probable predicted CSO followed. Under the assumption that the top- and second-predicted CSOs were each followed by a targeted confirmatory test, the RR was estimated for each subsequent scenario. RESULTS For an initial MCED test result with typical performance characteristics modeled (PPV, 40%; top-predicted CSO accuracy, 90%), after a negative initial confirmatory test (sensitivity, 70%, 90%, or 100%) the RR ranged from 6% to 20%. A second-predicted CSO (accuracy, 50%), after a negative second confirmatory test, still provided a significant RR (3%-18%) in comparison with the National Institute for Health and Care Excellence-recommended cancer risk threshold warranting investigation in symptomatic individuals (3%). With a 40% PPV for an MCED test and 90% specificity for a confirmatory test, the risk of incidental findings after one or two confirmatory tests was 6% and 12%, respectively. CONCLUSIONS These results may illustrate the impact of a positive MCED test on follow-up decision-making.
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Affiliation(s)
- Andrew G Hudnut
- Family Medicine, Sutter Medical Group, Elk Grove, California, USA
| | - Earl Hubbell
- GRAIL, LLC, a subsidiary of Illumina, Inc., Menlo Park, California, USA
| | - Oliver Venn
- GRAIL, LLC, a subsidiary of Illumina, Inc., Menlo Park, California, USA
| | - Timothy R Church
- Division of Environmental Health Sciences, University of Minnesota, Minneapolis, Minnesota, USA
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9
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Alexander GE, Lin W, Ortega FE, Ramaiah M, Jung B, Ji L, Revenkova E, Shah P, Croisetiere C, Berman JR, Eubank L, Naik G, Brooks J, Mich A, Shojaee S, Ronaghi N, Chawla H, Hou X, Liu Q, Yakym CJAV, Moradi PW, Halks-Miller M, Aravanis AM, Parpart-Li S, Hunkapiller N. Analytical validation of a multi-cancer early detection test with cancer signal origin using a cell-free DNA-based targeted methylation assay. PLoS One 2023; 18:e0283001. [PMID: 37058491 PMCID: PMC10104288 DOI: 10.1371/journal.pone.0283001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 02/28/2023] [Indexed: 04/15/2023] Open
Abstract
The analytical validation is reported for a targeted methylation-based cell-free DNA multi-cancer early detection test designed to detect cancer and predict the cancer signal origin (tissue of origin). A machine-learning classifier was used to analyze the methylation patterns of >105 genomic targets covering >1 million methylation sites. Analytical sensitivity (limit of detection [95% probability]) was characterized with respect to tumor content by expected variant allele frequency and was determined to be 0.07%-0.17% across five tumor cases and 0.51% for the lymphoid neoplasm case. Test specificity was 99.3% (95% confidence interval, 98.6-99.7%). In the reproducibility and repeatability study, results were consistent in 31/34 (91.2%) pairs with cancer and 17/17 (100%) pairs without cancer; between runs, results were concordant for 129/133 (97.0%) cancer and 37/37 (100%) non-cancer sample pairs. Across 3- to 100-ng input levels of cell-free DNA, cancer was detected in 157/182 (86.3%) cancer samples but not in any of the 62 non-cancer samples. In input titration tests, cancer signal origin was correctly predicted in all tumor samples detected as cancer. No cross-contamination events were observed. No potential interferent (hemoglobin, bilirubin, triglycerides, genomic DNA) affected performance. The results of this analytical validation study support continued clinical development of a targeted methylation cell-free DNA multi-cancer early detection test.
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Affiliation(s)
- Gregory E. Alexander
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Wendy Lin
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Fabian E. Ortega
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Madhuvanthi Ramaiah
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Byoungsok Jung
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Lijuan Ji
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Ekaterina Revenkova
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Payal Shah
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Christian Croisetiere
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Jennifer R. Berman
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Lane Eubank
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Gunjan Naik
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Jacqueline Brooks
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Andrea Mich
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Seyedmehdi Shojaee
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Neda Ronaghi
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Hemanshi Chawla
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Xinyi Hou
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Qinwen Liu
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Christopher-James A. V. Yakym
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Patriss Wais Moradi
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Meredith Halks-Miller
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Alexander M. Aravanis
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Sonya Parpart-Li
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
| | - Nathan Hunkapiller
- GRAIL, LLC, A Subsidiary of Illumina, Inc., Currently Held Separate from Illumina, Inc., Under the Terms of the Interim Measures Order of the European Commission Dated 29 October 2021, Menlo Park, California, United States of America
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10
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He S, Ding L, Yuan H, Zhao G, Yang X, Wu Y. A review of sensors for classification and subtype discrimination of cancer: Insights into circulating tumor cells and tumor-derived extracellular vesicles. Anal Chim Acta 2023; 1244:340703. [PMID: 36737145 DOI: 10.1016/j.aca.2022.340703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 12/02/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022]
Abstract
Liquid biopsy can reflect the state of tumors in vivo non-invasively, thus providing a strong basis for the early diagnosis, individualized treatment monitoring and prognosis of tumors. Circulating tumor cells (CTCs) and tumor-derived extracellular vesicles (tdEVs) contain information-rich components, such as nucleic acids and proteins, and they are essential markers for liquid biopsies. Their capture and analysis are of great importance for the study of disease occurrence and development and, consequently, have been the subject of many reviews. However, both CTCs and tdEVs carry the biological characteristics of their original tissue, and few reviews have focused on their function in the staging and classification of cancer. In this review, we focus on state-of-the-art sensors based on the simultaneous detection of multiple biomarkers within CTCs and tdEVs, with clinical applications centered on cancer classification and subtyping. We also provide a thorough discussion of the current challenges and prospects for novel sensors with the ultimate goal of cancer classification and staging. It is hoped that these most advanced technologies will bring new insights into the clinical practice of cancer screening and diagnosis.
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Affiliation(s)
- Sitian He
- College of Public Health, Zhengzhou University, Zhengzhou, 450001, China
| | - Lihua Ding
- College of Public Health, Zhengzhou University, Zhengzhou, 450001, China
| | - Huijie Yuan
- College of Public Health, Zhengzhou University, Zhengzhou, 450001, China
| | - Gaofeng Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450001, China.
| | - Xiaonan Yang
- School of Information Engineering, Zhengzhou University, Zhengzhou, 450001, China.
| | - Yongjun Wu
- College of Public Health, Zhengzhou University, Zhengzhou, 450001, China.
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11
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Estimating the lifetime risk of a false positive screening test result. PLoS One 2023; 18:e0281153. [PMID: 36791062 PMCID: PMC9931091 DOI: 10.1371/journal.pone.0281153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/14/2023] [Indexed: 02/16/2023] Open
Abstract
False positive results in screening tests have potentially severe psychological, medical, and financial consequences for the recipient. However, there have been few efforts to quantify how the risk of a false positive accumulates over time. We seek to fill this gap by estimating the probability that an individual who adheres to the U.S. Preventive Services Task Force (USPSTF) screening guidelines will receive at least one false positive in a lifetime. To do so, we assembled a data set of 116 studies cited by the USPSTF that report the number of true positives, false negatives, true negatives, and false positives for the primary screening procedure for one of five cancers or six sexually transmitted diseases. We use these data to estimate the probability that an individual in one of 14 demographic subpopulations will receive at least one false positive for one of these eleven diseases in a lifetime. We specify a suitable statistical model to account for the hierarchical structure of the data, and we use the parametric bootstrap to quantify the uncertainty surrounding our estimates. The estimated probability of receiving at least one false positive in a lifetime is 85.5% (±0.9%) and 38.9% (±3.6%) for baseline groups of women and men, respectively. It is higher for subpopulations recommended to screen more frequently than the baseline, including more vulnerable groups such as pregnant women and men who have sex with men. Since screening technology is imperfect, false positives remain inevitable. The high lifetime risk of a false positive reveals the importance of educating patients about this phenomenon.
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12
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ÖZGÜR E, YILDIZ A, BADEMLER S, GEZER U. Kan Plazmasında Satellit-2 Tekrar Elementi DNA Dizilerinin Karakterizasyonu. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.38079/igusabder.1105142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Amaç: Son yıllarda tıp biliminin farklı disiplinlerinde sıkça karşılaşılan kavramlardan biri olan “sıvı biyopsi”, hastaların tanı, prognoz analizi ve tedaviye cevabını değerlendirme gibi konularda girişimsel doku biyopsisi yerine, kan ve çeşitli vücut sıvılarındaki moleküler ve epigenetik biyobelirteçlerin kullanılmasını içerir. Dolaşımda serbest halde dolaşan DNA’da (‘cell-free DNA’, cfDNA) kanser hücrelerine özgü gen mutasyonlarının saptanması, kanser hücrelerinin içeriğinin vücut sıvılarına geçtiğinin kesin kanıtı olarak kabul edilmektedir. cfDNA’nın bileşiminin belirlenmesine yönelik dizileme çalışmaları, perisentrik satellit DNA dizilerinin, cfDNA’da genom oranlarına kıyasla daha fazla oranda temsil edildiğini bildirmiştir. Bu çalışmada, kanser açısından spesifik dizilerin saptanması amacıyla, Sat-2 dizilerinin polimeraz zincir reaksiyonunda (PCR) çoğaltılmaları sonrasında daha detaylı karakterizasyonu amaçlanmıştır.Yöntem: Çalışmada, sağlıklı ve metastatik meme kanserli hastaların plazmalarından 1. ve 10. kromozoma spesifik Sat-2 dizileri PCR ile çoğaltıldıktan sonra, otomatik elektroforez sisteminde ayrıştırıldılar.Bulgular: Yapılan büyüklük analizinde, iki bölgeden çok sayıda amplikon oluştuğu, bunların yaklaşık %50’ni sırasıyla 143 ve 115 bç uzunluğunda ürünlerin oluşturduğu belirlenmiştir. Bu iki PCR amplikonunun miktarı meme kanserli hastalarda daha yüksek olarak hesaplandı. Onuncu kromozoma özgü 115 bç’lik fargman dışındaki Sat-2 dizileri açısından kontroller ile hastalar arasında önemli farklar olduğu belirlenmiştir.Sonuç: Çalışma kapsamında elde edilen bulgular, Sat-2 tekrar elementine ait DNA dizilerinin sekanslanması sonrası kansere spesifik hedef bölgelerin saptanabileceğini ortaya koymaktadır.
