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The multicenter cancer of pancreas screening study: Impact on stage and survival

A new, multicenter study suggests that surveillance programs for individuals at high risk of developing pancreatic cancers can help detect precancerous conditions and cancers early, when they are most treatable (J Clin Oncol 2022; doi:10.1200/JCO.22.00298). The Cancer of the Pancreas Screening-5 (CAPS5) study enrolled individuals at high risk of developing pancreatic cancer and participants underwent annual pancreatic imaging tests. Of the 1,461 included in the study, 48.5 percent had a pathogenic variant in a pancreatic ductal adenocarcinoma (PDAC) susceptibility gene. Ten patients were diagnosed with pancreatic cancer, including one who was diagnosed 4 years after dropping out of recommended surveillance. Of the nine remaining patients, seven were diagnosed with Stage I disease and the other two had progressed to high-stage cancer. After a median follow-up of 2.6 years, seven of the nine patients with PDAC were alive. An additional eight patients had surgical resection for worrisome lesions. Three had high-grade and five had low-grade dysplasia in their resected specimens, according to the study authors. In the entire CAPS cohort (CAPS1-5 studies, 1,731 patients), 26 PDAC cases have been diagnosed, 19 of which occurred within surveillance, the study authors reported. Of these patients, 57.9 percent had Stage I and 5.2 percent had Stage IV disease. Conversely, six of the seven cases detected outside of surveillance were Stage IV. "Five-year survival to date of the patients with a screen-detected PDAC is 73.3 percent, and median overall survival is 9.8 years, compared with 1.5 years for patients diagnosed with PDAC outside surveillance," the study authors stated.


AUTHOR COMMENTARY: "A clear majority of patients in the CAPS program who were diagnosed with pancreatic cancer were detected at the first stage of the disease if they maintained their surveillance," said senior study author Michael Goggins, MBBCh, MD, Sol Goldman Professor of Pancreatic Cancer Research and Director of the Pancreatic Cancer Early Detection Laboratory at Johns Hopkins. "Many of those diagnosed with pancreatic cancer under surveillance can be potentially cured. By contrast, people who dropped off their surveillance had poor survival rates. Our results support the CAPS surveillance recommendation that those who meet the criteria should undergo regular screenings."



Persistent disparities in colorectal cancer screening: A tell-tale sign for implementing new guidelines in younger adults

A recently published study found that, in 2018, Americans ages 50-54 were 30.4 percent less likely to meet recommended colorectal cancer screening guidelines than Americans ages 70-75. The data also revealed that this age group faced higher screening disparities based on race, ethnicity, household income, educational attainment, and insurance coverage (Cancer Epidemiol Biomarkers Prev 2022; doi: 10.1158/1055-9965.EPI-21-1330). Given the rising incidence of colorectal cancer in adults younger than 50, the U.S. Preventive Services Task Force (USPSTF) updated their guidelines in May 2021 to recommend colorectal cancer screening for all individuals beginning at age 45, which is 5 years earlier than previous recommendations. The researchers, who sought to predict screening disparities that may arise in the new age group, used data from the National Health Interview Survey. They assessed colorectal screening participation during eight discontinuous years between 2000 and 2018. The study showed that, while colorectal cancer screening participation increased over time, the increase was smallest among individuals ages 50-54 with a change from 28.2 percent in 2000 to 47.6 percent in 2018. Conversely, the study authors observed that screening for individuals ages 70-75 years increased from 46.4 percent in 2000 to 78 percent in 2018. In 2018, larger screening disparities were observed between individuals of different racial and ethnic groups, education levels, household income, and health insurance coverage in individuals aged 50-54 versus those aged 70-75, according to the study authors. "Prevalence of colorectal cancer screening remains low in adults ages 50-54 years," they concluded. "As new guidelines are implemented, care must be taken to ensure screening benefits are realized equally by all population groups, particularly newly eligible adults ages 45-49 years."


AUTHOR COMMENTARY: "Across all age groups, colorectal cancer screening participation remains below national goals, and the benefits of screening are not equally realized across populations," said Caitlin Murphy, PhD, MPH, Associate Professor of Health Promotion and Behavioral Sciences at the UTHealth School of Public Health. "The disparities in screening that have been observed among older adults may extend to adults ages 45-49 as the new USPSTF recommendations are implemented. Extra care must be taken to ensure that expanding screening to younger ages does not negatively impact efforts to eliminate disparities in colorectal screening and outcomes, nor jeopardize efforts to increase screening initiation among older adults who remain unscreened."



A randomized trial of telephone-based smoking cessation treatment in the lung cancer screening setting

Findings suggest that intensive, weekly, telephone-based cessation counseling coupled with nicotine replacement for people who smoke and who were undergoing screening for lung cancer resulted in over a twofold greater cigarette quit rate compared to people who received minimal counseling and nicotine replacement (J Natl Cancer Inst 2022; doi: 10.1093/jnci/djac127). In this study, 818 people between the ages of 50 and 80 with a 20-plus pack-year smoking history were randomized. Participants either received intensive phone counseling of eight, 20-minute sessions along with up to 8 weeks of nicotine patches, or three counseling sessions and 2 weeks of patches. Counseling sessions included discussions on smoking-related goals, nicotine patch use, strategies to address triggers for smoking, readiness to quit, and confidence and motivation to quit. The data showed that self-reported 3-month quit rates were significantly higher in the intensive versus minimal groups (14.3% vs. 7.9%). Study authors noted that quit rates verified by saliva strips or carbon monoxide tests were lower, but with similar relative differences between groups (9.1% vs. 3.9%). When compared to the minimal counseling arm, the intensive group was more effective at cessation in individuals with greater nicotine dependence.


AUTHOR COMMENTARY: "Quitting smoking is very difficult and people who seek medication and support are more successful than those who try to quit on their own," said Kathryn L. Taylor, PhD, Professor in the Department of Oncology and a member of the Georgetown Lombardi Comprehensive Cancer Center's Cancer Prevention and Control Program, and corresponding author of the study. "Importantly, making a quit attempt while undergoing lung screening may provide a boost to one's motivation to stop smoking."


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