Robert A Smith

Robert A Smith
American Cancer Society Inc. | ACS · Early Cancer Detection Science

PhD
I lead the development of cancer screening guidelines, and research studies on the evaluation of cancer screening

About

367
Publications
56,521
Reads
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46,512
Citations
Additional affiliations
January 2015 - November 2016
American Cancer Society Inc.
Position
  • Vice-President, Cancer Screening
June 2014 - present
Queen Mary, University of London
Position
  • Honorary Proffessorial Fellow
January 2005 - present
Emory University
Position
  • Adjunct Professor of Epidemiology

Publications

Publications (367)
Article
Purpose To use mammographic tumour features (imaging biomarkers) to identify and investigate breast cancers originating from the terminal ductal lobular units (TDLUs) of the breast in order to overcome the confusion arising from the current histopathology terminology, which calls cancers arising from the TDLUs either “ductal” or “lobular”. Method...
Article
Purpose To encourage and facilitate the recognition of ductal adenocarcinoma of the breast, DAB, as a distinct, invasive breast cancer subtype by describing the imaging biomarkers in detail. Methods Correlation of breast imaging biomarkers with the corresponding histopathological findings using large format technology, with additional evidence fro...
Article
9127 Background: Guidelines have evolved from 2011-2019; there are now 23 approved therapies targeting various predictive biomarkers in mNSCLC. 2021 NCCN Guidelines advocate for a minimum of ALK, EGFR, BRAF, METex14, NTRK1/2/3, RET, KRAS, and ROS1 testing before determining a treatment regimen. The study objective was to estimate the association be...
Article
Purpose To call attention to a highly fatal breast cancer subtype arising from the major lactiferous ducts that is currently underdiagnosed as ductal carcinoma in situ (DCIS) with or without microinvasion. Method All breast cancers diagnosed at the Department of Mammography, Falun Central Hospital, Sweden, since 1977 have been classified according...
Article
Purpose To use mammographic tumour features (imaging biomarkers) to classify breast cancer according to its apparent anatomic site of origin in the new era where tumours are found at their nonpalpable, earliest detectable phase. Method Large format, subgross, three-dimensional histopathologic images of breast cancer subtypes and their correspondin...
Article
Background: Although recommended lung cancer screening with low-dose computed tomography scanning (LDCT) reduces mortality among high-risk adults, annual screening rates remain low. This study complements a previous nationwide assessment of access to lung cancer screening within 40 miles by evaluating differences in accessibility across rural and...
Article
Full-text available
Background An ASCO taskforce comprised of representatives of oncology clinicians, the American Cancer Society National Lung Cancer Roundtable (NLCRT), LUNGevity, the GO2 Foundation for Lung Cancer, and the ROS1ders sought to: characterize U.S. oncologists’ biomarker ordering and treatment practices for advanced non-small-cell lung cancer (NSCLC); a...
Article
(Abstracted from N Engl J Med 2021;385:1908–1918) In May 2018, the World Health Organization (WHO) called for the elimination of global cervical cancer as a major public health priority, with a 2-pronged approach focusing on effective vaccination against human papillomavirus (HPV) and the screening for and treatment of early cervical cancer. Cervic...
Article
Background Pretreatment invasive nodal staging is paramount for appropriate treatment decisions in non-small cell lung cancer. Despite guidelines recommending when to perform staging, many studies suggest that invasive nodal staging is underutilized. Attitudes and barriers to guideline-recommended staging are unclear. The National Lung Cancer Round...
Article
Screening can decrease the burden of breast, cervical, and colorectal cancers. The COVID-19 pandemic led many countries to suspend cancer screening services as part of their response to the pandemic. The International Cancer Screening Network (ICSN) carried out an online survey to assess the effects of the first wave of the COVID-19 pandemic on can...
Article
Background: During the coronavirus disease 2019 pandemic, US unemployment rates rose to historic highs, and they remain nearly double those of prepandemic levels. Employers are the most common source of health insurance among nonelderly adults. Thus, job loss may lead to a loss of health insurance and reduce access to cancer screening. This study...
