Exp Gerontol. 2016 May 17. pii: S0531-5565(16)30139-5. doi: 10.1016/j.exger.2016.05.004. [Epub ahead of print]

Frailty - From concept to clinical practice.

Sieber CC1.

Author information

• 1Institute for Biomedicine of Ageing, Friedrich-Alexander Universität Erlangen-Nürnberg, Germany; Department of General Internal Medicine and Geriatrics, Hospital St. John of Lord, Regensburg, Germany. Electronic address: cornel.sieber@fau.de.

Abstract

Frailty has emerged as a true geriatric syndrome with increasing interest for both basic scientist as well as clinicians. The conceptual frame of a decreased resistance to internal and external stressors shows - when speaking of physical frailty - substantial overlaps to primary sarcopenia, the age-related loss of muscle mass. Consensus for the definition of frailty and sarcopenia is rapidly increasing and ease the path for a common understanding of these syndromes with high impact on functionality, independence and thereby quality of life of older adults. Ageing per se has long been thought to be unalterable and being the major cause for most chronic diseases and frailty. Significant increases in the understanding of cellular senescence now challenge this. Interventions may delay age-related conditions and thus compressing late-life morbidity with positive consequences for public health. Besides pharmacological interventions, lifestyle choices including diet and physical activity can optimize the biology of ageing and extend healthy life span.

Obese Young Adults At High Risk Of Kidney Disease

"Also found was that among all young adults with albuminuria, fewer than five percent had ever been told they have kidney disease.

Obesity should be considered an independent risk factor for CKD and that doctors should be testing for kidney damage when evaluating obese young adults, the researchers suggested."

Clin Lab Med. 2016 Jun;36(2):385-399. doi: 10.1016/j.cll.2016.01.012. Epub 2016 Mar 14.

The Past, Present, and Future of Preimplantation Genetic Testing.

Imudia AN1, Plosker S2.

Author information

• 1Division of Reproductive Endocrinology and Infertility, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Suite 6022, Tampa, FL 33606, USA. Electronic address: aimudia@health.usf.edu.
• 2Division of Reproductive Endocrinology and Infertility, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Suite 6022, Tampa, FL 33606, USA.

Abstract

Preimplantation genetic testing (PGT) of oocytes and embryos is the earliest form of prenatal testing. PGT requires in vitro fertilization for embryo creation. In the past 25 years, the use of PGT has increased dramatically. The indications of PGT include identification of embryos harboring single-gene disorders, chromosomal structural abnormalities, chromosomal numeric abnormalities, and mitochondrial disorders; gender selection; and identifying unaffected, HLA-matched embryos to permit the creation of a savior sibling. PGT is not without risks, limitations, or ethical controversies. This review discusses the techniques and clinical applications of different forms of PGT and the debate surrounding its associated uncertainty and expanded use.

Drs. Laposata and Cohen: Implications for Pathology From the Institute of Medicine's Report on Diagnostic Error

Michael Laposata and Michael B. Cohen (2016) It's Our Turn: Implications for Pathology From the Institute of Medicine's Report on Diagnostic Error. Archives of Pathology & Laboratory Medicine: June 2016, Vol. 140, No. 6, pp. 505-507.

EDITORIALS

It's Our Turn: Implications for Pathology From the Institute of Medicine's Report on Diagnostic Error

Michael Laposata , MD, PhD; Michael B. Cohen , MD

From the Department of Pathology, University of Texas Medical Branch-Galveston, Galveston (Dr Laposata); and the Department of Pathology, University of Utah, Salt Lake City (Dr Cohen).

"We must go beyond providing numbers or short verbal reports delivered behind the scenes to becoming fully integrated members of the diagnostic team."

Philip T. Cagle, MD: Forging into the Future: Archives Continues to Grow. Jerad Gardner now Deputy Editor-in-Chief

Philip T. Cagle (2016) Forging into the Future: Archives Continues to Grow. Archives of Pathology & Laboratory Medicine: June 2016, Vol. 140, No. 6, pp. 500-500.

EDITORIALS

Forging into the Future: Archives Continues to Grow

Philip T. Cagle , MD

From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas

US Army Med Dep J. 2016 Apr-Sep;(2-16):161-6.

