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Researchers Suggest Rethinking 'cancer' Label For Early-stage Prostate Changes
A new paper in the Journal of the National Cancer Institute indicates that patients may benefit if doctors stop calling certain early-stage changes to the prostate "cancer" at all. The paper is titled "When is prostate cancer really cancer?".
Prostate cancer is the second leading cause of cancer death worldwide in men, but far more patients are diagnosed than die of the disease. In 2022, there were nearly 1.5 million cases of prostate cancer, but only 400,000 deaths. Low-grade prostate cancer, commonly known as GG1 among physicians, virtually never metastasizes or causes symptoms. Some medical researchers have wondered recently if it would be a benefit to public health to call GG1 something other than cancer.
To further this discussion, researchers convened an international symposium with participants from multiple fields, including patient advocacy.
Key considerations included the very high rate of GG1 detectable on autopsy studies, the focus of contemporary diagnostic tests on detecting higher grade cancers, the benefits of relegating GG1 to something more like "incidentaloma" status, the adverse health effects of overtreatment, and the psychological burden of a cancer diagnosis for patients.
Those who convened at the meeting emphasized that while GG1 is common among older men, it should not be considered normal. Patients with this condition should continue to monitor it with their physicians, according to investigators.
One concern is that patients may not bother to monitor the progression of the condition if their doctor doesn't use the word "cancer" to explain what's going on. Ultimately, those involved in the discussion emphasized, the goal of prostate cancer screening, diagnosis, and treatment is to bring down mortality rates while also reducing the harms of overdiagnosis and overtreatment.
Matthew Cooperberg, the principal investigator involved with the symposium, believes that a reconsideration of nomenclature may be a good way to help bring this about.
"The word 'cancer' has resonated with patients for millennia as a condition associated with metastasis and mortality," explained Cooperberg.
"We are now finding exceptionally common cellular changes in the prostate that in some cases presage development of aggressive cancer but in most do not. We absolutely need to monitor these abnormalities no matter what we label them, but patients should not be burdened with a cancer diagnosis if what we see has zero capacity to spread or to kill."
More information: Matthew R Cooperberg et al, When is prostate cancer really cancer?, Journal of the National Cancer Institute (2024). DOI: 10.1093/jnci/djae200
Citation: Researchers suggest rethinking 'cancer' label for early-stage prostate changes (2024, October 1) retrieved 1 October 2024 from https://medicalxpress.Com/news/2024-09-rethinking-cancer-early-stage-prostate.Html
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Reach Out For Help With Early Breast Cancer Detection
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Until I was diagnosed with breast cancer, I lacked anything more than a basic understanding of the numerical stages assigned to the levels of its progression.
I thought all cancers were alike, except that some were more aggressive than others, depending on the individual or body location. For example, I was aware that when cancer invaded an organ like the pancreas, the liver, or the kidney, it could spread like wildfire because of its vital function in the complex biological systems that keep us alive.
As a responsible woman, I schedule a mammogram every June. The importance of doing so has been amplified by the breast cancer diagnosis of my sisters and my niece, two of whom are 15 years younger: traumatic experiences for all.
I know the drill. A drive to the radiologists' for a mammogram and home again in an hour, door to door. A call later the same day reports reliably unremarkable results. Safe for another year.
Not so when I answer the phone this year, I listen to the news that an area of my left breast requires another view via ultrasound. My calmness is a blessing and a surprise. Does anyone ever know how they'll react to bad news?
After the ultrasound, a biopsy confirms expectations of ductile carcinoma in situ, with minor calcifications in a small portion of the breast tissue: cancer in the milk ducts. The radiologist advises that this is the best possible early diagnosis, short of a mammogram showing nothing. I have Stage 0 Cancer.
At first I try not to research the new terms online, but then I give in – and it is good that I did, because it turns out that I am well-prepared for my appointment with the breast surgeon.
As I sit in the waiting room, another woman, also waiting, begins to weep. I hesitate a moment before locating a box of tissues and offering them, quietly saying, "I'm so sorry." Selfishly, I hope this is not a harbinger of things to come.
With palpable relief, I'm summoned to the doctor's office. She is a slim woman, younger than me, but she is pale and grave, with an almost care-worn expression,
"If you could handle this any way you wanted, what would that be?" she asks.
I answer without hesitation. "I would have you remove all affected areas, with ample margins as insurance. Then, I would have breast reconstruction, with a breast reduction/lift to match. I wouldn't have to have radiation or chemotherapy or take estrogen blockers."
"Okay, " she smiles," We can do that."
