The document discusses breast cancer risk assessment using nipple aspirate fluid (NAF) cytology and the HALO Breast Pap Test. It notes that atypia found in NAF cytology confers a 4-5x increased relative risk of breast cancer, similar to atypical ductal hyperplasia found on biopsy. The HALO test is a simple, non-invasive method to obtain NAF samples to evaluate for atypia and better determine a patient's risk level. Identifying atypia through NAF cytology allows for more tailored risk reduction strategies and increased screening for high-risk patients.
This document summarizes key points from a presentation on women's health. It discusses common causes of hysterectomy in India like fibroids, discusses ways to save the uterus for many conditions like using an IUS for heavy bleeding or uterine balloon therapy for DUB. It notes that 80-90% of hysterectomies could be avoided with better counseling. It covers effects of early hysterectomy like earlier menopause and increased risk of depression, osteoporosis, heart disease. It discusses ovarian conservation versus removal during hysterectomy. The ideal age for bilateral salpingo-oophorectomy is debated but generally 50 years is a good balance between cancer prevention and risks. New developments in treating early cervical cancer can now potentially save
This document discusses screening for ovarian cancer. It notes that ovarian cancer often presents at an advanced stage and has a poor survival rate as a result. Screening aims to detect the cancer earlier when it is more treatable. However, current screening methods like pelvic exams and the tumor marker CA-125 lack sufficient accuracy. A large clinical trial found that annual screening using transvaginal ultrasound and CA-125 did not result in earlier detection or reduced mortality compared to no screening. The high rate of false positives can lead to unnecessary surgeries, which pose risks. More accurate tests are needed for population-wide ovarian cancer screening to be effective.
This document discusses screening for early detection of ovarian cancer. Pelvic examinations are currently the standard screening method, but evidence shows they often find benign conditions and lead to unnecessary follow-up procedures. Blood tests measuring tumor markers and imaging tests also have limitations in screening. While earlier detection could improve outcomes, currently available screening methods are not sufficiently effective at finding early ovarian cancers. Improved screening approaches are still needed.
Cancer genetic testing and risk assessment overview.
This slide deck was the basis of a presentation to nurse practitioners and genetic counselors who are actively identifying and managing women at high risk of breast and ovarian cancer.
- An estimated 1300 new cases of cervical cancer were diagnosed in Canada in 2011, with about 350 deaths. The incidence and mortality of cervical cancer have substantially decreased in the past 50 years due to screening.
- Screening for cervical cancer using the Pap test detects precursor lesions, allowing earlier treatment and reducing incidence of invasive disease and death from cervical cancer.
- This guideline provides updated recommendations for cervical cancer screening in Canada based on new evidence about epidemiology and diagnosis of cervical cancer. It recommends screening with Pap tests every 3 years for women aged 30-69, and discusses potential benefits and harms of screening for other age groups.
The document provides recommendations for investigating breast complaints and diagnosing breast diseases and cancer in British Columbia. Key recommendations include screening for breast cancer as per BC Cancer Agency guidelines, taking a full family history to assess genetic risk and referring to the Hereditary Cancer Program when appropriate, using core biopsy as the standard to establish a histological diagnosis, and using diagnostic ultrasound as the initial investigation for women under 30 or who are pregnant/lactating with breast symptoms, and using mammogram and ultrasound as initial tests for women 30 and over. Differential diagnoses of common breast diseases are also listed.
This document provides recommendations for breast cancer screening. It recommends mammography every 2 years for women aged 50 to 74, as mammography is the recommended screening method for average risk women. It also provides guidance for higher risk women, such as those with a family history or biopsy results showing increased risk. The recommendations are based on evidence regarding breast cancer risk factors like age, heredity, biopsy history, chest radiation, and breast density. Screening aims to balance benefits and risks, such as false positives and radiation exposure.
This document summarizes key points from a presentation on women's health. It discusses common causes of hysterectomy in India like fibroids, discusses ways to save the uterus for many conditions like using an IUS for heavy bleeding or uterine balloon therapy for DUB. It notes that 80-90% of hysterectomies could be avoided with better counseling. It covers effects of early hysterectomy like earlier menopause and increased risk of depression, osteoporosis, heart disease. It discusses ovarian conservation versus removal during hysterectomy. The ideal age for bilateral salpingo-oophorectomy is debated but generally 50 years is a good balance between cancer prevention and risks. New developments in treating early cervical cancer can now potentially save
This document discusses screening for ovarian cancer. It notes that ovarian cancer often presents at an advanced stage and has a poor survival rate as a result. Screening aims to detect the cancer earlier when it is more treatable. However, current screening methods like pelvic exams and the tumor marker CA-125 lack sufficient accuracy. A large clinical trial found that annual screening using transvaginal ultrasound and CA-125 did not result in earlier detection or reduced mortality compared to no screening. The high rate of false positives can lead to unnecessary surgeries, which pose risks. More accurate tests are needed for population-wide ovarian cancer screening to be effective.
This document discusses screening for early detection of ovarian cancer. Pelvic examinations are currently the standard screening method, but evidence shows they often find benign conditions and lead to unnecessary follow-up procedures. Blood tests measuring tumor markers and imaging tests also have limitations in screening. While earlier detection could improve outcomes, currently available screening methods are not sufficiently effective at finding early ovarian cancers. Improved screening approaches are still needed.
Cancer genetic testing and risk assessment overview.
This slide deck was the basis of a presentation to nurse practitioners and genetic counselors who are actively identifying and managing women at high risk of breast and ovarian cancer.
- An estimated 1300 new cases of cervical cancer were diagnosed in Canada in 2011, with about 350 deaths. The incidence and mortality of cervical cancer have substantially decreased in the past 50 years due to screening.
- Screening for cervical cancer using the Pap test detects precursor lesions, allowing earlier treatment and reducing incidence of invasive disease and death from cervical cancer.
- This guideline provides updated recommendations for cervical cancer screening in Canada based on new evidence about epidemiology and diagnosis of cervical cancer. It recommends screening with Pap tests every 3 years for women aged 30-69, and discusses potential benefits and harms of screening for other age groups.
The document provides recommendations for investigating breast complaints and diagnosing breast diseases and cancer in British Columbia. Key recommendations include screening for breast cancer as per BC Cancer Agency guidelines, taking a full family history to assess genetic risk and referring to the Hereditary Cancer Program when appropriate, using core biopsy as the standard to establish a histological diagnosis, and using diagnostic ultrasound as the initial investigation for women under 30 or who are pregnant/lactating with breast symptoms, and using mammogram and ultrasound as initial tests for women 30 and over. Differential diagnoses of common breast diseases are also listed.
This document provides recommendations for breast cancer screening. It recommends mammography every 2 years for women aged 50 to 74, as mammography is the recommended screening method for average risk women. It also provides guidance for higher risk women, such as those with a family history or biopsy results showing increased risk. The recommendations are based on evidence regarding breast cancer risk factors like age, heredity, biopsy history, chest radiation, and breast density. Screening aims to balance benefits and risks, such as false positives and radiation exposure.