Select Public Health and Communicable Disease Lessons Learned During Operations Iraqi Freedom and Enduring Freedom.

Garges EC1, Taylor KM, Pacha LA.

Author information

• 1Director, Preventive Medicine Residency Program, US Army Public Health Center, Aberdeen Proving Ground, MD.

Abstract

History has taught us that the threat of communicable diseases to operational readiness should not be underestimated. The unique operational challenges of a decade at war in Southwest Asia have left us with many new lessons about prevention and mitigation of disease. The successes of military immunization programs demonstrated the successful application of military science to modern combat. Historic maladies such as tuberculosis and malaria continue to challenge our Army health leadership while new challenges with diseases like Q fever and rabies led to questions about our preparedness. These conflicts also brought awareness of issues about the broader deployed community, and the often unique risks that arise when US service members interact more frequently with foreign militaries, local nationals, and third country nationals. Application of these lessons to predeployment training and integration into leadership decision-making will improve our ability to maintain force readiness in future conflicts and adapt Army policy to current evidence and intelligence.

World Health Organization rejects call to postpone Rio Olympics because of Zika virus

World Health Organization rejects call to postpone Rio Olympics because of Zika virus


The Geneva-based U.N. health agency argued that Brazil is one of almost 60 countries and territories which are reporting transmission of the virus by mosquitoes, and that “people continue to travel between these countries and territories for a variety of reasons.” 

“Based on the current assessment of Zika virus circulating in almost 60 countries globally and 39 in the Americas, there is no public health justification for postponing or cancelling the games,” it said. “WHO will continue to monitor the situation and update our advice as necessary.” 

Am J Obstet Gynecol. 2016 Apr 19. pii: S0002-9378(16)30059-X. doi: 10.1016/j.ajog.2016.04.018. [Epub ahead of print]

Midurethral Slings: Evidence-Based Medicine vs. The Medicolegal System.

Nager CW1.

Author information

• 1Department of Reproductive Medicine, UC San Diego School of Medicine. Electronic address: cnager@ucsd.edu.

Abstract

Midurethral slings are minimally invasive surgeries for stress urinary incontinence that use a trocar system to place a narrow ribbon of polypropylene mesh under the midurethra. The peer-reviewed scientific literature on these procedures is abundant and midurethral slings are the most well -studied incontinence procedure ever. Systematic reviews of the literature demonstrate that midurethral slings are safer, and more (or equally) effective as traditional procedures. The midurethral sling is the worldwide standard for the treatment of female stress urinary incontinence and over 3 million procedures have been performed. The FDA and international scientific review agencies have consistently differentiated transvaginal mesh for stress urinary incontinence from transvaginal mesh for prolapse. In the recruitment of patients to participate in the transvaginal mesh litigation, plaintiff lawyers have not made the distinction between stress urinary incontinence and prolapse procedures because s, more women have received midurethral slings than transvaginal mesh for prolapse by an order of magnitude. The litigation costs of defending their products have forced several companies that manufactured midurethral slings to leave the marketplace. It is not inconceivable that midurethral slings could become absent from the U.S. market. If that happens, then American women with stress urinary incontinence will be harmed because they will not have access in this country to the best and safest stress urinary incontinence surgical procedure ever developed. It may be time for the Institute of Medicine, or another comparable national agency to provide evidence-based recommendations on the midurethral sling.

Br J Sociol. 2016 May 21. doi: 10.1111/1468-4446.12195. [Epub ahead of print]

Malala and the politics of global iconicity.

Olesen T1.

Author information

• 1Department of Political Science, Aarhus University.

Abstract

The article presents a case analysis of Malala Yousafzai's transformation into a global injustice icon after she was shot in 2012 by the Pakistani Taliban for advocating for girls' right to education. The analysis focuses on the political aspects of this process and is divided into three parts. The first looks at factors that facilitated Malala's iconization as she was undergoing medical treatment and was unable to participate in her iconization. The second part starts when Malala enters the global public sphere and begins to actively contribute to the iconization process. The third part identifies de-iconizing resistance to Malala from Pakistani actors who see her iconization as a symbolic colonization in which Malala has become a vehicle of the West. Theoretically, the article is located within cultural sociology, but expands it in a political and global direction.

