American Cancer Society National Research Articles

Abstract PO4-11-02: Accelerating Progress and Achieving Health Equity: The American Cancer Society National Breast Cancer Roundtable

Abstract Background: Breast cancer continues to be a leading cause of death among women, with disparities in mortality rates persisting, particularly for Black women and under-supported communities. In response to this urgent need, the American Cancer Society (ACS) has launched the American Cancer Society National Breast Cancer Roundtable (ACS NBCRT) to address complex challenges across the breast cancer continuum and improve access to quality care. Methods: The ACS NBCRT is a coalition of organizations committed to eliminating disparities and reducing mortality rates. By leveraging strategic partnerships and using the Collective Impact Model, the ACS NBCRT aims to ensure equitable access to screening, treatment, and comprehensive support services. The roundtable follows the proven ACS Roundtable Model, which brings together diverse contributors to drive progress on breast cancer priorities. Results: The ACS NBCRT, chaired by prominent leaders in the field, has engaged thought leaders, organizations, policymakers, and individuals with lived experiences to identify initial roundtable priorities through a community-informed process. The ACS NBCRT conducted three listening sessions, 8 focus groups, 10 community conversations, and 33 informant interviews and received 700+ responses to a nationwide survey. As a result of this work, the ACS NBCRT leadership was able to interpret the data to inform our roundtable's strategic priorities focused on risk reduction, screening, early detection, access to treatment, clinical trials, and support services. Workgroups will address cross-cutting approaches, including health equity, patient navigation, and education, to develop short- and long-term goals for the roundtable. This approach to addressing health equity through our priority areas is intentional, and it is reflected in our engagement with lived experience experts and diverse community contributors in our early planning, formative research, leadership recruitment, and our member engagement and recruitment. Conclusion: Through its Collective Impact approach, the ACS NBCRT is poised and positioned to accelerate progress, promote health equity, and reduce the burden of breast cancer. The roundtable is uniquely designed to identify and addresses gaps by providing a neutral platform to convene diverse stakeholders to establish national priorities across the cancer continuum, catalyze policy and patient care solutions, promote evidence-based strategies and translate them into practice, and leverage volunteer knowledge and experiences to inform the reduction of health disparities. The roundtable's commitment to strategic partnerships, evidence-based strategies, and health equity will drive change and allow the ACS NBCRT to lead the national dialogue on breast cancer. Implications: The establishment of the ACS NBCRT signifies a crucial step towards achieving health equity in breast cancer care. By addressing disparities and promoting collaborative solutions, the roundtable aims to improve outcomes for all people facing breast cancer. Citation Format: Ashley Dedmon, Theresa Petee, Olufunmilayo Olopade, John Williams, Arif Kamal, Sarah Shafir. Accelerating Progress and Achieving Health Equity: The American Cancer Society National Breast Cancer Roundtable [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-11-02.

Patient Navigation for Timely, Guideline-Adherent Adjuvant Therapy for Head and Neck Cancer: A National Landscape Analysis.

Aligned with the NCCN Clinical Practice Guidelines in Oncology for Head and Neck Cancers, in November 2021 the Commission on Cancer approved initiation of postoperative radiation therapy (PORT) within 6 weeks of surgery for head and neck cancer (HNC) as its first and only HNC quality metric. Unfortunately, >50% of patients do not commence PORT within 6 weeks, and delays disproportionately burden racial and ethnic minority groups. Although patient navigation (PN) is a potential strategy to improve the delivery of timely, equitable, guideline-adherent PORT, the national landscape of PN for this aspect of care is unknown. From September through November 2022, we conducted a survey of health care organizations that participate in the American Cancer Society National Navigation Roundtable to understand the scope of PN for delivering timely, guideline-adherent PORT for patients with HNC. Of the 94 institutions that completed the survey, 89.4% (n=84) reported that at least part of their practice was dedicated to navigating patients with HNC. Sixty-eight percent of the institutions who reported navigating patients with HNC along the continuum (56/83) reported helping them begin PORT. One-third of HNC navigators (32.5%; 27/83) reported tracking the metric for time-to-PORT at their facility. When estimating the timeframe in which the NCCN and Commission on Cancer guidelines recommend commencing PORT, 44.0% (37/84) of HNC navigators correctly stated ≤6 weeks; 71.4% (60/84) reported that they did not know the frequency of delays starting PORT among patients with HNC nationally, and 63.1% (53/84) did not know the frequency of delays at their institution. In this national landscape survey, we identified that PN is already widely used in clinical practice to help patients with HNC start timely, guideline-adherent PORT. To enhance and scale PN within this area and improve the quality and equity of HNC care delivery, organizations could focus on providing better education and support for their navigators as well as specialization in HNC.