Weeks later, with the extraordinary skill of my breast surgeon and the art of an equally skilled plastic surgeon, everything I hoped for came to pass, thanks to the early diagnosis of cancer cells still primarily confined to the milk ducts.
A fairy tale ending? Perhaps.
While my experience may be an homage to annual mammograms and early detection, this rosy outcome is rare. A similar diagnosis in another woman might require a different treatment protocol than the option I was able to choose.
A factor in favor of my choices is my age of 73 at the time of diagnosis. Hence, I could opt out of radiation, chemotherapy, and estrogen blockers as their value as long-range prophylactic or protective treatment is a more significant benefit to a woman with 25, 30, 40, or 50 years of life expectancy. Statistically, the likelihood of recurrence increases exponentially over 40 or 50 years.
Additionally, the nature of my diagnosis of ductile carcinoma in situ meant the milk ducts were acting as a barrier between the cancer cells and the surrounding breast tissue. Had the cancer cells breached the ducts and invaded the breast tissue and lymph nodes, it would have been classified as invasive, and the treatment required for survival would have included more aggressive treatment like mastectomy and mandated therapy with radiation, chemotherapy, and estrogen blockers.
The outcome could have been very different if I had skipped my mammogram for a year.
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The truth is that happy endings like mine can be of a limited duration, the length of which is not currently predictable with a high degree of accuracy. Breast cancer can take a variety of forms, which may call for a variety of medical protocols and treatments to produce the most desirable results and best outcomes.
Nevertheless, early diagnosis is the best tool available to women with breast cancer.
Annual mammograms, funded by insurance, government agencies, or privately endowed institutions, are available to every woman in Connecticut who seeks them.
The Connecticut Department of Public Health's Early Detection and Prevention Program offers a bounty of resources to assure that every woman has access to mammograms and breast cancer care, regardless of income or insurance coverage.
According to the Connecticut Department of Health, in 2022, Connecticut ranked fourth in the nation for breast cancer screening rates in women 40 years and older – 76.2% compared to the national rate of 70.2%. In that same period, 81.7% of women in Connecticut between the ages of 50 and 74 reported having had a mammogram within the preceding two years, compared to the national rate of 76.3%.
Until every woman over 40 (or earlier for those at greater risk) commits to obtaining an annual mammogram as a right we must exercise, as an obligation we must fulfill for our loved ones if not ourselves, and above all, as an act of self-respect, too many of us will suffer needlessly.
We must all agree to set a better example for our daughters, sisters, partners, and friends, and nothing prevents us from doing so.
October is National Breast Cancer Awareness Month, and October 18 is National Mammography Day. Please commemorate these observances by scheduling a mammogram and encouraging other women you know to do the same.
Gloria Gouveia is a member of the Connecticut Mirror's Community Editorial Board.
Ovarian Cancer Awareness Month: Prioritizing Early Detection, Bridging Equity Gaps
September marked Ovarian Cancer Awareness Month, highlighting the importance of early detection and the need for equitable treatment access.
National Ovarian Cancer Awareness Month provided an opportunity to raise awareness about ovarian cancer risks, the importance of early screening, and the ongoing disparities in care.
September marks Ovarian Cancer Awareness Month, highlighting the importance of early detection and the need for equitable care access.Image Credit: Rabin - stock.Adobe.Com
Ovarian Cancer Awareness Month HistoryPresident Bill Clinton first recognized ovarian cancer awareness by proclaiming September 13 to September 19, 1998, as Ovarian Cancer Awareness Week.1 In 2000, the National Ovarian Cancer Coalition expanded this to the entire month of September, an effort formalized the next year by President George W. Bush.2,3 From then on, the month was annually recognized as such.
In his proclamation, Bush highlighted that experts predicted that more than 23,000 ovarian cancer cases would be diagnosed in 2001 and about 13,900 women would die from the disease. Additionally, he wrote that ovarian cancer is "very treatable when detected early," but only 25% of US patients are diagnosed in the early stages.
Consequently, when diagnosed in advanced stages, the chance of 5-year survival is about 25%. Therefore, about 50% of women with ovarian cancer die within 5 years; in particular, only 48% of Black women with ovarian cancer survive 5 years or more. This is because diagnoses often occur after the cancer has spread beyond the ovaries. Therefore, Bush emphasized the need for early detection, encouraging women to educate themselves on ovarian cancer symptoms and risk factors.
Today's Ovarian Cancer StatisticsCompared with the 2001 predictions, experts estimated that about 19,680 women will receive a new ovarian cancer diagnosis this year and about 12,740 women will die from it.4 Therefore, ovarian cancer diagnoses have been slowly decreasing.
