A National Cancer Institute sponsored screening trial for prostatic, lung, colorectal, and ovarian cancers

National Cancer Institute, Division of Cancer Prevention and Control, National Institutes of Health, Bethesda, MD 20892.
Cancer (Impact Factor: 4.89). 01/2010; 71(2 Suppl):589-93. DOI: 10.1002/cncr.2820710215
Source: PubMed


BACKGROUND. Ovarian cancer is the fifth most common cause of cancer-related death in American women. The median age at diagnosis is about 62 years; incidence rises rapidly after age 60. Pelvic examination has been the primary method for detection of ovarian carcinoma. It is insensitive for the detection of early disease, however: most women present with disease beyond the pelvis (Stages III and IV) and are not curable with existing techniques. Two new technologies may be useful as screening tools for earlier detection of ovarian cancer. CA 125 is an antigenic determinant expressed on an ovarian cancer cell line. Transvaginal ultrasound (TVUS) images the ovaries from within the vagina and can be performed by a technician in about 10 minutes. In small preoperative studies of women with ovarian masses, serum CA 125 levels have been elevated (typically above 35 U/ml) in over two-thirds of cases and in up to 50% of Stage I cases. The test is not absolutely specific: elevations have been reported with pregnancy, endometriosis, menstruation, benign ovarian tumors, and with cancers of the breast, colon, pancreas, lung, stomach, and liver. Nevertheless, the specificity of CA 125 in postmenopausal women has been reported at about 95% or more. TVUS provides higher resolving power for ovarian abnormalities than transabdominal ultrasound or physical examination; however, experience with it is limited. CA 125 and TVUS may be complementary. CONCLUSIONS. For these reasons, the National Cancer Institute is planning a randomized trial of all three tests versus routine medical care in women of ages 60-74 years. This is part of a larger trial to determine the efficacy of screening for lung, colorectal, and ovarian cancers in women, and for lung, colorectal, and prostatic cancers in men. Seventy-four thousand women will be randomized in the study.

