Early Detection Of Precursor Lesions Research Articles

Revolutionizing healthcare by use of artificial intelligence in esophageal carcinoma - a narrative review.

Esophageal cancer is a major cause of cancer-related mortality worldwide, with significant regional disparities. Early detection of precursor lesions is essential to improve patient outcomes. Artificial intelligence (AI) techniques, including deep learning and machine learning, have proved to be of assistance to both gastroenterologists and pathologists in the diagnosis and characterization of upper gastrointestinal malignancies by correlating with the histopathology. The primary diagnostic method in gastroenterology is white light endoscopic evaluation, but conventional endoscopy is partially inefficient in detecting esophageal cancer. However, other endoscopic modalities, such as narrow-band imaging, endocytoscopy, and endomicroscopy, have shown improved visualization of mucosal structures and vasculature, which provides a set of baseline data to develop efficient AI-assisted predictive models for quick interpretation. The main challenges in managing esophageal cancer are identifying high-risk patients and the disease's poor prognosis. Thus, AI techniques can play a vital role in improving the early detection and diagnosis of precursor lesions, assisting gastroenterologists in performing targeted biopsies and real-time decisions of endoscopic mucosal resection or endoscopic submucosal dissection. Combining AI techniques and endoscopic modalities can enhance the diagnosis and management of esophageal cancer, improving patient outcomes and reducing cancer-related mortality rates. The aim of this review is to grasp a better understanding of the application of AI in the diagnosis, treatment, and prognosis of esophageal cancer and how computer-aided diagnosis and computer-aided detection can act as vital tools for clinicians in the long run.

HISTOPATHOLOGICAL SPECTRUM OF ENDOMETRIAL LESIONS IN WOMEN PRESENTING WITH ABNORMAL UTERINE BLEEDING IN A TERTIARY CARE CENTRE.

Background: Abnormal uterine bleeding is one of the signicant gynaecological complaints, often related to endometrial pathology. It is important to differentiate non neoplastic lesion from neoplastic lesions as well as early detection of precursor lesions and exclusion of malignancy. Aim: Materials And Methods: To study the histopathological spectrum of endometrial lesions in women presenting with AUB in our population. It was a retrospective hospital based study, conducted among 200 patients in the Department of Pathology, AMCH, Dibrugarh from 1st July, 2021 to 30th June 2022. The samples included were curettage, biopsy and resection specimen. Most common cause of AUB in reproductive and Results: Perimenopausal women were normal cyclical endometrium, and in cases of post-menopausal women it was atrophic endometrium and nonatypical hyperplasia in all the age groups. Patients with AUB shows a va Conclusion: rying spectrum of endometrial pattern. Hence, It is important to evaluate endometrial pathology in all women presenting with AUB without a known cause.

HISTOPATHOLOGICAL SPECTRUM OF ENDOMETRIAL LESIONS IN TERTIARY CARE CENTRE- A PROSPECTIVE STUDY

Introduction: Endometrial sampling is most often performed for abnormal uterine bleeding. Irregular cycles, abnormal and dysfunctional uterine bleeding is considered to be one of the most common presenting symptom in gynaecological practice amongst all age group of patients. Early detection of precursor lesions and exclusions of malignancy is a diagnostic challenge for pathologist. This study aims at evaluation of the histopathological spectrum of endometrial lesions common for particular age group, presenting complaints and underlying cause for the same. Materials and methods: A prospective study for a period of 2 years from January 2021 to December 2022 in the Department of Pathology. Total of 870cases , between 18-80years were included. Histopathological study was done and each sample was categorized on the basis of age, bleeding pattern and histomorphological patterns. The mean age was found out to be 42.5±2 years. M Results: ost common age group was 3rd and 4th decade with 231 patients (26.55%) of 31-40 years and 226 patients (25.97%) of 41-50 years with lower abdominal pain and menorrhagia [210 cases (24.13%) & 191cases(21.83%) respectively], proliferative phase endometrium was noted in 35.74% cases, disordered proliferative endometrium and endometrial polyps in 10.34% cases , non atypical hyperplasia was seen in 8.39% cases, pill endometrium in 3.33% and endometrial carcinoma contributed to 0.46%. Perimenopausal period is a vulnerable age group to a numbe Conclusion: r of endometrial lesions. Lower abdominal pain and menorrhagia were most common clinical presentation and confronted wide spectrum of histomorphological changes in endometrial samples presenting with various patterns of bleeding ranging from normal cyclical changes to malignancy. It is observed that patients with obesity, diabetes mellitus, sedentary lifestyle and low socioeconomic status are more proned to these conditions. Histopathological examination plays a vital role in diagnostic evaluation as a rst modality and therapeutic management