The document discusses recent research on early detection of ovarian cancer, including findings from the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Key points include:
- UKCTOCS found that multimodal screening (MMS) using CA125 and ultrasound was more sensitive (86%) than ultrasound alone (63%) for detecting early stage ovarian cancers, and led to fewer unnecessary surgeries.
- Mortality was reduced by 15-28% with MMS compared to no screening over 7-14 years of follow up. MMS also resulted in more cancers being diagnosed at early stages.
- Further analysis of UKCTOCS data is needed to better establish the benefits and
This document summarizes several breast cancer risk assessment models. It discusses two main types of risk assessment: the chances of developing breast cancer over time, and the chances of carrying a mutation in a high-risk gene like BRCA1/2. Several models are described that assess these risks, including the Gail model, Claus model, BRCAPRO, and Cuzick-Tyrer models. Each model incorporates different sets of risk factors and has varying levels of validation and ability to predict cancer risk. The document advocates that improved models integrating more genetic and lifestyle risk factors could achieve more accurate individualized risk prediction.
Aflibercept in combination with fluorouracil, leucovorin, and irinotecan in t...Mary Ondinee Manalo Igot
The document describes a study examining the safety and efficacy of aflibercept in combination with FOLFIRI chemotherapy for Asian patients with metastatic colorectal cancer who had progressed after prior oxaliplatin-based chemotherapy. The study was a retrospective, single-center analysis of 19 Asian patients treated at the National Cancer Centre Singapore. The analysis found that the combination of aflibercept and FOLFIRI resulted in an acceptable safety profile, with the most common adverse events being diarrhea, fatigue, neuropathy and hematologic toxicities. The objective response rate was 21%, comparable to results seen in other studies.
Why was screening implemented?
What is overdiagnosis?
The evidence for overdiagnosis
Available data
Facts from recent studies
Risks of screening
The illusion of early detection
Harms due to overdiagnosis
Benefit-risk balance
So, what to do?
About mammograms: https://desdaughter.wordpress.com/tag/mammograms/
About overdiagnosis: https://desdaughter.wordpress.com/tag/overdiagnosis/
About screening: https://desdaughter.wordpress.com/tag/screening/
1) Cancer screening aims to detect asymptomatic potentially curable disease earlier through screening tests to improve outcomes and reduce cancer mortality and morbidity in the screened population.
2) Randomized clinical trials have shown that screening for breast and colorectal cancers can reduce cancer mortality when screening finds cancer at an earlier stage.
3) Screening tests have limitations including false positives, overdiagnosis, costs, and psychological impacts of screening that must be considered.
This document provides updated guidelines for healthcare providers on managing menopause in asymptomatic healthy women and women with menopausal symptoms. It presents lifestyle interventions, medications, and complementary therapies for treating menopausal symptoms according to their efficacy. It also reviews counselling strategies for sexuality concerns during peri- and postmenopause. Approaches to identifying and treating osteoporosis risk are presented in a companion guideline. The guidelines are based on a literature review of recent clinical practice guidelines, randomized controlled trials, observational studies, and other sources.
HPV is the cause of cervical cancer. There is a long lag between infection and development of cancer. There are two major opportunities to prevent this entirely preventable cancer.
Deborah K. Armstrong, M.D., explains the newly-released patient guide for ovarian cancer patients, which was sponsored by the National Ovarian Cancer Coalition (NOCC).
This document summarizes the key findings of a survey conducted by the Working Mother Research Institute on women's knowledge and attitudes around breast cancer screening and breast health. Some of the main findings include:
- 9 out of 10 women consider mammograms an important part of health management and 80% have had at least one mammogram, with 70% getting screened annually.
- However, many women lack knowledge about breast density and its health implications, and options for screening technologies. Nearly half did not know if they had dense breasts.
- Of women who had a mammogram, 5 out of 10 were called back for additional testing, with most finding nothing suspicious but some receiving cancer diagnoses.
- The document reviews
Primary High Risk HPV Testing with Cyctology TriagePHEScreening
1) Primary testing for high-risk HPV will replace cytology-based screening as the initial test in the NHS cervical screening program. Women who test positive for high-risk HPV will receive cytology triage, while HPV-negative women will be returned to routine recall.
2) A large trial showed primary HPV testing improved sensitivity over cytology alone. A pilot of primary HPV testing confirmed benefits and informed clinical protocols.
3) Women will receive results and follow-up management based on HPV and cytology results, with longer recall for HPV-negative women and colposcopy referral for HPV-positive women with abnormal cytology.
This document summarizes a conference on cancer screening and genetics risk assessment programs at the Xanit Oncology Institute. It discusses how screening can help avoid cancer deaths by detecting cancers earlier when treatment is often less aggressive. It outlines features that suggest hereditary cancer risk and merits genetic counseling. The process of genetic counseling and testing is explained. Risk assessment considers personal and family history. While screening and counseling help manage risk, prophylactic procedures like mastectomy can prevent breast cancers.
The document discusses guidelines for cervical cancer screening, including incorporating HPV testing. It finds that HPV testing for women over 30 with ASCUS can reduce unnecessary colposcopies by identifying HPV-negative patients with very low risk. However, HPV testing also poses problems like increased anxiety and many HPV-positive women referred for colposcopy having normal results. Overall, HPV testing may help triage some abnormal pap results but also adds new issues to consider.
Advancing The Prevention And Cure Of Cancerfondas vakalis
The document discusses the shared missions and collaborations between the American Association for Cancer Research (AACR) and the National Cancer Institute (NCI) to advance cancer research and reduce the burden of cancer. It outlines their joint efforts in conferences, workshops, and think tanks. It also summarizes advances in cancer prevention, early detection, and treatment that have contributed to reduced cancer mortality rates in recent years but challenges remain.
Breast cancer screening guidlines for mammographyShima Aran
Breast cancer is the most common cancer in women worldwide and the second leading cause of cancer death in women in the United States. Screening mammography can help reduce the risk of death from breast cancer by 15-20% for women aged 40-74. However, screening also carries risks of false positives, overdiagnosis, unnecessary biopsies, pain and radiation exposure. Guidelines from different organizations vary in their recommendations for age to start screening and screening interval.
The document discusses controversies around breast self-exams (BSE) and mammography for breast cancer screening. It provides an overview of studies that have evaluated the effectiveness of BSE in reducing mortality and notes mixed recommendations from different organizations. The document also compares digital mammography to traditional mammography and MRI. Guidelines for mammography screening from organizations like USPSTF, ACS, and ACOG are summarized, which differ in their recommended screening ages and intervals. Controversies regarding mammography include its ability to reduce breast cancer mortality and the biological significance of precancerous lesions detected.
