Tag: cancer screening

I Am Afraid of Early Cancer Detection

Mary Pat Campbell

Link: https://www.sensible-med.com/p/i-am-afraid-of-early-cancer-detection?utm_source=post-email-title&publication_id=1000397&post_id=141592311&utm_campaign=email-post-title&isFreemail=true&r=15zk5&utm_medium=email

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Excerpt:

Looking a bit more closely you see why Grail’s test is actually useless, or dangerous, or both. Let’s start with the sensitivity of the test. For a cancer screening test to work, it must find disease before it has caused symptoms — when it is in an early or premalignant stage. Say what you want about lung cancer screening, mammography, PSA, and colonoscopy (I’m talking to you Drs. M and P) but at least they look for, and succeed at finding, early stage/premalignant disease. Here is the sensitivity of the Galleri test by stage: stage 1, 16.8%; stage 2, 40.4%; stage 3, 77%; stage 4, 90.1%.

The test is nearly worthless at finding stage 1 disease, the stage we would like to find with screening. The type of disease that is usually cured with surgery alone.

How about specificity? Let’s consider a fictional, 64-year-old male patient who presents to his internist worried about pancreatic cancer. I pick pancreatic not only because it is a scary cancer: we can’t screen for it, our treatments stink, and it seems to kill half the people in NYT obituary section. I also chose it because it is the anecdotal disease in the WSJ article.

….

Working through the math (prevalence 0.03%, sensitivity 61.9%, specificity 99.5%), this means our patient’s likelihood of having pancreatic cancer after a positive test is only 3.58%. For our patient, we have caused anxiety and the need for an MRI. You almost hope to find pancreatic cancer at this point to be able to say, “Well, it was all worth it.” If the MRI or ERCP is negative, the patient will live with fear and constant monitoring. (You will have to wait until next week to consider with me the impact of this test if we were to deploy it widely).

If the evaluation is positive, and you have managed to diagnose asymptomatic, pancreatic cancer, the likelihood of survival is probably, at best, 50%.

Let’s end this week with two thoughts. First the data for the Galleri test is not good, yet. The test characteristics are certainly not those we would like to see for a screening test. Even more importantly, good test characteristics are just the start. To know that a test is worthwhile, you would like to know that it does more good than harm. This has not even been tested. The WSJ article scoffs at the idea that we would want this data.5

Author(s): Adam Cifu, MD

Publication Date: 15 Feb 2024

Publication Site: Sensible Medicine, substack

Europe faces ‘cancer epidemic’ after estimated 1m cases missed during Covid

Mary Pat Campbell

Link: https://www.theguardian.com/society/2022/nov/15/europe-faces-cancer-epidemic-after-estimated-1m-cases-missed-during-covid

Excerpt:

Experts have warned that Europe faces a “cancer epidemic” unless urgent action is taken to boost treatment and research, after an estimated 1m diagnoses were missed during the pandemic.

The impact of Covid-19 and the focus on it has exposed “weaknesses” in cancer health systems and in the cancer research landscape across the continent, which, if not addressed as a matter of urgency, will set back cancer outcomes by almost a decade, leading healthcare and scientific experts say.

A report, European Groundshot – Addressing Europe’s Cancer Research Challenges: a Lancet Oncology Commission, brought together a wide range of patient, scientific, and healthcare experts with detailed knowledge of cancer across Europe.

One unintended consequence of the pandemic was the adverse effects that the rapid repurposing of health services and national lockdowns, and their continuing legacy, have had on cancer services, on cancer research, and on patients with cancer, the experts said.

“To emphasise the scale of this problem, we estimate that about 1m cancer diagnoses might have been missed across Europe during the Covid-19 pandemic,” they wrote in The Lancet Oncology. “There is emerging evidence that a higher proportion of patients are diagnosed with later cancer stages compared with pre-pandemic rates as a result of substantial delays in cancer diagnosis and treatment. This cancer stage shift will continue to stress European cancer systems for years to come.

Author(s): Andrew Gregory

Publication Date: 15 Nov 2022

Publication Site: The Guardian UK

A colonoscopy study has some wondering if they should have the procedure. What you should know

Mary Pat Campbell

Link: https://www.cnn.com/2022/10/10/health/colonoscopy-study-q-and-a-wellness/index.html

Excerpt:

What did this new study show about the effectiveness of colonoscopies?

In this study, about 12,000 people in Sweden, Poland and Norway got colonoscopies. They saw a 31% reduction in their risk of colon cancer and a 50% reduction in their risk of dying from colon cancer compared with people who were not invited to get a colonoscopy.

Was that about what would be expected?

Some US studies have suggested that colonoscopies are even more effective. One study followed nearly 90,000 health care professionals for 22 years. Some of them chose to receive a screening colonoscopy, and some did not. The researchers estimated that screening colonoscopy was associated with a 40% reduction in the risk of getting colon cancer and a 68% reduction in the risk of dying of colon cancer.

Why would there be different success rates in the three European countries compared with the US?

Dominitz says one reason might be that most people in the European study didn’t have sedation when they got their colonoscopies. Only 23% of the patients in the European study received sedation, but virtually everyone having a colonoscopy in the US gets it. Colonoscopies can be uncomfortable, and doctors might, without even realizing it, be less thorough if people are in pain. Thoroughness – getting the scope into the folds and crevices of the colon – is important for finding growths called polyps. The more polyps doctors are able to find, the more they can reduce the person’s risk of being diagnosed with or dying from colon cancer.

Author(s): Elizabeth Cohen

Publication Date: 11 Oct 2022

Publication Site: CNN

John Hancock to Pilot 50-Cancer Detection Test

Mary Pat Campbell

Link: https://www.thinkadvisor.com/2022/09/20/john-hancock-to-pilot-50-cancer-detection-test/

Excerpt:

John Hancock wants to find out what happens when life insurance insureds get a blood test that might reveal early signs of about 50 different types of cancer.

The Boston-based Manulife subsidiary is working with Munich Re and other reinsurers to offer a pilot program that will pay either 50% or 100% of the cost of Grail’s Galleri cancer screening test for insureds in the John Hancock Vitality wellness program.

John Hancock will not get individual test results for the insureds who use the pilot program, nor will the program results affect the participants’ coverage, premiums or Vitality points.

Author(s): Allison Bell

Publication Date: 20 Sept 2022

Publication Site: Think Advisor