Reduction In Cancer-related Mortality Research Articles

Shifting the Cancer Screening Paradigm: Developing a Multi-Biomarker Class Approach to Multi-Cancer Early Detection Testing.

Guideline-recommended screening programs exist for only a few cancer types. Although all these programs are understood to lead to reductions in cancer-related mortality, standard-of-care screening tests vary in accuracy, adherence and effectiveness. Recent advances in high-throughput technologies and machine learning have facilitated the development of blood-based multi-cancer cancer early detection (MCED) tests. MCED tests are positioned to be complementary to standard-of-care screening and they may broaden screening availability, especially for individuals who are not adherent with current screening programs and for individuals who may harbor cancers with no available screening options. In this article, we outline some key features that should be considered for study design and MCED test development, provide an example of the developmental pathway undertaken for an emerging multi-biomarker class MCED test and propose a clinical algorithm for an imaging-based diagnostic resolution strategy following MCED testing.

Vitamin D, Menopausal Health and COVID-19: Critical Appraisal of Current Data.

Inconsistency exists across studies conducted in postmenopausal women regarding the effect of vitamin D deficiency (VDD) and supplementation on several aspects of menopausal health, such as fractures, vasomotor symptomatology, cardiovascular disease (CVD), cancer and infections, including coronavirus disease 2019 (COVID-19). The aim of this review is to critically summarize the evidence provided by observational studies and randomized controlled trials (RCTs) of vitamin D supplementation in postmenopausal women with VDD. Observational studies have found that VDD is associated with an increased risk of falls and fractures after the menopause. VDD also has a negative effect on menopausal symptomatology. VDD, especially its severe form, is associated with an increased risk of CVD risk factors and CVD events. VDD is associated with increased risk and mortality from several cancer types and risk of infections. The evidence from RCTs regarding the effect of vitamin D supplementation on falls, fractures, menopausal symptoms, cardiovascular disease, cancer and infections is not robust. Thus, skeletal health may benefit only when vitamin D is co-administered with calcium, especially in those ≥70 years old and with severe VDD. There is no evidence of a favorable effect on menopausal symptoms or risk of CVD or cancer, except for a modest reduction in cancer-related mortality. Inconsistency still exists regarding its effect on infection risk, disease severity and mortality due to COVID-19.

EMAS position statement: Vitamin D and menopausal health

IntroductionThere is increasing evidence that vitamin D has widespread tissue effects. In addition to osteoporosis, vitamin D deficiency has been associated with cardiovascular disease, diabetes, cancer, infections and neurodegenerative disease. However, the effect of vitamin D supplementation on non-skeletal outcomes requires clarification, especially in postmenopausal women. AimThis position statement provides an evidence-based overview of the role of vitamin D in the health of postmenopausal women based on observational and interventional studies. Materials and methodsLiterature review and consensus of expert opinion. Results and conclusionsVitamin D status is determined by measuring serum 25-hydroxyvitamin D levels. Concentrations <20 ng/ml (<50 nmol/l) and <10 ng/ml (<25 nmol/l) are considered to constitute vitamin D deficiency and severe deficiency, respectively. Observational data suggest an association between vitamin D deficiency and adverse health outcomes in postmenopausal women, although they cannot establish causality. The evidence from randomized controlled trials concerning vitamin D supplementation is not robust, since many studies did not consider whether people were deficient at baseline. Moreover, high heterogeneity exists in terms of the population studied, vitamin D dosage, calcium co-administration and duration of intervention.Concerning skeletal health, vitamin D deficiency is associated with low bone mass and an increased risk of fractures. Vitamin D supplementation at maintenance doses of 800–2000 IU/day (20–50 μg/day), after repletion of vitamin D status with higher weekly or daily doses, may be of benefit only when co-administered with calcium (1000–1200 mg/day), especially in the elderly populations and those with severe vitamin D deficiency.Concerning cardiovascular disease, vitamin D deficiency is associated with an increased prevalence of cardiovascular risk factors, mainly metabolic syndrome, type 2 diabetes mellitus and dyslipidemia. Vitamin D deficiency, especially its severe form, is associated with an increased risk of cardiovascular events (coronary heart disease, stroke, mortality), independently of traditional risk factors. Vitamin D supplementation may have a modestly beneficial effect on lipid profile and glucose homeostasis, especially in obese individuals or those ≥60 years old and at doses of ≥2000 IU/day (≥50 μg/day). However, it has no effect on the incidence of cardiovascular events.Concerning cancer, vitamin D deficiency is associated with increased incidence of and mortality from several types of cancer, such as colorectal, lung and breast cancer. However, the data on other types of gynecological cancer are inconsistent. Vitamin D supplementation has no effect on cancer incidence, although a modest reduction in cancer-related mortality has been observed.Concerning infections, vitamin D deficiency has been associated with acute respiratory tract infections, including coronavirus disease 2019 (COVID-19). Vitamin D supplementation may decrease the risk of acute respiratory tract infections and the severity of COVID-19 (not the risk of infection).Concerning menopausal symptomatology, vitamin D deficiency may have a negative impact on some aspects, such as sleep disturbances, depression, sexual function and joint pains. However, vitamin D supplementation has no effect on these, except for vulvovaginal atrophy, at relatively high doses, i.e., 40,000–60,000 IU/week (1000–1500 IU/week) orally or 1000 IU/day (25 μg/day) as a vaginal suppository.