Evidence Based Guide of Screening for Prevention of Cervical Cancer Lifecare Centre
This document discusses cervical cancer prevention in India. It notes that India accounts for about 23-25% of new cervical cancer cases and deaths worldwide despite having only about 16% of the world's female population. Human papillomavirus (HPV) infection, especially types 16 and 18, is responsible for nearly all cervical cancer cases. The document recommends primary prevention through HPV vaccination and secondary prevention via cervical cancer screening to detect and treat precancerous lesions. However, it notes that current cervical cancer screening coverage in India is very low at only about 2.6% of the female population, highlighting the need to scale up screening efforts.
Evidence based management options for women at increased breast diseases Kawita Bapat
This document provides an overview of evidence-based management options for women at increased risk of breast cancer. It discusses risk assessment models like Claus and Gail, surveillance methods, and risk reduction measures including chemoprevention and surgical interventions. Key points covered include how the models assess risk factors like family history and are useful but limited tools, and that surveillance strategies and preventive options require careful consideration given their impacts.
This document discusses controversies around breast cancer screening methods like breast self-exams (BSE) and mammography. It notes that while some organizations recommend against teaching BSE, others believe BSE can provide an added layer of protection when used in conjunction with mammography. The document also discusses different screening guidelines and age ranges recommended by various organizations for mammography. It summarizes various breast cancer risk assessment models like the Gail and Tyrer-Cuzick models and notes screening should be stratified based on risk starting at age 40 since the majority of breast cancer is preventable through chemoprevention.
This document discusses cancer screening guidelines for several common cancers. It recommends screening for breast cancer with annual mammograms and clinical exams starting at age 40, and beginning earlier or including MRI for those at high risk. Cervical cancer screening should begin at age 21 with Pap tests every 3 years or co-testing with HPV every 5 years. Colorectal cancer screening options include colonoscopy every 10 years, sigmoidoscopy every 5 years, or annual fecal tests. Genetic screening is recommended for those with a family history suggesting inherited cancer risk. Lung cancer screening with low-dose CT is advised for high-risk smokers aged 55-74. Prostate cancer screening involves PSA testing and DRE for men aged 50-69
CA-125 is a protein marker that is elevated in many ovarian cancer patients. While it returns a true positive result in only 50% of stage I ovarian cancer, serial CA-125 testing over time can achieve a high specificity of 99.6%. Combining CA-125 testing with transvaginal ultrasound and examination increases accuracy for detection. HE4 is another protein marker that is elevated in epithelial ovarian cancer and not benign gynecological conditions. Using both CA-125 and HE4 tests in an algorithm called ROMA can help determine likelihood of malignancy in women with ovarian masses, outperforming CA-125 alone. ROMA and ultrasound are useful first-line tests to select high risk patients for referral and further diagn
This document discusses benign breast disease, risk factors for breast cancer, hereditary breast cancer syndromes, screening and surveillance for breast cancer, evaluation of breast symptoms such as lumps, nipple discharge, and abnormal mammogram findings. It provides guidelines for managing increased risk and evaluating various breast abnormalities to determine if biopsy or other follow up is needed.
- Ovarian cancer is the 4th leading cause of cancer death in women in the US, with a 5-year survival rate of only 35% for advanced cases. Most cases are diagnosed at an advanced stage due to non-specific early symptoms.
- There is no consensus on screening guidelines due to a lack of evidence that screening reduces mortality. Current screening methods like ultrasound and CA-125 lack sensitivity and specificity.
- Several large trials are underway to evaluate new screening strategies using ultrasound, tumor markers, and genetic testing to enable earlier detection when treatment is most effective. Improved screening methods are needed to reduce ovarian cancer mortality rates.
The document discusses recent research on early detection of ovarian cancer, including findings from the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Key points include:
- UKCTOCS found that multimodal screening (MMS) using CA125 and ultrasound was more sensitive (86%) than ultrasound alone (63%) for detecting early stage ovarian cancers, and led to fewer unnecessary surgeries.
- Mortality was reduced by 15-28% with MMS compared to no screening over 7-14 years of follow up. MMS also resulted in more cancers being diagnosed at early stages.
- Further analysis of UKCTOCS data is needed to better establish the benefits and
This document summarizes several breast cancer risk assessment models. It discusses two main types of risk assessment: the chances of developing breast cancer over time, and the chances of carrying a mutation in a high-risk gene like BRCA1/2. Several models are described that assess these risks, including the Gail model, Claus model, BRCAPRO, and Cuzick-Tyrer models. Each model incorporates different sets of risk factors and has varying levels of validation and ability to predict cancer risk. The document advocates that improved models integrating more genetic and lifestyle risk factors could achieve more accurate individualized risk prediction.
Aflibercept in combination with fluorouracil, leucovorin, and irinotecan in t...Mary Ondinee Manalo Igot
The document describes a study examining the safety and efficacy of aflibercept in combination with FOLFIRI chemotherapy for Asian patients with metastatic colorectal cancer who had progressed after prior oxaliplatin-based chemotherapy. The study was a retrospective, single-center analysis of 19 Asian patients treated at the National Cancer Centre Singapore. The analysis found that the combination of aflibercept and FOLFIRI resulted in an acceptable safety profile, with the most common adverse events being diarrhea, fatigue, neuropathy and hematologic toxicities. The objective response rate was 21%, comparable to results seen in other studies.
Why was screening implemented?
What is overdiagnosis?
The evidence for overdiagnosis
Available data
Facts from recent studies
Risks of screening
The illusion of early detection
Harms due to overdiagnosis
Benefit-risk balance
So, what to do?
About mammograms: https://desdaughter.wordpress.com/tag/mammograms/
About overdiagnosis: https://desdaughter.wordpress.com/tag/overdiagnosis/
About screening: https://desdaughter.wordpress.com/tag/screening/
1) Cancer screening aims to detect asymptomatic potentially curable disease earlier through screening tests to improve outcomes and reduce cancer mortality and morbidity in the screened population.
2) Randomized clinical trials have shown that screening for breast and colorectal cancers can reduce cancer mortality when screening finds cancer at an earlier stage.
3) Screening tests have limitations including false positives, overdiagnosis, costs, and psychological impacts of screening that must be considered.
This document provides updated guidelines for healthcare providers on managing menopause in asymptomatic healthy women and women with menopausal symptoms. It presents lifestyle interventions, medications, and complementary therapies for treating menopausal symptoms according to their efficacy. It also reviews counselling strategies for sexuality concerns during peri- and postmenopause. Approaches to identifying and treating osteoporosis risk are presented in a companion guideline. The guidelines are based on a literature review of recent clinical practice guidelines, randomized controlled trials, observational studies, and other sources.
HPV is the cause of cervical cancer. There is a long lag between infection and development of cancer. There are two major opportunities to prevent this entirely preventable cancer.
Deborah K. Armstrong, M.D., explains the newly-released patient guide for ovarian cancer patients, which was sponsored by the National Ovarian Cancer Coalition (NOCC).
This document summarizes the key findings of a survey conducted by the Working Mother Research Institute on women's knowledge and attitudes around breast cancer screening and breast health. Some of the main findings include:
- 9 out of 10 women consider mammograms an important part of health management and 80% have had at least one mammogram, with 70% getting screened annually.