States with the highest obesity rates

"The increase in illness and hospitalizations drives up health care costs both for individuals and for health systems. Health care costs are highest in states with the highest rates of obesity. Louisiana, which has the second highest obesity rate, also has the highest annual health care costs in the nation. By contrast, Colorado has the lowest obesity rate and lowest health care costs of all states.

Ultimately, a lifetime of obesity can lead to a premature death. According to aNational Institutes of Health study, participants with a BMI of 40-44.9 — an extreme level of obesity — lost 6.5 years of life. At BMI levels of 55-59.9, the years of life lost more than doubled to 13.7."

"Professional use of Twitter is ideal for physicians interested in both networking and education and is optimally used to facilitate in-person networking."

Arch Pathol Lab Med. 2016 May 19. [Epub ahead of print]

Let's Have a Tweetup: The Case for Using Twitter Professionally.

Fuller MY1, Allen TC1.

Author information

• 1From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Fuller); and the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen).

Abstract

Social media use is very common and can be an effective way for professionals to discuss information and interact with colleagues. Twitter (Twitter, Inc, San Francisco, California) is a social media network where posts, termed tweets, are limited to 140 characters. Professional use of Twitter is ideal for physicians interested in both networking and education and is optimally used to facilitate in-person networking. Live-tweeting (posting real-time reactions to events) at professional meetings is also a popular and highly successful use of Twitter. Physicians report patient privacy as the top concern preventing use of social media for professional reasons, and although generally social media use is safe, it is essential to understand how to protect patient confidentially. Other social media platforms with potential for professional use include Facebook (Facebook, Inc, Menlo Park, California), Instagram (Facebook, Inc), YouTube (YouTube, LLC, San Bruno, California), and Periscope (Twitter, Inc). With Twitter and other social media options, now is the time for pathologists to increase our visibility on social media and worldwide.

Healthc Policy. 2016 May;11(4):70-81.

Some Numbers behind Canada's Decision to Adopt an Orphan Drug Policy: US Orphan Drug Approvals in Canada, 1997-2012.

Herder M1, Krahn TM2.

Author information

• 1Associate Professor, Faculties of Medicine and Law, Health Law Institute, Dalhousie University, Halifax, NS.
• 2Research Associate, Faculty of Medicine, Novel Tech Ethics, Dalhousie University, Halifax, NS.

Abstract

We examined whether access to US-approved orphan drugs in Canada has changed between 1997 (when Canada chose not to adopt an orphan drug policy) and 2012 (when Canada reversed its policy decision). Specifically, we looked at two dimensions of access to US-approved orphan drugs in Canada: (1) regulatory access; and (2) temporal access. Whereas only 63% of US-approved orphan drugs were granted regulatory approval in 1997, we found that regulatory access to US-approved orphan drugs in Canada increased to 74% between 1997 and 2012. However, temporal access to orphan drugs is slower in Canada: in a head-on comparison of 40 matched drugs, only two were submitted and four were approved first in Canada; moreover, the mean review time in Canada (423 days) was longer than that in the US (mean = 341 days), a statistically significant difference (t[39] = 2.04, p = 0.048). These results raise questions about what motivated Canada's apparent shift in orphan drug policy.

From U Tasmania: Kindness in Australia: an empirical critique of moral decline sociology

Br J Sociol. 2016 May 27. doi: 10.1111/1468-4446.12194. [Epub ahead of print]

Kindness in Australia: an empirical critique of moral decline sociology.

Habibis D1, Hookway N1, Vreugdenhil A1.

Author information

• 1School of Social Sciences, University of Tasmania.

Abstract

A new sociological agenda is emerging that interrogates how morality can be established in the absence of the moral certainties of the past but there is a shortage of empirical work on this topic. This article establishes a theoretical framework for the empirical analysis of everyday morality drawing on the work of theorists including Ahmed, Bauman and Taylor. It uses the Australian Survey of Social Attitudes to assess the state and shape of contemporary moralities by asking how kind are Australians, how is its expression socially distributed, and what are the motivations for kindness. The findings demonstrate that Australians exhibit a strong attachment and commitment to kindness as a moral value that is primarily motivated by interiorized sources of moral authority. We argue these findings support the work of theorists such as Ahmed and Taylor who argue authenticity and embodied emotion are legitimate sources of morality in today's secular societies. The research also provides new evidence that generational changes are shaping understandings and practices of kindness in unexpected ways.