The Role of Nutrition in Primary and Secondary Prevention of Cardiovascular Damage in Childhood Cancer Survivors.

Innovative therapeutic strategies in childhood cancer led to a significant reduction in cancer-related mortality. Cancer survivors are a growing fragile population, at risk of long-term side effects of cancer treatments, thus requiring customized clinical attention. Antineoplastic drugs have a wide toxicity profile that can limit their clinical usage and spoil patients’ life, even years after the end of treatment. The cardiovascular system is a well-known target of antineoplastic treatments, including anthracyclines, chest radiotherapy and new molecules, such as tyrosine kinase inhibitors. We investigated nutritional changes in children with cancer from the diagnosis to the end of treatment and dietary habits in cancer survivors. At diagnosis, children with cancer may present variable degrees of malnutrition, potentially affecting drug tolerability and prognosis. During cancer treatment, the usage of corticosteroids can lead to rapid weight gain, exposing children to overweight and obesity. Moreover, dietary habits and lifestyle often dramatically change in cancer survivors, who acquire sedentary behavior and weak adherence to dietary guidelines. Furthermore, we speculated on the role of nutrition in the primary prevention of cardiac damage, investigating the potential cardioprotective role of diet-derived compounds with antioxidative properties. Finally, we summarized practical advice to improve the dietary habits of cancer survivors and their families.

Is a ‘cancer check-up’ near for high-risk adults? clinician attitudes and perspectives on multicancer early detection tests.

e23008 Background: Current screening guidelines for many cancers are limited and multiple cancer-screening tests are not yet FDA approved. The development and potential use of a pan-tumor or multi-cancer early detection (MCED) test has been met with both enthusiasm and hesitation, despite its potential for early detection and a resultant reduction in cancer-related mortality and morbidity. The lack of knowledge of clinician perceptions of MCED test and the need to educate a multidisciplinary team prompted the design of educational initiatives in 2020 and 2021. Methods: In September 2020 and July 2021; two 1-hour CME activities were launched live-online on OMedLive.com; the 2021 activity remains on-demand until July 2022. The 2020 activity introduced the value proposition and trial designs of MCED tests and reviewed the current cancer screening guidelines. Challenges revealed from the 2020 activity informed the multidisciplinary approach of the 2021 activity presenting epidemiology, oncology, and primary care perspectives. In both activities, participants were assessed at 3 time points (pre-, immediate post-, and 2 mos. post-activity) and McNemar tests compared paired responses with Cohen’s d for effect size. Behavioral impact, perception, and practice pattern questions were also assessed immediately post-activity and year-to-year data analyzed. Results: As of 02/13/22, 1,015 clinicians have participated in the 2020 activity and 3,372 in the 2021 activity. Across the eight CME test questions, seven exhibited improvements in knowledge/competence related to screening modalities, trial data, value of MCED tests, and clinical workflow following results. In the analysis of perception and practice pattern questions, 50% of clinicians were likely to integrate MCED tests into their practice; however, expectation of high costs and access/availability to utilize MCED tests at their practice were the top barriers identified. A lack of consensus in identifying adults at higher risk of cancer was observed in 2020 with improvements seen in 2021. At 2-mos. follow-up for the 2020 and 2021 activity, respectively, clinicians reported practice behavior changes as 89% and 73% related to clinical practice, while 89% and 72% reported improved patient experience/outcomes. Qualitative data including clinician write-in examples of specific practice behavior changes will be analyzed. Conclusions: These data provide real-world insight into clinician perspectives on MCED tests and the clinical, patient-care, and workflow challenges that should be considered before incorporating future approaches on multi-cancer screening. As the primary care setting is most suited for the introduction of novel cancer-screening tools, PCPs and oncologists will require continued education to apply practical strategies for point-of-care decision-making and transitions of care protocols.

