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Take a look at a selection of our recent media coverage:

Many cancer diagnoses made after emergency care visit

13th April 2022

A large number of cancer diagnoses are made after emergency care visits and which are associated with a higher 12-month mortality

A high proportion of cancer diagnoses occur through emergency care presentations and which are associated with a greater 12-month mortality compared to non-emergency care detected cancers. This was the main finding of a study by an international team of researchers.

There is some evidence to show that many patients with cancer are first diagnosed through an emergency presentation and which is associated with inferior clinical and patient-reported outcomes. Furthermore, one US study found that among patients with stage IV colon cancer, 34.6% presented as emergencies. The reasons for the high level of emergency care cancer diagnoses are complex and related to several different and interacting factors. For example, patients might experience no or only minimal symptoms prior to life-threatening complications requiring urgent medical or surgical attention. Secondly, patient-related factors e.g., knowledge, beliefs and attitudes, may also lead to ‘first presentation’ as an emergency diagnosis and thirdly, there could by any number of different and practical barriers that have prevented prior care.

For the present study, which formed part of the International Cancer Benchmarking Partnership, the researchers aimed to identify predictors and the consequences of cancer diagnoses made through an emergency presentation across 8 different cancer sites: stomach, colon, rectal, liver, pancreatic, lung and ovarian. For the purposes of the study, they defined an emergency presentation as one in which a cancer diagnosis was made within 30 days after an emergency hospital admission Countries for which data was collected included England, Norway, Denmark and several provinces such as Victoria (Australia) and Ontario (Canada).

Cancer diagnoses and emergency visits

A total of 857,068 patients with at least one of the 8 cancers mentioned above were included in the analysis. Across the different areas, the percentage of cancer diagnoses made through an emergency presentation ranged from 24% to 42.5%. The most commonly diagnosed cancer was pancreatic cancer, with an average of 46.1% but which ranged from 34.1% to 60.4%. The least commonly diagnosed cancer was rectal cancer, with an average of 12.1% and ranging from 9.1% to 19.8%.

Among factors associated with an emergency presentation cancer diagnosis were older age (85 years and older) and stomach and among stomach and colon cancer diagnoses, there was a J-shaped distribution by age, whereby patients aged 15 to 64, had the highest percentage of emergency presentation diagnoses.

The cancer stage adjusted odds ratios for 12-month mortality, compared with non-emergency presentations, were greater than 3.2 in all of the different areas studied, e.g. for Norway the odds ratio was 3.31 (95% CI 3.39 – 3.53).

Commenting on their findings, the authors suggested that the high level of emergency presentation diagnoses for pancreatic cancer probably reflected the low predictive value for symptoms such as abdominal or back pain. In contrast, rectal cancers were likely diagnosed less frequently due to the much clearer symptoms such as rectal bleeding.

The concluded that emergency presentations were frequent and associated with worse prognostic implications.

Citation
Mcphail S et al. Risk factors and prognostic implications of diagnosis of cancer within 30 days after an emergency hospital admission (emergency presentation): an International Cancer Benchmarking Partnership (ICBP) population-based study Lancet Oncol 2022

Breast cancer scans detected tumours in 40% of women with no risk factors

10th February 2022

Breast cancer scans in women with no recognised risk factors identified tumours in 40% of cases highlighting a need to scan all eligible women

Breast cancer scans for women with no recognisable risk factors for the disease has identified that around 40% of these women have a tumour, emphasising the need to continue scanning eligible women. This was the conclusion of a study by researchers from the Sydney School of Public Health, University of Sydney, Australia.

A 2015 systematic review of the benefits and harms of breast cancer screening concluded that for women of all ages and at average risk, screening was associated with a reduction in breast cancer mortality of approximately 20%. However, risk-stratification of breast cancer screening might improve the cost-effectiveness of the whole scanning process and at the same time, potentially reduce any associated risks. In fact, a 2018 study found that not offering breast cancer screening to women at lower risk could improve the cost-effectiveness of the screening programme, through reducing over diagnosis and at the same time, maintaining the benefits of screening. Nevertheless, little is known about the screening outcomes for women without any known breast cancer risk factors and who are therefore assumed to be at a lower risk.