Article
Full-text available
Background This study investigates whether quantitative breast density (BD) serves as an imaging biomarker for more intensive breast cancer screening by predicting interval, and node-positive cancers. Methods This case–control study of 1204 women aged 47–73 includes 599 cancer cases (302 screen-detected, 297 interval; 239 node-positive, 360 node-n...
Article
Background: Targeted therapies for advanced non-small cell lung cancer (NSCLC) with oncogenic drivers have caused a paradigm shift in care. Biomarker testing is needed to assess eligibility for these therapies. Pulmonologists often perform bronchoscopy, providing tissue for both pathological diagnosis and biomarker analysis. We performed this surv...
Article
9067 Background: With rapid advancements in biomarker testing informing lung cancer treatment decisions, clinicians are challenged to maintain knowledge of who, what and when to test and how to treat based on test results. An ASCO taskforce including representatives from the American Cancer Society National Lung Cancer Roundtable and patient advoca...
Article
Full-text available
Purpose To review the scientific literature seeking lessons for the COVID-19 era that could be learned from previous health services interruptions that affected the delivery of cancer screening services. Methods A systematic search was conducted up to April 17, 2020, with no restrictions on language or dates and resulted in 385 articles. Two resea...
Article
Full-text available
Background Previously, the risk of death from breast cancer was analyzed for women participating versus those not participating in the last screening examination before breast cancer diagnosis. Consecutive attendance patterns may further refine estimates. Purpose To estimate the effect of participation in successive mammographic screening examinati...
Article
Lung cancer screening with a low radiation dose chest CT scan is the standard of care for screen eligible individuals. The net benefit of screening may be optimized by delivering high-quality care, capable of maximizing the benefit and minimizing the harms of screening. Valid, feasible, and relevant indicators of the quality of lung cancer screenin...
Article
Using low-dose computed tomography (LDCT) to screen for lung cancer is associated with improved outcomes among eligible current and former smokers (ie, aged 55-77, at least 30-pack–year smoking history, current smoker or former smoker who quit within the past 15 years). However, the overall uptake of LDCT is low, especially in health care settings...
Chapter
Synopsis The understanding at the beginning of the last century that colorectal cancer began as a localized disease that progressed and became systemic, and that most colorectal cancer arose from adenomatous polyps gave rise to aggressive attempts at curative treatment and eventually attempts to detect advanced lesions before they progressed to inv...
Article
Full-text available
In recent years, studies have shown that low-dose computed tomography (LDCT) is a safe and effective way to screen high-risk adults for lung cancer. Despite this, uptake remains low, especially in limited-resource settings. The American Cancer Society (ACS) partnered with two federally qualified health centers and accredited screening facilities on...
Article
Full-text available
Background Annual lung cancer screening (LCS) with low dose chest computed tomography in older current and former smokers (ie,, eligible adults) has been recommended since 2013. Uptake has been slow and variable across the United States (US). We estimated the LCS rate and growth at the national and state level between 2016–2018. Methods The Americ...
Article
Clinicians and the public have always depended on expert advice to guide clinical practice. However, since the 1970s, a growing emphasis on evidence-based medicine has led to clinical practice guidelines being less expert based and increasingly evidence based and judgments about the balance between the two. Because the existence of standards for gu...
Article
Cancer screening uses many investigative procedures, and different screening programs and methods have different objectives. For example, mammography aims to detect breast cancer at an earlier stage when successful treatment is more likely, whereas colonoscopy is aimed primarily at detecting adenomas in the colon and removing them, thus preventing...
Article
The burden of cancer in the United States is substantial, providing important opportunity and obligation for primary care clinicians to promote cancer prevention and early detection. Without a system of organized screening to support reminders and follow-up of cancer screening, primary care clinicians face challenges in addressing risk assessment,...
Article
PurposeWomen with a first-degree family history of breast cancer (FHBC) are sometimes advised to initiate screening mammography when they are 10 years younger than the age at which their youngest relative was diagnosed, despite a lack of unambiguous evidence that this is an effective strategy. It is unknown how often this results in women initiatin...