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Affiliation(s)
- Emre ÖZGÜR
- İSTANBUL ÜNİVERSİTESİ, ONKOLOJİ ENSTİTÜSÜ, TEMEL ONKOLOJİ ANABİLİM DALI
| | - Anıl YILDIZ
- İSTANBUL ÜNİVERSİTESİ, ONKOLOJİ ENSTİTÜSÜ, KLİNİK ONKOLOJİ ANABİLİM DALI
| | - Süleyman BADEMLER
- İSTANBUL OKAN ÜNİVERSİTESİ, TIP FAKÜLTESİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, GENEL CERRAHİ ANABİLİM DALI
| | - Uğur GEZER
- İSTANBUL ÜNİVERSİTESİ, ONKOLOJİ ENSTİTÜSÜ, TEMEL ONKOLOJİ ANABİLİM DALI
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13
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Jamshidi A, Liu MC, Klein EA, Venn O, Hubbell E, Beausang JF, Gross S, Melton C, Fields AP, Liu Q, Zhang N, Fung ET, Kurtzman KN, Amini H, Betts C, Civello D, Freese P, Calef R, Davydov K, Fayzullina S, Hou C, Jiang R, Jung B, Tang S, Demas V, Newman J, Sakarya O, Scott E, Shenoy A, Shojaee S, Steffen KK, Nicula V, Chien TC, Bagaria S, Hunkapiller N, Desai M, Dong Z, Richards DA, Yeatman TJ, Cohn AL, Thiel DD, Berry DA, Tummala MK, McIntyre K, Sekeres MA, Bryce A, Aravanis AM, Seiden MV, Swanton C. Evaluation of cell-free DNA approaches for multi-cancer early detection. Cancer Cell 2022; 40:1537-1549.e12. [PMID: 36400018 DOI: 10.1016/j.ccell.2022.10.022] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 08/03/2022] [Accepted: 10/26/2022] [Indexed: 11/19/2022]
Abstract
In the Circulating Cell-free Genome Atlas (NCT02889978) substudy 1, we evaluate several approaches for a circulating cell-free DNA (cfDNA)-based multi-cancer early detection (MCED) test by defining clinical limit of detection (LOD) based on circulating tumor allele fraction (cTAF), enabling performance comparisons. Among 10 machine-learning classifiers trained on the same samples and independently validated, when evaluated at 98% specificity, those using whole-genome (WG) methylation, single nucleotide variants with paired white blood cell background removal, and combined scores from classifiers evaluated in this study show the highest cancer signal detection sensitivities. Compared with clinical stage and tumor type, cTAF is a more significant predictor of classifier performance and may more closely reflect tumor biology. Clinical LODs mirror relative sensitivities for all approaches. The WG methylation feature best predicts cancer signal origin. WG methylation is the most promising technology for MCED and informs development of a targeted methylation MCED test.
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Affiliation(s)
| | - Minetta C Liu
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | | | | | | | | | | | - Nan Zhang
- GRAIL, LLC, Menlo Park, CA 94025, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Zhao Dong
- GRAIL, LLC, Menlo Park, CA 94025, USA
| | | | - Timothy J Yeatman
- Gibbs Cancer Center and Research Institute, Spartanburg, SC 29303, USA; Department of Surgery, University of Utah, Salt Lake City, UT 84112, USA
| | - Allen L Cohn
- Rocky Mountain Cancer Center, Denver, CO 80218, USA
| | - David D Thiel
- Department of Urology, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Donald A Berry
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | | | | | | | | | | | - Charles Swanton
- Francis Crick Institute, London, NW1 1AT, UK; UCL Cancer Institute, CRUK Lung Cancer Centre of Excellence, London, WC1E 6DD, UK
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14
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Neal RD, Johnson P, Clarke CA, Hamilton SA, Zhang N, Kumar H, Swanton C, Sasieni P. Cell-Free DNA-Based Multi-Cancer Early Detection Test in an Asymptomatic Screening Population (NHS-Galleri): Design of a Pragmatic, Prospective Randomised Controlled Trial. Cancers (Basel) 2022; 14:4818. [PMID: 36230741 PMCID: PMC9564213 DOI: 10.3390/cancers14194818] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 12/24/2022] Open
Abstract
We report the design of the NHS-Galleri trial (ISRCTN91431511), aiming to establish whether a multi-cancer early detection (MCED) test that screens asymptomatic individuals for cancer can reduce late-stage cancer incidence. This randomised controlled trial has invited approximately 1.5 million persons and enrolled over 140,000 from the general population of England (50-77 years; ≥3 years without cancer diagnosis or treatment; not undergoing investigation for suspected cancer). Blood is being collected at up to three annual visits. Following baseline blood collection, participants are randomised 1:1 to the intervention (blood tested by MCED test) or control (blood stored) arm. Only participants in the intervention arm with a cancer signal detected have results returned and are referred for urgent investigations and potential treatment. Remaining participants in both arms stay blinded and return for their next visit. Participants are encouraged to continue other NHS cancer screening programmes and seek help for new or unusual symptoms. The primary objective is to demonstrate a statistically significant reduction in the incidence rate of stage III and IV cancers diagnosed in the intervention versus control arm 3-4 years after randomisation. NHS-Galleri will help determine the clinical utility of population screening with an MCED test.
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Affiliation(s)
- Richard D. Neal
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter EX4 4PY, UK
| | | | | | | | - Nan Zhang
- GRAIL, LLC, a Subsidiary of Illumina, Inc., Menlo Park, CA 94025, USA
| | - Harpal Kumar
- GRAIL, LLC, a Subsidiary of Illumina, Inc., London, WC1V 7HP, UK
| | - Charles Swanton
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, WC1E 6DD, UK
- Cancer Evolution and Genome Instability Laboratory, Francis Crick Institute, London NW1 1AT, UK
| | - Peter Sasieni
- Comprehensive Cancer Centre, King’s College London, London WC2R 2LS, UK
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15
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Re: Sabrina H. Rossi, Grant D. Stewart. Re: Clinical Validation of a Targeted Methylation-based Multi-cancer Early Detection Test Using an Independent Validation Set. Eur Urol. In press. https://doi.org/10.1016/j.eururo.2022.06.012. Eur Urol 2022; 82:e144. [PMID: 35970656 DOI: 10.1016/j.eururo.2022.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/14/2022] [Indexed: 11/21/2022]
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16
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A Novel Blood-Based microRNA Diagnostic Model with High Accuracy for Multi-Cancer Early Detection. Cancers (Basel) 2022; 14:cancers14061450. [PMID: 35326599 PMCID: PMC8946599 DOI: 10.3390/cancers14061450] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 02/08/2023] Open
Abstract
Early detection is critical to reduce cancer deaths as treating early stage cancers is more likely to be successful. However, patients with early stage diseases are often asymptomatic and thus less likely to be diagnosed. Here, we utilized four microarray datasets with a standardized platform to investigate comprehensive microRNA expression profiles from 7536 serum samples. A 4-miRNA diagnostic model was developed from the lung cancer training set (n = 416, 208 lung cancer patients and 208 non-cancer participants). The model showed 99% sensitivity and specificity in the lung cancer validation set (n = 3328, 1358 cancer patients and 1970 non-cancer participants); and the sensitivity remained to be >99% for patients with stage 1 disease. When applied to the additional combined dataset of 3792 participants including 2038 cancer patients across 12 different cancer types and 1754 independent non-cancer controls, the model demonstrated high sensitivities ranging from 83.2 to 100% for biliary tract, bladder, colorectal, esophageal, gastric, glioma, liver, pancreatic, and prostate cancers, and showed reasonable sensitivities of 68.2 and 72.0% for ovarian cancer and sarcoma, respectively, while maintaining 99.3% specificity. Our study provided a proof-of-concept data in demonstrating that the 4-miRNA model has the potential to be developed into a simple, inexpensive and noninvasive blood test for early detection of multiple cancers with high accuracy.
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17
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Peralta P, Hall MP, Singh Bhan S, Brown K, Parton MA, Yeshwant K, Finucane S, Keeling P, Ofman JJ. Industry engagement: Accelerating discovery, application, and adoption through industry partnerships. Cancer 2022; 128 Suppl 4:918-926. [PMID: 35133660 DOI: 10.1002/cncr.34041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 11/11/2022]
Affiliation(s)
| | - Megan P Hall
- GRAIL, LLC, a subsidiary of Illumina, Inc, Menlo Park, California
| | | | - Kim Brown
- Thrive, an Exact Sciences Company, Cambridge, Massachusetts
| | | | | | | | | | - Joshua J Ofman
- GRAIL, LLC, a subsidiary of Illumina, Inc, Menlo Park, California
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18
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Opportunities for Early Cancer Detection: The Rise of ctDNA Methylation-Based Pan-Cancer Screening Technologies. EPIGENOMES 2022; 6:epigenomes6010006. [PMID: 35225958 PMCID: PMC8883983 DOI: 10.3390/epigenomes6010006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 02/01/2023] Open
Abstract
The efficiency of conventional screening programs to identify early-stage malignancies can be limited by the low number of cancers recommended for screening as well as the high cumulative false-positive rate, and associated iatrogenic burden, resulting from repeated multimodal testing. The opportunity to use minimally invasive liquid biopsy testing to screen asymptomatic individuals at-risk for multiple cancers simultaneously could benefit from the aggregated diseases prevalence and a fixed specificity. Increasing both latter parameters is paramount to mediate high positive predictive value—a useful metric to evaluate a screening test accuracy and its potential harm-benefit. Thus, the use of a single test for multi-cancer early detection (stMCED) has emerged as an appealing strategy for increasing early cancer detection rate efficiency and benefit population health. A recent flurry of these stMCED technologies have been reported for clinical potential; however, their development is facing unique challenges to effectively improve clinical cost–benefit. One promising avenue is the analysis of circulating tumour DNA (ctDNA) for detecting DNA methylation biomarker fingerprints of malignancies—a hallmark of disease aetiology and progression holding the potential to be tissue- and cancer-type specific. Utilizing panels of epigenetic biomarkers could potentially help to detect earlier stages of malignancies as well as identify a tumour of origin from blood testing, useful information for follow-up clinical decision making and subsequent patient care improvement. Overall, this review collates the latest and most promising stMCED methodologies, summarizes their clinical performances, and discusses the specific requirements multi-cancer tests should meet to be successfully implemented into screening guidelines.