MA02.10 A Strategic Plan to Accelerate Lung Cancer Screening - An American Cancer Society National Lung Cancer Roundtable Initiative

MA02.10 A Strategic Plan to Accelerate Lung Cancer Screening - An American Cancer Society National Lung Cancer Roundtable Initiative

P2.08-07 The Campaign to End Lung Cancer Stigma: The ACS National Lung Cancer Roundtable Efforts to Confront and Extinguish Lung Cancer Stigma

Lung cancer stigma is common across the lung cancer care continuum and has a significant psychosocial impact on individuals diagnosed with lung cancer and their families. From hampering efforts to support lung cancer risk reduction to impeding biomarker testing post-diagnosis or restricting access to optimal treatment and survivorship, lung cancer stigma plays a pernicious role, contributing to suboptimal delivery of care and outcomes. Recognizing the need for coordinated and comprehensive efforts to eliminate lung cancer stigma, the American Cancer Society National Lung Cancer Roundtable’s (NLCRT) Survivorship, Stigma, and Nihilism Task Group developed and launched a national initiative, the Campaign to End Lung Cancer Stigma.

Defining comprehensive biomarker-related testing and treatment practices for advanced non-small-cell lung cancer: Results of a survey of U.S. oncologists.

BackgroundAn ASCO taskforce comprised of representatives of oncology clinicians, the American Cancer Society National Lung Cancer Roundtable (NLCRT), LUNGevity, the GO2 Foundation for Lung Cancer, and the ROS1ders sought to: characterize U.S. oncologists’ biomarker ordering and treatment practices for advanced non‐small‐cell lung cancer (NSCLC); ascertain barriers to biomarker testing; and understand the impact of delays on treatment decisions.MethodsWe deployed a survey to 2374 ASCO members, targeting U.S. thoracic and general oncologists.ResultsWe analyzed 170 eligible responses. For non‐squamous NSCLC, 97% of respondents reported ordering tests for EGFR, ALK, ROS1, and BRAF. Testing for MET, RET, and NTRK was reported to be higher among academic versus community providers and higher among thoracic oncologists than generalists. Most respondents considered 1 (46%) or 2 weeks (52%) an acceptable turnaround time, yet 37% usually waited three or more weeks to receive results. Respondents who waited ≥3 weeks were more likely to defer treatment until results were reviewed (63%). Community and generalist respondents who waited ≥3 weeks were more likely to initiate non‐targeted treatment while awaiting results. Respondents <5 years out of training were more likely to cite their concerns about waiting for results as a reason for not ordering biomarker testing (42%, vs. 19% with ≥6 years of experience).ConclusionsRespondents reported high biomarker testing rates in patients with NSCLC. Treatment decisions were impacted by test turnaround time and associated with practice setting and physician specialization and experience.

Physician concern about delaying lung cancer treatment while awaiting biomarker testing: Results of a survey of U.S. oncologists.

