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CDC Grand Rounds: the Future of Cancer Screening

April 7, 2015 Comments off

CDC Grand Rounds: the Future of Cancer Screening
Source: Morbidity and Mortality Weekly Report (CDC)

Cancer is the second leading cause of death in the United States, with 52% of deaths caused by cancers of the lung and bronchus, female breast, uterine cervix, colon and rectum, oral cavity and pharynx, prostate, and skin (melanoma) (1). In the 1930s, uterine cancer, including cancer of the uterine cervix, was the leading cause of cancer deaths among women in the United States (2). With the advent of the Papanicolaou (Pap) test in the 1950s to detect cellular level changes in the cervix, cervical cancer death rates declined significantly (2). Since this first cancer screening test, others have been developed that detect the presence of cancer through imaging procedures (e.g., mammography, endoscopy, and computed tomography) and laboratory tests (e.g., fecal occult blood tests) (3).

The U.S. Preventive Services Task Force (USPSTF) provides cancer screening recommendations and continually reviews the scientific evidence for the potential benefits and harms of screening (4). USPSTF cancer screening recommendations that are graded A or B (indicating that they are recommended by USPSTF) include those for breast cancer, cervical cancer, colorectal cancer, and for lung cancer in heavy smokers (4) (Table 1); Grade A indicates high certainty that the net benefit is substantial, and Grade B indicates high certainty that the net benefit is moderate, or moderate certainty exists that the net benefit is moderate to substantial. Healthy People 2020 objectives include cancer-related objectives that address incidence, mortality, and screening for each of these cancers; no objective has been established for lung cancer screening because it was not recommended by USPSTF until 2013, after the Healthy People 2020 objectives were released (5) (Table 2).

Invasive Cancer Incidence and Survival — United States, 2011

March 18, 2015 Comments off

Invasive Cancer Incidence and Survival — United States, 2011
Source: Morbidity and Mortality Weekly Report (CDC)

Because of improvements in early detection and treatment of cancer, the proportion of persons with cancer who survive ≥5 years after diagnosis has increased (1). To assess progress toward achieving Healthy People 2020 objectives (2),* CDC analyzed data from U.S. Cancer Statistics (USCS) for 2011, the most recent data available. USCS includes incidence and survival data from CDC’s National Program of Cancer Registries (NPCR) and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program and mortality data from the National Vital Statistics System (3). In 2011, a total of 1,532,066 invasive cancers were reported to cancer registries in the United States (excluding Nevada), for an annual incidence rate of 451 cases per 100,000 persons. Cancer incidence rates were higher among males (508) than females (410), highest among black persons (458), and ranged by state, from 374 to 509 per 100,000 persons (339 in Puerto Rico). The proportion of persons with cancer who survived ≥5 years after diagnosis was 65% and was similar among males (65%) and females (65%) but lower among black persons (60%) compared with white persons (65%). Surveillance of cancer incidence and survival are essential for identifying population groups with high cancer incidence rates and low cancer survival rates as well as for estimating the number of cancer survivors, which was 13.7 million in 2012 (1). These data are being used by states to effectively develop comprehensive cancer control programs, including supporting the needs of cancer survivors.

Pricing in the Market for Anticancer Drugs

January 28, 2015 Comments off

Pricing in the Market for Anticancer Drugs
Source: National Bureau of Economic Research

Drugs like bevacizumab ($50,000 per treatment episode) and ipilimumab ($120,000 per episode) have fueled the perception that the launch prices of anticancer drugs are increasing over time. Using an original dataset of 58 anticancer drugs approved between 1995 and 2013, we find that launch prices, adjusted for inflation and drugs’ survival benefits, increased by 10%, or about $8,500, per year. Although physicians are not penalized for prescribing costly drugs, they may be reluctant to prescribe drugs with prices that exceed subjective standards of fairness. Manufacturers may set higher launch prices over time as standards evolve. Pricing trends may also reflect manufacturers’ response to expansions in the 340B Drug Pricing Program, which requires manufacturers to provide steep discounts to eligible providers.

The Emerging Crisis: Noncommunicable Diseases

January 15, 2015 Comments off

The Emerging Crisis: Noncommunicable Diseases
Source: Council on Foreign Relations

The gravest health threats facing low- and middle-income countries are not the plagues, parasites, and blights that dominate the news cycle and international relief efforts. They are the everyday diseases the international community understands and could address, but fails to take action against.

Once thought to be challenges for affluent countries alone, cardiovascular diseases, cancer, diabetes, and other noncommunicable diseases (NCDs) have emerged as the leading cause of death and disability in developing countries. In 2013, these diseases killed eight million people before their sixtieth birthdays in these countries. The chronic nature of NCDs means patients are sick and suffer longer and require more medical care. The resulting economic costs are high and escalating. Unless urgent action is taken, this emerging crisis will worsen in low- and middle-income countries and become harder to address.