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19
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Nadauld LD, McDonnell CH, Beer TM, Liu MC, Klein EA, Hudnut A, Whittington RA, Taylor B, Oxnard GR, Lipson J, Lopatin M, Shaknovich R, Chung KC, Fung ET, Schrag D, Marinac CR. The PATHFINDER Study: Assessment of the Implementation of an Investigational Multi-Cancer Early Detection Test into Clinical Practice. Cancers (Basel) 2021; 13:3501. [PMID: 34298717 PMCID: PMC8304888 DOI: 10.3390/cancers13143501] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 01/22/2023] Open
Abstract
To examine the extent of the evaluation required to achieve diagnostic resolution and the test performance characteristics of a targeted methylation cell-free DNA (cfDNA)-based multi-cancer early detection (MCED) test, ~6200 participants ≥50 years with (cohort A) or without (cohort B) ≥1 of 3 additional specific cancer risk factors will be enrolled in PATHFINDER (NCT04241796), a prospective, longitudinal, interventional, multi-center study. Plasma cfDNA from blood samples will be analyzed to detect abnormally methylated DNA associated with cancer (i.e., cancer "signal") and a cancer signal origin (i.e., tissue of origin). Participants with a "signal detected" will undergo further diagnostic evaluation per guiding physician discretion; those with a "signal not detected" will be advised to continue guideline-recommended screening. The primary objective will be to assess the number and types of subsequent diagnostic tests needed for diagnostic resolution. Based on microsimulations (using estimates of cancer incidence and dwell times) of the typical risk profiles of anticipated participants, the median (95% CI) number of participants with a "signal detected" result is expected to be 106 (87-128). Subsequent diagnostic evaluation is expected to detect 52 (39-67) cancers. The positive predictive value of the MCED test is expected to be 49% (39-58%). PATHFINDER will evaluate the integration of a cfDNA-based MCED test into existing clinical cancer diagnostic pathways. The study design of PATHFINDER is described here.
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Affiliation(s)
- Lincoln D. Nadauld
- Hematology/Oncology, Intermountain Healthcare, St. George, UT 84790, USA
| | | | - Tomasz M. Beer
- Hematology/Medical Oncology, Oregon Health & Science University Knight Cancer Institute, Portland, OR 97239, USA;
| | - Minetta C. Liu
- Departments of Oncology and Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Eric A. Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Andrew Hudnut
- Sutter Health, Sacramento, CA 95816, USA; (C.H.M.III); (A.H.)
| | - Richard A. Whittington
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, UT 84111, USA; (R.A.W.); (B.T.)
| | - Bruce Taylor
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, UT 84111, USA; (R.A.W.); (B.T.)
| | - Geoffrey R. Oxnard
- Department of Medical Oncology, Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (G.R.O.); (D.S.); (C.R.M.)
| | - Jafi Lipson
- Radiology Department, Stanford Hospital and Clinics, Stanford, CA 94305, USA;
| | - Margarita Lopatin
- GRAIL, Inc., Menlo Park, CA 94025, USA; (M.L.); (R.S.); (K.C.C.); (E.T.F.)
| | - Rita Shaknovich
- GRAIL, Inc., Menlo Park, CA 94025, USA; (M.L.); (R.S.); (K.C.C.); (E.T.F.)
| | - Karen C. Chung
- GRAIL, Inc., Menlo Park, CA 94025, USA; (M.L.); (R.S.); (K.C.C.); (E.T.F.)
| | - Eric T. Fung
- GRAIL, Inc., Menlo Park, CA 94025, USA; (M.L.); (R.S.); (K.C.C.); (E.T.F.)
| | - Deborah Schrag
- Department of Medical Oncology, Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (G.R.O.); (D.S.); (C.R.M.)
| | - Catherine R. Marinac
- Department of Medical Oncology, Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (G.R.O.); (D.S.); (C.R.M.)
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20
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Klein EA, Richards D, Cohn A, Tummala M, Lapham R, Cosgrove D, Chung G, Clement J, Gao J, Hunkapiller N, Jamshidi A, Kurtzman KN, Seiden MV, Swanton C, Liu MC. Clinical validation of a targeted methylation-based multi-cancer early detection test using an independent validation set. Ann Oncol 2021; 32:1167-1177. [PMID: 34176681 DOI: 10.1016/j.annonc.2021.05.806] [Citation(s) in RCA: 312] [Impact Index Per Article: 104.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 05/27/2021] [Accepted: 05/30/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A multi-cancer early detection (MCED) test used to complement existing screening could increase the number of cancers detected through population screening, potentially improving clinical outcomes. The Circulating Cell-free Genome Atlas study (CCGA; NCT02889978) was a prospective, case-controlled, observational study and demonstrated that a blood-based MCED test utilizing cell-free DNA (cfDNA) sequencing in combination with machine learning could detect cancer signals across multiple cancer types and predict cancer signal origin (CSO) with high accuracy. The objective of this third and final CCGA substudy was to validate an MCED test version further refined for use as a screening tool. PATIENTS AND METHODS This pre-specified substudy included 4077 participants in an independent validation set (cancer: n = 2823; non-cancer: n = 1254, non-cancer status confirmed at year-one follow-up). Specificity, sensitivity, and CSO prediction accuracy were measured. RESULTS Specificity for cancer signal detection was 99.5% [95% confidence interval (CI): 99.0% to 99.8%]. Overall sensitivity for cancer signal detection was 51.5% (49.6% to 53.3%); sensitivity increased with stage [stage I: 16.8% (14.5% to 19.5%), stage II: 40.4% (36.8% to 44.1%), stage III: 77.0% (73.4% to 80.3%), stage IV: 90.1% (87.5% to 92.2%)]. Stage I-III sensitivity was 67.6% (64.4% to 70.6%) in 12 pre-specified cancers that account for approximately two-thirds of annual USA cancer deaths and was 40.7% (38.7% to 42.9%) in all cancers. Cancer signals were detected across >50 cancer types. Overall accuracy of CSO prediction in true positives was 88.7% (87.0% to 90.2%). CONCLUSION In this pre-specified, large-scale, clinical validation substudy, the MCED test demonstrated high specificity and accuracy of CSO prediction and detected cancer signals across a wide diversity of cancers. These results support the feasibility of this blood-based MCED test as a complement to existing single-cancer screening tests. CLINICAL TRIAL NUMBER NCT02889978.
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Affiliation(s)
- E A Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA.
| | | | - A Cohn
- The US Oncology Network, Denver, USA
| | - M Tummala
- Mercy Clinic Cancer Center, Springfield, USA
| | - R Lapham
- Spartanburg Regional Healthcare System, Spartanburg, USA
| | | | - G Chung
- The Christ Hospital Health Network, Cincinnati, USA
| | - J Clement
- Hartford HealthCare Cancer Institute, Hartford, USA
| | - J Gao
- GRAIL, Inc., Menlo Park, USA
| | | | | | | | - M V Seiden
- US Oncology Research, The Woodlands, USA
| | - C Swanton
- The Francis Crick Institute, London, UK; University College London Cancer Institute, London, UK
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21
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Clarke CA, Hubbell E, Ofman JJ. Multi-cancer early detection: A new paradigm for reducing cancer-specific and all-cause mortality. Cancer Cell 2021; 39:447-448. [PMID: 33606995 DOI: 10.1016/j.ccell.2021.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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22
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Ferraro S, Bussetti M, Rossi RS, Incarbone GP, Panteghini M. Is pre-biopsy serum prostate specific antigen retesting always justified? A study of the influence of individual and analytical factors on decision making for biopsy referral. Clin Chim Acta 2021; 516:77-82. [PMID: 33524337 DOI: 10.1016/j.cca.2021.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/08/2021] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS We investigated factors influencing pre-biopsy prostate-specific antigen (PSA) retesting as recommended by clinical guidelines. MATERIALS AND METHODS 333 patients screened for prostate cancer (PCa) repeated PSA (Roche Cobas systems) after a median of 3.9 months, before performing biopsy. Multiple regression models were used to assess effects of patients' characteristics on PSA results and changes over time. RESULTS PCa [n = 132 (40.7%)] and cancer-free [n = 192 (59.3%)] patients had similar rate of PSA positive results at baseline (84.8% vs. 83.9%, P = 0.931). Their rate of reversion to normal PSA after retesting was negligible (0.9% in PCa and 3.7% in PCa-free patients, P = 0.286). 31.1% of PCa and 31.3% of cancer-free patients (P = 0.426) showed a significant PSA increase after retesting. Age was a confounder since not only PSA increased in older PCa patients, but it was also related to PCa histological grade, in turn associated to PSA increase. In PCa-free patients, glandular inflammation, present in 1/3 of subjects, was also associated to higher PSA concentrations. CONCLUSION When obtained with the same immunoassay under controlled analytical conditions, a PSA positive result is confirmed after retesting in the great majority of screened patients. Neither analytical factors nor intraindividual variability appeared to justify PSA retesting before biopsy referral.