9067 Background: With rapid advancements in biomarker testing informing lung cancer treatment decisions, clinicians are challenged to maintain knowledge of who, what and when to test and how to treat based on test results. An ASCO taskforce including representatives from the American Cancer Society National Lung Cancer Roundtable and patient advocates conducted a study to assess biomarker testing and treatment practices for patients with advanced non-small cell lung cancer (aNSCLC) among U.S. oncologists. Methods: A survey was sent to 2374 ASCO members – lung cancer specialists and general oncologists. Eligibility required treating ≥1 lung cancer patient/month. Proportions were estimated across groups and compared using chi-square tests. Results: 170 responses were analyzed. 59% of respondents work at an academic center (i.e., have a fellowship program), while 41% work at a community (non-academic hospital/health system/private practice). Nearly all (98%) believe biomarker results should be received within 1 or 2 weeks of ordering, yet 37% wait an average of 3 or 4 weeks for results. Of respondents who usually wait 3 or 4 weeks, 37% initiate a non-targeted systemic treatment while waiting. Respondents from community practices were more likely to initiate non-targeted systemic treatment if results were not available after 2 weeks (59% compared to 40% of academic respondents; p = 0.013). ). When asked about reasons for not testing, respondents &lt;5 years since training were more likely to report that delaying treatment while waiting for results was always/often a concern compared to those &gt;6 years from training (41% vs 19%). Respondents reported high testing rates in both non-squamous and squamous aNSCLC. Roughly equal representation of generalists/specialists and academic/community respondents helps mitigate potential concerns about external validity. Conclusions: Respondents indicated that treatment decisions are impacted by delays in biomarker test results. Clinicians should be informed about when it is safe and appropriate to defer treatment while biomarker testing is pending. Respondents suggest that diagnostic biomarker testing companies should strive to expedite results.[Table: see text]

Abstract PO-255: A colorectal cancer screening intervention to help increase screening rate within the Harris Health safety-net health care system

Abstract Background: Colorectal Cancer (CRC) is often preventable through regular screening. CRC screening is an evidence-based intervention for early detection and prevention of CRC. However, screening rates are low among medically underserved, minority populations. In collaboration with a local safety-net healthcare system and community clinics, we are implementing a comprehensive, multi-modal CRC prevention program. Our CRC screening program includes community outreach, culturally and linguistically targeted educational point-of-care patient education videos, patient navigation services, and provider and staff training. In 2018, a new component was introduced that includes a CRC survivor led provider-targeted assessment intervention leveraging the American Cancer Society National Colorectal Roundtable’s “80% in Every Community” campaign. Methods: As part of the 80% in Every Community campaign, providers and clinical staff are trained by the CRC survivor staff member to employ strategies from the Roundtable’s toolkit to heighten clinic-level commitment to improving screening rates. Specific strategies include providing tips for evidence-based messaging to reach the unscreened, and training providers to consistently give a strong CRC screening recommendation. A baseline survey was administered ahead of the initial training to assess current clinical practices. Results: Survey data indicated 84.3% (N= 297, 14 clinics) of respondents identified patients not completing and returning FIT as a screening barrier (61.7%-Sometimes and 22.7%-Usually). When asked if they had mechanism to ensure patients given a FIT kit have completed and returned them -75.7 % said Yes and 24.3%-No. In the follow-up question, asking if they had a mechanism to ensure FIT were completed and returned, responses showed: 13.9 % said no mechanism, 43.0% reminder call, 8.1% mail reminder, and 28.6% said a chart reminder to return kit at next visit. 73 respondents wrote in various other mechanisms. Discussion: Respondents believed a systematic mechanism already existed to remind patients to complete their FIT and return it to their clinic. Our next steps are to present these findings to health system leadership and investigate the possibility to strengthen screening patient reminders in various forms of communication to increase FIT completion rate. Citation Format: Allison Rosen, Roshanda Chenier, Jane Montealegre, Maria Jibaja-Weiss. A colorectal cancer screening intervention to help increase screening rate within the Harris Health safety-net health care system [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-255.

Creating and Implementing a National Public Health Campaign: The American Cancer Society's and National Colorectal Cancer Roundtable's 80% by 2018 Initiative.

Creating and Implementing a National Public Health Campaign: The American Cancer Society's and National Colorectal Cancer Roundtable's 80% by 2018 Initiative.

Minimally invasive surgery for gastric cancer: the American experience.