Multicontrast Pocket Colposcopy Cervical Cancer Diagnostic Algorithm for Referral Populations.

Objective and Impact Statement. We use deep learning models to classify cervix images-collected with a low-cost, portable Pocket colposcope-with biopsy-confirmed high-grade precancer and cancer. We boost classification performance on a screened-positive population by using a class-balanced loss and incorporating green-light colposcopy image pairs, which come at no additional cost to the provider. Introduction. Because the majority of the 300,000 annual deaths due to cervical cancer occur in countries with low- or middle-Human Development Indices, an automated classification algorithm could overcome limitations caused by the low prevalence of trained professionals and diagnostic variability in provider visual interpretations. Methods. Our dataset consists of cervical images () from 880 patient visits. After optimizing the network architecture and incorporating a weighted loss function, we explore two methods of incorporating green light image pairs into the network to boost the classification performance and sensitivity of our model on a test set. Results. We achieve an area under the receiver-operator characteristic curve, sensitivity, and specificity of 0.87, 75%, and 88%, respectively. The addition of the class-balanced loss and green light cervical contrast to a Resnet-18 backbone results in a 2.5 times improvement in sensitivity. Conclusion. Our methodology, which has already been tested on a prescreened population, can boost classification performance and, in the future, be coupled with Pap smear or HPV triaging, thereby broadening access to early detection of precursor lesions before they advance to cancer.

Vroegtijdige opsporing van voorstadia van een anaal carcinoom bij hiv-seropositieve patiënten

Early detection of precursor lesions of anal cancer in HIV-seropositive patients Although anal cancer is rare in the overall population, its incidence is increasing in the last decades. Especially HIV-seropositive patients have an increased risk of developing anal squamous cell carcinoma (SCC), mainly because of the high prevalence of high-grade anal intraepithelial neoplasia (AIN) among these patients. High-grade AIN is a precursor lesion for anal SCC associated with human papillomavirus (HPV) infection. Despite the lack of direct evidence demonstrating that AIN identification reduces the risk of anal cancer, experts think that screening and treatment of high-risk patients will prevent the disease. This article aims to review the current literature about AIN and discusses the screening options, including digital rectal examination, anal cytology and high-resolution anoscopy.

Assessment of the Risk of Colorectal Cancer in Patients with Diabetes Mellitus.

Background: The increased incidence of both colorectal cancer and diabetes mellitus, as well as the fact that they are important causes of high morbidity and especially mortality, place the two pathologies on the list of priorities of the health system. There are studies which have observed that diabetes mellitus is directly involved in carcinogenesis and is an independent risk factor for colorectal cancer. The diabetic patient requires a complex medical-surgical approach, so setting the risk criteria for them can be the starting point for improving the survival rate. Materials and methods: The association between colorectal cancer and diabetes mellitus as well as screening criteria were analyzed in a descriptive prospective study (442 patients) conducted in the Dr. I. Cantacuzino Clinical Hospital during 2017-2018. In the study, patients were distributed in two clusters, one with diabetes mellitus (N = 194) and one without diabetes mellitus (N = 248) in which basic clinical and laboratory evaluations were performed followed by screening colonoscopies. Results: Statistically significant (p 0.005) correlations were highlighted between 7 of the variables tested and the positive results on colonoscopy, which were subsequently combined to achieve a risk score. Conclusions: Diabetes mellitus is an independent risk factor and a negative prognostic factor for colorectal cancer. The risk score described as a result of this study is a feasible, simple solution for early detection of precursor lesions or neoplasms with the ultimate goal of improving the prognosis and survival of these patient.

