Hiroyuki Kuramoto, Jun Miyagawa, Hiroyuki Okajima, Manichi Iida, Toshiko Jobo, Takehiko Fukami, Fumiki Hirahara, Kazushige Kiguchi, Mikio Mikami and Hiroki Nakayama
Background: To evaluate the effectiveness of population screening program for cancer of the cervix using a mobile office.
Methods: The screening using a bus with an examination office has been conducted since 1968 in Kanagawa Prefecture, Japan. The bus visits local communities, where people enjoy convenient opportunity to receive the detection program. The screening method was cervical cytology. Women who were recommended to have the detailed examination were controlled strictly under the Quality Assurance Committee.
Results: A total of 2,070,282 women, including 30.2% of women with their first visit, were screened between 1968 and 2009. Among them 13,687 (0.66%) were recommended for the detailed examination and 95.1% of them received it. Two thousands, one hundred and seventy-two of cervical cancer and 2,476 of dysplasia were detected with the detection rates of 0.10% and 0.12%, respectively. The detection rates of cancer have been decreased year by year until 0.05% in1993, and have been stationary since then. The decreasing tendency was obvious in the repeaters and higher age group. The detection rates of carcinoma in situ have been increasing up to 69.2%, whereas those of invasive cancer have been decreased. Those of dysplasia have been increased up to 0.34% in 2009 and the increasing tendency was obvious in women with first visit and age 30s followed by age 40s. However, the incidences even in the repeaters were above 0.1% in recent years.
Conclusion: The mobile screening program has been successful for detecting carcinoma in situ and dysplasia and will be useful for the women who live in a long distance before arriving at a permanent medical office.
David R Baldwin and Richard B Hubbard
Lung cancer accounts for an estimated 1.4 million deaths globally that is, 18.4% of all cancer deaths. More than 35,000 people died from lung cancer in 2008 in the UK. In males this was almost a quarter of all cancer deaths and in females just over a fifth. By comparison, 16% of female cancer deaths were from breast cancer and the second commonest cause of cancer death overall (colorectal) accounts for 10% of all cancer deaths. The majority of people with lung cancer (three quarters in the UK) present with stage IIIb or IV disease where cure is impossible and so survival low in comparison with other common cancers.
There are two ways in which we are likely to diminish the huge public health burden that mortality from lung cancer constitutes: smoking cessation and earlier diagnosis. Smoking cessation has already produced dramatic falls in the age-adjusted incidence of lung cancer and it appears that lung cancer incidence has passed its peak in males at least. Continued efforts to reduce the prevalence of smoking across all sectors of society are a key public health priority. However there remains a large population at risk of developing lung cancer. In the US in 2007 there were an estimated 94 million people with a history of smoking and about half of these were current smokers. Thus the second way mortality may be substantially altered by early detection initiatives that lead to diagnosis at an earlier stage. There are, in turn, two ways in which people may be diagnosed earlier: by the use of early diagnosis and awareness initiatives and by population screening. The first of these methods is unproven and the second has only recently been shown to be effective.
Laura Evangelista, Marta Burei and Anna Rita Cervino
The present report discuss about the most important roles of nuclear medicine related to the early detection of breast cancer. We summarily describe the established and emerging diagnostic techniques, their indications and clinical impact for planar and tomographic breast scintigraphy, positron emission tomography (PET)/computed tomography (CT) and positron emission mammography (PEM).
Background: Cervical cancer is the third most common disease and the fourth leading cause of death in female’s worldwide. Treatment of this disease is successful when detection is at early neoplasic stages. Hence, multiple efforts have been pursued for early detection of cervical neoplasia. The aim of this study was to analyze the differential expression of mitochondrial non-coding RNAs or ncRNA (sense and antisense) in normal and neoplastic cervical biopsies as a potential tool for diagnostic of cervical cancer.