More specifically, the incidence rate declined by 1% to 2% per year from 1990 to the mid-2010s and by almost 3% per year from 2015 to 2019. The experts hypothesized that this is due to the increased use of oral contraceptives and the decreased use of menopausal hormone therapy.
Overall, the ovarian cancer death rate has decreased by 40% since 1975, with most of the progress happening since the mid-2000s. The experts hypothesized this is likely due to the decreasing number of diagnoses and better treatments available.
Potential Early Detection MethodsWhile ovarian cancer diagnoses have decreased since 2001, the need for early detection remains critical; the earlier the cancer is caught, the better the survival outcomes. Though ovarian cancer often shows no early symptoms, regular pelvic exams, awareness of symptoms, and screening tests can improve early detection rates.5
Pelvic exams involve health care professionals feeling the ovaries and uterus for shape, size, and consistency. Although most early ovarian tumors are difficult or impossible to feel, these exams may help find other cancers or female conditions.
Experts also urge women who experience ovarian cancer symptoms to see a doctor; the most common symptoms include bloating, pelvic or abdominal pain, urinary urgency or frequency, and trouble eating or feeling full quickly.6
However, early ovarian cancer often causes no symptoms, so the cancer has likely already spread if it is considered a possible cause of these symptoms.5 Despite this, paying attention to symptoms may improve the odds of earlier diagnosis and successful treatment. Therefore, experts instruct that patients report their symptoms to a health care professional if they experience them almost daily for more than a few weeks.
Because symptoms often do not manifest for those with early ovarian cancer, experts suggested using screening tests. The 2 most commonly used are transvaginal ultrasound (TVUS) and the cancer antigen (CA)-125 blood test. TVUS uses sound waves to look at the uterus, fallopian tubes, and ovaries with an ultrasound wand; it can help find a tumor in the ovary, but it cannot determine if it is cancerous.
Additionally, the CA-125 blood test measures the amount of CA-125 protein in the blood; many women with ovarian cancer have high CA-125 levels. However, experts do not consider it an effective screening test since high CA-125 levels can be caused by other conditions and are not present in all patients with ovarian cancer. Conversely, it can be useful during treatment for those with high CA-125 levels; treatments could be considered successful if the CA-125 levels decrease.
Extensive research has been initiated to develop an effective ovarian cancer screening test, but there has not yet been much success.
Various Treatment Options Now AvailableTreatment varies by patient, depending on the type, stage, and grade of ovarian cancer, as well as their overall health and personal preferences.7 Therefore, it may include surgery, chemotherapy, targeted therapy, or a combination.
Experts noted that surgery aims to remove as much of the tumor as possible, while chemotherapy is used to kill any remaining cancer cells. On the other hand, targeted therapies offer a more personalized approach by focusing on preventing cancer cells from growing.
Other treatment methods include immunotherapy and hormone therapy.8 In immunotherapy, doctors assist the immune system in recognizing and attacking cancer cells; immune checkpoint inhibitors, like pembrolizumab, are often used in ovarian cancer treatment.
Also, hormone therapy uses hormones or hormone-blocking drugs to slow or stop the growth of cancers that use hormones to grow. For patients with ovarian cancer, this treatment is most often used in cancers that are sensitive to hormones like progesterone or estrogen.
Ovarian Cancer Care Disparities PersistDespite the availability of these treatments, care disparities still exist. Ovarian cancer incidence remains higher in White women, but Black and Hispanic women continue to experience disparities in survival and recurrence rates, underscoring the urgent need for equitable access to care.9
The overall 5-year survival rate for Black women is 41% compared with 49% among White women. Black women are more likely to be diagnosed with advanced disease and more aggressive tumors, and when ovarian cancer is diagnosed at a late stage, the 5-year survival was 23% in Black women and 34% in White women.
Conversely, on average, Hispanic women are diagnosed at an earlier stage, but they tend to be diagnosed at a younger age than White women. Also, inequitable health care access remains an ongoing challenge for Hispanic women. Consequently, social determinants of health are considered key contributors to ovarian cancer disparities as they impact how patients navigate within the health care system.
Diane Mahoney, PhD, DNP, FNP-BC, WHNP-BC, APRN, of the University of Kansas Medical Center, said in an interview with The American Journal of Managed Care® that health care professionals "can no longer live in silos" and promoted a multidisciplinary approach to help mitigate these disparities.10
"...It can't be health care professionals carrying the torch of doing everything," Mahoney said. "...I think it has to be multidisciplinary, but it needs to be centered around the patient, it needs to be centered around the community. The key thing, I think, is prevention.... Because if we can come together to prevent the disease in the first place, if there's these factors that we could collaboratively work together on, I think that could really revolutionize things and it can change how we look at these approaches."
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