Posts Tagged ‘gynaecology’

Recommendations for prostate cancer active surveillance

With active surveillance, patients undergo regular visits with prostate-specific antigen (PSA) tests and repeated prostate biopsies rather than aggressive treatment. It is distinguished from watchful waiting, in which treatment for localized disease is withheld and palliative treatment for systemic disease is initiated.

“Active surveillance is an important management option for men with low-risk prostate cancer,” says lead author Mahul Amin, MD, FCAP, Chair, Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA. “Vital to this process is the critical role pathologic parameters play in identifying appropriate candidates for active surveillance.”

Dr. Amin spearheaded the team that highlighted the pathologic parameters key for the successful identification of patients likely to succeed with active surveillance. The key parameters, at a general level, address: •Sampling, submission, and processing issues in needle biopsies used to diagnose prostate cancer •Tumor extent in needle biopsies •Biopsy reporting for all and special cases •Gleason scores, the system for grading prostate cancer tissue based on how it looks under a microscope •Precision medicine markers •Other pathologic considerations

The team further concluded that the key parameters to be reported by the surgical pathologists: 1) need to be reproducible and consistently reported and 2) highlight the importance of accurate pathology reporting.

Recommendations from the United States Preventive Services Task Force, an independent group of national experts in prevention and evidence-based medicine, and randomized trials have drawn attention to overtreatment of localized, low-risk prostate cancer. PSA screening and changing consensus on PSA testing practices are among the many factors that contribute to prostate cancer’s overdiagnosis and overtreatment.

The pathology recommendations are included in the Archives article: The Critical Role of the Pathologist in Determining Eligibility for Active Surveillance as a Management Option in Patients with Prostate Cancer: Consensus Statement with Recommendations Supported by the College of American Pathologists, International Society Of Urological Pathology, Association of Directors of Anatomic and Surgical Pathology, the New Zealand Society of Pathologists, and the Prostate Cancer Foundation.

source : http://www.sciencedaily.com/releases/2014/08/140826100651.htm

Cervical cancer screenings overused in some groups of women

“Almost two-thirds (64.5%) of women who have had hysterectomies reported having recent Pap tests,” said Deanna Kepka, PhD, MPH, co-author of the study, a Huntsman Cancer Institute (HCI) investigator, and assistant professor in the College of Nursing at the University of Utah. “And half (50.4%) of women over 65 who have no cervical cancer history also reported a recent Pap test. This represents 14 million women in the United States receiving an unnecessary procedure.”

Because the risk of developing this slow-growing cancer is very small at such a late stage in life, Pap tests do not benefit women over age 65 who have no history of cervical cancer or pre-cancerous conditions. In addition, women who have had hysterectomies do not benefit from the test because nearly all of them no longer have a cervix, the specific target of this cancer screening test.

Since 2003, the U.S. Preventive Services Task Force (USPSTF) has recommended that Pap tests are unnecessary for these two groups of women. The USPSTF is an independent panel of experts in prevention and evidence-based medicine composed of primary care providers (such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists).

The researchers examined data from the 2010 National Health Interview Survey, an annual health survey of representative samples of the entire United States population since 1957. The 2010 survey included the most recent cancer control supplement, which is included every three to five years.

“We knew there would be overuse of Pap tests, because the few studies of cervical cancer screening showed overuse ten years ago,” said Kepka. “But we were shocked to see so little change over the past ten years.

“We’re hoping to see better use of the tests over the next decade as changes in the health care infrastructure take place,” she added. “Electronic medical records, health care provider reminder systems, decision support, and new strategies to improve the quality of care may promote guideline-consistent practices among clinicians.”

Kepka’s future work in this area includes a closer look at the demographics of women likely to receive unnecessary Pap tests, and an examination of how this information applies to Utah women.

source : http://www.sciencedaily.com/releases/2013/11/131125164212.htm