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Affiliation(s)
- Simona Ferraro
- Unità Operativa di Patologia Clinica, ASST Fatebenefratelli-Sacco, Milano, Italy.
| | - Marco Bussetti
- Unità Operativa di Patologia Clinica, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Roberta Simona Rossi
- Unità Operativa di Anatomia Patologica, ASST Fatebenefratelli-Sacco, Milano, Italy
| | | | - Mauro Panteghini
- Unità Operativa di Patologia Clinica, ASST Fatebenefratelli-Sacco, Milano, Italy
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Hubbell E, Clarke CA, Aravanis AM, Berg CD. Modeled Reductions in Late-stage Cancer with a Multi-Cancer Early Detection Test. Cancer Epidemiol Biomarkers Prev 2020; 30:460-468. [PMID: 33328254 DOI: 10.1158/1055-9965.epi-20-1134] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/23/2020] [Accepted: 12/10/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cancer is the second leading cause of death globally, with many cases detected at a late stage when prognosis is poor. New technologies enabling multi-cancer early detection (MCED) may make "universal cancer screening" possible. We extend single-cancer models to understand the potential public health effects of adding a MCED test to usual care. METHODS We obtained data on stage-specific incidence and survival of all invasive cancers diagnosed in persons aged 50-79 between 2006 and 2015 from the US Surveillance, Epidemiology, and End Results (SEER) program, and combined this with published performance of a MCED test in a state transition model (interception model) to predict diagnostic yield, stage shift, and potential mortality reductions. We model long-term (incident) performance, accou.
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Liu M, Oxnard G, Klein E, Swanton C, Seiden M. Response to W.C. Taylor, and C. Fiala and E.P. Diamandis. Ann Oncol 2020; 31:1268-1270. [DOI: 10.1016/j.annonc.2020.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 11/25/2022] Open
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Liu MC, Oxnard GR, Klein EA, Swanton C, Seiden MV. Sensitive and specific multi-cancer detection and localization using methylation signatures in cell-free DNA. Ann Oncol 2020; 31:745-759. [PMID: 33506766 PMCID: PMC8274402 DOI: 10.1016/j.annonc.2020.02.011] [Citation(s) in RCA: 646] [Impact Index Per Article: 161.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 02/13/2020] [Accepted: 02/16/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Early cancer detection could identify tumors at a time when outcomes are superior and treatment is less morbid. This prospective case-control sub-study (from NCT02889978 and NCT03085888) assessed the performance of targeted methylation analysis of circulating cell-free DNA (cfDNA) to detect and localize multiple cancer types across all stages at high specificity. PARTICIPANTS AND METHODS The 6689 participants [2482 cancer (>50 cancer types), 4207 non-cancer] were divided into training and validation sets. Plasma cfDNA underwent bisulfite sequencing targeting a panel of >100 000 informative methylation regions. A classifier was developed and validated for cancer detection and tissue of origin (TOO) localization. RESULTS Performance was consistent in training and validation sets. In validation, specificity was 99.3% [95% confidence interval (CI): 98.3% to 99.8%; 0.7% false-positive rate (FPR)]. Stage I-III sensitivity was 67.3% (CI: 60.7% to 73.3%) in a pre-specified set of 12 cancer types (anus, bladder, colon/rectum, esophagus, head and neck, liver/bile-duct, lung, lymphoma, ovary, pancreas, plasma cell neoplasm, stomach), which account for ∼63% of US cancer deaths annually, and was 43.9% (CI: 39.4% to 48.5%) in all cancer types. Detection increased with increasing stage: in the pre-specified cancer types sensitivity was 39% (CI: 27% to 52%) in stage I, 69% (CI: 56% to 80%) in stage II, 83% (CI: 75% to 90%) in stage III, and 92% (CI: 86% to 96%) in stage IV. In all cancer types sensitivity was 18% (CI: 13% to 25%) in stage I, 43% (CI: 35% to 51%) in stage II, 81% (CI: 73% to 87%) in stage III, and 93% (CI: 87% to 96%) in stage IV. TOO was predicted in 96% of samples with cancer-like signal; of those, the TOO localization was accurate in 93%. CONCLUSIONS cfDNA sequencing leveraging informative methylation patterns detected more than 50 cancer types across stages. Considering the potential value of early detection in deadly malignancies, further evaluation of this test is justified in prospective population-level studies.
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Affiliation(s)
- M C Liu
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, USA
| | - G R Oxnard
- Lowe Center for Thoracic Oncology, Dana Farber Cancer Institute, Boston, USA
| | - E A Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA
| | - C Swanton
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute; Cancer Evolution and Genome Instability Laboratory, University College London Cancer Institute, London, UK
| | - M V Seiden
- US Oncology Research, US Oncology, The Woodlands, USA.
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The Dichotomous Nature of AZ5104 (an EGFR Inhibitor) Towards RORγ and RORγT. Int J Mol Sci 2019; 20:ijms20225780. [PMID: 31744223 PMCID: PMC6887705 DOI: 10.3390/ijms20225780] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 12/20/2022] Open
Abstract
The RORC (RAR related orphan receptor C) gene produces two isoforms by alternative promoter usage: RORγ (nuclear receptor ROR-gamma isoform 1) and RORγT (nuclear receptor ROR-gamma isoform 1). Both proteins have distinct tissue distributions and are involved in several physiological processes, including glucose/lipid metabolism and the development of Th17 lymphocytes. Previously, we developed a stably transfected reporter cell line and used it to screen a library of kinase inhibitors. We found that AZ5104 acts as an RORγ agonist at low micromolar concentrations. Molecular docking analysis showed that this compound occupies the ligand binding domain of the receptor with a significant docking score. However, analysis of the biological activity of this compound in Th17 cells revealed that it downregulates RORγT expression and Th17-related cytokine production via inhibition of SRC-ERK-STAT3 (SRC proto-oncogene - extracellular regulated MAP kinase - signal transducer and activator of transcription 3). We thus identified a compound acting as an agonist of RORγ that, due to the inhibition of downstream elements of EGFR (epidermal growth factor receptor) signaling, exerts different biological activity towards a Th17-specific isoform. Additionally, our results may be relevant in the future for the design of treatments targeting signaling pathways that inhibit Th17-related inflammation in certain autoimmune disorders.
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Ibáñez-Sanz G, Garcia M, Milà N, Hubbard RA, Vidal C, Binefa G, Benito L, Moreno V. False-Positive Results in a Population-Based Colorectal Screening Program: Cumulative Risk from 2000 to 2017 with Biennial Screening. Cancer Epidemiol Biomarkers Prev 2019; 28:1909-1916. [PMID: 31488415 DOI: 10.1158/1055-9965.epi-18-1368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 04/08/2019] [Accepted: 08/28/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of this study was to estimate the cumulative risk of a false-positive (FP) result in a fecal occult blood test (FOBT) through 7 screening rounds and to identify its associated factors in a population-based colorectal cancer screening program. METHODS Retrospective cohort study, which included participants ages 50 to 69 years of a colorectal cancer screening program in Catalonia, Spain. During this period, 2 FOBTs were used (guaiac and immunochemical). A discrete-time survival model was performed to identify risk factors of receiving a positive FOBT with no high-risk adenoma or colorectal cancer in the follow-up colonoscopy. We estimated the probability of having at least 1 FP over 7 screening rounds. RESULTS During the period of 2000 to 2017, the cumulative FP risk was 16.3% (IC95%: 14.6%-18.3%), adjusted by age, sex, and type of test. The median number of screens was 2. Participants who began screening at age 50 years had a 7.3% [95% confidence interval (CI), 6.35-8.51] and a 12.4% (95% CI, 11.00-13.94) probability of an FP with 4 screening rounds of guaiac-based test and immunochemical test, respectively. Age, the fecal immunochemical test, first screening, and number of personal screens were factors associated with an FP result among screenees. CONCLUSIONS The cumulative risk of an FP in colorectal screening using FOBT seems acceptable as the colonoscopy, with its high accuracy, lengthens the time until additional colorectal screening is required, while complication rates remain low. IMPACT It is useful to determine the cumulative FP risk in cancer screening for both advising individuals and for health resources planning.
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Affiliation(s)
- Gemma Ibáñez-Sanz
- Cancer Prevention and Control Programme, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
- Gastroenterology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Colorectal Cancer Group, ONCOBELL Programme, Bellvitge Biomedical Research Institute Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBEResp), Barcelona, Spain
| | - Montse Garcia
- Cancer Prevention and Control Programme, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBEResp), Barcelona, Spain
- Cancer Prevention and Control Group, IDIBELL Programme, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Barcelona, Spain
| | - Núria Milà
- Cancer Prevention and Control Programme, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
- Colorectal Cancer Group, ONCOBELL Programme, Bellvitge Biomedical Research Institute Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBEResp), Barcelona, Spain
| | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carmen Vidal
- Cancer Prevention and Control Programme, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, IDIBELL Programme, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Barcelona, Spain
| | - Gemma Binefa
- Cancer Prevention and Control Programme, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBEResp), Barcelona, Spain
- Cancer Prevention and Control Group, IDIBELL Programme, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Barcelona, Spain
| | - Llúcia Benito
- Cancer Prevention and Control Programme, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Víctor Moreno
- Cancer Prevention and Control Programme, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
- Colorectal Cancer Group, ONCOBELL Programme, Bellvitge Biomedical Research Institute Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBEResp), Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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Ergun O, Capar E, Goger YE, Ergun AG. Can expressed prostatic secretions effect prostate biopsy decision of urologist? Int Braz J Urol 2019; 45:246-252. [PMID: 30648827 PMCID: PMC6541132 DOI: 10.1590/s1677-5538.ibju.2018.0292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 11/03/2018] [Indexed: 11/22/2022] Open
Abstract
Objectives: To evaluate the frequency of NIH category IV prostatitis, and the use of expressed prostatic secretions tests in an effort to improve the reliability of prostate specific antigen as an indicator, to avoid unnecessary prostate biopsy. Materials and Methods: 178 expressed prostatic secretion positive patients with serum prostate specific antigen levels of ≥ 2.5 ng / mL were included in present prospective study. The diagnostic evaluation included detailed history and physical examination, digital rectal examination, urine analysis, urine culture, and expressed prostatic secretions tests. Transrectal ultrasonography was used both to measure prostate volume and conduct 12 core prostate biopsy. Results: The prevalence of NIH category IV prostatitis was 36.9% (178 / 482) in our population of men. In our study patients (n: 178) prostate biopsy results were classified as; 66 prostatitis, 81 BPH, and 31 Pca. In asymptomatic prostatitis group, expressed prostatic secretion mean leucocyte ratio was higher compared to other two groups (p < 0.0001). The relation between number of expressed prostatic secretion leucocytes and prostatitis, benign prostate hyperplasia, and prostate cancer is analyzed. If 16 is taken as the cut of number for leucocyte presence, its sensitivity is 0.92 (AUC = 0.78 p = 0.01). Conclusions: The number of leucocytes in expressed prostatic secretion is higher in the chronic prostatitis group. If the leukocyte presence of 16 and above is taken as the cut off point, the sensitivity becomes 0.92 (AUC = 0.78). We firmly believe that our new cut off value may be used as to aid prostate specific antigen and derivates while giving biopsy decision.