Whom to screen? A view on lung cancer screening from the pneumologist’s perspective

The benefits of screening programs are highly dependent on risk group definition. This is especially true for lung cancer screening. Results from the National Lung Cancer Screening Trial (NLST) and the NELSON trial (Dutch/Belgian randomised lung cancer screening trial) demonstrated that lung cancer screening using low-dose CT scans results in reduction of cancer-related mortality. This article gives a short overview on participant selection in the NLST and NELSON trials, and on current evidence for implementation of multivariable risk prediction models.

Safety and efficacy of aspirin for primary prevention of cancer: A meta-analysis of randomized controlled trials.

1533 Background: In the United States, cancer is the second leading cause of mortality, and millions more battle cancer worldwide. As such, primary prevention of cancer is a major interest globally. Aspirin has been studied as a primary prevention method for multiple diseases, mainly cardiovascular disease and various forms of cancer. The role of aspirin as a primary prevention of cancer is still controversial and may be more beneficial in certain cancers over others. With rapidly surfacing large randomized controlled trials (RCTs) studying this subject, we aimed to evaluate the efficacy and safety of aspirin as a primary prophylaxis for cancer. Methods: A comprehensive electronic database search was conducted for all RCTs that compared aspirin versus placebo for the prevention of any type of disease, and where cancer incidence or mortality was reported. The primary outcome was cancer-related mortality. Secondary outcomes were cancer incidence, all-cause mortality, major bleeding, any bleeding and gastrointestinal (GI) bleeding. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) using a random-effects model at the longest follow-up period. Results: We included 16 RCTs with 104,018total patients, mean age of 60.51 years, mean follow-up of 5.48 years, and a male percentage of 38.72%. We found that aspirin was not associated with a significant reduction of cancer-related mortality compared with placebo (RR 0.99; 95% CI: 0.87-1.12; P = 0.85: I2= 41%). Compared with placebo, aspirin was not associated with significant reduction of all-cause mortality (RR 0.97; 95% CI: 0.92-1.02; P = 0.19; I2= 13%) or cancer incidence (RR: 0.98; 95% CI: 0.92-1.04; P = 0.43; I2= 16%). However, aspirin treatment was associated with significantly increased risks of any bleeding (RR 1.63; 95% CI: 1.31-2.03; P &lt; 0.01), major bleeding (RR 1.41; 95% CI: 1.26-1.57; P &lt; 0.01), and GI bleeding (RR 1.85; 95% CI: 1.38-2.48; P &lt; 0.01) compared with placebo. Conclusions: Our study did not find any significant reductions in cancer-related mortality or cancer incidence when compared with placebo. Our study also highlights the dangers of aspirin for primary prevention of cancer as aspirin was found to cause higher rates of bleeding (any bleeding, major bleeding, and GI bleeding) compared to placebo at the longest follow-up period with no significant benefit in cancer primary prevention.

Safety and efficacy of aspirin for primary prevention of cancer: a meta-analysis of randomized controlled trials.