Decision Aids for Cancer Screening and Treatment

January 13, 2015 Comments off

Decision Aids for Cancer Screening and Treatment
Source: Agency for Healthcare Research and Quality

Decision Aids for Cancer Screening and Treatment, a new research review from AHRQ’s Effective Health Care Program, examined the effectiveness of decision aids used by people facing treatment or screening decisions for early cancer. Considerable diversity in both format and available evidence among the aids were found.

The review is useful for creators of patient decision aids and those considering whether to use decision aids. It found strong evidence that cancer-related decision aids increase knowledge about available treatments and next steps without negatively impacting decisionmaking ability or causing additional anxiety. The review also found evidence that decision aids can help users make informed decisions and choices that best agree with their values and provide accurate understanding about the risks of treatment.

Annual Report to the Nation on the status of cancer, 1975-2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer

January 9, 2015 Comments off

Annual Report to the Nation on the status of cancer, 1975-2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer (PDF)
Source: Cancer
BACKGROUND
The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updates on cancer incidence and death rates and trends in these outcomes for the United States. This year’s report includes the prevalence of comorbidity at the time of first cancer diagnosis among patients with lung, colorectal, breast, or prostate cancer and survival among cancer patients based on comorbidity level.

METHODS
Data on cancer incidence were obtained from the NCI, the CDC, and the NAACCR; and data on mortality were obtained from the CDC. Long-term (1975/1992-2010) and short-term (2001-2010) trends in age-adjusted incidence and death rates for all cancers combined and for the leading cancers among men and women were examined by joinpoint analysis. Through linkage with Medicare claims, the prevalence of comorbidity among cancer patients who were diagnosed between 1992 through 2005 residing in 11 Surveillance, Epidemiology, and End Results (SEER) areas were estimated and compared with the prevalence in a 5% random sample of cancer-free Medicare beneficiaries. Among cancer patients, survival and the probabilities of dying of their cancer and of other causes by comorbidity level, age, and stage were calculated.

RESULTS
Death rates continued to decline for all cancers combined for men and women of all major racial and ethnic groups and for most major cancer sites; rates for both sexes combined decreased by 1.5% per year from 2001 through 2010. Overall incidence rates decreased in men and stabilized in women. The prevalence of comorbidity was similar among cancer-free Medicare beneficiaries (31.8%), breast cancer patients (32.2%), and prostate cancer patients (30.5%); highest among lung cancer patients (52.9%); and intermediate among colorectal cancer patients (40.7%). Among all cancer patients and especially for patients diagnosed with local and regional disease, age and comorbidity level were important influences on the probability of dying of other causes and, consequently, on overall survival. For patients diagnosed with distant disease, the probability of dying of cancer was much higher than the probability of dying of other causes, and age and comorbidity had a smaller effect on overall survival.

CONCLUSIONS
Cancer death rates in the United States continue to decline. Estimates of survival that include the probability of dying of cancer and other causes stratified by comorbidity level, age, and stage can provide important information to facilitate treatment decisions. Cancer 2014;120:1290–1314. © 2013 American Cancer Society.

Categories: cancer, Cancer

Search and Breast Cancer: On Disruptive Shifts of Attention over Life Histories of an Illness

November 24, 2014 Comments off

Search and Breast Cancer: On Disruptive Shifts of Attention over Life Histories of an Illness
Source: Microsoft Research

We seek to understand the evolving needs of people who are faced with a life-changing medical diagnosis based on analyses of queries extracted from an anonymized search query log. Focusing on breast cancer, we manually tag a set of Web searchers as showing disruptive shifts in focus of attention and long-term patterns of search behavior consistent with the diagnosis and treatment of breast cancer. We build and apply probabilistic classifiers to detect these searchers from multiple sessions and to detect the timing of diagnosis, using a variety of temporal and statistical features. We explore the changes in information-seeking over time before and after an inferred diagnosis of breast cancer by aligning multiple searchers by the likely time of diagnosis. We automatically identify 1700 candidate searchers with an estimated 90% precision, and we predict the day of diagnosis within 15 days with an 88% accuracy. We show that the geographic and demographic attributes of searchers identified with high probability are strongly correlated with ground truth of reported incidence rates. We then analyze the content of queries over time from searchers for whom diagnosis was predicted, using a detailed ontology of cancerrelated search terms. Our analysis reveals the rich temporal structure of the evolving queries of people likely diagnosed with breast cancer. Finally, we focus on subtypes of illness based on inferred stages of cancer and show clinically relevant dynamics of information seeking based on dominant stage expressed by searchers.

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