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Affiliation(s)
- Osman Ergun
- Department of Urology, Medical Faculty, Süleyman Demirel University, Isparta, Turkey
| | - Erdem Capar
- Department of Urology, Gediz State Hospital, Gediz,Turkey
| | - Yunus Emre Goger
- Department of Urology, Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Ayse Gul Ergun
- Department of Microbiology, Isparta City Hospital, Isparta, Turkey
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Jatoi I, Anderson WF, Miller AB, Brawley OW. The history of cancer screening. Curr Probl Surg 2019; 56:138-163. [PMID: 30922446 DOI: 10.1067/j.cpsurg.2018.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/31/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Ismail Jatoi
- Division of Surgical Oncology, Dale H. Dorn Endowed Chair in Surgery, University of Texas Health Science Center, San Antonio, TX.
| | - William F Anderson
- National Institutes of Health/National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MA
| | - Anthony B Miller
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Otis W Brawley
- Michael Bloomberg Distinguished Professor of Oncology and Public Health, Johns Hopkins University, Baltimore, MA
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Wender RC, Brawley OW, Fedewa SA, Gansler T, Smith RA. A blueprint for cancer screening and early detection: Advancing screening's contribution to cancer control. CA Cancer J Clin 2019; 69:50-79. [PMID: 30452086 DOI: 10.3322/caac.21550] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
From the mid-20th century, accumulating evidence has supported the introduction of screening for cancers of the cervix, breast, colon and rectum, prostate (via shared decisions), and lung. The opportunity to detect and treat precursor lesions and invasive disease at a more favorable stage has contributed substantially to reduced incidence, morbidity, and mortality. However, as new discoveries portend advancements in technology and risk-based screening, we fail to fulfill the greatest potential of the existing technology, in terms of both full access among the target population and the delivery of state-of-the art care at each crucial step in the cascade of events that characterize successful cancer screening. There also is insufficient commitment to invest in the development of new technologies, incentivize the development of new ideas, and rapidly evaluate promising new technology. In this report, the authors summarize the status of cancer screening and propose a blueprint for the nation to further advance the contribution of screening to cancer control.
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Affiliation(s)
- Richard C Wender
- Chief Cancer Control Officer, American Cancer Society, Atlanta, GA
| | - Otis W Brawley
- Chief Medical Officer, American Cancer Society, Atlanta, GA
| | - Stacey A Fedewa
- Senior Principal Scientist, Department of Surveillance Research, American Cancer Society, Atlanta, GA
| | - Ted Gansler
- Strategic Director of Pathology Research, American Cancer Society, Atlanta, GA
| | - Robert A Smith
- Vice-President, Cancer Screening, Cancer Control Department, and Director, Center for Quality Cancer Screening and Research, American Cancer Society Atlanta, GA
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Schmitz CAA, Harzheim E. Oferta e utilização de teleconsultorias para Atenção Primária à Saúde no Programa Telessaúde Brasil Redes. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2017. [DOI: 10.5712/rbmfc12(39)1453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: Avaliar a adequação do Programa Telessaúde Brasil Redes, no âmbito das teleconsultorias, a partir da análise de dados de estrutura e processo da Plataforma Nacional de Telessaúde. Método: Estudo descritivo, com análise estatística de série histórica (24 meses) da produção de teleconsultoria pelos núcleos de telessaúde que utilizaram a ferramenta de outubro de 2013 a setembro de 2015. Resultados: Foram respondidas 29.575 teleconsultorias por 18 núcleos de telessaúde em todo o país, para 43.421 usuários em 9.801 unidades de saúde. Oferta e demanda mensal variaram entre 0,92 a 2,06 e 0,22 a 1,00 teleconsultorias, respectivamente. O percentual de unidades de saúde com ao menos uma solicitação/mês manteve-se próximo a 0,1%, sendo que 87,3% dos usuários cadastrados não realizou nenhuma solicitação no período. Os temas solicitados cobriram todos os capítulos da Classificação Internacional da Atenção Primária e da Classificação Internacional de Doenças. A satisfação dos usuários foi de 95,6% e o percentual de dúvidas totalmente respondidas foi 88,4%. Conclusões: Apesar da oferta adequada em relação às metas do programa, a demanda é muito baixa, gerando capacidade instalada ociosa de um grupo de teleconsultores com capacidade de resposta para um amplo leque de temas. Levanta-se a necessidade de ganho de escala, integração horizontal e fortalecimento da telerregulação e da auditoria das ações de telessaúde, com centralização de recursos e redução do número de núcleos de telessaúde. Além disso, é necessário investir em novas tipologias sinérgicas e sistêmicas de oferta de ações de telessaúde, como o apoio ao complexo regulador ambulatorial e à orientação da população.
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Ahrens BJ, Li L, Ciminera AK, Chea J, Poku E, Bading JR, Weist MR, Miller MM, Colcher DM, Shively JE. Diagnostic PET Imaging of Mammary Microcalcifications Using 64Cu-DOTA-Alendronate in a Rat Model of Breast Cancer. J Nucl Med 2017; 58:1373-1379. [PMID: 28450564 DOI: 10.2967/jnumed.117.190850] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/11/2017] [Indexed: 11/16/2022] Open
Abstract
The development of improved breast cancer screening methods is hindered by a lack of cancer-specific imaging agents and effective small-animal models to test them. The purpose of this study was to evaluate 64Cu-DOTA-alendronate as a mammary microcalcification-targeting PET imaging agent, using an ideal rat model. Our long-term goal is to develop 64Cu-DOTA-alendronate for the detection and noninvasive differentiation of malignant versus benign breast tumors with PET. Methods: DOTA-alendronate was synthesized, radiolabeled with 64Cu, and administered to normal or tumor-bearing aged, female, retired breeder Sprague-Dawley rats for PET imaging. Mammary tissues were subsequently labeled and imaged with light, confocal, and electron microscopy to verify microcalcification targeting specificity of DOTA-alendronate and elucidate the histologic and ultrastructural characteristics of the microcalcifications in different mammary tumor types. Tumor uptake, biodistribution, and dosimetry studies were performed to evaluate the efficacy and safety of 64Cu-DOTA-alendronate. Results:64Cu-DOTA-alendronate was radiolabeled with a 98% yield. PET imaging using aged, female, retired breeder rats showed specific binding of 64Cu-DOTA-alendronate in mammary glands and mammary tumors. The highest uptake of 64Cu-DOTA-alendronate was in malignant tumors and the lowest uptake in benign tumors and normal mammary tissue. Confocal analysis with carboxyfluorescein-alendronate confirmed the microcalcification binding specificity of alendronate derivatives. Biodistribution studies revealed tissue alendronate concentrations peaking within the first hour, then decreasing over the next 48 h. Our dosimetric analysis demonstrated a 64Cu effective dose within the acceptable range for clinical PET imaging agents and the potential for translation into human patients. Conclusion:64Cu-DOTA-alendronate is a promising PET imaging agent for the sensitive and specific detection of mammary tumors as well as the differentiation of malignant versus benign tumors based on absolute labeling uptake.
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Affiliation(s)
- Bradley J Ahrens
- Deparment of Molecular Immunology, Beckman Research Institute of the City of Hope, Duarte, California.,Division of Comparative Medicine, Beckman Research Institute of the City of Hope, Duarte, California.,Irell and Manella Graduate School of Biological Sciences, City of Hope, Duarte, California
| | - Lin Li
- Deparment of Molecular Immunology, Beckman Research Institute of the City of Hope, Duarte, California
| | - Alexandra K Ciminera
- Irell and Manella Graduate School of Biological Sciences, City of Hope, Duarte, California.,Department of Molecular Medicine, Beckman Research Institute of the City of Hope, Duarte, California
| | - Junie Chea
- Deparment of Molecular Immunology, Beckman Research Institute of the City of Hope, Duarte, California
| | - Erasmus Poku
- Deparment of Molecular Immunology, Beckman Research Institute of the City of Hope, Duarte, California
| | - James R Bading
- Department of Medical Oncology, City of Hope, Duarte, California; and
| | - Michael R Weist
- Deparment of Molecular Immunology, Beckman Research Institute of the City of Hope, Duarte, California.,Irell and Manella Graduate School of Biological Sciences, City of Hope, Duarte, California
| | - Marcia M Miller
- Department of Cell and Molecular Biology, Beckman Research Institute of the City of Hope, Duarte, California
| | - David M Colcher
- Deparment of Molecular Immunology, Beckman Research Institute of the City of Hope, Duarte, California
| | - John E Shively
- Deparment of Molecular Immunology, Beckman Research Institute of the City of Hope, Duarte, California
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Rekaya R, Smith S, Hay EH, Farhat N, Aggrey SE. Analysis of binary responses with outcome-specific misclassification probability in genome-wide association studies. Appl Clin Genet 2016; 9:169-177. [PMID: 27942229 PMCID: PMC5138056 DOI: 10.2147/tacg.s122250] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Errors in the binary status of some response traits are frequent in human, animal, and plant applications. These error rates tend to differ between cases and controls because diagnostic and screening tests have different sensitivity and specificity. This increases the inaccuracies of classifying individuals into correct groups, giving rise to both false-positive and false-negative cases. The analysis of these noisy binary responses due to misclassification will undoubtedly reduce the statistical power of genome-wide association studies (GWAS). A threshold model that accommodates varying diagnostic errors between cases and controls was investigated. A simulation study was carried out where several binary data sets (case-control) were generated with varying effects for the most influential single nucleotide polymorphisms (SNPs) and different diagnostic error rate for cases and controls. Each simulated data set consisted of 2000 individuals. Ignoring misclassification resulted in biased estimates of true influential SNP effects and inflated estimates for true noninfluential markers. A substantial reduction in bias and increase in accuracy ranging from 12% to 32% was observed when the misclassification procedure was invoked. In fact, the majority of influential SNPs that were not identified using the noisy data were captured using the proposed method. Additionally, truly misclassified binary records were identified with high probability using the proposed method. The superiority of the proposed method was maintained across different simulation parameters (misclassification rates and odds ratios) attesting to its robustness.