- However, many women lack knowledge about breast density and its health implications, and options for screening technologies. Nearly half did not know if they had dense breasts.
- Of women who had a mammogram, 5 out of 10 were called back for additional testing, with most finding nothing suspicious but some receiving cancer diagnoses.
- The document reviews
Primary High Risk HPV Testing with Cyctology TriagePHEScreening
1) Primary testing for high-risk HPV will replace cytology-based screening as the initial test in the NHS cervical screening program. Women who test positive for high-risk HPV will receive cytology triage, while HPV-negative women will be returned to routine recall.
2) A large trial showed primary HPV testing improved sensitivity over cytology alone. A pilot of primary HPV testing confirmed benefits and informed clinical protocols.
3) Women will receive results and follow-up management based on HPV and cytology results, with longer recall for HPV-negative women and colposcopy referral for HPV-positive women with abnormal cytology.
This document summarizes a conference on cancer screening and genetics risk assessment programs at the Xanit Oncology Institute. It discusses how screening can help avoid cancer deaths by detecting cancers earlier when treatment is often less aggressive. It outlines features that suggest hereditary cancer risk and merits genetic counseling. The process of genetic counseling and testing is explained. Risk assessment considers personal and family history. While screening and counseling help manage risk, prophylactic procedures like mastectomy can prevent breast cancers.
The document discusses guidelines for cervical cancer screening, including incorporating HPV testing. It finds that HPV testing for women over 30 with ASCUS can reduce unnecessary colposcopies by identifying HPV-negative patients with very low risk. However, HPV testing also poses problems like increased anxiety and many HPV-positive women referred for colposcopy having normal results. Overall, HPV testing may help triage some abnormal pap results but also adds new issues to consider.
Advancing The Prevention And Cure Of Cancerfondas vakalis
The document discusses the shared missions and collaborations between the American Association for Cancer Research (AACR) and the National Cancer Institute (NCI) to advance cancer research and reduce the burden of cancer. It outlines their joint efforts in conferences, workshops, and think tanks. It also summarizes advances in cancer prevention, early detection, and treatment that have contributed to reduced cancer mortality rates in recent years but challenges remain.
Breast cancer screening guidlines for mammographyShima Aran
Breast cancer is the most common cancer in women worldwide and the second leading cause of cancer death in women in the United States. Screening mammography can help reduce the risk of death from breast cancer by 15-20% for women aged 40-74. However, screening also carries risks of false positives, overdiagnosis, unnecessary biopsies, pain and radiation exposure. Guidelines from different organizations vary in their recommendations for age to start screening and screening interval.
The document discusses controversies around breast self-exams (BSE) and mammography for breast cancer screening. It provides an overview of studies that have evaluated the effectiveness of BSE in reducing mortality and notes mixed recommendations from different organizations. The document also compares digital mammography to traditional mammography and MRI. Guidelines for mammography screening from organizations like USPSTF, ACS, and ACOG are summarized, which differ in their recommended screening ages and intervals. Controversies regarding mammography include its ability to reduce breast cancer mortality and the biological significance of precancerous lesions detected.
Evidence Based Guide of Screening for Prevention of Cervical Cancer Lifecare Centre
This document discusses cervical cancer prevention in India. It notes that India accounts for about 23-25% of new cervical cancer cases and deaths worldwide despite having only about 16% of the world's female population. Human papillomavirus (HPV) infection, especially types 16 and 18, is responsible for nearly all cervical cancer cases. The document recommends primary prevention through HPV vaccination and secondary prevention via cervical cancer screening to detect and treat precancerous lesions. However, it notes that current cervical cancer screening coverage in India is very low at only about 2.6% of the female population, highlighting the need to scale up screening efforts.
Evidence based management options for women at increased breast diseases Kawita Bapat
This document provides an overview of evidence-based management options for women at increased risk of breast cancer. It discusses risk assessment models like Claus and Gail, surveillance methods, and risk reduction measures including chemoprevention and surgical interventions. Key points covered include how the models assess risk factors like family history and are useful but limited tools, and that surveillance strategies and preventive options require careful consideration given their impacts.
This document discusses controversies around breast cancer screening methods like breast self-exams (BSE) and mammography. It notes that while some organizations recommend against teaching BSE, others believe BSE can provide an added layer of protection when used in conjunction with mammography. The document also discusses different screening guidelines and age ranges recommended by various organizations for mammography. It summarizes various breast cancer risk assessment models like the Gail and Tyrer-Cuzick models and notes screening should be stratified based on risk starting at age 40 since the majority of breast cancer is preventable through chemoprevention.
This document discusses cancer screening guidelines for several common cancers. It recommends screening for breast cancer with annual mammograms and clinical exams starting at age 40, and beginning earlier or including MRI for those at high risk. Cervical cancer screening should begin at age 21 with Pap tests every 3 years or co-testing with HPV every 5 years. Colorectal cancer screening options include colonoscopy every 10 years, sigmoidoscopy every 5 years, or annual fecal tests. Genetic screening is recommended for those with a family history suggesting inherited cancer risk. Lung cancer screening with low-dose CT is advised for high-risk smokers aged 55-74. Prostate cancer screening involves PSA testing and DRE for men aged 50-69
CA-125 is a protein marker that is elevated in many ovarian cancer patients. While it returns a true positive result in only 50% of stage I ovarian cancer, serial CA-125 testing over time can achieve a high specificity of 99.6%. Combining CA-125 testing with transvaginal ultrasound and examination increases accuracy for detection. HE4 is another protein marker that is elevated in epithelial ovarian cancer and not benign gynecological conditions. Using both CA-125 and HE4 tests in an algorithm called ROMA can help determine likelihood of malignancy in women with ovarian masses, outperforming CA-125 alone. ROMA and ultrasound are useful first-line tests to select high risk patients for referral and further diagn
This document discusses benign breast disease, risk factors for breast cancer, hereditary breast cancer syndromes, screening and surveillance for breast cancer, evaluation of breast symptoms such as lumps, nipple discharge, and abnormal mammogram findings. It provides guidelines for managing increased risk and evaluating various breast abnormalities to determine if biopsy or other follow up is needed.
- Ovarian cancer is the 4th leading cause of cancer death in women in the US, with a 5-year survival rate of only 35% for advanced cases. Most cases are diagnosed at an advanced stage due to non-specific early symptoms.
- There is no consensus on screening guidelines due to a lack of evidence that screening reduces mortality. Current screening methods like ultrasound and CA-125 lack sensitivity and specificity.
- Several large trials are underway to evaluate new screening strategies using ultrasound, tumor markers, and genetic testing to enable earlier detection when treatment is most effective. Improved screening methods are needed to reduce ovarian cancer mortality rates.
I. Screening mammography has become the primary screening tool for breast cancer. It has been shown to decrease mortality rates by detecting cancers early through routine screening.
II. Mammography screening guidelines vary based on risk level. Average risk women are typically recommended annual screening starting at age 40. High risk women may be recommended earlier or more frequent screening, including breast MRI.