Early colorectal cancer detection-Current and evolving challenges in evidence, guidelines, policy, and practices.

The understanding at the beginning of the last century that colorectal cancer began as a localized disease that progressed and became systemic, and that most colorectal cancer arose from adenomatous polyps gave rise to aggressive attempts at curative treatment and eventually attempts to detect advanced lesions before they progressed to invasive disease. In the last four decades, steadily greater uptake of screening has led to reductions in colorectal cancer incidence and mortality. However, the fullest potential of screening is not being met due to the lack of organized screening, where a systems approach could lead to higher rates of screening of average and high risk groups, higher quality screening, and prompt followup of adults with positive screening tests. ABSTRACT: Since the beginning of the 20th century, there has been a general understanding that colorectal cancer is a clonal disease that progresses from a localized stage with a favorable prognosis through progressively more advanced stages which have progressively worse prognosis. That understanding led first to determined efforts to detect and treat early stage symptomatic disease, and then to detect pre-symptomatic colorectal cancer and precursor lesions, where there was hope that the natural history of the disease could be arrested and the incidence and premature mortality of colorectal cancer averted. Toward the end of the last century, guidelines for colorectal cancer screening, growth in the number of technical options for screening, and a steady increase in the proportion of the adult population who attended screening contributed to the beginning of a significant decline in colorectal cancer incidence and mortality. Despite this progress, colorectal cancer remains the third leading cause of death among men and women in the United States. Screening for early detection of precursor lesions and localized cancer offers the single most productive opportunity to further reduce the burden of disease, and yet nearly four in five deaths from colorectal cancer are associated with having never been screened, not recently screened, or not followed up for an abnormal screening test. This simple observation is a call to action in all communities to apply existing knowledge to fulfill the potential to prevent avertable incidence and mortality.

Histopathological study of endometrial samples in abnormal uterine bleeding

The histopathological diagnosis of abnormal uterine bleeding (AUB) shows spectrum of patterns and pathologist plays a vital role in the reporting of endometrium and differentiating non-neoplastic lesion from neoplastic lesions, early detection of precursor lesions and exclusion of malignancy. The aim of this study is to study the spectrum of endometrial patterns in women with AUB and to correlate with the different age groups.256 samples of endometrial samples in women with AUB are received from the gynaecology department, processed and stained with hematoxylin & eosin and subjected to histopathological examination.The peak incidence is observed in the age group of 51-60 years. The most common histomorphological pattern is proliferative pattern. 60 cases (23.43%) show endometrial hyperplasia out of which 6 cases show atypia. Only 1 case(0.39%) of endometrial carcinoma reported overall and reported in postmenopausal age. Pill endometrium and chronic endometritis are not reported in postmenopausal age group and all 3 cases of atrophic endometrium are reported in postmenopausal age group. AUB significantly affects the quality life of women and leads to anemia. Hence histopathological examination should be considered which plays a critical role in early diagnosis of endometrial pathology and to provide appropriate gynaecological management.

Knowledge, Attitudes and Practices of Women Attending One of the Health Facilities in Hhohho Region, Swaziland, in Relation to Cervical Cancer and Screening