Minimally invasive surgical techniques are increasingly being implemented in oncologic care. This study assesses the impact of minimally invasive surgery on oncologic and perioperative outcomes in the management of gastric cancer in the USA. From the American College of Surgeons and American Cancer Society National Cancer Data Base, we identified 6427 patients who underwent gastrectomy for cancer from 2010 to 2012. Treatment groups were categorized with an intention-to-treat paradigm as robotic, laparoscopic, and open surgery. Univariate and multivariate analyses were performed to estimate the impact of the surgical approach on oncologic and perioperative outcomes. Of patients undergoing definitive surgical intervention, 3.5% (n=223) underwent robotic gastrectomy, 23.1% (n=1487) underwent laparoscopic gastrectomy, and 73.4% (n=4717) underwent open surgery. Minimally invasive gastrectomy was more frequently performed on white (P=0.018), privately insured patients (P=0.049) treated at academic centers (P<0.0001) in the eastern USA (P<0.0001). After demographics, comorbidities, and tumor-related factors had been controlled for, patients who underwent laparoscopic gastrectomy had the postoperative length of stay decreased by 1.08days (P<0.0001) and greater odds of having at least 15 lymph nodes resected (odds ratio 1.16, P=0.023). Use of robotic surgery did not have a statistically significant effect on the postoperative length of stay relative to open surgery (P=0.222) but the patients so treated had greater odds of having at least 15 lymph nodes resected (odds ratio 1.51, P=0.005). There were no differences in R0 resection rates or perioperative mortality on the basis of the surgical approach alone. These findings suggest that use of minimally invasive surgery for gastric cancer in the USA is impacting the adequacy of oncologic resection but is not yet having a clinically significant impact on perioperative outcomes relative to a conventional open approach.

Cost-effectiveness of Treatment Strategies for Pancreatic Head Adenocarcinoma and Potential Opportunities for Improvement

Generally dismal outcomes have led to a nihilistic attitude toward treating pancreatic cancer, while fiscal constraints have increased scrutiny of treatments costs. Our objective was to compare the cost-effectiveness of various treatment strategies for resectable pancreatic head adenocarcinoma, and to identify opportunities for improved cost effectiveness. A decision model compared 6 strategies: no treatment, radiotherapy only, chemotherapy only, chemotherapy plus radiotherapy, surgery alone, and surgery plus adjuvant therapy. Outcomes and probabilities were identified using the National Cancer Data Base, the American Cancer Society National Surgical Quality Improvement Program, and the literature. Costs were estimated using Medicare payment. Incremental cost-effectiveness ratios (ICERs) were calculated, and sensitivity analyses were performed by varying potentially modifiable parameters of the model. Survival was reported in quality-adjusted life-months (QALMs). Surgery plus adjuvant therapy, chemotherapy alone, and no treatment were the only viable strategies in terms of cost effectiveness. Surgery plus adjuvant therapy versus no treatment demonstrated an incremental cost-effectiveness ratio (ICER) of $7,663/QALM. Theoretically increasing survival in node-negative, margin-negative patients from 14 to 22 QALMs produced the largest reduction in the ICER for surgery plus adjuvant therapy compared to no treatment ($6,386/QALM), whereas reducing the perioperative mortality from 3 to 1% had only a marginal effect. The ICER was significantly lower for high-performing centers ($5,991/QALM) than for low-performing centers ($9,144/QALM). Surgery plus adjuvant therapy for resectable pancreatic head adenocarcinoma extends survival, but at considerable expense. Significant cost reductions could be realized by improving treatment outcomes to levels of high-performing centers and development of increasingly effective adjuvant therapies.

Patient‐reported outcome measures suitable to assessment of patient navigation

Patient-reported outcomes (PROs) are measures completed by patients to capture outcomes that are meaningful and valued by patients. To help standardize PRO measures in patient navigation research and program evaluation, the Patient-Reported Outcomes Working Group (PROWG) was convened as part of the American Cancer Society's National Patient Navigator Leadership Summit. The PROWG consisted of clinicians, researchers, and program managers from a variety of perspectives who developed a set of recommended PRO measures across the cancer continuum (ie, screening, diagnostic follow-up, treatment, survivorship, end of life) as well as those useful for assessing family caregivers. Measures were recommended based on face validity, responsiveness to navigation, reliability, and construct validity in relevant populations. Other considerations included readability, existence of multiple language versions, the existence of norm groups, and respondent burden. The PROWG reached consensus on measures for use in the domains of treatment adherence; perceived barriers to care; satisfaction with cancer care; satisfaction with patient navigation services; working alliance with patient navigator; perceived knowledge/competence/self-efficacy; functional assessment/symptom burden; global quality of life; specific quality-of-life symptoms (eg, depression, anxiety); and perceived cultural competency of the navigator. In domains where validated measures were found lacking, recommendations were made for areas of needed scale development. These measures should guide research and programmatic evaluation of patient navigation.