Arch Pathol Lab Med. 2016 May 19. [Epub ahead of print]

Liquid Biopsy in Lung Cancer: A Perspective From Members of the Pulmonary Pathology Society.

Sholl LM1, Aisner DL1, Allen TC1, Beasley MB1, Cagle PT1, Capelozzi VL1, Dacic S1, Hariri LP1, Kerr KM1, Lantuejoul S1, Mino-Kenudson M1, Raparia K1,Rekhtman N1, Roy-Chowdhuri S1, Thunnissen E1, Tsao M1, Vivero M1, Yatabe Y1.

Author information

• 1From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (Drs Sholl and Vivero); the Department of Pathology, University of Colorado Cancer Center, Denver (Dr Aisner); the Department of Pathology, The University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York (Dr Beasley); the Department of Pathology, Weill Cornell Medical College, New York, New York, and the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Cagle); the Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil (Dr Capelozzi); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston (Drs Hariri and Mino-Kenudson); the Department of Pathology, Aberdeen University Medical School and Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, United Kingdom (Dr Kerr); the Department of Biopathology, Centre Léon Bérard, Lyon, France, and J Fourier University-INSERM U 823-Institut A Bonniot, Grenoble, France (Dr Lantuejoul); the Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois (Dr Raparia); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology, VU Medical Center, Amsterdam, the Netherlands (Dr Thunnissen); the Department of Pathology, University Health Network/Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada (Dr Tsao); and the Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan (Dr Yatabe).

Abstract

Liquid biopsy has received extensive media coverage and has been called the holy grail of cancer detection. Attempts at circulating tumor cell and genetic material capture have been progressing for several years, and recent financially and technically feasible improvements of cell capture devices, plasma isolation techniques, and highly sensitive polymerase chain reaction- and sequencing-based methods have advanced the possibility of liquid biopsy of solid tumors. Although practical use of circulating RNA-based testing has been hindered by the need to fractionate blood to enrich for RNAs, the detection of circulating tumor cells has profited from advances in cell capture technology. In fact, the US Food and Drug Administration has approved one circulating tumor cell selection platform, the CellSearch System. Although the use of liquid biopsy in a patient population with a genomically defined solid tumor may potentially be clinically useful, it currently does not supersede conventional pretreatment tissue diagnosis of lung cancer. Liquid biopsy has not been validated for lung cancer diagnosis, and its lower sensitivity could lead to significant diagnostic delay if liquid biopsy were to be used in lieu of tissue biopsy. Ultimately, notwithstanding the enthusiasm encompassing liquid biopsy, its clinical utility remains unproven.

Postgrad Med J. 2016 May 23. pii: postgradmedj-2016-134131. doi: 10.1136/postgradmedj-2016-134131. [Epub ahead of print]

Running on empty: a review of nutrition and physicians' well-being.

Hamidi MS1, Boggild MK2, Cheung AM2.

Author information

• 1University Health Network, Toronto, Ontario, Canada.
• 2University Health Network, Toronto, Ontario, Canada Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

Abstract

Resident and physician burnout is a complex issue. Adequate nutrition and hydration play important roles in the maintenance of health and well-being of all individuals. Given the high prevalence of burnout in physicians, we believe that in addition to issues related to heavy workload, structure and length of shifts, the current status of physicians' nutrition and hydration and their effects on their work performance and well-being should also be addressed. In this review, we summarise the current evidence on the potential effects of nutrition and hydration on physicians' occupational well-being and performance, identify gaps and discuss opportunities to address nutrition as one of the important means of improving physicians' well-being.

"...per capita cheese consumption in the United States is 64 percent higher than it was in 1975..."

Got cheese? America's Great Cheese Glut of 2016

"What is to be done? We could try to eat through the problem. You laugh, but the current level of per capita cheese consumption in the United States is 64 percent higher than it was in 1975, due partly to a richer society's growing taste for richer foods. In the short run, consumption might go up a bit, since the glut is making cheese cheaper.

What's more, the U.S. government has a long-standing pro-cheese-eating policy, which grew out of the need to do something with the subsidized excess of milk products generated by federal pro- production dairy policy - which, in turn, has persisted for decades despite declining consumer interest in drinking milk."