For the present study, the Australian team examined the breast cancer scan outcomes for women deemed to be at the lower end of the risk spectrum. They undertook a retrospective analysis of clinical data routinely collected in the BreastScreen Western Australia (BSWA) program and included women aged 40 years and older. Although the program does stratify women in terms of their risk, i.e., those with > 2 affected first-degree relatives etc), women age 40 and over can volunteer to participate, despite not being in the target group. The researchers collected variables such as age, need for repeat scans together with information such as a previous history of breast or ovarian cancer, use of hormone replacement therapy etc. The scans were then categorised as having none of these factors verses at least one factor and age bands of 40 -49, 50 -59, 60 – 69 and > 70 years were created. The outcomes of interest were cancer detection rates at screening (CDR) per 10,000 screens and the interval cancer rates (ICR) per 10,000 women-years.

Breast cancer scans and detection of tumours

A total of 1,026,137 screens were performed including 323,082 in women aged > 40 years, who had a mean age of 58.5 years. Among the total scans, 44.7% of women had at least one risk factor although for 55.3% of screens, the women had none of the recorded risk factors.

In the screens without any risk factors, the CDR was 50 (95% CI 48 – 52) per 10,000 screens and the ICR was 7.9 (95% CI 7.4 – 8.4). Overall, in all of the scans in which cancer was detected, for 40.9% of cases, there were no recognised risk factors present.

The authors concluded that given how many of the scans identified cancers in women without risk factors, their finding did not justify less frequent screening of women without recognised risks.

Citation
Noguchi N et al. Evidence from a BreastScreen cohort does not support a longer inter-screen interval in women who have no conventional risk factors for breast cancer Breast 2022

Non-traditional cardiovascular risk factors higher in women

1st September 2021

Swiss researchers have found that non-traditional risk factors for cardiovascular disease appear to affect women more than men.

According to research presented at the European Stroke Organisation Conference (ESOC), non-traditional risk factors for cardiovascular disease, appear to be increasing more in women than men. Researchers from the University of Zurich, Switzerland, turned to data contained in the Swiss Health Survey. This was established in 1981/82 and designed to provide data from a representative sample on a number of health-related issues such as perceived health status, use of health services and demand for health care. Information is collected every 5 years and since 2010, the data formed part of the Swiss population census. 

Using data obtained in 2007, 2012 and 2017 on 22,000 men and women, the researchers identified an increase in the number of women who reported non-traditional risk factors for cardiovascular disease. This change appeared to coincide with an increase in the proportion of women who reported working full-time, which had increased from 38% in 2007 to 44% by 2017. The data showed that the number of individuals reporting stress at work had risen from 59% in 2012 to 66% in 2017. Furthermore, the proportion reporting non-traditional factors such as being tired and fatigued had also increased from 23% to 29%, but had risen to 33% among women compared to 26% in men, with a slightly higher level of severe sleep disorders in women (8%) compared to men (5%).

Fortunately, the study observed that the more traditional cardiovascular disease risk factors had stabilised over the study period, with 27% having hypertension, 18% a raised cholesterol level and 5% diabetes. Nevertheless, while obesity had increased to 11%, the level of smoking had reduced slightly from 10.5 to 9.5 cigarettes per day though both obesity and levels of smoking were higher in men.

According to the study authors, Dr Martin Hänsel and Dr Susanne Wegener, “our study found men were more likely to smoke and be obese than women, but females reported a bigger increase in the non-traditional risk factors for heart attacks and strokes, such as work stress, sleep disorders, and feeling tired and fatigued.”

Reference

10-year trends in cardiovascular risk factors in Switzerland: non-traditional risk factors are on the rise in women more than in men. Presented at the European Stroke Organisation Conference, September 2021