Patients, family caregivers, and patient navigators

Navigation services may be strengthened by establishing a partnership between the patient, family/caregiver, and the navigator. Involvement of a patient's familial or social network in the navigation process would allow patient navigators to spend more time and resources with the subset of patients who do not have support from family and friends. The Partnership Approach evolves from combining the strength of a patient's existing social support and network with the delivery of navigation services. To develop this novel approach, the Family and Caregiver Workgroup was convened at the American Cancer Society's National Leadership Summit. Individuals were asked to serve in this group due to their interest, research, or experience in family and caregiver issues. By the end of the Summit, the workgroup had achieved 3 major outcomes: 1) enhancement of current patient navigation services by building a partnership between the patient, family or primary caregivers, and navigators; 2) identification of a set of core functions that a family/caregiver could perform in a partnership; and 3) consensus on a set of metrics to use with caregivers and patients. Five major domains were selected to measure patient and/or caregiver outcomes: quality of life, satisfaction with care, social support, distress, and caregiver burden. Metrics appropriate for each domain were recommended. Integration of these domains and scales in current navigation services is needed to develop future research. Evidence from such research would help determine whether the Partnership Approach contributes to improved patient and caregiver outcomes.

Estimating the National Public Health Burden Associated with Exposure to Ambient PM2.5 and Ozone

Ground-level ozone (O(3)) and fine particulate matter (PM(2.5)) are associated with increased risk of mortality. We quantify the burden of modeled 2005 concentrations of O(3) and PM(2.5) on health in the United States. We use the photochemical Community Multiscale Air Quality (CMAQ) model in conjunction with ambient monitored data to create fused surfaces of summer season average 8-hour ozone and annual mean PM(2.5) levels at a 12 km grid resolution across the continental United States. Employing spatially resolved demographic and concentration data, we assess the spatial and age distribution of air-pollution-related mortality and morbidity. For both PM(2.5) and O(3) we also estimate: the percentage of total deaths due to each pollutant; the reduction in life years and life expectancy; and the deaths avoided according to hypothetical air quality improvements. Using PM(2.5) and O(3) mortality risk coefficients drawn from the long-term American Cancer Society (ACS) cohort study and National Mortality and Morbidity Air Pollution Study (NMMAPS), respectively, we estimate 130,000 PM(2.5) -related deaths and 4,700 ozone-related deaths to result from 2005 air quality levels. Among populations aged 65-99, we estimate nearly 1.1 million life years lost from PM(2.5) exposure and approximately 36,000 life years lost from ozone exposure. Among the 10 most populous counties, the percentage of deaths attributable to PM(2.5) and ozone ranges from 3.5% in San Jose to 10% in Los Angeles. These results show that despite significant improvements in air quality in recent decades, recent levels of PM(2.5) and ozone still pose a nontrivial risk to public health.

Critical Appraisal of Prostate-specific Antigen in Prostate Cancer Screening: 20 Years Later

Prostate-specific antigen (PSA) is secreted by all types of prostate epithelial cells and has been used for 2 decades as a biologic marker for prostate cancer (PCa). Since the implementation of PSA screening in the United States, the detection of PCa has increased, accompanied by a decrease in the incidence of high-grade cancer and PCa-specific mortality rates. It has been suggested that these decreases have resulted from the enhanced detection of PCa while still curable. These data have been the impetus for early detection programs, which have recommended the initiation of screening as early as 40 years of age. Despite widespread use, PSA screening remains controversial, principally because of the lack of evidence from randomized controlled trials demonstrating a mortality benefit that could outweigh the concerns of the costs of overdiagnosis and overtreatment. Two ongoing, randomized controlled trials are examining whether screening reduces the risk of PCa-related mortality, and the results of these studies are expected soon. Although it has its limitations, PSA still remains the best-studied marker for the detection of PCa.