Article
Aim: The National Colorectal Cancer Roundtable convened a national Summit to discuss the causes of early-onset colorectal cancer and clinical challenges to mitigating burden of this disease. Materials & methods: Information presented was synthesized through scientific consensus building to determine priorities for new research and practice change....
Article
Background: There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by all high-risk groups, there must be careful attention to ensuring equitable access to this lifesaving preventive health measure. Objective...
Article
Background There remains disagreement on the long-term effect of mammographic screening in women aged 40–49 years. Objectives The long-term follow-up of a randomised controlled trial that offered annual mammography to women aged 40–49 years. The estimation of the effect of these mammograms on breast cancer and other-cause mortality, and the effect...
Conference Paper
Introduction: During the COVID-19 pandemic, the unemployment rate has sharply risen from 3.5% in February 2020 to 13.3% in May 2020, a level not seen since the Great Depression. There are an estimated 21.0 million unemployed adults in the United States. Employers are the most common source of health insurance among working-aged adults and their fam...
Article
Not only were social events and public facilities closed temporarily due to the coronavirus disease 2019 (COVID‐19) pandemic, but health services also were affected greatly. In this commentary, the authors discuss how the national program of mammography screening in Taiwan was affected, even without known community‐acquired transmission.
Article
Background Screening current and former heavy smokers aged 55-80 years for lung cancer with low dose chest CT has been recommended by the USPSTF since 2013. Although the number of screening facilities in the US has increased, screening uptake has been slow. To better understand the slow screening uptake, we evaluated geographic access to screening...
Preprint
Full-text available
Background: The American Cancer Society (ACS) partnered with two federally qualified health centers (FQHCs) and American College of Radiology designated lung cancer screening facilities on a two-year pilot project to implement lung cancer screening. The project aimed to develop a referral program and care coordination practices to move patients thr...
Article
Full-text available
Background The appropriate age range for breast cancer screening remains a matter of debate. We aimed to estimate the effect of mammographic screening at ages 40–48 years on breast cancer mortality. Methods We did a randomised, controlled trial involving 23 breast screening units across Great Britain. We randomly assigned women aged 39–41 years, u...
Article
Full-text available
The aim was to evaluate how the inter-screening interval affected the performance of screening by mammographic appearances. This was a Swedish retrospective screening cohort study with information on screening history and mammography features in two periods (1977–1985 and 1996–2010). The pre-clinical incidence and the mean sojourn time (MST) for sm...
Article
The American Cancer Society (ACS) presents an adaptation of the current Advisory Committee on Immunization Practices recommendations for human papillomavirus (HPV) vaccination. The ACS recommends routine HPV vaccination between ages 9 and 12 years to achieve higher on-time vaccination rates, which will lead to increased numbers of cancers prevented...
Article
Full-text available
The American Cancer Society (ACS) recommends that individuals with a cervix initiate cervical cancer screening at age 25 years and undergo primary human papillomavirus (HPV) testing every 5 years through age 65 years (preferred); if primary HPV testing is not available, then individuals aged 25 to 65 years should be screened with cotesting (HPV tes...
Article
Full-text available
Background: It is of paramount importance to evaluate the impact of participation in organized mammography service screening independently from changes in breast cancer treatment. This can be done by measuring the incidence of fatal breast cancer, which is based on the date of diagnosis and not on the date of death. Methods: Among 549,091 women,...
Article
Full-text available
Objectives To explain apparent differences among mammography screening services in Sweden using individual data on participation in screening and with breast cancer–specific survival as an outcome. Methods We analysed breast cancer survival data from the Swedish Cancer Register on breast cancer cases from nine Swedish counties diagnosed in women e...
Article
Colorectal cancer (CRC) is the second most common cause of cancer death in the United States. Every 3 years, the American Cancer Society provides an update of CRC occurrence based on incidence data (available through 2016) from population‐based cancer registries and mortality data (through 2017) from the National Center for Health Statistics. In 20...
Article
Full-text available
Women diagnosed with breast cancer at a relatively early age (≤45 years) or with bilateral disease at any age are at elevated risk for additional breast cancer, as are their female first-degree relatives (FDRs). We report on a randomized trial to increase adherence to mammography screening guidelines among survivors and FDRs. From the Georgia Cance...