III. Risk is determined through factors like family history, genetic testing, density of breast tissue, and use of models like Gail and Tyrer-Cuzick. Women at higher lifetime risk (>20%) may be counseled on additional screening or risk reduction options.
The document provides guidelines from the American Cancer Society and US Preventive Services Task Force for cancer screening in average-risk asymptomatic individuals. It discusses screening recommendations for breast, colorectal, cervical, lung and prostate cancer. For each cancer, it summarizes the guidelines from both organizations, noting areas of agreement and differences in their recommendations for when to begin screening, screening intervals, and when to stop screening.
Management and prevention of cervical cancer.pptxAmin Badamosi
The document provides an overview of cervical cancer including:
- It is the 4th most common cancer in women worldwide and is caused by HPV infection.
- Risk factors include early sexual activity, multiple partners, smoking, and immunosuppression.
- Prevention involves HPV vaccines and screening like Pap tests or HPV tests. Abnormal results may require further tests or treatment.
- Stages of cervical cancer are described along with management approaches like surgery, radiation, or chemotherapy depending on the stage. Recurrence is managed based on prior treatment and extent of disease. The goal is elimination of cervical cancer as a public health problem by 2030.
The Papanicolaou test (also called Pap smear, Pap test, cervical smear, or smear test) is a screening test used in gynecology to detect premalignant and malignant (cancerous) processes in the ectocervix. http://docturs.com/dd/pg/groups/2392/cervical-smear-test-pap-test/
Risk factors for breast cancer include both hormonal and non-hormonal factors. Hormonal risk factors include increased estrogen exposure from early menarche, nulliparity, late menopause, and obesity. Non-hormonal factors include radiation exposure during breast development, alcohol consumption, and high-fat diet. Several risk assessment models can estimate individual risk, such as the Gail and Claus models which incorporate family history and lifestyle factors. Risk management options include screening, chemoprevention drugs like tamoxifen, and risk-reducing surgeries for high-risk individuals like those with BRCA gene mutations.
This document summarizes information about cervical cancer screening in Malaysia. It discusses that cervical cancer is the 3rd most common cancer in Malaysian women. The main screening method used is the Pap smear, but newer methods like HPV testing and visual inspection are also presented. Guidelines for cervical cancer screening in Malaysia currently recommend Pap smear every 3 years for women ages 20-65, but the program could be improved as screening rates remain low and cervical cancer incidence has not decreased. The document reviews natural history, risk factors, screening modalities and their strengths/limitations, as well as guidelines for screening in Malaysia and other countries.
This document discusses screening for ovarian cancer. It notes that ovarian cancer often presents at an advanced stage and has a poor survival rate as a result. Screening aims to detect the cancer earlier when it is more treatable. However, current screening methods like pelvic exams and the tumor marker CA-125 lack sufficient accuracy. A large clinical trial found that annual screening using transvaginal ultrasound and CA-125 did not result in earlier detection or reduced mortality compared to no screening. The high rate of false positives can lead to unnecessary surgeries, which pose risks. More accurate tests are needed for population-wide ovarian cancer screening to be effective.
This document discusses screening for ovarian cancer. It notes that ovarian cancer often presents at an advanced stage and has a poor survival rate as a result. Screening aims to detect the cancer earlier when it is more treatable. However, current screening methods like pelvic exams and the tumor marker CA-125 lack sufficient accuracy. A large clinical trial found that annual screening using transvaginal ultrasound and CA-125 did not result in earlier detection or reduced mortality compared to no screening. The high rate of false positives can lead to unnecessary surgeries, which pose risks. More accurate tests are needed for population-wide ovarian cancer screening to be effective.
This document provides an overview of cervical cancer and HPV. It discusses that HPV is the underlying cause of cervical cancer and describes the natural history of HPV infection. HPV is very common and usually clears without symptoms, but sometimes causes pre-cancerous cervical changes that can develop into invasive cancer if left untreated. Screening guidelines and new HPV vaccines are aimed at preventing cervical cancer by detecting and treating pre-cancerous cells or protecting against HPV infection. Regular Pap screening allows most pre-cancer to be detected and treated before it develops into invasive cancer.
1) The document describes a quality improvement technique used at a medical center to enhance detection of ASC-H diagnoses through blinded rescreening of Pap tests.
2) It presents data on the usefulness of HPV testing for women diagnosed with ASC-H, showing higher rates of CIN among HPV-positive women compared to HPV-negative women.
3) The study found the highest CIN2/3 detection rate in women aged 30-39 with ASC-H and positive HPV tests, and that negative HPV tests had a 100% negative predictive value for ruling out CIN2/3 in women over 40.
Cervical cancer screening guidelines 2013 on 7th septLifecare Centre
The document summarizes the 2013 guidelines for cervical cancer screening in the United States. The key points are:
1. Screening should begin at age 21 with cytology alone every 3 years until age 30.
2. From ages 30-65, co-testing with cytology and HPV testing every 5 years is the preferred method. Cytology alone every 3 years is acceptable.
3. Screening can stop at age 65 for women with adequate negative prior screening and no history of CIN2 or worse. Screening after a hysterectomy also depends on whether the cervix was removed.
This document provides updates to guidelines for several types of cancer screening, including breast, colorectal, cervical, prostate, lung, and ovarian cancer. For each cancer, it discusses what screening tests are recommended, for which populations and age groups, and how frequently screening should occur. It also notes some controversial issues and new recommendations from groups like the US Preventive Services Task Force.
The document discusses cervical cancer screening alternatives for developing world contexts. It reviews cervical cancer incidence, risk factors, and the limitations of Pap screening in low-resource areas. The document proposes visual inspection with acetic acid (VIA) as a screening alternative that has shown favorable results compared to cytology in other studies. It describes how to perform VIA screening and the next steps needed to develop a cervical cancer screening program in Santa Lucia, Honduras.
This document discusses various methods for breast cancer screening. It summarizes that mammography is effective for women over 50 but misses 30% of cancers and has a high false positive rate. Newer technologies like MRI and ultrasound have limitations as well. The document then focuses on breast thermography, which uses infrared scanning to detect temperature variations in breast tissue. It outlines the history and improved accuracy of modern thermography, citing clinical studies showing it can detect cancers earlier and with greater sensitivity than other methods. The document advocates for wider adoption of thermography in breast cancer screening.
Nulife module 6 screening for malignancies editedManinder Ahuja
These six modules from 2-7 are on mid life health care of women and were made with intention of training general gynecologist and other speciality into care of mid life women and have Mid Life OPD cards as mainstay of care.
Breast cancer screening guidelines recommend biennial mammography for women aged 50-74 in well-resourced settings, as it can reduce breast cancer mortality by around 16% compared to no screening. For limited-resource settings, the guidelines conditionally recommend clinical breast examination as a low-cost alternative. Screening intervals of less than 24 months show no added benefit over longer intervals. Shared decision making around risks of false positives and overdiagnosis is important. Early diagnosis through awareness and symptom screening is prioritized where most women present at late stages due to weak health systems.