Background: In women cervical cancer is the leading cause of death among all cancers in developing countries, but it can be controlled through prevention and early detection of precursor lesions. In 2013 there were 223 new cases of cervical cancer in Swaziland with an estimated 118 cervical cancer related deaths. Most clients suffering from cervical cancer were below the age of 40 years and were diagnosed in the late stage. The study determined knowledge, attitudes and practices of women in relation to cervical cancer screening and treatment at one of the health facilities in the Hhohho Region, in Swaziland. Methodology: A quantitative-descriptive approach was utilized among 56 participants selected using purposive sampling. Respondents were women who came for health care services at the Health Facility’s Antiretroviral Therapy (ART) Department. The collected data were entered into SPSS and analyzed using descriptive statistics and Pearson’s correlation. Findings: Ninety-four percent (94.6%) of the respondents reported to have heard of cervical cancer, and 96.4% reported that screening for cervical cancer could detect symptoms before they appeared. Only 1.8% was aware of the association between cervical cancer and the Human Papilloma Virus (HPV). Thirty-seven percent (37.5%) of the respondents reported to have ever screened for cervical cancer. The major reasons reported for not screening were busy work schedule, and being turned back by nurses. There was a significant relationship between level of education and knowledge of risk factors for cervical cancer (r=0.306, p=0.022). Data also supported a significant relationship between age of the respondents and knowledge on how to protect self from getting cervical cancer(r=-0.402, p=0.002). Data supported a significant relationship between knowledge on risk factors and knowledge on how to protect self from acquiring cervical cancer (r=0.295, p=0.027). Recommendations: It is recommended that nursing practice should also focus on the provision of services to the working class by offering cervical cancer screening services on weekends and public holidays. Nurses need to be more responsive to clients’ health needs and avoid turning clients back.

Screening to Detect Precursor Lesions of Pancreatic Adenocarcinoma in High-risk Individuals: A Single-center Experience.

Objective of the workPancreatic cancer (PC) is a deadly disease that is most commonly diagnosed at an incurable stage. Early diagnosis is the most important factor for improving prognosis. Evidence is beginning to accumulate that screening and surveillance may lead to the early detection of precursor lesions and/or pancreatic cancer in asymptomatic individuals. Proper screening methods and identification of such precursor lesions may enable effective pre-emptive interventions to prevent further fatalities. The primary objective of this project was to examine the feasibility of identifying precursor or early cancerous lesions in high-risk individuals by endoscopic ultrasound (EUS) screening to prevent the deaths from pancreatic cancer.Research aimPancreatic cancer screening guidelines, based on consensus opinions, have been applied in various tertiary centers around the world; however, evidence for effectiveness is lacking. At Rambam Health Care Campus, we have established a cohort of high-risk individuals, and we report our local 10-year experience results of screening for pancreatic cancer.MethodsBetween 2008 and 2018, a cohort of 123 asymptomatic high-risk individuals came for annual/biannual EUS screening for pancreatic cancer. Retrospective and prospectively collected data were obtained, analyzed, and compared on the basis of several variables. These variables include age at beginning of screening, gender, smoking, obesity, diabetes, and presence of tumor markers, as well as the patients’ personal and family history of cancers. Findings on each EUS are described.ResultsThree patients out of 123 underwent potentially life-saving surgery as a result of this screening program. All of these three had only one first-degree relative (FDR) with pancreatic cancer at the time of their first screenings, but two eventually had a second FDR with PC. Findings from 296 EUS exams regarding smoking, obesity, and other risk factors are presented. Minor, possibly trivial, EUS findings are found to be common. Detection of precursor pancreatic lesions is feasible with EUS screenings.ConclusionsAdherence was an important limiting factor in screening. Better stratification of patients according to specific risk factors, including thorough genetics and family history, may direct when and how to initiate screening. International collaborations, such as the International Cancer of Pancreas Screening (CAPS) Consortium, of which Rambam is a collaborating partner, are needed to collate evidence for impact of screening to prevent pancreatic cancer morbidity and mortality, and are essential to achieve proof of concept. Different countries with varying health-care systems and budgets can find variance of appropriateness of screening procedures.

Fecal Metabolome in Hmga1 Transgenic Mice with Polyposis: Evidence for Potential Screen for Early Detection of Precursor Lesions in Colorectal Cancer.