"...there is a fundamental tension in the missions of the prison and doctor."

Int J Prison Health. 2016 Jun 13;12(2):73-7. doi: 10.1108/IJPH-03-2016-0007.

When security and medicine missions conflict: confidentiality in prison settings.

Allen SA1, Aburabi R2.

Author information

• 1School of Medicine, University of California Riverside, Riverside, California, USA.
• 2International Committee of the Red Cross, Geneva, Switzerland.

Abstract

Purpose - It is a simple fact that prisons cannot exist - practically, legally, ethically or morally - without the support of physicians and other health professionals. Access to adequate healthcare is one of the fundamental measures of the legitimacy of a jail or prison. At the same time, there is a fundamental tension in the missions of the prison and doctor. The primary mission of the prison is security and often punishment. Reform and rehabilitation have intermittently been stated goals of prisons in the last century, but in practice those humane goals have rarely governed prison administrative culture. The primary mission of the physician is to promote the health and welfare of his or her patient. The paper aims to discuss these issues. 

Design/methodology/approach - At times, what is required to serve the patient's best interest is at odds with the interests of security. Much of the work of the prison physician does not conflict with the operation of security. Indeed, much of the work of the prison physician is allowed to proceed without much interference from the security regime. But given the fundamental discord in the legitimate missions of security vs medicine, conflict between the doctor and the warden is inevitable. 

Findings - In this paper, the authors consider the example of patient confidentiality to illustrate this conflict, using case examples inspired by real cases from the experience of the authors. 

Originality/value - The authors provide an ethical and practical framework for health professionals to employ when confronting these inevitable conflicts in correctional settings.

Soc Sci Res. 2016 Jul;58:34-45. doi: 10.1016/j.ssresearch.2016.02.008. Epub 2016 Mar 2.

Moral opinion polarization and the erosion of trust.

Rapp C1.

Author information

• 1University of Bern, Institute of Political Science, Fabrikstrasse 8, CH-3012 Bern, Switzerland. Electronic address: carolin.rapp@ipw.unibe.ch.

Abstract

Since Puntam's seminal work on declining levels of social capital, the question of how social trust is formed has reached unprecedented heights of critical enquiry. While most of the current research concentrates on ethnic diversity and income inequality as the main influences driving down generalized trust, we focus on opinion polarization as another potential impact factor on trust. In more detail, we investigate the extent to which polarization over morally charged issues such as homsexuality, abortion and euthanasia affects individuals' likelihood to trust others. We hypothesize that moral issues have a natural tendency to divide societies' opinions into opposing poles and, thus, to challenge social cohesion in modern civil societies. Based on hierarchical analyses of the fifth wave of the World Values Survey (WVS) - comprising a sample of 39 countries - our results reveal that individuals living in countries characterized by more opinion polarization tend to have less trust in other people.

Do The Major FDA Nutrition Label Changes Go Far Enough?

"...morals exist in human nature as part of our evolutionary heritage..."

Ann N Y Acad Sci. 2016 May 19. doi: 10.1111/nyas.13077. [Epub ahead of print]

Morality is real, objective, and natural.

Shermer M1.

Author information

• 1Skeptic Magazine, Altadena, California, and Chapman University, Orange, California.

Abstract

To make the case that morality is real, objective, and natural, it will be argued, first, that morals exist in human nature as part of our evolutionary heritage; that morality involves how we think and act toward other moral agents in terms of whether our thoughts and actions are right or wrong with regard to their survival and flourishing; and that moral progress is real, quantifiable, and the result of our improved understanding of causality in the social and moral sciences in the same manner as our understanding of causality has progressed in the physical and biological sciences. A moral starting point is the survival and flourishing of sentient beings.

Lung Cancer. 2016 Apr;94:7-14. doi: 10.1016/j.lungcan.2016.01.010. Epub 2016 Jan 21.

The role of new PET tracers for lung cancer.

Szyszko TA1, Yip C2, Szlosarek P3, Goh V4, Cook GJ5.