Malignant epithelial ovarian tumors account for 90% of ovarian cancers and are the fourth most common cause of cancer death in women. Ovarian cancers are often called "silent killers" as they rarely produce symptoms in early stages. When diagnosed at Stage I, the cure rate is around 90% but drops to 20-25% at Stage III/IV. Screening is recommended for women over 50 or those at high risk due to family history or genetic mutations. Screening involves measuring serum CA125 levels and transvaginal ultrasound but has not been proven to reduce mortality in average risk women.
Similar to Slide Deck M4 001, 3 2010 P2 P Final Ppt 3.10 (20)
3. Cervical Pap Tests have dramatically reduced mortality Progress against Breast Cancer has been modest Source: American Cancer Society, Surveillance Research 2006 Unmet Clinical Need Pap Intro Cervical Breast 1943 : Cytologic cervical pap test introduced 1958 : Dr. George Papanicolaou finds that NAF cytology is valuable in diagnosing breast disease. 1960 : Mammography introduced for breast cancer screening. 2007 : HALO Breast Pap Test provides opportunity to use cytologic evaluation of NAF to differentiate between normal and pre-malignant cells
4. Biology of “Atypia” Cellular and/or Histologic Atypia: a reflection of MUTATIONS – genomic in all cells; somatic (environmental) in scattered cells – that impart a growth advantage These mutations are the common denominator of ALL risk factors – known & unknown. The historical “field effect” (once used to support mastectomy) is actually a valid concept at the molecular level -- the “field” is BOTH breasts. (simplified, conceptual framework for ER+ carcinogenesis) Slide credit: Dr. Alan Hollingsworth, Mercy Women’s Center and Mercy Cancer Center at Mercy Health Center in Oklahoma City
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6. Photo credits: N.I.H. Histologic ADH – based mostly on architecture, while cytology is secondary, as long as cells are monomorphic, low or hi grade Cytologic Atypia (a.k.a “hyperplasia with atypia”) - is based on many cytologic features, but also takes into account the relationship among cells (architecture) Histologic Atypia vs Cytologic Atypia Slide credit: Dr. Alan Hollingsworth, Mercy Women’s Center and Mercy Cancer Center at Mercy Health Center in Oklahoma City
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9. Relative Risk for Selected Factors Rating the Risk Factors for Breast Cancer, S. Eva Singletary, MD, FACS, Annals of Surgery--Ann Surg. 2003 Apr;237(4):474-82. Review.
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15. 90-95% visible on X-ray 90-95% with X-ray & MRI plus breast MRI MRI NAF cytology Taking a bite out of submerged pathology
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22. A negative NAF test does not rule out cancer any more than … - Negative history for risk factors - A low number on the Gail model or other risk tool - A negative BRCA test - A negative self or clinical breast exam - A negative mammogram A false sense of security exists with ALL of the above Atypia is a known, elevated risk factor for breast cancer. Collection of NAF using HALO is the only non-invasive, automated method for collecting NAF and assessing this individual risk.
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Editor's Notes
Many patients share the belief that if there is no family history for breast cancer, then their risk for breast cancer is low. This is simply not the case. The facts are worth reviewing to understand and share with patients who may not clearly understand their individual risk for BC. REVIEW BULLETS 1-3 8 of 9 women who develop breast cancer have no primary family history 70% of the women in the US who develop breast cancer have no known identifiable risk factors other than age The most common cause of death for women 25-55 is breast cancer The US Preventive Task Force recommendation in late 2009 has highlighted, in particular, mammographic screening for BC. And the recommendations from that group have been widely rejected by the clinical community and alienated BC advocates and survivors. However, a good outcome of this debate has been to highlight the advances and the limitations of mammographic screening – particularly for the population of women between 40 and 50. REVIEW BULLET 4 Mammograms are indicated for women > 40 years old* Less effective for detecting BC in younger women Many breast cancers grow slowly, taking an average of 8 years before they can be detected by mammography Compliance is variable Advances are needed to help identify women at higher risk for BC, particularly in populations where mammographic screening may be less reliable, or become unavailable through policy or practice changes. The presence of atypia has been long studied and proven to be a significant risk factor. REVIEW BULLET 5 The presence of atypical cells (“atypia”) in the breast impart a higher risk of developing BC, and can signal occult disease. Non-invasive testing using Nipple Aspirate Fluid (NAF) cytology is a studied, proven method for detecting the presence of atypia We want to highlight the science behind the discovery of atypia through collection of NAF and the opportunity to leverage this science to address an unmet clinical need and identify those patients are higher risk for BC.
The cervical pap test for screening of cervical cancer has had a dramatic effect on mortality over the > 60 years since it’s introduction. The same principles used to detect abnormal cells in the cervix were discovered in 1958 to apply to fluid collected from the breast ducts. Although screening mammography has helped advance the reduction in mortality from BC somewhat, there remains opportunity improve the prevention of, detection of, and reduction in morality of breast cancer. The use of NAF to detect pre-malignant conditions can help address this unmet clinical need.
In reviewing the biology of atypia, genetic mutations impart a growth advantage. While it is not widely agreed that atypical cell proliferation follows a linear progression from normal to hyperplastic, to eventual invasive carcinoma, it is agreed that SOME breast cancers behave in this manner. Furthermore, the “field effect,” now being demonstrated through advanced imaging modalities such as MRI and PET Mammography, exists at the molecular level. The "field effect" in carcinogenesis, in which a seemingly normal epithelium is the result of the clonal expansion of a genetically abnormal clone, has been documented in colon and lung cancers. The literature is dotted with reports of the harboring in normal breast tissue of mutations, including TP53 mutations, Her2 amplification, loss of heterozygosity, and mitochondrial mutations. There is even some evidence that these mutations are associated with susceptibility to disease. (Lui, Stromal Effects in Breast Cancer, N Engl J Med. 2007 Dec 20;357(25):2537-8) If we can identify atypia at the cellular level which is a reflection of changes on the molecular level, there is opportunity to leverage the advances in breast cancer prevention.
Some benign breast disease and certainly atypical breast disease predicts risk to all breast tissue (the commonly accepted concept of field effect which is the idea of generalized risk applicable to all breast tissue because of genetic and/or environmental insults.) The field effect is why prevention modalities like chemoprevention works for both breasts, even when disease is identified in only one breast….) This is a visual demonstration using color enhanced MRI of the field effect. Tissue sampling is a common way to determine these important biomarkers but…. But it’s important to recognize that tissue sampling (biopsy) has inherent error and can only detect conditions like atypia, if they are easily identified on imaging, and furthermore, captured within the biopsy sample.
So is histologic atypia equivalent to cytologic atypia? Isn’t tissue better than fluid? Yes for DIAGNOSIS. Studies since the 1950’s have shown that cytology from nipple aspirate fluid is not a good diagnostic — it does not have a good enough sensitivity for detecting the presence of breast cancer, although in rare cases NAF can demonstrate cancer. However, studies following patients over time have shown that atypia is a significant risk factor for future development of breast cancer. Atypia is present and easily interpreted in NAF . Cytology does examine architecture (similar to histology) which helps define atypia -- this is mostly helpful for the trained pathologist/cytologist to identify atypia. “ From the standpoint of risk stratification, however, cytologic atypia seems to be comparable with histologic atypical hyperplasia. “ From Risk Assessment Working Group—Hollingsworth et al” - this is demonstrated in the next slide.