Because colorectal cancer (CRC) remains a leading cause of cancer mortality worldwide, more accessible screening tests are urgently needed to identify early stage lesions. We hypothesized that highly sensitive, metabolic profile analysis of stool samples will identify metabolites associated with early stage lesions and could serve as a noninvasive screening test. We therefore applied traveling wave ion mobility mass spectrometry (TWIMMS) coupled with ultraperformance liquid chromatography (UPLC) to investigate metabolic aberrations in stool samples in a transgenic model of premalignant polyposis aberrantly expressing the gene encoding the high mobility group A (Hmga1) chromatin remodeling protein. Here, we report for the first time that the fecal metabolome of Hmga1 mice is distinct from that of control mice and includes metabolites previously identified in human CRC. Significant alterations were observed in fatty acid metabolites and metabolites associated with bile acids (hypoxanthine xanthine, taurine) in Hmga1 mice compared to controls. Surprisingly, a marked increase in the levels of distinctive short, arginine-enriched, tetra-peptide fragments was observed in the transgenic mice. Together these findings suggest that specific metabolites are associated with Hmga1-induced polyposis and abnormal proliferation in intestinal epithelium. Although further studies are needed, these data provide a compelling rationale to develop fecal metabolomic analysis as a noninvasive screening tool to detect early precursor lesions to CRC in humans.

Monitoring the progression from intraductal carcinoma to invasive ductal carcinoma based on multiphoton microscopy.

Intraductal carcinoma is a precancerous lesion of the breast and the immediate precursor of invasive ductal carcinoma. Multiphoton microscopy (MPM) was used to monitor the progression from intraductal carcinoma to invasive ductal carcinoma, which can improve early detection of precursor lesions and halt progression to invasive neoplastic disease. It was found that MPM has the capability to reveal the qualitative changes in features of cells, structure of basement membranes, and architecture of collagens during the development from intraductal carcinoma to invasive ductal carcinoma, as well as the quantitative alterations in nuclear area, circle length of basement membrane, and collagen density. Combined with intra-fiberoptic ductoscopy or transdermal biopsy needle, MPM has the potential to provide immediate histological diagnosis of tumor progression in the field of breast carcinoma.

The diagnostic process of cervical cancer; areas of good practice, and windows of opportunity

ObjectiveDespite an extensive screening programme in The Netherlands, some cases of cervical cancer are still diagnosed in late stages of disease. The aim of the present study was to investigate which elements in the diagnostic process of cervical cancer may be improved. MethodsThis is a retrospective study of 120 patients with cervical cancer diagnosed between January 1st 2008 and June 1st 2010 at the University Medical Center Utrecht. Patient charts, referral information, and pathology results were analyzed. Results39.1% of cancer cases were screen or interval detected; the other 60.9% of patients had not been screened, either due to non-attendance or because they fell outside the age range for screening. The final diagnosis of cervical cancer was established by biopsy in 77 (64.2%) and by excision of the cervical transformation zone in 35 (29.2%) of the patients. Fifteen (43%) of these excisions could have been avoided if biopsies would have been taken at the first examination, and had shown invasive cancer. ConclusionsCervical cancer screening aims at early detection of precursor lesions to decrease the incidence of cancer. This in-depth analysis suggests that improvement of quality of care is to be expected from correct recognition of cervical cancer by physicians and adjustments of the screening programme to reach younger women and non-responders.

Measuring telomere length for the early detection of precursor lesions of esophageal squamous cell carcinoma

BackgroundEsophageal cancer is the sixth leading cause of cancer death worldwide; current early detection screening tests are inadequate. Esophageal balloon cytology successfully retrieves exfoliated and scraped superficial esophageal epithelial cells, but cytologic reading of these cells has poor sensitivity and specificity for detecting esophageal squamous dysplasia (ESD), the precursor lesion of esophageal squamous cell carcinoma (ESCC). Measuring telomere length, a marker for chromosomal instability, may improve the utility of balloon cytology for detecting ESD and early ESCC.MethodsWe examined balloon cytology specimens from 89 asymptomatic cases of ESD (37 low-grade and 52 high-grade) and 92 age- and sex-matched normal controls from an esophageal cancer early detection screening study. All subjects also underwent endoscopy and biopsy, and ESD was diagnosed histopathologically. DNA was extracted from the balloon cytology cells, and telomere length was measured by quantitative PCR. A receiver operating characteristic (ROC) curve was plotted for telomere length as a diagnostic marker for high-grade dysplasia.ResultsTelomere lengths were comparable among the low- and high-grade dysplasia cases and controls, with means of 0.96, 0.96, and 0.92, respectively. The area under the ROC curve was 0.55 for telomere length as a diagnostic marker for high-grade dysplasia. Further adjustment for subject characteristics, including sex, age, smoking, drinking, hypertension, and body mass index did not improve the use of telomere length as a marker for ESD.ConclusionsTelomere length of esophageal balloon cytology cells was not associated with ESCC precursor lesions. Therefore, telomere length shows little promise as an early detection marker for ESCC in esophageal balloon samples.