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Affiliation(s)
- Romdhane Rekaya
- Department of Animal and Dairy Science, College of Agricultural and Environmental Sciences
- Department of Statistics, Franklin College of Arts and Sciences
- Institute of Bioinformatics, The University of Georgia, Athens, GA
| | | | - El Hamidi Hay
- United States Department of Agriculture, Agricultural Research Service, Beltsville, MD
| | | | - Samuel E Aggrey
- Institute of Bioinformatics, The University of Georgia, Athens, GA
- Department of Poultry Science, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA, USA
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Ogden J. Do no harm: Balancing the costs and benefits of patient outcomes in health psychology research and practice. J Health Psychol 2016; 24:25-37. [PMID: 27247091 DOI: 10.1177/1359105316648760] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
This article analyses research exploring medication adherence, help-seeking behaviour, screening and behaviour change to argue that all interventions have the potential for both benefit and harm. Accordingly, health psychology may have inadvertently contributed to psychological harms (e.g. lead times, anxiety, risk compensation and rebound effects); medical harms (e.g. medication side effects, unnecessary procedures) and social harms (e.g. financial costs, increased consultations rates). Such harms may result from medicalisation or pharmaceuticalisation. Or, they may reflect the ways in which we manage probabilities and an optimistic bias that emphasises benefit over cost.
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Greiman A, Shah J, Bhavsar R, Armeson K, Caulder S, Jones R, Keane TE, Clarke HS, Savage SJ. Six Weeks of Fluoroquinolone Antibiotic Therapy for Patients With Elevated Serum Prostate-specific Antigen Is Not Clinically Beneficial: A Randomized Controlled Clinical Trial. Urology 2016; 90:32-7. [DOI: 10.1016/j.urology.2015.11.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 09/28/2015] [Accepted: 11/07/2015] [Indexed: 10/22/2022]
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Yoon JH, Lee HS, Kim EK, Youk JH, Kim HG, Moon HJ, Kwak JY. Short-term Follow-up US Leads to Higher False-positive Results Without Detection of Structural Recurrences in PTMC. Medicine (Baltimore) 2016; 95:e2435. [PMID: 26735548 PMCID: PMC4706268 DOI: 10.1097/md.0000000000002435] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To investigate the value of the annual follow-up neck ultrasonography (US) for postoperative surveillance in patients with papillary thyroid microcarcinoma (PTMC). This retrospective study has been approved by our institutional review board (IRB) with waiver for informed consent. A total of 375 patients diagnosed as PTMCs, who underwent total thyroidectomy with radioiodine remnant ablation were included, to identify the recurrence rate and the false-positive rate of annual ultrasound. The number, interval, and the results of follow-up US or fine needle aspiration were obtained from electronic medical records. Four (1.1%, 4/375) recurrences were found 3 years after the initial treatment, and only 1 patient (0.3%, 1/375) had a metastatic lymph node larger than 8 mm in the shortest diameter on US found 7.6 years after initial treatment with biochemical abnormalities. Cumulative risk of having at least 1 false-positive exam was 8.3% by the 8th US, and 8.1% by the 8-9 year follow-up. Cox multivariate regression showed shorter interval of follow-up US and presence of lymph node metastasis at initial surgery are independent predictors affecting the cumulative false-positive results (hazard ratio [HR], 0.60; 95% confidence interval [CI]: 0.49-0.73; P < 0.001 and HR, 2.19; 95% CI: 1.01-4.75; P = 0.048, respectively). Short-term follow-up US can result in higher cumulative false-positive results without detection of meaningful recurrences in patients with PTMCs who do not have biochemical abnormalities.
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Affiliation(s)
- Jung Hyun Yoon
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (JHY, E-KK, HJM, JYK); Department of Research Affairs, Biostatistics Collaboration Unit (HSL); Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (JHY); and Department of Radiology, Ajou University School of Medicine, Suwon, Korea (HGK)
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Moul JW. Population Screening for Prostate Cancer and Early Detection. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00001-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Matthew AG, Davidson T, Ochs S, Currie KL, Petrella A, Finelli A. Risk perception and psychological morbidity in men at elevated risk for prostate cancer. ACTA ACUST UNITED AC 2015; 22:e462-9. [PMID: 26715884 DOI: 10.3747/co.22.2679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE As prostate-specific antigen (psa) makes prostate cancer (pca) screening more accessible, more men are being identified with conditions that indicate high risk for developing pca, such as elevated psa and high-grade intraepithelial neoplasia (hgpin). In the present study, we assessed psychological well-being and risk perception in individuals with those high-risk conditions. METHODS A questionnaire consisting of a psychological symptom survey, a trait risk-aversion survey, and a cancer-specific risk perception survey was administered to 168 patients with early-stage localized pca and 69 patients at high risk for pca (n = 16 hgpin, n = 53 psa > 4 ng/mL). Analysis of variance was used to examine differences in psychological well-being and appraisal of risk between the groups. RESULTS Compared with the pca group, the high-risk group perceived their risk of dying from something other than pca to be significantly lower (p = 0.007). However, pca patients reported significantly more clinically important psychological symptoms. CONCLUSIONS The identification of prostate conditions that predict progression to cancer might not result in the psychological symptoms commonly experienced by pca patients, but does appear to be related to a distorted perception of the disease's mortal risk. Patients with pca experience reduced psychological well-being, but better understand the risks of pca recurrence and death. Education on the risks and outcomes of pca can help at-risk men to view health assessments with reduced worry.
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Affiliation(s)
- A G Matthew
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - T Davidson
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - S Ochs
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - K L Currie
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - A Petrella
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - A Finelli
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON
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Sathe A, Zhang YA, Ma X, Ray P, Cadinu D, Wang YW, Yao X, Liu X, Tang H, Wang Y, Huang Y, Liu C, Gu J, Akerman M, Mo Y, Cheng C, Xuan Z, Chen L, Xiao G, Xie Y, Girard L, Wang H, Lam S, Wistuba II, Zhang L, Gazdar AF, Zhang MQ. SCT Promoter Methylation is a Highly Discriminative Biomarker for Lung and Many Other Cancers. ACTA ACUST UNITED AC 2015; 1:30-33. [PMID: 33758771 DOI: 10.1109/lls.2015.2488438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aberrant DNA methylation has long been implicated in cancers. In this work we present a highly discriminative DNA methylation biomarker for non-small cell lung cancers and fourteen other cancers. Based on 69 NSCLC cell lines and 257 cancer-free lung tissues we identified a CpG island in SCT gene promoter which was verified by qMSP experiment in 15 NSCLC cell lines and 3 immortalized human respiratory epithelium cells. In addition, we found that SCT promoter was methylated in 23 cancer cell lines involving >10 cancer types profiled by ENCODE. We found that SCT promoter is hyper-methylated in primary tumors from TCGA lung cancer cohort. Additionally, we found that SCT promoter is methylated at high frequencies in fifteen malignancies and is not methylated in~1000 non-cancerous tissues across >30 organ types. Our study indicates that SCT promoter methylation is a highly discriminative biomarker for lung and many other cancers.
