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Bedia JS, Jacobs IJ, Ryan A, Gentry-Maharaj A, Burnell M, Singh N, Manchanda R, Kalsi JK, Dawnay A, Fallowfield L, McGuire AJ, Campbell S, Parmar MKB, Menon U, Skates SJ. Estimating the ovarian cancer CA-125 preclinical detectable phase, in-vivo tumour doubling time, and window for detection in early stage: an exploratory analysis of UKCTOCS. EBioMedicine 2025; 112:105554. [PMID: 39808947 PMCID: PMC11782890 DOI: 10.1016/j.ebiom.2024.105554] [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: 07/23/2024] [Revised: 12/20/2024] [Accepted: 12/27/2024] [Indexed: 01/16/2025] Open
Abstract
BACKGROUND The ovarian cancer (OC) preclinical detectable phase (PCDP), defined as the interval during which cancer is detectable prior to clinical diagnosis, remains poorly characterised. We report exploratory analyses from the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). METHODS In UKCTOCS between Apr-2001 and Sep-2005, 101,314 postmenopausal women were randomised to no screening (NS) and 50,625 to annual multimodal screening (MMS) (until Dec-2011) using serum CA-125 interpreted by the Risk of Ovarian Cancer Algorithm (ROCA). All provided a baseline blood sample. Women with invasive epithelial OC diagnosed between randomisation and trial censorship (Dec-2014) in the MMS and NS arms with two or more CA-125 measurements, including one within two years of diagnosis were included. OC-free women (2:1 to cases) from the MMS arm provided information on baseline CA-125 distribution. CA-125 measurements were obtained from MMS results, secondary analysis of baseline samples, and medical records. PCDP duration and in-vivo tumour doubling time were estimated using the change-point model underlying ROCA. Early-stage (Stage I and II) PCDP was estimated from a Bayesian model for the probability of early stage given a CA-125 measurement. FINDINGS Of 541 women (2371 CA-125 measurements) with high-grade serous cancer (HGSC), 93% (504/541) secreted CA-125 into the circulation. Median CA-125 PCDP duration for clinically-diagnosed HGSC was 15.2 (IQR 13.1-16.9, 95% IPR 9.6-21.8) months, of which 11.9 (IQR 10.5-13.1, 95% IPR 7.5-16.5) months was in early stage. The median HGSC in-vivo tumour doubling time for cancers secreting CA-125 was 2.9 (IQR 2.3-3.7, 95% IPR 1.5-7.6) months. INTERPRETATION We report a comprehensive characterisation of the OC CA-125 PCDP. The 12-month window for early-stage detection and short tumour doubling time of HGSC provide a benchmark for researchers evaluating novel screening approaches including need to reduce diagnostic workup interval. Equally the findings provide urgent impetus for clinicians to reduce intervals from presentation to treatment onset. FUNDING NCI Early Detection Research Network, Concord (MA) Detect Ovarian Cancer Early Fund, MRC Clinical Trials Unit at UCL Core Funding.
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Affiliation(s)
- Jacob S Bedia
- MGH Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Ian J Jacobs
- Department of Women's Cancer, Elizabeth Garrett Anderson Institute for Women's Health, UCL, London, UK
| | - Andy Ryan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Aleksandra Gentry-Maharaj
- Department of Women's Cancer, Elizabeth Garrett Anderson Institute for Women's Health, UCL, London, UK; MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Matthew Burnell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Naveena Singh
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - Ranjit Manchanda
- Centre for Cancer Screening, Prevention & Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK; Department of Health Services Research, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK; Department of Gynaecological Oncology, Barts Health NHS Trust, London, UK; MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Jatinderpal K Kalsi
- AGE Research Unit, School of Public Health, Imperial College London, London, UK
| | - Anne Dawnay
- Department of Clinical Biochemistry, Barts Health NHS Trust, London, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | | | | | - Mahesh K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Usha Menon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Steven J Skates
- MGH Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Qin H, Zhang M, Zhang G, Zhao L, Zhang H, Zhang W, Wang Y, Zhang X, Xie L, Qian B. Enhancing colorectal cancer screening in high-risk population through fecal immunochemical test surveillance: Results from a surveillance program. Cancer Med 2024; 13:e70145. [PMID: 39428708 PMCID: PMC11491543 DOI: 10.1002/cam4.70145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 07/05/2024] [Accepted: 08/09/2024] [Indexed: 10/22/2024] Open
Abstract
BACKGROUND Current guidelines recommend colonoscopy-based surveillance to decrease the risk of colorectal cancer (CRC) among these participants with above-average risk. The fecal immunochemical test (FIT) holds promise as a viable alternative surveillance tool, but the existing evidence regarding the use of settings remains limited. Therefore, our aim is to evaluate the CRC incidence rates in individuals with above-average CRC risk and the relationship between FIT surveillance and CRC incidence. METHODS The retrospective cohort study was performed based on the CRC screening program between January 2012 and December 2022, in Tianjin, China. This cohort study included 12,515 participants aged 40-74 years with above-average risk. The primary outcomes were the incidence rates of CRC and advanced colorectal neoplasia which were expressed as the number of events per 100,000 person-years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. RESULTS We included 12,515 