Tag Archives: cancer

Racial Disparities in Sentinel Lymph Node Biopsy in Women with Breast Cancer

Sentinel nodeMain Points:

The use of sentinel lymph node biopsy (SLNB) to stage early breast cancer increased in both black and white women from 2002 to 2007, but the rates remained lower in black than white patients, a disparity that contributed to disparities in the risk for lymphedema (arm swelling common after breast cancer treatment because of damage to the lymphatic system).

Published in:

JAMA Surgery


Dalliah M. Black, M.D., of the University of Texas MD Anderson Cancer Center, Houston, Texas.


SLNB was developed to replace axillary (arm pit) lymph node dissection (ALND) for staging early breast cancer to minimize complications. SLNB can often provide patients with a much more limited surgery. Racial disparities exist in many aspects of breast cancer care but their existence in the use of SLNB had been uncharacterized. Continue reading

Use of Tumor Necrosis Factor Inhibitors for Treatment of Inflammatory Bowel Disease Not Associated With Increased Risk of Cancer

Tumor necrosis factor α (Source: Wikipedia)

Main Points:

In a study that included more than 56,000 patients with inflammatory bowel disease, use of a popular class of medications known as tumor necrosis factor alpha antagonists was not associated with an increased risk of cancer over a median follow-up of 3.7 years, although an increased risk of malignancy in the long term, or with increasing number of doses, cannot be excluded, according to a study in the June 18 issue of JAMA.

Published in:


Study Further:

Tumor necrosis factor α (TNF-α) antagonists are drugs that have been shown to be beneficial in reducing the inflammation in inflammatory diseases such as rheumatoid arthritis, and inflammatory bowel disease (IBD) (Crohn disease and ulcerative colitis). The therapeutic benefits of TNF-α antagonists must be weighed against the potential for adverse effects, including a possible increased risk of cancer. “Therefore, long-term observational studies of consequences of treatment with TNF-α antagonists are needed,” the authors write.

Nynne Nyboe Andersen, M.D., of the Statens Serum Institut, Copenhagen, and colleagues studied cancer rates in patients with IBD exposed to TNF-α antagonists, as compared with patients with IBD not exposed to these drugs. The study included 56,146 patients (15 years or older) with IBD identified in the National Patient Registry of Denmark (1999-2012), of whom 4,553 (8.1 percent) were treated with TNF-α antagonists. Cancer cases were identified in the Danish Cancer Registry.

In total, 3,465 patients with IBD unexposed to TNF-α antagonists (6.7 percent) and 81 exposed to TNF-α antagonists (1.8 percent; median follow-up, 3.7 years) developed cancer. The study results indicated that exposure to TNF-α antagonists was not associated with an increased overall cancer risk. In addition, no site-specific cancers were observed in significant excess. Continue reading

Liver cancer screening may not increase survival in chronic hepatitis C

Liver cancer screening may not increase survival in chronic hepatitis C (Credit: Flickr/Chandra Marsono)

Liver cancer screening may not increase survival in chronic hepatitis C (Credit: Flickr/Chandra Marsono)

Main Point:

Screening for liver cancer may not lead to greater survival among patients infected with chronic hepatitis C virus, according to an evidence review.

Published in:

Annals of Internal Medicine

Study Further:

Current guidelines recommend screening high-risk individuals for liver cancer, but the strength of evidence supporting these guidelines is unclear.

Researchers for the Veterans Health Administration conducted a systematic review of published literature to determine the benefits and harms of routine screening for liver cancer in patients with chronic hepatitis C virus (HCV). Twenty-two studies were included in the review. While screening could identify patients with earlier-stage disease who could benefit from treatment, the researchers found very-low-strength evidence about the effects of liver cancer screening on mortality.

Studies show that liver cancer has variable rates of progression and some patients may never experience symptoms. Diagnosing and treating patients for liver cancer that would never progress is an example of overtreatment. The researchers found no evidence examining rates of overdiagnosis in liver cancer screening. These findings neither support nor refute current clinical guidelines. Continue reading

Intervention Increased Adherence to Fecal Occult Blood Testing for Colorectal Cancer Screening

Blood test (Credit: Flickr)Main Point:

A multipart intervention increased adherence rates of annual fecal occult blood testing (FOBT) for colorectal cancer (CRC) screening in vulnerable populations.