Article
Full-text available
Background and study aims Adenoma detection rate (ADR), the proportion of an endoscopist’s screening colonoscopies in which at least one adenoma is found, is an established quality metric. Several publications have suggested that a technique referred to as “one and done,” where less attention is paid to additional polyp detection following discover...
Article
In Reply We thank Mendelson and colleagues for their interest in our study.
Conference Paper
Background: Low-dose CT (LDCT) lung cancer screening is associated with improved outcomes in high-risk adults, but uptake remains low and such medical advances are often not available in low-resource areas. The American Cancer Society (ACS) launched a pilot program focused on establishing effective processes to refer and screen patients for lung ca...
Conference Paper
Background: Low-dose CT (LDCT) lung cancer screening is associated with improved outcomes in high-risk adults, but uptake remains low and such medical advances are often not available in low-resource areas. The American Cancer Society (ACS) launched a pilot program focused on establishing effective processes to refer and screen patients for lung ca...
Article
Introduction: Medicaid expansions following the Affordable Care Act have improved insurance coverage in low-income adults, but little is known about its impact on cancer screening. This study examined associations between Medicaid expansion timing and colorectal cancer (CRC) and breast cancer (BC) screening. Methods: Up-to-date and past 2-year C...
Article
Full-text available
Background To differentiate the risk of breast cancer death in a longitudinal cohort using imaging biomarkers of tumor extent and biology, specifically, the mammographic appearance, basal phenotype, histologic tumor distribution, and conventional tumor attributes. Methods Using a prospective cohort study design, 498 invasive breast cancer patients...
Data
Supplementary materials contain relationships between mammographic appearance and biomarkers (Tables S1-S6), the estimated results of Cox regression model in both test and validation cohorts (Tables S7), the estimated results of Cox regression model with and without consideration of competing risk of death (Table S9), and model validation with obse...
Article
Importance Whole-breast ultrasonography has been advocated to supplement screening mammography to improve outcomes in women with dense breasts. Objective To determine the performance of screening mammography plus screening ultrasonography compared with screening mammography alone in community practice. Design, Setting, and Participants Observatio...
Article
Full-text available
Background Women and their health care providers need a reliable answer to this important question: If a woman chooses to participate in regular mammography screening, then how much will this choice improve her chances of avoiding a death from breast cancer compared with women who choose not to participate? Methods To answer this question, we used...
Article
Full-text available
From the mid‐20th century, accumulating evidence has supported the introduction of screening for cancers of the cervix, breast, colon and rectum, prostate (via shared decisions), and lung. The opportunity to detect and treat precursor lesions and invasive disease at a more favorable stage has contributed substantially to reduced incidence, morbidit...
Article
Background: Low-dose CT (LDCT) screening for lung cancer in adults at high-risk is associated with a reduction in lung cancer mortality in high-risk adults, yet screening rates remain low. Increasing access to high-quality lung cancer screening is critical to further reducing deaths from the disease. In 2015 the American Cancer Society implemented...
Article
Full-text available
BACKGROUND Colorectal cancer (CRC) risk varies by race and sex. This study, 1 of 2 microsimulation analyses to inform the 2018 American Cancer Society CRC screening guideline, explored the influence of race and sex on optimal CRC screening strategies. METHODS Two Cancer Intervention and Surveillance Modeling Network microsimulation models, informe...
Article
Full-text available
Background: In 2016, the Microsimulation Screening Analysis-Colon (MISCAN-Colon) model was used to inform the US Preventive Services Task Force colorectal cancer (CRC) screening guidelines. In this study, 1 of 2 microsimulation analyses to inform the update of the American Cancer Society CRC screening guideline, the authors re-evaluated the optima...
Article
Full-text available
Each year, the American Cancer Society publishes a summary of its guidelines for early cancer detection, data and trends in cancer screening rates from the National Health Interview Survey, and select issues related to cancer screening. In this 2018 update, we also summarize the new American Cancer Society colorectal cancer screening guideline and...