Multiple studies, 4 highlighted here, have been conducted to prove that atypia confers an increased risk for breast cancer. Two of those here involved histology, and two involved cytology. All 4 studies demonstrated similar relative risk for atypia, supporting the equivalency of histologic and atypia. 20,000 Patients in Multiple Studies 20+ Years Follow-Up Nearly 100 Peer Reviewed Publications NCI, ASBS, ACOG Recognize Importance of ADH The obvious difference in the different methods is the invasiveness of biopsy versus collection of NAF. Furthermore, biopsy doesn’t address the “field effect” problem, whereas NAF collection offers the opportunity to collect cells from multiple ducts.
Generally, patients frequently think of family history as their primary risk factor for breast cancer. However, gender and age are the primary risk factors for breast cancer. In addition, multiple risk factors are at play, which play a role in a patient’s individualized risk for BC. Some of these risk factors are identifiable and quantifiable, such as genetic mutations and parity, however, many remain under study and will be defined with more research over time, such as lifestyle, and hormone use. A review of some specific risk factors can illustrate where tissue risk falls. (next slide)
As this chart shows, risk factors that may be shared by nearly all patients such as age at menarche and alcohol consumption confer slightly elevated risk. Family history also confers elevated risk, but not the to extent that most patients assume. Prior invasive cancer and LCIS/DCIS ( when known ) obviously confer a greater risk. But look at the position of atypia within the risk stratification: higher than family history and nearly as high as prior invasive cancer. This is the relative risk for cytologic atypia. Histologic atypia (through prior breast biopsy) is slightly higher at 5.3x, but a biopsy presumes presence of a lump or abnormality, whereas cytologic sampling can occur in asymptomatic women.
Quantitative risk models for breast cancer risk prediction began with the Gail model which includes primary family history (material 1 st degree relatives only), age at menarche and parity, and previous breast biopsy (regardless of diagnosis). The Gail model was first published in 1989 and has been updated over time. Other models have been developed, such as the Claus Model (best known for incorporating paternal history) and the Tyrer-Cuzick model, which incorporates primary and secondary family history, and personal risk factors, like atypia, along with some other ethnic risk factors. All of these models have been studied and validated. Quantitative risk assessment tools are invaluable to the clinician because they yield estimates of the probability that the patient will develop breast cancer within a defined period of time and, if helpful, over a lifetime. This temporal framework helps make the level of risk real and understandable to the patient. However, shortcomings of these population-based risk models include over and/or under-estimation of risk based upon a patient's individualized risk. The use of NAF cytology can help identify a significant risk factor – atypia – in asymptomatic women, and in a population of women who are either not undergoing any type of screening, and where risk assessment using models, may poorly estimate her individual risk.
Standard of care screening currently includes clinical breast exam, mammography in women > 40 (variable compliance) and MRI only in high risk patients after negative mammogram. This tool, while powerful, is only used in a limited patient population and is not a standard screening tool. All methods for screening yield 1% or less for detection of breast cancer. Despite the US Preventive Task Force recommendation against self and clinical breast exam, the clinical community continues to believe in the value of women, and their doctors, in performing this exam, as currently, it serves as the only type of screening for asymptomatic women who are not yet receiving mammograms. Use of NAF offers another method to help stratify risk for these younger, asymptomatic patients.
It’s important to recognize that screening for risk factors occurs in many aspects of a patient’s health care. Cholesterol testing is one such common example. One evaluating a patient's cholesterol levels, you are not identifying that a patient has cardiovascular disease, but rather, what her risk may be for developing cardiovascular disease so that intervention may occur, if it is needed to ward off disease progression. Likewise, identifying atypia through NAF is similar. You are helping an asymptomatic woman identify an important risk factor for breast cancer as part of the overall risk assessment. Then you can stratify her into a care path that is appropriate for her state of health.
An important concept in BC risk assessment is that it is fluid. A patient’s condition, and her risk, changes over time, and new information can change her care path. Comprehensive risk assessment, therefore, must include the use of quantitative risk models, periodically (recommend: annually) along with offering her the latest advancements in risk assessment, which are being developed rapidly. One such advancement is the use of NAF screening using NeoMatrix HALO.
The use of NAF cytology enables the physician to distinguish cellular characteristics in NAF that may indicate risk before a solid lesion appears on self or clinical breast exam or imaging. While there is no defined timeframe for cellular progression, it is generally believed that cellular changes that are precursors to invasive cancer exist up to 8 years prior to the appearance of a detectable mass. The use of NAF, and HALO, is an attempt to stratify some of the 70% of women with no known risk factors who may have an important risk factor for breast cancer, but who does not yet know it.
It’s important to recognize that we, as clinicians, with the current state of the art, see only the “tip of the iceberg” when it comes to breast cancer. We see palpable or imaging detected masses, which are generally invasive by the time we detect them. Advances, including imaging (although not used widespread for screening) and use of NAF cytology, enable us to look beneath the surface to identify potential malignancies before they present through conventional imaging. NAF is a currently available, non-invasive, and cost effective method of identifying this “submerged pathology.”
HALO, developed, by NeoMatrix, is FDA cleared and indicated for the collection of NAF for cytological evaluation in the determination and/or differentiation of normal vs. pre-malignant cells. It has been used in OBGYN, PCP, and breast specialist offices in over 60,000 procedures and has a small footprint, enabling easy storage and movement within the office.
Technology acquisition is easy with multiple options to obtain the system. A NeoMatrix representative can discuss these. Further of interest to doctors is that, after training, a nurse or medical assistant can perform the test, so your presence is not required during the test. Currently, performing the test is not covered by 3 rd party payers, but the single patient use disposables are inexpensive (~< $25 each) enabling a practice to offer the test at a reasonably low cost to the patient, generally between $75-150 (determined by the practice). NeoMatrix can provide you a proforma to help you identify the return on investment timeframe and revenue modeling for your practice. Many practices have reported using the additional income obtained from offering HALO to offset the ever increasing insurance premiums, the addition of a medical assistant, or addition of other technological advancements for patient care. In short, using HALO can not only help you offer an important test to a patient to help her, and you, understand her BC risk, but can also enhance your practice.
HALO is a quick, well-tolerated test. It’s principles are similar to that of a breast pump used by nursing moms, if that helps you to describe it to your patients. Once fluid is collected (in ~ 50% of cases, patients will yield fluid), it is processed in a manner similar to that of a cervical pap. If you so choose, trained labs can be recommended by the company to process the samples, but the company can also work with your pathologist/cytologist to train him/her in evaluating HALO samples.