Meeting the Public's Cancer Information Needs: Characteristics of Callers to the National Cancer Information Center of the American Cancer Society

In this study, we describe the characteristics of the callers of the American Cancer Society's National Cancer Information Center (NCIC), why they called, how they learned about NCIC, and their satisfaction. A random sample of callers (N = 19,487) completed a telephone survey. The majority were female, White, 45 to 74 years old, had incomes greater than 35,001 dollars, and were college educated. They learned about the NCIC through TV advertisements and requested information about specific cancers, local programs, or making donations. These findings validate the usefulness of the NCIC and are helpful in identifying and targeting persons who do not routinely use this service.

The Use Of Real-Time Quantitative Polymerase Chain Reaction To Detect Hypermethylation Of The Cpg Islands In The Promoter Region Flanking The Gstp1 Gene To Diagnose Prostate Carcinoma

We developed a real-time, quantitative, methylation sensitive polymerase chain reaction (PCR) protocol to analyze hypermethylation of the CpG islands in the promoter region of the pi class glutathione-S-transferase gene GSTP1 in prostate cancer tissue. A total of 21 prostate cancer and 72 benign prostate hyperplasia (BPH) tissue samples were analyzed. Genomic DNA was digested with restriction enzyme, followed by real-time quantitative PCR amplification. Cycle threshold values were used to determine whether cancer genome was present in these tissues. A cutoff cycle threshold value of 35 was arbitrarily assigned. Samples with a cycle threshold of 35 or less were considered positive for prostate cancer. Conventional nested PCR was also performed for comparison. The mean cycle threshold values plus or minus standard deviation in prostate cancer and BPH cases were 30.12 +/- 2.88 and 37.77 +/- 2.72, respectively. All prostate cancer samples analyzed showed positive results, while 5 of the 72 BPH samples tested positive. Conventional nested PCR data indicated that 19 of 21 prostate cancer cases were positive for the methylation change, while 71 of 72 BPH cases tested negative. The test limitations of real-time PCR and the nested PCR protocols were determined to be 0.048 and 0.64 ng. DNA, respectively. We established a novel protocol for detecting the methylation change in the 5' regulatory sequence flanking the GSTP1 gene. The sensitivity of this protocol was superior to that of conventional nested PCR. The data also suggest that this novel protocol may accurately discriminate prostate carcinoma from BPH.

THE INCIDENCE OF PROSTATE CANCER IN A SCREENING POPULATION WITH A SERUM PROSTATE SPECIFIC ANTIGEN BETWEEN 2.5 AND 4.0 NG./ML.: RELATION TO BIOPSY STRATEGY

It has recently been suggested that the diagnostic threshold for the prostate specific antigen (PSA) assay be lowered to enhance prostate cancer detection. A 22% incidence of prostate cancer has been reported in men with PSA between 2.5 and 4.0 ng/ml. We designed a study to confirm this observation. Men who participated in our free early detection program and who had serum PSA between 2.5 and 4.0 ng/ml were asked to undergo prostate biopsy. Of 268 eligible men 151 (56%) agreed to participate in this free trial. All men underwent biopsy using an 11-core multisite directed biopsy scheme. All biopsy cores were color coded for location specificity and examined by 1 pathologist. Cancer was identified in 24.5% (37 of 151) of the men biopsied. The median age of men with cancer was 62 years (range 43 to 74). Conventional systematic sextant biopsies, which accounted for 6 of the 11 cores, detected 73.0% (27 of 37) of the cancers and the alternate site biopsies identified the remaining 10. Gleason score was 6 in 25 men, 3 + 4 in 5, 4 + 3 in 4 and 8 or greater in 3 (median Gleason score 6). There were 14 men who had 1 core positive for cancer, 9 had 2 and 14 had more than 2 (median number of positive cores 2). Of the 14 men with 1 positive core 11 had a less than 3 mm focus of cancer and 8 had only a positive alternate site biopsy. There were 11 cases of abnormal results on digital rectal examination, 5 of which were cancer, and 31 cases of abnormal results on ultrasonography, 13 of which were cancer. Median biological variability in PSA was +/-15% (range 0.4% to 440.0%). We found a significant incidence of cancer (24.5%, 37 of 51) in men with serum PSA between 2.5 and 4.0 ng/ml. In our study 67.6% of the detected cancers were significant based on the biopsy data. If the PSA threshold is lowered the conventional systematic sextant technique may be preferable to an extended strategy.