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Affiliation(s)
- Adwait Sathe
- Center for Systems Biology, Department of Molecular and Cell Biology, The University of Texas at Dallas, 800 W Campbell Rd., Richardson, TX, 75080, USA
| | - Yu-An Zhang
- The Hamon Center for Therapeutic Oncology Research and Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Xiaotu Ma
- Center for Systems Biology, Department of Molecular and Cell Biology, The University of Texas at Dallas, 800 W Campbell Rd., Richardson, TX, 75080, USA
| | - Pradipta Ray
- Center for Systems Biology, Department of Molecular and Cell Biology, The University of Texas at Dallas, 800 W Campbell Rd., Richardson, TX, 75080, USA
| | - Daniela Cadinu
- Center for Systems Biology, Department of Molecular and Cell Biology, The University of Texas at Dallas, 800 W Campbell Rd., Richardson, TX, 75080, USA
| | - Yi-Wei Wang
- The Hamon Center for Therapeutic Oncology Research and Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Xiao Yao
- Center for Systems Biology, Department of Molecular and Cell Biology, The University of Texas at Dallas, 800 W Campbell Rd., Richardson, TX, 75080, USA
| | - Xiaoyun Liu
- The Hamon Center for Therapeutic Oncology Research and Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Hao Tang
- Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Yunfei Wang
- Center for Systems Biology, Department of Molecular and Cell Biology, The University of Texas at Dallas, 800 W Campbell Rd., Richardson, TX, 75080, USA
| | - Ying Huang
- Center for Systems Biology, Department of Molecular and Cell Biology, The University of Texas at Dallas, 800 W Campbell Rd., Richardson, TX, 75080, USA
| | - Changning Liu
- Center for Systems Biology, Department of Molecular and Cell Biology, The University of Texas at Dallas, 800 W Campbell Rd., Richardson, TX, 75080, USA
| | - Jin Gu
- Division of Bioinformatics, Center for Synthetic and Systems Biology, TNLIST, Tsinghua University, Beijing 100084, China
| | - Martin Akerman
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY 11724, USA
| | - Yifan Mo
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY 11724, USA
| | - Chao Cheng
- Department of Genetics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Zhenyu Xuan
- Center for Systems Biology, Department of Molecular and Cell Biology, The University of Texas at Dallas, 800 W Campbell Rd., Richardson, TX, 75080, USA
| | - Lei Chen
- Laboratory of Signal Transduction, Eastern Hepatobiliary Surgery Hospital, SMMU, Shanghai 200438, China
| | - Guanghua Xiao
- Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Yang Xie
- Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Luc Girard
- The Hamon Center for Therapeutic Oncology Research and Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Hongyang Wang
- Laboratory of Signal Transduction, Eastern Hepatobiliary Surgery Hospital, SMMU, Shanghai 200438, China
| | - Stephen Lam
- BC Cancer Research Center, BC Cancer Agency, Vancouver, BC V521L3, Canada
| | - Ignacio I Wistuba
- Department of Translational Molecular Pathology, Thoracic/Head and Neck Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston TX 77030, USA
| | - Li Zhang
- Center for Systems Biology, Department of Molecular and Cell Biology, The University of Texas at Dallas, 800 W Campbell Rd., Richardson, TX, 75080, USA
| | - Adi F Gazdar
- The Hamon Center for Therapeutic Oncology Research and Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Michael Q Zhang
- Center for Systems Biology, Department of Molecular and Cell Biology, The University of Texas at Dallas, 800 W Campbell Rd., Richardson, TX, 75080, USA.,Division of Bioinformatics, Center for Synthetic and Systems Biology, TNLIST, Tsinghua University, Beijing 100084, China
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Gibson L, Tan ASL, Freres D, Lewis N, Martinez L, Hornik RC. Nonmedical information seeking amid conflicting health information: negative and positive effects on prostate cancer screening. HEALTH COMMUNICATION 2015; 31:417-24. [PMID: 26362829 PMCID: PMC4703373 DOI: 10.1080/10410236.2014.963786] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This study investigates the impact of seeking information about the prostate-specific antigen (PSA) test on men's PSA test use during a period of conflicting recommendations. Analyses used longitudinal survey data collected in 2005 and 2006 from a nationally representative sample of U.S. males aged 40-70 years (n = 777). Cross-sectionally, nonmedical information seeking was significantly associated with increased odds of having a PSA test in the past year (Time 1 odds ratio [OR] = 9.74, p < .01, 95% confidence interval [CI] = 4.37, 21.70; Time 2 OR = 5.78, p < .01, 95% CI = 3.17, 10.55). However, lagged analyses showed that among men who had a PSA at Time 1, active seeking is associated with reduced odds of later having a PSA test (OR = 0.33, p < .05, 95% CI = 0.13, 0.85). Participants who had not had a PSA test in the past year very rarely sought information about PSA tests. Information acquisition in an environment of conflicting recommendations may influence adoption of cancer screening behaviors.
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Affiliation(s)
- Laura Gibson
- a Annenberg School for Communication , University of Pennsylvania
| | - Andy S L Tan
- a Annenberg School for Communication , University of Pennsylvania
| | - Derek Freres
- a Annenberg School for Communication , University of Pennsylvania
| | - Nehama Lewis
- b Department of Communication , University of Haifa
| | | | - Robert C Hornik
- a Annenberg School for Communication , University of Pennsylvania
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Gelfond J, Choate K, Ankerst DP, Hernandez J, Leach RJ, Thompson IM. Intermediate-Term Risk of Prostate Cancer is Directly Related to Baseline Prostate Specific Antigen: Implications for Reducing the Burden of Prostate Specific Antigen Screening. J Urol 2015; 194:46-51. [DOI: 10.1016/j.juro.2015.02.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2015] [Indexed: 10/24/2022]
Affiliation(s)
- Jonathan Gelfond
- Department of Biostatistics and Epidemiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Kara Choate
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Donna P. Ankerst
- Department of Biostatistics and Epidemiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Javier Hernandez
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Robin J. Leach
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Cellular and Structural Biology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Ian M. Thompson
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Vemana G, Vetter J, Chen L, Sandhu G, Strope SA. Sources of variation in follow-up expenditure after radical cystectomy. Urol Oncol 2015; 33:267.e31-7. [PMID: 25907624 DOI: 10.1016/j.urolonc.2015.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 03/04/2015] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Follow-up care after radical cystectomy is poorly defined, with extensive variation in practice patterns. We sought to determine sources of these variations in care as well as examine the economic effect of standardization of care to guideline-recommended care. METHODS Using linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 1992 to 2007, we determined follow-up care expenditures (time and geography standardized) for 24 months after surgery. Accounted expenditures included office visits, imaging studies, urine tests, and blood work. A multilevel model was implemented to determine the effect of region, surgeon, and patient factors on care delivery. We then compared the actual expenditures on care in the Medicare system (interquartile range) with the expenditures if patients received care recommended by current clinical guidelines. RESULTS Expenditures over 24 months of follow-up were calculated per month and per patient. The mean and median total expenditures per patient were $1108 and $805 respectively (minimum $0, maximum $9,805; 25th-75th percentile $344-$1503). Variations in expenditures were most explained at the patient level. After accounting for surgeon and patient levels, we found no regional-level variations in care. Adherence to guidelines would lead to an increase in expenditures by 0.80 to 10.6 times the expenditures exist in current practice. CONCLUSION Although some regional-level and surgeon-level variations in care were found, the most variation in expenditure on follow-up care was at the patient level, largely based on node positivity, chemotherapy status, and final cancer stage. Standardization of care to current established guidelines would create higher expenditures on follow-up care than current practice patterns.
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Affiliation(s)
- Goutham Vemana
- Division of Urology, Department of Surgery, Washington University, St. Louis, MO
| | - Joel Vetter
- Division of Urology, Department of Surgery, Washington University, St. Louis, MO
| | - Ling Chen
- Division of Biostatistics, Washington University, St. Louis, MO
| | - Gurdarshan Sandhu
- Division of Urology, Department of Surgery, Washington University, St. Louis, MO
| | - Seth A Strope
- Division of Urology, Department of Surgery, Washington University, St. Louis, MO.
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Tang V, Boscardin WJ, Stijacic-Cenzer I, Lee SJ. Time to benefit for colorectal cancer screening: survival meta-analysis of flexible sigmoidoscopy trials. BMJ 2015; 350:h1662. [PMID: 25881903 PMCID: PMC4399600 DOI: 10.1136/bmj.h1662] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the time to benefit of using flexible sigmoidoscopy for colorectal cancer screening. DESIGN Survival meta-analysis. DATA SOURCES A Cochrane Collaboration systematic review published in 2013, Medline, and Cochrane Library databases. ELIGIBILITY CRITERIA Randomized controlled trials comparing screening flexible sigmoidoscopy with no screening. Trials with fewer than 100 flexible sigmoidoscopy screenings were excluded. RESULTS Four studies were eligible (total n = 459,814). They were similar for patients' age (50-74 years), length of follow-up (11.2-11.9 years), and relative risk for colorectal cancer related mortality (0.69-0.78 with flexible sigmoidoscopy screening). For every 1000 people screened at five and 10 years, 0.3 and 1.2 colorectal cancer related deaths, respectively, were prevented. It took 4.3 years (95% confidence interval 2.8 to 5.8) to observe an absolute risk reduction of 0.0002 (one colorectal cancer related death prevented for every 5000 flexible sigmoidoscopy screenings). It took 9.4 years (7.6 to 11.3) to observe an absolute risk reduction of 0.001 (one colorectal cancer related death prevented for every 1000 flexible sigmoidoscopy screenings). CONCLUSION Our findings suggest that screening flexible sigmoidoscopy is most appropriate for older adults with a life expectancy greater than approximately 10 years.
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Affiliation(s)
- Victoria Tang
- San Francisco VA Medical Center, San Francisco, CA 94121, USA
| | - W John Boscardin
- San Francisco VA Medical Center, San Francisco, CA 94121, USA Division of Geriatrics, University of California San Francisco CA, USA
| | - Irena Stijacic-Cenzer
- San Francisco VA Medical Center, San Francisco, CA 94121, USA Division of Geriatrics, University of California San Francisco CA, USA
| | - Sei J Lee
- San Francisco VA Medical Center, San Francisco, CA 94121, USA Division of Geriatrics, University of California San Francisco CA, USA
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Tang V, Boscardin WJ, Stijacic-Cenzer I, Lee SJ. Time to benefit for colorectal cancer screening: survival meta-analysis of flexible sigmoidoscopy trials. BMJ (CLINICAL RESEARCH ED.) 2015. [PMID: 25881903 DOI: 10.1136/bmj.h1662.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the time to benefit of using flexible sigmoidoscopy for colorectal cancer screening. DESIGN Survival meta-analysis. DATA SOURCES A Cochrane Collaboration systematic review published in 2013, Medline, and Cochrane Library databases. ELIGIBILITY CRITERIA Randomized controlled trials comparing screening flexible sigmoidoscopy with no screening. Trials with fewer than 100 flexible sigmoidoscopy screenings were excluded. RESULTS Four studies were eligible (total n = 459,814). They were similar for patients' age (50-74 years), length of follow-up (11.2-11.9 years), and relative risk for colorectal cancer related mortality (0.69-0.78 with flexible sigmoidoscopy screening). For every 1000 people screened at five and 10 years, 0.3 and 1.2 colorectal cancer related deaths, respectively, were prevented. It took 4.3 years (95% confidence interval 2.8 to 5.8) to observe an absolute risk reduction of 0.0002 (one colorectal cancer related death prevented for every 5000 flexible sigmoidoscopy screenings). It took 9.4 years (7.6 to 11.3) to observe an absolute risk reduction of 0.001 (one colorectal cancer related death prevented for every 1000 flexible sigmoidoscopy screenings). CONCLUSION Our findings suggest that screening flexible sigmoidoscopy is most appropriate for older adults with a life expectancy greater than approximately 10 years.
