(Press-News.org) Contact information: John N. Primrose
j.n.primrose@soton.ac.uk
The JAMA Network Journals
Follow-up tests improve colorectal cancer recurrence detection
Among patients who had undergone curative surgery for primary colorectal cancer, the screening methods of computed tomography and carcinoembryonic antigen each provided an improved rate of surgical treatment of cancer recurrence compared with minimal follow-up, although there was no advantage in combining these tests, according to a study in the January 15 issue of JAMA.
Colorectal cancer is the third most common cancer worldwide, with 1.24 million cases reported to the International Agency for Research on Cancer in 2008. Traditionally, patients who have had curative surgery for colorectal cancer undergo regular follow-up for at least 5 years to detect recurrence, a common practice based on limited evidence, according to background information in the article.
John N. Primrose, M.D., F.R.C.S., of the University of Southampton, England, and colleagues assessed detection of recurrence using two common screening methods: measurement of blood carcinoembryonic antigen (CEA; a glycoprotein used as a tumor marker), and computed tomography (CT). They randomized 1,202 patients from 39 hospitals in England to 1 of 4 groups: CEA only (n = 300), CT only (n = 299), CEA+CT (n = 302), or minimum follow-up (n = 301).
Cancer recurrence was detected in 199 participants (16.6 percent) during the period of observation for recurrence (average 4.4 years), and 5.9 percent of participants with recurrence underwent surgery for cure (recurrence detected early enough via follow-up test that surgery can still be performed for cure). The researchers found that surgical treatment of recurrence with curative intent was higher in each of the 3 more intensive follow-up groups compared with the minimum follow-up group. Compared with minimum follow-up, the absolute difference in the number treated with curative intent in the CEA group was 4.4 percent, 5.7 percent in the CT group, and 4.3 percent in the CEA+CT group.
The number of deaths was nonsignificantly higher in the more intensive follow-up groups compared with the minimum follow-up group, as was the number of disease-specific colorectal cancer deaths. "More than two-thirds of the patients treated surgically with curative intent were still alive at a median [midpoint] follow-up of just over 4 years postrecurrence, suggesting that 5-year survival may be more than the 40 percent previously reported," the authors write. They note that if there is a survival advantage to any strategy, it is likely to be small, but either test is better than no follow-up testing.
"The benefits of follow-up appear to be independent of diagnostic stage (because although there are fewer recurrences with better-stage tumors, they are more likely to be curable), suggesting that stage-specific follow-up strategies may not be necessary. However, thorough staging investigation at the end of primary treatment to detect residual disease is still important because a large number of 'recurrences' reported in routine series are probably residual disease that should be detected and treated before embarking on follow-up."
###
(doi:10.1001/jama.2013.285718; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: The project was funded by the UK National Institute for Health Research Health Technology Assessment program. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr. Rose reports board membership with GP Update Ltd. No other disclosures were reported.
Follow-up tests improve colorectal cancer recurrence detection
2014-01-15
ELSE PRESS RELEASES FROM THIS DATE:
Patients with mild hyperglycemia and genetic mutation have low prevalence of vascular complications
2014-01-15
Patients with mild hyperglycemia and genetic mutation have low prevalence of vascular complications
Despite having mild hyperglycemia for approximately 50 years, patients with a mutation in the gene encoding the enzyme glucokinase had a low prevalence of clinically ...
Natural selection can favor 'irrational' behavior
2014-01-15
Natural selection can favor 'irrational' behavior
It seems paradoxical that a preference for which of two houses to buy could depend on another, inferior, house – but researchers at the University of Bristol have identified that seemingly irrelevant ...
Risk of transient breathing difficulties in newborns of mothers on antidepressants
2014-01-15
Risk of transient breathing difficulties in newborns of mothers on antidepressants
Risk is still low, but women should be counselled about the condition
Infants of expectant mothers who take antidepressant drugs, known as selective serotonin reuptake ...
Researchers suggest risk of cervical or vaginal cancer higher in women previously treated for pre-cancerous cells on cervix
2014-01-15
Researchers suggest risk of cervical or vaginal cancer higher in women previously treated for pre-cancerous cells on cervix
But researchers say that the overall risk is still low
Women previously treated for abnormal cells on the cervix (CIN3 or cervical ...
Study indicates the potential of new tests in long-term diabetes complications
2014-01-15
Study indicates the potential of new tests in long-term diabetes complications
Monitoring glucose levels is imperative for diabetes patients, but for some the standard Hemoglobin A1c (HbA1c) test is not valid. Researchers from Johns ...
Vanderbilt study reveals senses of sight and sound separated in children with autism
2014-01-15
Vanderbilt study reveals senses of sight and sound separated in children with autism
Like watching a foreign movie that was badly dubbed, children with autism spectrum disorders (ASD) have trouble integrating simultaneous information from their ...
Screening helps prevent cervical cancer in older women
2014-01-15
Screening helps prevent cervical cancer in older women
New research from Queen Mary University of London reveals women over the age of 50 who don't attend cervical screening are four times more likely to be diagnosed with cervical cancer in later ...
World's tiniest drug cabinets could be attached to cancerous cells for long term treatment
2014-01-15
World's tiniest drug cabinets could be attached to cancerous cells for long term treatment
Novel method for slow release drugs
As if being sick weren't bad enough, there's also the fear of frequent injections, side effects and overdosing on you medication. Now a team of ...
Microbes swap for tiny goods in minuscule markets, researchers find
2014-01-15
Microbes swap for tiny goods in minuscule markets, researchers find
A closer look at microbes reveals there is big business going on in their very small world, and sometimes we are part of the transaction.
An international team of researchers, including ...
NASA sees Tropical Cyclone Colin coming 'unwound'
2014-01-15
NASA sees Tropical Cyclone Colin coming 'unwound'
Tropical Cyclone Colin is not as tightly wrapped as it was a day ago. Satellite imagery from NASA's Aqua and TRMM satellites show Colin is not as organized as it was, and most of the strongest precipitation was occurring ...