Observations on the early detection of prostate cancer from the American Cancer Society National Prostate Cancer Detection Project.

The American Cancer Society National Prostate Cancer Detection Project (ACS-NPCDP) was established in 1987. The experience of the ACS-NPCDP demonstrates the yield and impact of periodic examinations for the early detection of prostate cancer. A cohort of 2999 well men ages 55-70 years was tested annually at 10 clinical centers by prostate specific antigen (PSA), transrectal ultrasound (TRUS), and digital rectal examination (DRE). Biopsies were performed on men with suspicious findings. Pathologic findings were reviewed. The initial study outcomes were the detection yield of multimodality testing and the comparative sensitivity and specificity of the different tests employed. Longer term outcomes included patient quality of life and survival. The cancer detection rate declined significantly across the years of intervention. DRE had lower sensitivity than TRUS or PSA, particularly in later years of follow-up. The specificity of TRUS was lower than that of DRE. Fewer than 9% of the cancers detected in this study were clinically advanced at the time of diagnosis. Ninety-four percent of patients in whom cancer was detected are alive after an average follow-up of 54 months. In one case, death occurred after surgery. Two deaths were attributed to prostate cancer, and eleven other deaths were unrelated to prostate cancer or its treatment. Results of the ACS-NPCDP indicate that a combined-modality approach to prostate cancer detection yields high levels of early detection with infrequent adverse outcomes. Continued follow-up is required to evaluate long term morbidity and mortality.

The American Cancer Society National Prostate Cancer Detection Project and National patterns of prostate cancer detection and treatment.

The ACS National Prostate Cancer Detection Project was established in 1987 to demonstrate the feasibility of early detection as a cancer control strategy for prostate cancer. Ten years later, the compliance results suggest that early detection programs can achieve long-term participation in a healthy population.

Effect of Digital Rectal Examination and Needle Biopsy on Serum Total and Percentage of Free Prostate Specific Antigen Levels

We determined the effect of digital rectal examination and prostatic biopsy on serum total and free prostate specific antigen (PSA) concentrations in men undergoing screening for prostate cancer. In 93 men recruited from our PSA screening program we measured the serum concentrations of total and free PSA on 3 occasions during a 30-day interval before performing digital rectal examination. Total and free PSA measurements were repeated 1 and 24 hours after the rectal examination. Serum total and free PSA also was measured immediately before, and 1 hour, 24 hours and 1 week after prostatic biopsy in 30 men. Biological variation for total and free PSA was 14.7 and 14.0%, respectively. At 1 hour after rectal examination total and free PSA increased by more than the biological variation in 31 and 48% of the men, respectively. Increases were significantly greater in men whose initial PSA concentrations were less than 4.0 ng./ml. There was a dramatic increase in total and percentage of free PSA in all men 1 hour after prostatic biopsy. Increases in percentage of free PSA were greater in men whose biopsies revealed cancer. Total PSA remained elevated for at least 1 week in most men, while percentage of free PSA returned to within or less than the biological variation of the baseline level in 90% of the men by 24 hours. Digital rectal examination causes a modest increase in total and percentage of free PSA. Prostate needle biopsy causes more dramatic increases in both forms of PSA. Free PSA is preferentially released into the serum after prostatic manipulation and appears to be cleared more rapidly than complexed PSA. The differential return of the different PSA forms to baseline levels after biopsy could affect the use of measurements of the percentage of free PSA in clinical practice.