Published in:

JAMA Internal Medicine


David W. Baker, M.D., M.P.H., of the Feinberg School of Medicine at Northwestern University, Chicago, and colleagues.


The vast majority of CRC screening in the U.S. is by colonoscopy, although studies suggest that FOBT can achieve similar reductions in CRC mortality.  Colorectal cancer screening rates are lower among Latinos and people living in poverty.  Expanded use of FOBT testing my help reduce disparities in CRC screening that persist because of income, education, race/ethnicity, language, and insurance coverage.

How the Study Was Conducted:

The authors examined the effectiveness of a multipart intervention that involved mailing a FOBT kit to patients’ homes and following up with automated telephone and text reminders. If the FOBT was not completed in three months, patients received a personal call. The study included 450 patients who had previously completed a home FOBT and had a negative result: 72 percent of the participants were women, 87 percent were Latino, 83 percent used Spanish as their preferred language and 77 percent were uninsured. Patients were divided into two groups: 225 patients to usual care (including computerized reminders and standing orders for medical assistants to give patients home FOBT tests) and 225 patients to the intervention.


Intervention patients were more likely (82.2 percent vs. 37.3 percent) than patients who received usual care to complete FOBT. Of the 185 patients who completed screening, 10.2 percent completed prior to their due date (intervention was not given), 39.6 percent within two weeks (after initial intervention), 24 percent within two to 13 weeks (after automated call/text reminder) and 8.4 percent between 13 and 26 weeks (after receiving a personal call).  The estimated cost of the intervention was $34.59 per patient.  Only 59 percent of patients with a positive FOBT completed a diagnostic colonoscopy.


“Despite the success of this intervention at increasing adherence to annual FOBT, the hope that this strategy might be used in the future to reduce disparities in CRC mortality must be tempered by the fact that only 17 of 29 patients with a positive FOBT result completed diagnostic colonoscopy (59 percent),” which was offered to patients for free along with access to transportation.


David W. Baker MD, MPH, Tiffany Brown MPH, David R. Buchanan MD, MS, Jordan Weil BA, Kate Balsley MPH, Lauren Ranalli MPH, Ji Young Lee MS, Kenzie A. Cameron PhD, MPH, M. Rosario Ferreira MD, Quinn Stephens BA, Shira N. Goldman MPH, Alred Rademaker PhD, Michael S. Wolf PhD. Comparative Effectiveness of a Multifaceted Intervention to Improve Adherence to Annual Colorectal Cancer Screening in Community Health Centers: A Randomized Clinical Trial. JAMA Intern Med. 2014; 174(8):-. doi:10.1001/jamainternmed.2014.2352

Editor’s Note:

This research project is funded by a grant from the Agency for Healthcare Research and Quality. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Commentary: Benefits to Increase Colorectal Cancer Screening in Priority Populations

In a related commentary, Beverly B. Green, M.D., M.P.H., of the Group Health Research Institute, Seattle, and Gloria D. Coronado, Ph.D., of Kaiser Permanente Center for Health Research Northwest, Portland, write: “Follow-up colonoscopy is crucial, since the chance of CRC is as high as 4 percent in individuals with a positive FOBT result, and almost one-third have advanced precancerous adenomas.”

“Lack of a follow-up colonoscopy defeats the purpose of a FOBT screening program,” they continue.

“Baker et al do not describe the reasons for low rates of follow-up diagnostic colonoscopy, but for many people in the United States, the barriers to this procedure are substantial and include limited availability and cost,” they write.


Beverly B. Green MD, MPH, Gloria D. Coronado PhD.“BeneFITs” to Increase Colorectal Cancer Screening in Priority Populations. JAMA Intern Med. 2014; 174(8):-. doi:10.1001/jamainternmed.2014.730

Editor’s Note:

Work on this article was supported in part by a National Institutes of Health Common Fund award for the NIH Health Care Systems Research Collaboratory and awards from the National Cancer Institute. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Media Advisory:

To contact author David W. Baker, M.D., M.P.H., call Marla Paul at 312-503-8928 or email marla-paul@northwestern.edu or call Erin White at 847-491-4888 or email ewhite@northwestern.edu. To contact commentary author Beverly B. Green, M.D., M.P.H., call Rebecca Hughes at 206-287-2055 or email hughes.r@ghc.org.