Abstract C25: Measuring Alu and LINE-1 methylation for the early detection of precursor lesions of esophageal squamous cell carcinoma

Abstract Objectives: Esophageal cancer is the sixth leading cause of cancer death worldwide. The prognosis for esophageal cancer is dismal because most patients are diagnosed at a late stage. Patients can be successfully treated if diagnosed early, but current early detection screening tests are inadequate. Balloon cytology is a simple and inexpensive method of retrieving esophageal cells, but traditional cytologic examination of these cells has poor sensitivity and specificity for detecting precursor lesions. Thus, a biomarker such as DNA hypomethylation, which predisposes cells to chromosomal defects and genetic instability, may be used to improve the early detection of precursor lesions. In this study, we examined whether overall methylation levels of transposable elements Alu and long-interspersed nuclear elements (LINE-1) in the DNA extracted from balloon cytology-collected esophageal cells are associated with precursor lesions of esophageal squamous cell carcinoma (ESCC). Methods: The Cytology Sampling Study 2, a population-based early detection screening study of ESCC, recruited over 700 healthy subjects from a high-risk population in Linxian, China. The screening study used a mesh-covered balloon to collect esophageal cells. All subjects underwent endoscopy and Lugol's iodine, and precursor lesions were diagnosed by biopsy. Using a nested case-control study design, we examined the association between Alu and LINE-1 methylation levels and esophageal health in 50 esophagitis cases, 38 low-grade dysplasia cases, 55 high-grade dysplasia cases, and 94 matched normal controls. DNA methylation assessment of Alu and LINE-1 repetitive elements was conducted using quantitative PCR pyrosequencing on bisulphate-treated DNA extracted from cells collected by balloon cytology. Receiver operating characteristic (ROC) curves were plotted, and the area under the ROC curve (AUC) was calculated for methylation levels as a diagnostic marker for high-grade dysplasia. Logistic regression models adjusted for age, sex, smoking tobacco, alcohol intake, and hypertension were used to examine the association between Alu and LINE-1 methylation levels and risk of high-grade dysplasia compared with the other diagnoses. Results: Median Alu methylation levels were comparable among the esophagitis cases (24.5%), low-grade dysplasia cases (24.6%), high-grade dysplasia cases (24.6%), and normal controls (24.6%). Median LINE-1 methylation levels were also comparable among the esophagitis cases (71.8%), low-grade dysplasia cases (72.2%), high-grade dysplasia cases (71.6%), and controls (72.2%). The AUCs for using Alu and LINE-1 methylation levels as a diagnostic marker for high-grade dysplasia were 0.62 and 0.59, respectively. Overall, Alu and LINE-1 methylation levels were not associated with risk of high-grade dysplasia, with odds ratios (95% confidence interval) of 1.1 (0.9-1.4) and 1.1 (0.9-1.3), respectively. Conclusions: Given that esophageal cancers have very poor prognoses, it is of utmost importance to improve early detection methods. In this study, esophageal cell DNA methylation levels of Alu and LINE-1 were not associated with esophageal precursor lesions, and thus do not appear useful as an early detection marker. Future early detection studies may examine DNA hypomethylation in general or loci-specific methylation levels. Citation Format: Shih-Wen Lin, Christian C. Abnet, Neal D. Freedman, Lee Moore, Liying Yan, Ann Meyer, Qin-Jing Pan, Mark Roth, Guo-Qing Wang, Wen-Qiang Wei, Ning Lu, Philip R. Taylor, You-Lin Qiao, Sanford M. Dawsey. Measuring Alu and LINE-1 methylation for the early detection of precursor lesions of esophageal squamous cell carcinoma. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr C25.