Methods: The expression pattern of the sense and the antisense mitochondrial ncRNAs in cervical biopsies was carried out by chromogenic in situ hybridization (ISH). We examined 17 normal cervical tissues, 108 early and late neoplasias and 24 invasive cervical carcinomas. The hybridization results were compared with the diagnostic of each specimen carried out by pathologists.
Results: Like normal human keratinocytes, normal cervical epithelium expresses the sense and the antisense mitochondrial ncRNAs at the basal layer of the epithelium. Interestingly, ISH reveals that the antisense transcripts are always localized in the nucleus of basal cells in normal cervical epithelium. Early and late cervical intraepithelial neoplasia as well as invasive cervical carcinoma expresses the sense transcript. In contrast, the antisense transcripts are down-regulated in early and late neoplasia and in invasive cervical carcinoma.
Conclusions: This pilot study indicates that down-regulation of the antisense mitochondrial transcripts at early stages of cervical neoplasia can be explored as a diagnostic tool for early cervical neoplasia.
Ilija Aleksic, Vladamir Mouraviev and David Albala
Screening recommendations must take into consideration the variable course of PCa for individual patients. While prostate cancer is commonly referred to as a slow growing process, this over-generalization is filled with potentially dangerous assumptions for individuals who harbor aggressive forms of disease. Widespread screening with prostate specific antigen began in the late 1980’s, with mortality due to prostate cancer in decline for the past two decades. This approach has led to a substantial decrease in the diagnosis of high-grade disease. Therefore, population-wide data supports the utility of prostate cancer screening with prostate specific antigen. The purpose of this article is to evaluate the current status of prostate screening in light of the US Preventative Service Task Force guidelines against routine screening and the more recently published American Urological Association guidelines for shared decision-making centered on patient education and autonomy. The difference in recommendations arises from the interpretation of the results from large, randomized prospective screening trials. While the studies may not illustrate a significant benefit for screening, they have notable limitations that make definitive conclusions based on their results, difficult to arrive. Epidemiologic data supports the use of screening modalities for diseases with high prevalence and a prolonged asymptomatic phase. As with any test, there are risks associated with prostate specific antigen screening. The major concerns are over diagnosis and over treatment. While the scientific community works toward more specific screening tests, it is imperative that individual patients are educated and involved in the shared decision-making. Patient perception of their individual harm and benefit becomes a major contributor to the decision-making process when evidence is largely inconclusive and unable to provide definitive direction for the practitioner.
Roland B Sennerstam
The present study focused on mammography screening during two periods representing 2 years (1991) to 8 years (1997/98) after the introduction of screening in 1989 in the Stockholm Gotland County, Sweden for women aged 50-69 years. Subjects were sorted by age, as younger (<50 years) unscreened women, screening women aged 50-69 years and analyzed in two decades between 50-59 years and 60-69 years respectively, and unscreened women of ≥ 70 years. Tumor size was compared with an unscreened cohort from 1987, 2 years before screening was introduced. Resolution was increased by focusing on three tumor-size intervals instead of mean tumor size, which showed a tending reduction in tumors ≥ 20 mm for women diagnosed with breast cancer aged 50-59 years in the 1991 sample but a significant decline for women aged 60-69 years having attended two screening tests. After 8 years of biennial screening (1997/98) patients with tumor size ≤ 10 mm at diagnosis had significantly increased, and tumors ≥ 20 mm declined significantly–most clearly among 60-69-year-old women after attending up to five screening tests. A transient increase in tumor sized 10 mm to 20 mm was seen due to the stepwise-altered distribution in size. Women in the two unscreened age groups <50 years and ≥ 70 years, were compared with screened women aged 60-69 (1997/98) according to tumor size, genomic instability, proliferation index , lymph node metastases, cyclin-A and ki67, alteration in breast tumor stage I and stage IIB and survival rate. In all parameters except ki67, only in relation to unscreened women <50 years old showed a significant reduction. A post-screening effect was also found for women aged 70-79 years with tumors size > 20 mm still being reduced compared with controls and the tumors ≤ 10mm decreasing significantly to the control level.