participants aged 40-74 years, of whom 4980 received subsequent FIT surveillance during the study period. Among these participants, 51 CRC cases occurred in the non-FIT surveillance group (incidence rate, 233.88 per 100,000 person-years) and there were 29 cases of CRC in the FIT surveillance group (incidence rate, 184.85 per 100,000 person-years), resulting in an incidence rate ratio (IRR) of 0.58 (95% CI, 0.37-0.91). Meanwhile, 428 advanced colorectal neoplasia cases were reported in the non-FIT surveillance group, while 269 cases occurred in the FIT surveillance group, with significantly lower incidence of advanced colorectal neoplasia in the FIT surveillance group (IRR: 0.64; 95% CI, 0.55-0.74). Compared with the non-FIT surveillance group, the FIT surveillance group had a 54% decreased risk of developing CRC (HR, 0.46; 95% CI, 0.29-0.74) and a 45% decreased risk of developing advanced colorectal neoplasia (HR, 0.55; 95% CI, 0.47-0.64). CONCLUSIONS In this retrospective cohort study, above-average risk individuals who received subsequent FIT in the intervals between colonoscopies were associated with a reduction of CRC and advanced colorectal neoplasia incidence, which indicated the value and utility of FIT in the surveillance program.
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Affiliation(s)
- Hai Qin
- Department of Colorectal Surgery, Tianjin Union Medical CenterNankai UniversityTianjinChina
- Department of Preventive and health care, Tianjin Union Medical CenterNankai UniversityTianjinChina
- Colorectal Cancer Screening OfficeTianjin Institute of ColoproctologyTianjinChina
| | - Mingqing Zhang
- Department of Colorectal Surgery, Tianjin Union Medical CenterNankai UniversityTianjinChina
- Colorectal Cancer Screening OfficeTianjin Institute of ColoproctologyTianjinChina
| | - Guanglu Zhang
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and School of Public HealthShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Lizhong Zhao
- Department of Colorectal Surgery, Tianjin Union Medical CenterNankai UniversityTianjinChina
- Department of Preventive and health care, Tianjin Union Medical CenterNankai UniversityTianjinChina
- Colorectal Cancer Screening OfficeTianjin Institute of ColoproctologyTianjinChina
| | - Huan Zhang
- Cancer Prevention CenterTianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for CancerTianjinChina
| | - Weituo Zhang
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and School of Public HealthShanghai Jiao Tong University School of MedicineShanghaiChina
- Clinical Research Institute, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yijia Wang
- Department of Pathology, Tianjin Union Medical CenterNankai UniversityTianjinChina
- Laboratory of Oncologic Molecular Medicine, Tianjin Union Medical CenterNankai UniversityTianjinChina
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medical CenterNankai UniversityTianjinChina
- Colorectal Cancer Screening OfficeTianjin Institute of ColoproctologyTianjinChina
| | - Li Xie
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and School of Public HealthShanghai Jiao Tong University School of MedicineShanghaiChina
- Clinical Research Institute, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Biyun Qian
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and School of Public HealthShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Clinical Research Promotion and Development CenterShanghai Hospital Development CenterShanghaiChina
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Bhatt R, van den Hout A, Antoniou AC, Shah M, Ficorella L, Steggall E, Easton DF, Pharoah PDP, Pashayan N. Estimation of age of onset and progression of breast cancer by absolute risk dependent on polygenic risk score and other risk factors. Cancer 2024; 130:1590-1599. [PMID: 38174903 PMCID: PMC7615824 DOI: 10.1002/cncr.35183] [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: 06/14/2023] [Revised: 11/08/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Genetic, lifestyle, reproductive, and anthropometric factors are associated with the risk of developing breast cancer. However, it is not yet known whether polygenic risk score (PRS) and absolute risk based on a combination of risk factors are associated with the risk of progression of breast cancer. This study aims to estimate the distribution of sojourn time (pre-clinical screen-detectable period) and mammographic sensitivity by absolute breast cancer risk derived from polygenic profile and the other risk factors. METHODS The authors used data from a population-based case-control study. Six categories of 10-year absolute risk based on different combinations of risk factors were derived using the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm. Women were classified into low, medium, and high-risk groups. The authors constructed a continuous-time multistate model. To calculate the sojourn time, they simulated the trajectories of subjects through the disease states. RESULTS There was little difference in sojourn time with a large overlap in the 95% confidence interval (CI) between the risk groups across the six risk categories and PRS studied. However, the age of entry into the screen-detectable state varied by risk category, with the mean age of entry of 53.4 years (95% CI, 52.2-54.1) and 57.0 years (95% CI, 55.1-57.7) in the high-risk and low-risk women, respectively. CONCLUSION In risk-stratified breast screening, the age at the start of screening, but not necessarily the frequency of screening, should be tailored to a woman's risk level. The optimal risk-stratified screening strategy that would improve the benefit-to-harm balance and the cost-effectiveness of the screening programs needs to be studied.