Abstract 1165: Measuring telomere length for the early detection of precursor lesions of esophageal squamous cell carcinoma.

Abstract Objectives: Esophageal cancer is the fifth leading cause of cancer death worldwide. The five-year survival is approximately 16%. Patients can be successfully treated if diagnosed early, but current early detection screening tests are inadequate. Balloon cytology is a simple and inexpensive method of retrieving esophageal cells, but traditional cytologic examination of these cells has poor sensitivity and specificity. We examined whether telomere length, a marker for chromosomal instability, in DNA extracted from balloon cytology-collected esophageal cells is associated with precursor lesions of esophageal squamous cell carcinoma. Methods: The Cytology Sampling Study 2, a population-based esophageal cancer early detection screening study, recruited over 700 healthy subjects from a high-risk population in Linxian, China. The screening study used a mesh-covered balloon to collect esophageal cells. All subjects underwent endoscopy, and precursor lesions were diagnosed by biopsy. Using a nested case-control study design, we examined the association between telomere length and dysplasia in 37 low-grade dysplasia cases, 52 high-grade dysplasia cases, and 92 matched controls. DNA was extracted from cells collected by balloon cytology, and telomere length was measured in triplicate by a quantitative PCR assay. Logistic regression models adjusted for age, sex, smoking tobacco, alcohol intake, and hypertension were used to examine the association between telomere length and risk of low-grade dysplasia and high-grade dysplasia, compared with normal controls. Results: Telomere lengths were comparable among the low-grade dysplasia cases, high-grade dysplasia cases, and controls, with a median of 0.93 [interquartile range (IQR), 0.84-1.06], 0.94 (IQR, 0.82-1.09), and 0.93 (IQR, 0.78-1.05), respectively. Overall, telomere length was not associated with risk of low-grade dysplasia or high-grade dysplasia, with an odds ratio [OR, 95% confidence interval (CI)] of 1.16 (0.87-1.54) and 1.20 (0.92-1.56), respectively. Conclusions: Given that esophageal cancers have very poor prognoses, it is of utmost importance to improve early detection. In this study, esophageal cell telomere length was not associated with esophageal precursor lesions and cannot serve as an early detection marker. Citation Format: Shih-Wen Lin, Christian C. Abnet, Neal D. Freedman, Rosana Risques, Donna Prunkard, Peter Rabinovitch, Ning Lu, You-Lin Qiao, Sanford M. Dawsey. Measuring telomere length for the early detection of precursor lesions of esophageal squamous cell carcinoma. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1165. doi:10.1158/1538-7445.AM2013-1165

Cobertura e adequação do exame citopatológico de colo uterino em estados das regiões Sul e Nordeste do Brasil

Cervical cancer is the second most common cancer among women both in Brazil and elsewhere in the world and can be averted through early detection of precursor lesions. Pap smear is still the most effective and efficient screening test. This study focused on the coverage and adequacy of Pap test and associated factors. The authors adopted a cross-sectional design with a sample of 3,939 women who had given birth in the two previous years in 41 municipalities (counties) of Brazil. Lifetime Pap test coverage was 75.3% (95%CI: 74.0-76.7), and prevalence of adequacy was 70.7% (95%CI: 69.3-72.1). Adequacy was positively associated with age over 25 years, schooling, prenatal care in the last pregnancy, and gynecological visit in the previous year, and was less frequent among primiparous women and those with lower socioeconomic status. It is thus necessary to strengthen preventive measures in vulnerable subgroups and maximize situations for use of health services.