In the United States, cancer is the second leading cause of mortality, and millions more battle cancer worldwide. As such, primary prevention of cancer is a major interest globally. Aspirin has been studied as a primary prevention method for multiple diseases, mainly cardiovascular disease and various forms of cancer. The role of aspirin as a primary prevention of cancer is still controversial and may be more beneficial in certain cancers over others. With rapidly surfacing large randomized controlled trials (RCTs) studying this subject, we aimed to evaluate the efficacy and safety of aspirin as a primary prophylaxis for cancer. A comprehensive electronic database search was conducted for all RCTs that compared aspirin versus placebo for the prevention of any type of disease, and where cancer incidence or mortality was reported. The primary outcome was cancerrelated mortality. Secondary outcomes were cancer incidence, all-cause mortality, major bleeding, any bleeding and gastrointestinal (GI) bleeding. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) using a random-effects model at the longest follow-up period. We included 16 RCTs with 104,018 total patients, mean age of 60.51 years, mean follow-up of 5.48 years, and a male percentage of 38.72%. We found that aspirin was not associated with a significant reduction of cancer-related mortality compared with placebo (RR 0.99; 95% CI: 0.87-1.12; P = 0.85: I2 = 41%). Compared with placebo, aspirin was not associated with significant reduction of all-cause mortality (RR 0.97; 95% CI: 0.92-1.02; P = 0.19; I2 = 13%) or cancer incidence (RR: 0.98; 95% CI: 0.92-1.04; P = 0.43; I2 = 16%). However, aspirin treatment was associated with significantly increased risks of any bleeding (RR 1.63; 95% CI: 1.31-2.03; P < 0.01), major bleeding (RR 1.41; 95% CI: 1.26-1.57; P < 0.01), and GI bleeding (RR 1.85; 95% CI: 1.38-2.48; P < 0.01) compared with placebo. Our study did not find any significant reductions in cancer-related mortality or cancer incidence when compared aspirin use with placebo or no aspirin. Our study also highlights that the use of aspirin for primary prevention of cancer was found to cause higher rates of bleeding (any bleeding, major bleeding, and GI bleeding) compared to placebo or no aspirin at the longest follow-up period with no significant benefit in cancer primary prevention.

Positron-Emission Tomography-Computed Tomography for Cancer Screening: Boon or Bane.

We read the article by Caliskan et al. [1] with great interest. The authors have reported a case of incidentally detected rectal cancer in a patient undergoing positron-emission tomography–computed tomography (PET-CT) examination for assessment of a screen detected pulmonary nodule. Though PET-CT may be able to further characterize the lesion (more than 8-mm solid or partly solid pulmonary nodule) identified on screening CT, it is of low specificity if the patient has granulomatous disease. Based on the identification of a clinically asymptomatic rectal cancer in this patient, the authors have pitched for utilization of PET-CT for cancer screening. They have flagged the government policy for not reimbursing the cost of PET-CT done for cancer screening. The case report is interesting, but its scientific value is anecdotal, at best. There are some vital questions which need to be addressed before one endorses the use of PET-CT for cancer screening. Firstly, there has been a lot of scepticism about the benefits of cancer screening: whether it really leads to a reduction in solid tumours related mortality rates in the screened population. It needs to be further clarified that differences in survival rates following cancer screening do not always translate into differences in mortality rates due to ‘lead time’ and ‘over diagnosis’ bias. PSA screening for prostate cancer has been a classic example of how the screening failed to reduce the mortality rates despite having improvement in survival rates. Secondly, using PET-CT for cancer screening has its own pitfalls. The impact of PET-CTcancer screening on the cancer-related mortality has not been investigated by any prospective randomized controlled trial. The cost effectiveness and efficiency of PET-CT and other conventional screening tests (mammography, colonoscopy etc.) has also never been compared in any previous study to ascertain if it can lead to superior detection of those lesions which are missed by conventional screening tests. This is a well-known fact that small malignant or precancerous lesions are likely to be missed by a PET-CT (for example, in colon cancer) while resection of these early lesions actually may bring about reduction in cancer-related mortality [2]. Moreover, false positive findings are a major concern as they result in further work up and secondary expenditure. Another area of concern is FDG-negative malignant lesions which may not be evident of PET-CT and may lead to false negative results [3]. One of the criteria for a good screening test is that it should minimally affect the nondiseased screened individuals. In the absence of robust data to support benefit of PET-CT in cancer screening, its associated radiation hazard remains an important deterring factor against its indiscriminate use. The expansion of indications for PET-CT in oncology is inevitable in the time to come. However, various pitfalls of this extremely alluring imaging investigation need to be explained to the patients/asymptomatic persons with complete professional integrity. * Pankaj Kumar Garg dr.pankajgarg@gmail.com

Abstract A029: Cell-based cancer immunotherapy using tumor presenting cells: A phase II trial with local advance prostate cancer patients