As mentioned, ~ 50% of patients will not yield fluid. This means that these patients are at “normal” risk for BC. She is not at a reduced risk. Recall, however, that risk assessment is fluid and annual HALO is recommended, just like annual pap and wellness exams. Patients who do produce fluid may have acelluar fluid, or cells with no atypia. For the pathologist, his is similar to a thyroid FNA where obtaining and interpreting acellular samples (or 10 or fewer cells) is common. These patients are at a slightly elevated risk (1.7-2.8x) and should be annually monitored to detect any changes. Patients who show cells with atypia should be evaluated according to the following care path.
Acellular or normal cell samples should be followed annually, or if hyperplasia is identified, possibly referred to a breast specialist, after discussion with the patient. Many studies have indicated a 2x or close to 2x risk associated with hyperplasia finding in NAF. Seeing these patients and following up with them is a local/regional care path preference. Some breast specialists want to see and evaluate these patients, some want them followed by their OBGYN or PCP and tested for changes. Fluid with atypia confers elevated risk and this offers the opportunity to refer the patient to your partner breast health specialist and facilitate her care as a higher risk patient. NeoMatrix can help you identify a breast surgeon or specialist in your area if you need to find a partner who will employ the most state of the art risk assessment recommended by breast specialists.
We are learning more all the time about prevention and risk reduction, but current studied and understood risk reduction strategies include these listed. SERM intervention “threshold numbers” are based upon quantitative risk models such as Gail, Tyrer-Cuzick and the NSABP P-1 Breast Cancer Prevention Trial study. The success of that trial in achieving a 49% risk reduction in the development of breast cancer reinforced the utility of objective measures of risk. (Hollingsworth, Am J Surg. 2004 Mar;187(3):349-62. Review) It’s important to note that lifestyle changes can not only help a patient reduce her risk for breast cancer, but other types of cancer and disease as well .
You might wonder if collection of NAF and a “normal” test result rules out breast cancer. The answer is not any more so than the current risk assessment and/or screening methods used. Recall the yields on routine screening is currently ~1%. Detection of atypia in NAF is also ~1%, consistent with these other methods. HOWEVER, it is currently the ONLY method that can be used in asymptomatic women (besides CBE) and those who are not yet eligible for mammographic screening, or in whom mammographic screening is less reliable (dense breasts, etc.) Furthermore, atypia is a proven, studied, and validated risk factor. HALO offers a well-tolerated, non-invasive method for collecting NAF, and obtaining a valuable piece of risk data for a patient that is otherwise not obtained.
The use of NAF and detection of atypia is not new science. As early as 1958, Dr. Papanicolaou (of the “pap test”) identified that NAF cytology could convey important information about the state of breast health. Since the early 1970’s, this concept has been studied in tens of thousands of women – both high risk and normal risk. All of the studies verify that presence of atypia – detected both through histology and cytology – conveys an elevated risk, of about 5.0x, for the development of breast cancer.
The use of NAF and detection of atypia is not new science. As early as 1958, Dr. Papanicolaou (of the “pap test”) identified that NAF cytology could convey important information about the state of breast health. One study showed that the presence of epithelial cells alone (without the presence of atypia) conferred an elevated risk of 1.92, compared to women who don’t produce NAF, or produce NAF that is acellular and this risk is increased in patients who are younger than 55. Since the early 1970’s, this concept has been studied in tens of thousands of women – both high risk and normal risk. All of the studies verify that presence of atypia – detected both through histology and cytology – conveys an elevated risk, of about 5.0x, for the development of breast cancer.
Specifically, NeoMatrix HALO has been studied as a modern method to obtain NAF, which is easier, better tolerated, and less time consuming than prior methods used. Results, as shown, are consistent with the prior studies and demonstrates HALO as a valuable tool to use with modern risk assessment methods and models. HALO simply automates and more consistently applies the Sartorius method which was the method used in the previously referenced studies. You may recall the use of ductal lavage to collect NAF and we want to mark the distinction between collection of NAF using HALO and that of ductal lavage. First of all, ductal lavage required the use of a microcathether that was inserted into the nipple. It was not well tolerated by women. It was a time consuming procedure for both the patient and the clinician. Lastly, most studies were done on high risk women, not asymptomatic, normal risk women. These are important distinctions to make when you think about the collection of NAF – both for your practice and for your patients who may be familiar with ductal lavage. Although ductal lavage studies provided important data to the clinical community relative to the importance of NAF and risk associated with atypia, the collection using HALO is very different from that using ductal lavage. HALO is well tolerated, quick, can be done by nurse or MA, and is cost-effective. And it is done on asymptomatic patients during an annual wellness visit. The HALO system has been used in > 60,000 procedures and studied by individual practices who have had posters peer reviewed and accepted at recognized national specialty meetings. Should you be interested in joining a study, NeoMatrix can discuss their clinical programs with you.
Even before the controversy of last fall regarding mammograms, specialists recognized the important of their role in the recognition, and treatment of breast disease. The OBGYN and PCP are often the only practitioners a women is seeing for her breast health, and use of the best knowledge of breast cancer risk assessment must begin here. The American Society for Breast Surgeons in 2003 recognized the valuable role of cell based risk assessment and the increased risk of atypia for the development of breast cancer, validating the decades of science performed on this subject.
Since the USPTF recommendations, there have been responses from a myriad of groups emphasizing the importance of cost effective screening and the increasing role that individual risk assessment will play in detecting and treating breast cancer.
Further, the very group who recommended screening mammography for women > 50 included a statement emphasizing the need for annual screening for women in their 40’s if they have personal risk factors, including abnormal breast pathology. Given the backlash, it’s unlikely that clinical recommendations will change, but patients are confused and upset at the information and misinformation resulting in this task force recommendation. This is an important time to discuss individual risk assessment and your role in helping your patient in assessing her BC risk. HALO can be a part of that assessment.
Why do risk assessment at all? Patients want it. Breast cancer is well publicized and most women and men have been in some way touched by the disease. In an environment of increasing emphasis on prevention and wellness, patients want to know what they can do to maintain their health. They do this through information. High volume practices leave little time for traditional breast cancer risk assessment. How can we triage high risk women from primary care to appropriate referral receptacles? HALO offers another, valuable piece of information to the patient.
With limited time and resources and mounting pressure to do less in some regards, in a busy practice, how do we identify the high risk patient and do more? How do we determine who can benefit from further screening, and specialist care? How do we best use limited and specialized resources in health care, now and in the future? The answer lies in comprehensive risk assessment and can be as simple as the annual addition of a quantitative risk model and HALO to your current exam regimen.
Atypia is a proven, studied, elevated risk factor. Outside of breast biopsy, only indicated for symptomatic patients, HALO is the only method for identifying atypia in the asymptomatic patient – the 70% of your patients who have no KNOWN risk factors for breast cancer. The clinical community is driving individualized risk assessment, and breast health starts with the PCP or OBGYN. HALO is well tolerated, cost effective and can offer an advancement to your patients, distinguishing your practice and care. The valuable data obtained from HALO can help you refer your high risk patients to a specialize for further evaluation.