Reasons for Participation and Nonparticipation in Colorectal Cancer Screening: A Randomized Trial of Colonoscopy and CT Colonography

We compared reported reasons for participation and nonparticipation in colorectal cancer (CRC) screening between colonoscopy and computed tomographic (CT) colonography in a randomized controlled trial. We randomly invited 8,844 people for screening by colonoscopy or CT colonography. On a questionnaire, invitees indicated reasons for participation or nonparticipation and indicated the most decisive reason. The most frequently cited reasons to accept screening were early detection of precursor lesions and CRC, and contribution to science. The most frequently cited reasons to decline were the unpleasantness of the examination, the inconvenience of the preparation, a lack of symptoms, and "no time/too much effort." Among colonoscopy nonparticipants, elderly invitees cited inconvenience less often, and absence of symptoms more often, than did the group overall. The reason reported most frequently as the most decisive reason not to participate was the unpleasantness of the examination among colonoscopy nonparticipants, and "no time/too much effort" and lack of symptoms among CT colonography nonparticipants. In light of these results, future screening programs could tailor the information provided to invitees.

Usefulness of serum mass spectrometry to identify women diagnosed with higher grades of cervical intraepithelial neoplasia may differ by race

BackgroundAn early detection of precursor lesions of cervical cancer will help to eliminate the worldwide burden of cervical cancer.MethodsThis exploratory study aimed to identify, by matrix-assisted laser desorption/ionization (MALDI) time-of-flight (TOF) mass spectrometry (MS), serum protein profiles that distinguish cervical intraepithelial neoplasia grades CIN 1 or lower (≤CIN 1) from CIN 2+ among 127 women infected with human papillomavirus (HPV) 16. Of these 127 women, 25 and 23 were diagnosed with CIN 2 or CIN 3, respectively (cases), and 79 were diagnosed with ≤CIN 1 (non-cases). Serum protein profiles were generated by MALDI-TOF-MS. A total of 95 m/z peaks were tested for association with case status by two racial groups, African American (AAs) and Caucasian American (CAs).ResultsOverall, 2 protein peaks identified by our study demonstrated higher specificity for identifying CIN 2+ than previously published studies. An increasing intensity of [m/z 4459] was associated with a higher risk of being a case, regardless of race with a specificity of 58% for CIN 2 and a specificity of 75% for CIN 3. An increasing intensity of [m/z 4154] was not only associated with a higher risk of being a case only among CAs, but also had an opposite effect among AAs.ConclusionIdentification of specific proteins associated with the peaks detected in serum and development of antibody-based tests such as ELISA should lead to the development of race-specific, non-invasive and cost effective screening tests with higher specificity for identifying HPV 16 associated CIN 2+.

Feasibility and yield of screening in relatives from familial pancreatic cancer families.

Pancreatic adenocarcinoma is a lethal disease. Over 80% of patients are found to have metastatic disease at the time of diagnosis. Strategies to improve disease-specific outcome include identification and early detection of precursor lesions or early cancers in high-risk groups. In this study, we investigate whether screening at-risk relatives of familial pancreatic cancer (FPC) patients is safe and has significant yield. We enrolled 309 asymptomatic at-risk relatives into our Familial Pancreatic Tumor Registry (FPTR) and offered them screening with magnetic resonance cholangiopancreaticogram (MRCP) followed by endoscopic ultrasound (EUS) with fine needle aspiration if indicated. Relatives with findings were referred for surgical evaluation. As of 1 August 2009, 109 relatives had completed at least one cycle of screening. Abnormal radiographic findings were present on initial screening in 18/109 patients (16.5%), 15 of whom underwent EUS. A significant abnormality was confirmed in 9 of 15 patients, 6 of whom ultimately had surgery for an overall diagnostic yield of 8.3% (9/109). Yield was greatest in relatives >65 years old (35%, 6/17) when compared with relatives 55-65 years (3%, 1/31) and relatives <55 years (3%, 2/61). Screening at-risk relatives from FPC families has a significant diagnostic yield, particularly in relatives >65 years of age, confirming prior studies. MRCP as initial screening modality is safe and effective.