Abstract We described a non-randomized control phase II trial, using a novel Cell Based Cancer Immunotherapy using Tumor Presenting Cells (TPC). The patient population was selected at HCPA – Porto Alegre Brazil (University Hospital). Patients with clinical localized prostate cancer and scheduled to undergo radical retro pubic prostatectomy (RRP) were identified. High-risk patients (initial PSA levels above 10 ng/ml, Gleason above 8 or upstaged from the clinical staging) were offer to participate on the trial. This group of patients represent a very important clinical population that cloud benefit from an adjuvant therapy. Tumor Presenting Cells are a new strategy for immunotherapy. Solid tumor cells as other non-immunological cells do not present MHC Class II. The MHC class II is a critical molecule responsible for peptide presentation to T helper cells. The presence of a not-self peptide on a MHC II molecule trigger the production of cytokines responsible for different steps on T cell expansion and maturation. Without the appropriate cytokine stimulation, cytotoxic T cells that identified a not-self peptide associate to a MHC class I molecules, may not proliferate or even be induce to anergy. In our model, solid tumor cells (prostate cancer) are induce to express MHCII on their surface. In this novel approach of Cell Based Cancer Immunotherapy (CBCI), patient's tumor cells were expanded in tissue culture and treated causing de novo expression of MHC II and activation of the MHC II peptide presentation pathway. Thus, the modified cancer cells are bifunctional, being capable of activating both helper T cells (MHC II) and cytotoxic T cells (MHCI), leading to cytokine production and a surprisingly robust and cancer-specific immune response. The modified solid tumor cell by itself will now behave as an antigen-presenting cell creating a Tumor Presenting Cell (TPC). Once the tumor cells are modified, they are irradiated and inoculated as intradermal injections (7 doses). Although the individualized preparation of CBCI is labor intensive, we were able to prepare the cell material on almost all collected samples (103/107 - 96%). DTH reactions (≥ 5 mm) were positive in 73% of the patients (16/23). This study corroborates with low toxicity of cell based immunotherapy. We have found mild skin reactions on inoculation sites in all vaccinated patients. More intense reactions (ulceration, low-grade fever, and adenopathy) were found in 13% of patients (3/23). We demonstrated a clinical benefit with the used of the CBCI: 27% (6/22) of the patients submitted to CBCI presented detectable levels of PSA (above 0.004 ng/mL) after 5 years, when compare to 53% (19/36) on the control group (p=0.03). There was also trend on reduction of cancer related mortality, 4% (1/23) on the CBCI group against 10% (4/40) on the control group. Several new therapies were approved in recent years for advanced prostate cancer treatment. The pharmaco-economic cost of these therapies are significant, and most of them shown an improvement survival of less than six months. New therapies such as Cell Base Cancer Immunotherapy with Tumor Presenting Cells could change this scenario, improving quality life, reducing mortality and cost to the health care providers. We are now designing a Phase III trial in North America for local advance prostate cancer. Other indication (triple negative breast cancer, pancreatic or gastric cancer patients) are also under evaluation. Citation Format: Fernando T. Kreutz. Cell-based cancer immunotherapy using tumor presenting cells: A phase II trial with local advance prostate cancer patients. [abstract]. In: Proceedings of the CRI-CIMT-EATI-AACR Inaugural International Cancer Immunotherapy Conference: Translating Science into Survival; September 16-19, 2015; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2016;4(1 Suppl):Abstract nr A029.

Should All Patients Receive Statins to Reduce Cancer Risk After Heart Transplantation?

The study by Frolich et al1 in this issue of Circulation adds to the body of evidence that statins as a class of drugs have effects that reduce the chance of cancer initiation and progression, recapitulating findings showing reductions in cancer-related mortality in statin users in other major malignancies such as breast and prostate cancer.2,3 The authors are explicit in recognizing the flaws inherent in interpreting the data from their single-center case series, but nonetheless, the size of their series is substantial, patients have been followed carefully for long and clinically relevant time periods, and the reduction in cancer incidence, from 34% to 13%, is impressive. Furthermore, there is an overall reduction in the cancer-related death rate, …