Author information

• 1King's College London and Guy's & St. Thomas' PET Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, London SE1 7EH, UK; Department of Cancer Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
• 2King's College London and Guy's & St. Thomas' PET Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, London SE1 7EH, UK; Department of Cancer Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK; Department of Radiation Oncology, National Cancer Centre Singapore 169610, Singapore.
• 3Lung and Mesothelioma Unit, Department of Medical Oncology, KGV Basement, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.
• 4Department of Cancer Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK; Radiology Department, Guys & St. Thomas' NHS Trust, London SE1 7EH, UK.
• 5King's College London and Guy's & St. Thomas' PET Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, London SE1 7EH, UK; Department of Cancer Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK. Electronic address: gary.cook@kcl.ac.uk.

Abstract

18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET/CT) is established for characterising indeterminate pulmonary nodules and staging lung cancer where there is curative intent. Whilst a sensitive technique, specificity for characterising lung cancer is limited. There is recognition that evaluation of other aspects of abnormal cancer biology in addition to glucose metabolism may be more helpful in characterising tumours and predicting response to novel targeted cancer therapeutics. Therefore, efforts have been made to develop and evaluate new radiopharmaceuticals in order to improve the sensitivity and specificity of PET imaging in lung cancer with regards to characterisation, treatment stratification and therapeutic monitoring. 18F-fluorothymidine (18F-FLT) is a marker of cellular proliferation. It shows a lower accumulation in tumours than 18F-FDG as it only accumulates in the cells that are in the S phase of growth and demonstrates a low sensitivity for nodal staging. Its main role is in evaluating treatment response. Methionine is an essential amino acid. 11C-methionine is more specific and sensitive than 18F-FDG in differentiating benign and malignant thoracic nodules. 18Ffluoromisonidazole (18F-FMISO) is used for imaging tumour hypoxia. Tumour response to treatment is significantly related to the level of tumour oxygenation. Angiogenesis is the process by which new blood vessels are formed in tumours and is involved in tumour growth and metastatic tumour spread and is a therapeutic target. Most clinical studies have focused on targeted integrin PET imaging of which αvβ3 integrin is the most extensively investigated. It is upregulated on activated endothelial cells in association with tumour angiogenesis. Neuroendocrine tumour tracers, particularly 68Ga-DOTA-peptides, have an established role in imaging of carcinoid tumours. Whilst most of these tracers have predominantly been used in the research environment, they offer exciting opportunities for improving staging, characterisation, stratification and response assessment in an era of increased personalised therapy in lung cancer.

Nat Rev Clin Oncol. 2016 Apr 13. doi: 10.1038/nrclinonc.2016.50. [Epub ahead of print]

Population-based screening for cancer: hope and hype.

Shieh Y1, Eklund M2, Sawaya GF3, Black WC4, Kramer BS5, Esserman LJ6.

Author information

• 1Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, 1545 Divisadero Street, San Francisco, California 94115, USA.
• 2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17177 Stockholm, Sweden.
• 3Departments of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco, 550 16th Street, San Francisco, California 94158, USA.
• 4Department of Radiology, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, New Hampshire 03756, USA.
• 5Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Bethesda, Maryland 20892, USA.
• 6Departments of Surgery and Radiology, University of California, San Francisco, 1600 Divisadero Street, Box 1710, San Francisco, California 94115, USA.

Abstract

Several important lessons have been learnt from our experiences in screening for various cancers. Screening programmes for cervical and colorectal cancers have had the greatest success, probably because these cancers are relatively homogenous, slow-growing, and have identifiable precursors that can be detected and removed; however, identifying the true obligate precursors of invasive disease remains a challenge. With regard to screening for breast cancer and for prostate cancer, which focus on early detection of invasive cancer, preferential detection of slower-growing, localized cancers has occurred, which has led to concerns about overdiagnosis and overtreatment; programmes for early detection of invasive lung cancers are emerging, and have faced similar challenges. A crucial consideration in screening for breast, prostate, and lung cancers is their remarkable phenotypic heterogeneity, ranging from indolent to highly aggressive. Efforts have been made to address the limitations of cancer-screening programmes, providing an opportunity for cross-disciplinary learning and further advancement of the science. Current innovations are aimed at identifying the individuals who are most likely to benefit from screening, increasing the yield of consequential cancers on screening and biopsy, and using molecular tests to improve our understanding of disease biology and to tailor treatment. We discuss each of these concepts and outline a dynamic framework for continuous improvements in the field of cancer screening.