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Affiliation(s)
- Victoria Tang
- San Francisco VA Medical Center, San Francisco, CA 94121, USA
| | - W John Boscardin
- San Francisco VA Medical Center, San Francisco, CA 94121, USA Division of Geriatrics, University of California San Francisco CA, USA
| | - Irena Stijacic-Cenzer
- San Francisco VA Medical Center, San Francisco, CA 94121, USA Division of Geriatrics, University of California San Francisco CA, USA
| | - Sei J Lee
- San Francisco VA Medical Center, San Francisco, CA 94121, USA Division of Geriatrics, University of California San Francisco CA, USA
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Doseeva V, Colpitts T, Gao G, Woodcock J, Knezevic V. Performance of a multiplexed dual analyte immunoassay for the early detection of non-small cell lung cancer. J Transl Med 2015; 13:55. [PMID: 25880432 PMCID: PMC4335536 DOI: 10.1186/s12967-015-0419-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 01/25/2015] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES "PAULA's" test (Protein Assays Utilizing Lung cancer Analytes) is a novel multiplex immunoassay blood test that incorporates both tumor antigens and autoantibodies to determine the risk that lung cancer (LC) is present in individuals from a high-risk population. The test's performance characteristics were evaluated in a study using 380 retrospective clinical serum samples. METHODS PAULA's test is performed on the Luminex xMAP technology platform, and detects a panel of 3 tumor antigens (CEA, CA-125, and CYFRA 21-1) and 1 autoantibody marker (NY-ESO-1). A training set (n = 230) consisting of 115 confirmed diagnoses of non-small cell lung carcinoma (NSCLC) cases and 115 age- and smoking history-matched controls was used to develop the LC predictive model. Data from an independent matched validation set (n = 150) was then used to evaluate the model developed, and determine the ability of the test to distinguish NSCLC cases from controls. RESULTS The 4-biomarker panel was able to discriminate NSCLC cases from controls with 74% sensitivity, 80% specificity, and 0.81 AUC in the training set and with 77% sensitivity, 80% specificity, and 0.85 AUC in the independent validation set. The use of NY-ESO-1 autoantibodies substantially increased the overall sensitivity of NSCLC detection as compared to the 3 tumor markers alone. Overall, the multiplexed 4-biomarker panel assay demonstrated comparable performance to a previously employed 8-biomarker non-multiplexed assay. CONCLUSIONS These studies confirm the value of using a mixed panel of tumor antigens and autoantibodies in the early detection of NSCLC in high-risk individuals. The results demonstrate that the performance of PAULA's test makes it suitable for use as an aid to determine which high-risk patients need to be directed to appropriate noninvasive diagnostic follow-up testing, especially low-dose CT (LDCT).
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Affiliation(s)
- Victoria Doseeva
- 20/20 GeneSystems, 9430 Key West Avenue, Rockville, MD, 20850, USA.
| | - Tracey Colpitts
- Abbott Molecular Inc, 1300 E Touhy Avenue, Des Plaines, IL, 60018, USA.
| | - Grace Gao
- 20/20 GeneSystems, 9430 Key West Avenue, Rockville, MD, 20850, USA.
| | - Juliana Woodcock
- 20/20 GeneSystems, 9430 Key West Avenue, Rockville, MD, 20850, USA.
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Odland AP, Lammy AB, Perle JG, Martin PK, Grote CL. Reaffirming normal: the high risk of pathologizing healthy adults when interpreting the MMPI-2-RF. Clin Neuropsychol 2015; 29:38-52. [PMID: 25643047 DOI: 10.1080/13854046.2015.1005675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Monte Carlo simulations were utilized to determine the proportion of the normal population expected to have scale elevations on the MMPI-2-RF when multiple scores are interpreted. Results showed that when all 40 MMPI-2-RF scales are simultaneously considered, approximately 70% of normal adults are likely to have at least one scale elevation at or above 65 T, and as many as 20% will have five or more elevated scales. When the Restructured Clinical (RC) Scales are under consideration, 34% of normal adults have at least one elevated score. Interpretation of the Specific Problem Scales and Personality Psychopathology Five Scales--Revised also yielded higher than expected rates of significant scores, with as many as one in four normal adults possibly being miscategorized as having features of a personality disorder by the latter scales. These findings are consistent with the growing literature on rates of apparently abnormal scores in the normal population due to multiple score interpretation. Findings are discussed in relation to clinical assessment, as well as in response to recent work suggesting that the MMPI-2-RF's multiscale composition does not contribute to high rates of elevated scores.
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Affiliation(s)
- Anthony P Odland
- a Department of Behavioral Sciences , Rush University Medical Center , Chicago , IL , USA
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Bell N, Connor Gorber S, Shane A, Joffres M, Singh H, Dickinson J, Shaw E, Dunfield L, Tonelli M. Recommendations on screening for prostate cancer with the prostate-specific antigen test. CMAJ 2014; 186:1225-34. [PMID: 25349003 DOI: 10.1503/cmaj.140703] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Neil Bell
- Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Public Health Agency of Canada (Connor Gorber, Shane, Dunfield), Ottawa, Ont.; Faculty of Health Sciences (Joffres), Simon Fraser University, Burnaby, BC; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Departments of Family Medicine and Community Health Sciences (Dickinson) and Office of the Associate Dean - Research (Tonelli), University of Calgary, Calgary, Alta.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont
| | - Sarah Connor Gorber
- Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Public Health Agency of Canada (Connor Gorber, Shane, Dunfield), Ottawa, Ont.; Faculty of Health Sciences (Joffres), Simon Fraser University, Burnaby, BC; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Departments of Family Medicine and Community Health Sciences (Dickinson) and Office of the Associate Dean - Research (Tonelli), University of Calgary, Calgary, Alta.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont
| | - Amanda Shane
- Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Public Health Agency of Canada (Connor Gorber, Shane, Dunfield), Ottawa, Ont.; Faculty of Health Sciences (Joffres), Simon Fraser University, Burnaby, BC; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Departments of Family Medicine and Community Health Sciences (Dickinson) and Office of the Associate Dean - Research (Tonelli), University of Calgary, Calgary, Alta.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont
| | - Michel Joffres
- Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Public Health Agency of Canada (Connor Gorber, Shane, Dunfield), Ottawa, Ont.; Faculty of Health Sciences (Joffres), Simon Fraser University, Burnaby, BC; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Departments of Family Medicine and Community Health Sciences (Dickinson) and Office of the Associate Dean - Research (Tonelli), University of Calgary, Calgary, Alta.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont
| | - Harminder Singh
- Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Public Health Agency of Canada (Connor Gorber, Shane, Dunfield), Ottawa, Ont.; Faculty of Health Sciences (Joffres), Simon Fraser University, Burnaby, BC; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Departments of Family Medicine and Community Health Sciences (Dickinson) and Office of the Associate Dean - Research (Tonelli), University of Calgary, Calgary, Alta.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont
| | - James Dickinson
- Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Public Health Agency of Canada (Connor Gorber, Shane, Dunfield), Ottawa, Ont.; Faculty of Health Sciences (Joffres), Simon Fraser University, Burnaby, BC; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Departments of Family Medicine and Community Health Sciences (Dickinson) and Office of the Associate Dean - Research (Tonelli), University of Calgary, Calgary, Alta.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont
| | - Elizabeth Shaw
- Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Public Health Agency of Canada (Connor Gorber, Shane, Dunfield), Ottawa, Ont.; Faculty of Health Sciences (Joffres), Simon Fraser University, Burnaby, BC; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Departments of Family Medicine and Community Health Sciences (Dickinson) and Office of the Associate Dean - Research (Tonelli), University of Calgary, Calgary, Alta.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont
| | - Lesley Dunfield
- Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Public Health Agency of Canada (Connor Gorber, Shane, Dunfield), Ottawa, Ont.; Faculty of Health Sciences (Joffres), Simon Fraser University, Burnaby, BC; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Departments of Family Medicine and Community Health Sciences (Dickinson) and Office of the Associate Dean - Research (Tonelli), University of Calgary, Calgary, Alta.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont
| | - Marcello Tonelli
- Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Public Health Agency of Canada (Connor Gorber, Shane, Dunfield), Ottawa, Ont.; Faculty of Health Sciences (Joffres), Simon Fraser University, Burnaby, BC; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Departments of Family Medicine and Community Health Sciences (Dickinson) and Office of the Associate Dean - Research (Tonelli), University of Calgary, Calgary, Alta.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont
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Abstract
Screening tests are widely used in medicine to assess the likelihood that members of a defined population have a particular disease. This article presents an overview of such tests including the definitions of key technical (sensitivity and specificity) and population characteristics necessary to assess the benefits and limitations of such tests. Several examples are used to illustrate calculations, including the characteristics of low dose computed tomography as a lung cancer screen, choice of an optimal PSA cutoff and selection of the population to undergo mammography. The importance of careful consideration of the consequences of both false positives and negatives is highlighted. Receiver operating characteristic curves are explained as is the need to carefully select the population group to be tested.
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50
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Wang S, Kong H, Gong X, Zhang S, Zhang X. Multicolor imaging of cancer cells with fluorophore-tagged aptamers for single cell typing. Anal Chem 2014; 86:8261-6. [PMID: 25054485 DOI: 10.1021/ac501657g] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The discrimination of the type of cancer cells remains challenging due to the subtle differences in their expression of membrane receptors. In this work, we developed a multicolor cell imaging method for distinguishing the type of cancer cells with fluorophore-tagged aptamers. We found that the interaction between aptamers and cancer cells was affected by both of the sequence of aptamers and the labeled dyes. As the co-ownership of biomarkers for different cancer cell lines, the fluorophore-tagged aptamers interacted with different cancer cell lines in different degree, resulting in a distinct color to discriminate the type of cancer cells at single cell level. Taking advantage of the cross-reactive ability of the fluorophore-tagged aptamers, we could not only distinguish the cancerous cells quickly from large quantities of noncancerous cells, but also identify the type of the cancerous cells. This work has potential application for cancer diagnostic and therapy in the future.
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Affiliation(s)
- Song Wang
- Department of Chemistry, Beijing Key Laboratory of Microanalytical Methods and Instrumentation, Tsinghua University , Beijing, 100084, P. R. China
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