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Available from: John K Gohagan, Oct 06, 2014
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    • "Only CA-125 and hK6 levels were further raised in advanced stage disease compared to early stage. The ovarian cancer cohorts from this study were younger (mean, 45.5 years) than reported for the incidence in postmenopausal women in the United States (mean, 60 years) and Scandinavia (mean, 61 years) [35,36]. Expression of the highest levels of hK6/hK10 in ovarian cancer were seen in mucinous cancer, contrary to the serous type reported [32]. "
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    ABSTRACT: To determine the predictive accuracy of the combined panels of serum human tissue kallikreins (hKs) and CA-125 for the detection of epithelial ovarian cancer. Serum specimens collected from 5 Indonesian centers and 1 Vietnamese center were analyzed for CA-125, hK6, and hK10 levels. A total of 375 specimens from patients presenting with ovarian tumors, which include 156 benign cysts, 172 epithelial ovarian cancers (stage I/II, n=72; stage III/IV, n=100), 36 germ cell tumors and 11 borderline tumors, were included in the study analysis. Receiver operating characteristic analysis were performed to determine the cutoffs for age, CA-125, hK6, and hK10. Sensitivity, specificity, negative, and positive predictive values were determined for various combinations of the biomarkers. The levels of hK6 and hK10 were significantly elevated in ovarian cancer cases compared to benign cysts. Combination of 3 markers, age/CA-125/hk6 or CA-125/hk6/hk10, showed improved specificity (100%) and positive predictive value (100%) for prediction of ovarian cancer, when compared to the performance of single markers having 80-92% specificity and 74-87% positive predictive value. Four-marker combination, age/CA-125/hK6/hK10 also showed 100% specificity and 100% positive predictive value, although it demonstrated low sensitivity (11.9%) and negative predictive value (52.8%). The combination of human tissue kallikreins and CA-125 showed potential for improving prediction of epithelial ovarian cancer in patients presenting with ovarian tumors.
    Journal of Gynecologic Oncology 07/2012; 23(3):175-81. DOI:10.3802/jgo.2012.23.3.175 · 2.49 Impact Factor
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    • "e.g. endometriosis and endometrial cancer (Kramer et al. 1993: Rose et al. 1994). This is also true for cxtokeratins . "
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    ABSTRACT: The aim of the present study was to evaluate the clinical usefulness of the cytokeratin marker CYFRA 21-1 as a screening marker for ovarian cancer, as a predictive marker in patients with adnexal masses and as a prognostic marker in women suffering from ovarian cancer. In order to determine the specificity of the CYFRA 21-1 test, we have investigated CYFRA 21-1 serum levels in several benign conditions. This retrospective study comprises 37 patients suffering from ovarian cancer FIGO stages Ia-III. Sera from patients with benign ovarian cysts, endometriosis, pelvic inflammatory disease, inflammatory bowel disease and liver cirrhosis were evaluated in 90, 10, 38, 10 and 20 cases respectively. With a sensitivity of 41% and a specificity of 95%, CYFRA 21-1 was not suitable as a screening marker for ovarian cancer. Although CYFRA 21-1 was able to discriminate between ovarian cancer and benign adnexal tumours (univariate regression model, P = 0.0001), CYFRA 21-1 did not reveal additional information to CA 125 in a multivariate regression analysis (P = 0.06). CYFRA 21-1 serum levels were elevated in benign conditions such as liver cirrhosis, but not in endometriosis and inflammatory diseases. In ovarian cancer patients, elevated CYFRA 21-1 serum levels before therapy were associated with a poor overall and disease-free survival (log-rank test, P = 0.02 and log-rank test, P = 0.005 respectively). CYFRA 21-1, while obviously not suitable for screening or differential diagnosis of adnexal masses, could be useful as an additional prognostic factor in ovarian cancer patients.
    British Journal of Cancer 11/1998; 78(8):1108-12. DOI:10.1038/bjc.1998.636 · 4.84 Impact Factor
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    ABSTRACT: We sought increased understanding of men's decision-making process for prostate-specific antigen (PSA) screening, especially among elderly men, and a more knowledgeable basis for interventions to modify screening rates. A cross-sectional postal questionnaire assessed measures consistent with the Theory of Planned Behavior among a population-based age-stratified random sample of 452 Iowa men who were free of prostate cancer and aware of PSA. Our primary outcome was intention to receive PSA screening within a year; this encompassed the degree men wanted and planned to be screened. We examined three explanatory variables via structural equation modeling: attitude, social influence, and perceived control. Attitude included the degree screening is important-unnecessary, reassuring-worrisome, and useful-useless. Social influence encompassed the extent a man believed people expect him to, and think he should be screened. Perceived control covered the degree a man can be screened, if desired, and how much control he has over screening. We then examined attitude, social influence, and perceived control as dependent variables. We examined how potential outcomes of screening influenced attitude, how specific people affected overall social influence, and how specific factors influenced perceived control. Roughly 75% expressed intent to receive PSA screening within a year. Attitude, social influence, and perceived control each contributed significantly to the explanation of intentions (p<0.001); the model accounted for 72% of the variability in intention. Detecting cancer early, obtaining peace of mind, knowing their PSA value, and false test results were potential outcomes and each convincingly influenced attitude. A man's wife, primary care physician, urologist, family, friends, and people with cancer each visibly swayed overall perceived social influence. The impacts of health insurance, transportation, information, health problems, including PSA in routine exams, and primary care physicians on perceived control was less clear. Elderly men were unaware of the PSA controversy and believed physicians recommend screening men their age. Our results suggest potential strategies to modify screening rates that include messages to modify men's attitudes about PSA screening and messages that target socially influential people. Being uninformed appears to be an important problem among elderly men who receive PSA screening.
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