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Affiliation(s)
- Rikesh Bhatt
- Department of Applied Health Research, University College London, London, UK
| | - Ardo van den Hout
- Department of Statistical Science, University College London, London, UK
| | - Antonis C. Antoniou
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Mitul Shah
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Lorenzo Ficorella
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Douglas F. Easton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Paul D. P. Pharoah
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Department of Computational Biomedicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Nora Pashayan
- Department of Applied Health Research, University College London, London, UK
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Aspberg J, Heijl A, Bengtsson B. Estimating the Length of the Preclinical Detectable Phase for Open-Angle Glaucoma. JAMA Ophthalmol 2023; 141:48-54. [PMID: 36416831 PMCID: PMC9857634 DOI: 10.1001/jamaophthalmol.2022.5056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022]
Abstract
Importance A 50% reduction of glaucoma-related blindness has previously been demonstrated in a population that was screened for open-angle glaucoma. Ongoing screening trials of high-risk populations and forthcoming low-cost screening methods suggest that such screening may become more common in the future. One would then need to estimate a key component of the natural history of chronic disease, the mean preclinical detectable phase (PCDP). Knowledge of the PCDP is essential for the planning and early evaluation of screening programs and has been estimated for several types of cancer that are screened for. Objective To estimate the mean PCDP for open-angle glaucoma. Design, Setting, and Participants A large population-based screening for open-angle glaucoma was conducted from October 1992 to January 1997 in Malmö, Sweden, including 32 918 participants aged 57 to 77 years. A retrospective medical record review was conducted to assess the prevalence of newly detected cases at the screening, incidence of new cases after the screening, and the expected clinical incidence, ie, the number of new glaucoma cases expected to be detected without a screening. The latter was derived from incident cases in the screened age cohorts before the screening started and from older cohorts not invited to the screening. A total of 2029 patients were included in the current study. Data were analyzed from March 2020 to October 2021. Main Outcomes and Measures The length of the mean PCDP was calculated by 2 different methods: first, by dividing the prevalence of screen-detected glaucoma with the clinical incidence, assuming that the screening sensitivity was 100% and second, by using a Markov chain Monte Carlo (MCMC) model simulation that simultaneously derived both the length of the mean PCDP and the sensitivity of the screening. Results Of 2029 included patients, 1352 (66.6%) were female. Of 1420 screened patients, the mean age at screening was 67.4 years (95% CI, 67.2-67.7). The mean length of the PCDP of the whole study population was 10.7 years (95% CI, 8.7-13.0) by the prevalence/incidence method and 10.1 years (95% credible interval, 8.9-11.2) by the MCMC method. Conclusions and Relevance The mean PCDP was similar for both methods of analysis, approximately 10 years. A mean PCDP of 10 years found in the current study allows for screening with reasonably long intervals, eg, 5 years.
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Affiliation(s)
- Johan Aspberg
- Department of Clinical Sciences in Malmö, Ophthalmology, Lund University, Malmö, Sweden
- Department of Ophthalmology, Skåne University Hospital, Malmö, Sweden
| | - Anders Heijl
- Department of Clinical Sciences in Malmö, Ophthalmology, Lund University, Malmö, Sweden
- Department of Ophthalmology, Skåne University Hospital, Malmö, Sweden
| | - Boel Bengtsson
- Department of Clinical Sciences in Malmö, Ophthalmology, Lund University, Malmö, Sweden
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