Lung cancer screening: Examining the issues

The goal of screening is to detect disease at a stage when cure or control is possible, thereby decreasing disease-specific deaths in the population. Many studies have attempted to demonstrate that lung cancer screening using chest radiography or computed tomography (CT) identifies patients with lung cancer and reduces cancer-related mortality. Until recently, there was no evidence confirming a reduction in disease-specific mortality with screening. Early cancer screening should result in a gradual population-wide stage shift toward earlier cancer stages over time, but stage shifting was not reported in early lung cancer screening studies. Lead-time, length-time, and overdiagnosis biases may each have an impact on screening studies reporting survival as an outcome. In this past year, the National Lung Screening Trial reported a significant reduction in cancer-related mortality as a result of screening with chest CT imaging. This will shape the direction of future screening programs.

Outcomes and efficiency of national gastric cancer screening program in Korea: Single-center, large-scale study.

29 Background: Gastric cancer is a major cause of death and a substantial socioeconomic burden in Korea. The National Cancer Screening Program for Medicaid recipients was initiated in 1999 and has contributed to reduction of cancer-related mortality in Korea. Endoscopy may be cost-effective screening tool in Korea, where the cost of endoscopy and UGIS are similar and the incidence of gastric cancer is high. Most of Japanese studies on the efficiency of mass screening for gastric cancer have dealt with photoflurography as a screening tool. Although biennial gastric cancer screening by endoscopy has been increasing in Korea as part of the National Cancer Screening Program, few studies have evaluated its efficiency. Therefore, we analyzed the outcomes and efficiency of the National Gastric Cancer Screening Program using endoscopy in Korea. Methods: We reviewed medical records from the National Gastric Cancer Screening Program at Chung-Ang University hospital in Korea from January 2007 to December 2010. The study population was comprised of Medicaid recipients ≥ 40 years of age who were taken from the National Health Insurance Corporation. Results: A total of 41,150 asymptomatic subjects underwent endoscopy for gastric cancer screening. The mean age of the screened subjects was 56.3 years for men and 48.9 years for women. The male to female ratio of the screened subjects was 1.57:1. Gastric cancer was diagnosed in 102 (0.24%) of 41,150 subjects (60 men and 42 women). Their mean age was 54.4 years. Of these, 76 subjects (0.18%) were diagnosed as early gastric cancer and 26 subjects (0.06%) as advanced gastric cancer. The proportion of early gastric cancer among total gastric cancers was 74.5%. During the period, only 6,586 (16.0%) subjects participated in the biennial gastric cancer screening (59% for men and 49% for women). Conclusions: Despite accomplishments of the National Gastric Cancer Screening Program in Korea, low compliance to the screening program remains an issue. Furthermore, its cost-effectiveness analysis will be needed for successful progression.

Cancer screening in older adults: What to do when we don't know

Abstract More than one-half of new cancers and over 70% of cancer deaths in industrialized nations occur in adults age 65 or older. Systematic screening has been associated with reductions in cancer-related mortality for a variety of cancers, including breast, cervical, and colorectal cancer. Prostate cancer screening remains more controversial despite the recent publication of two large randomized trials of screening. Although guidelines are beginning to address cancer screening specifically among the growing group of seniors age 70 or older, guidance on estimating remaining life expectancy by explicitly considering competing causes of mortality (e.g. comorbid medical illness) and functional status in this age group is limited. In this article, key evidence-based guidelines are reviewed for cancer screening in adults and limitations of screening studies with respect to older adults are discussed. A framework is reviewed for deciding how long to continue cancer screening in older adults, which incorporates age and health status to provide quantitative estimates of remaining life expectancy.

Outcomes and efficiency of National Cancer Screening Program for gastric cancer in Korea.

13 Background: Gastric Cancer is a major cause of death and a substantial socioeconomic burden in Korea. The National Cancer Screening Program for Medicaid recipients was initiated in 1999 and has contributed to reduction of cancer-related mortality in Korea. Endoscopy may be cost-effective screening tool in Korea, where the cost of endoscopy and UGIS are similar and the gastric cancer incidence is high. Most of Japanese studies on the efficiency of mass screening for gastric cancer have dealt with photoflurography as a screening tool. Although biennial gastric cancer screening by endoscopy has been increasing in Korea as part of the National Cancer Screening Program, few studies have evaluated its efficiency. Therefore, we analyzed the outcomes and efficiency of the National Cancer Screening Program for gastric cancer using endoscopy in Korea. Methods: We reviewed results from the National Cancer Screening Program for gastric cancer at Chung-Ang University Yongsan Hospital in Korea from March 2003 to March 2008. The study population was comprised of Medicaid recipients ≥ 40 years of age who were taken from the National Health Insurance Corporation. Results: A total of 7,278 asymptomatic subjects underwent endoscopy for gastric cancer screening. The mean age of the screened subjects was 51.3 years for men and 48.9 years for women. The male to female ratio of the screened subjects was 1.2:1. Gastric cancer was diagnosed in 32 (0.44%) of 7,278 subjects (22 men and 10 women). Their mean age was 54.4 years. Of these, 21 subjects (0.29%) were diagnosed as early gastric cancer and 11 subjects (0.15%) were advanced gastric cancer. The proportion of EGCs among total gastric cancers was 65.6%. The compliance with this program was low (59% for men and 49% for women). Conclusions: Despite accomplishments of the National Cancer Screening Program for gastric cancer in Korea, its effectiveness remains an issue. Efficiency and cost-effectiveness analysis will be needed for successful progression. No significant financial relationships to disclose.

Discordence of HER-2/neu overexpression and estrogen receptor between the primary breast cancer and axillary lymph node with metastasis

20106 Background: Adjuvant hormonal therapy and trastuzumab are known to be associated with a significant reduction in cancer-related mortality in a subset of women with breast cancer. The treatment decision is usually based on immunohistochemistry (IHC) staining of the primary tumor. We reported here a case of discordance of HER-2/neu overexpression and estrogen receptor status between the primary breast cancer and axillary lymph node with metastasis. Methods: IHC and fluorescence in situ hybridization (FISH) analysis was perfromed for the assessment of HER-2/neu. E-cadherin staining was done on the primary tumor and lymph node with metastasis. Results: A 52 year old woman presented with right breast lump. The imaging studies showed a 5 × 5 cm speculated mass. No other abnormalities were noted. An excision biopsy revealed 3 cm moderately differentiated invasive lobular carcinoma. Subsequently a wider excision and axillary lymph node dissection was done. 2/20 lymph nodes were involved by the cancer. IHC was done in the primary tumor and the lymph node with metastasis. IHC of the primary tumor revealed less than 1% nuclei positive for estrogen receptor (ER), 0% nuclei positive for progesterone receptor (PR), and no HER-2/neu overexpression. IHC of the lymph nodes with metastasis revealed 80% nuclei positive for ER, less than 1% nuclei positive for PR, and equivocal HER-2/neu overexpression. FISH analysis for HER-2/neu gene was done on the primary tumor which revealed no amplification in the tumor nuclei (Her2/CEP17 ratio was 3.6/2.7 = 1.3) whereas FISH analysis on the lymph node section revealed amplification in tumor nuclei (Her2/CEP 17 ratio of 7.3/1.9 = 3.9). E-cadherin staining of the primary breast tumor as well as the lymph node with metastasis revealed no membrane staining of the malignant cells in either section. Conclusions: The unusual occurrence of a divergent IHC profile and FISH analysis results between the primary carcinoma and metastatic carcinoma may be due to a subselection of a malignant clone which were not represented in the section of primary tumor chosen for IHC. Future studies are required to determine the utility of IHC staining of metastatic cells involving the lymph nodes if primary tumor is negative for HER-2/neu &amp; ER. No significant financial relationships to disclose.

Advantages and disadvantages of population screening for cancer and surveillance of at-risk groups

Despite improvements in diagnostic and therapeutic modalities, the prognosis of patients with gastrointestinal malignancies has remained poor. In essence, this poor outcome is related to the majority of patients presenting at an already advanced stage of disease at the time of diagnosis. Unfortunately, however, mass screening and surveillance programmes aimed at early detection and treatment in the population at large are in most countries considered to be cost-ineffective. Moreover, even with regard to established risk groups, there is considerable debate over whether current surveillance strategies are beneficial to these patients in terms of a reduction in cancer-related mortality. This chapter addresses various aspects of screening and surveillance. In the first part, general issues are discussed, whereas the second part focuses particularly on disease entities frequently encountered in gastrointestinal practice.