- Email: [email protected]
HPV Elimination of Cervical Cancer: The Novel Options in Vaccination and Screening
Annals of Oncology 23 (Supplement 9): ix53, 2012 doi:10.1093/annonc/mds387
86IN
HPV ELIMINATION OF CERVICAL CANCER: THE NOVEL OPTIONS IN VACCINATION AND SCREENING
J. Cuzick Centre for Cancer Prevention, Queen Mary University of London, London, UNITED KINGDOM
87IN
PROSTATE CANCER: WHAT ARE THE PROSPECTS AND GUIDELINES FOR SCREENING AND PREVENTION?
H. De Koning Public Health, Erasmus MC, Rotterdam, NETHERLANDS The European Randomized Study of Screening for Prostate Cancer (ERSPC) showed a significant prostate cancer mortality reduction in the screening group of 21% after a median follow-up of 11 years, and of 29% in screened men when adjusted for selection bias. However, PSA screening is associated with considerable unfavorable effects. In the ERSPC screening group, cumulative incidence of prostate cancer was 7.4%, versus 5.1% in the control group. A proportion of the screen-detected tumors (10-56%) would never have led to clinical symptoms but these over-diagnosed cancers are frequently treated with associated risks of adverse effects. Furthermore, because of a long lead-time, estimated 5-12 years, men have to live longer with those effects. Two specific studies on quality of life after prostate cancer treatment have been performed for men participating in Rotterdam and Sweden. Pre-operatively 1-2% of the men were incontinent and 31-40% impotent. After 18-52 months 6-16% of the radical prostatectomy patients and 3% of the radiation therapy patients were incontinent. Six to 52 months after radical prostatectomy, 83-88% of pre-operatively potent men became impotent, compared with 42-66% of the men receiving radiation therapy. In this lecture the effects of screening strategies on prostate cancer mortality and quality of life will be quantified, using the well-validated MISCAN-model, developed by our institute, and hereby using results from the ERSPC. The implications of our results are that the benefit of PSA screening is diminished by loss of QALYs, that is dependent primarily on post-diagnosis long-term utility assumptions. Longer follow-up data from both the ERSPC and quality of life and cost-effectiveness analyses are essential for making universal recommendations regarding screening, but it is possible that limited testing of middle-aged men with relatively long intervals is a cost-effective public health policy. Disclosure: The author has declared no conflicts of interest.
SCREENING FOR COLORECTAL CANCER: EUROPEAN GUIDELINES
N. Segnan1, J. Patnick2, L. von Karsa3 1 Head, Department of Cancer Screening and Unit of Cancer Epidemiology, CPO Piemonte and S.Giovanni University Hospital, Turin, ITALY, 2Nhs Breast Screening Programme, Oxford University, Sheffield, UNITED KINGDOM, 3Quality Assurance Group, International Agency for Research on Cancer, Lyon Cedex, FRANCE Screening for colorectal cancer: European guidelines for quality assurance According to the most recent estimates by the International Agency for Research on Cancer (IARC) colorectal cancer (CRC) is the most common cancer in Europe and it is one of the most causes of cancer death in Europe. Worldwide CRC ranks third in incidence and fourth in mortality with an estimated 1.2 million cases and 0.6 million deaths annually. In the 27 Member States of the European Union (EU), CRC ranks first in incidence and second in mortality in both sexes, with approximately 334 000 new cases and 149 000 deaths estimated for men and women combined in 2008. Even in those Member States in the lower range of age-standardised rates of CRC, the burden of disease is significant compared to other regions of the world. CRC is therefore an important health problem across the EU. Screening is an important tool in cancer control in countries with a significant burden of CRC, provided the screening services are of high quality. The EU recommends population-based screening for breast, cervical and colorectal cancer using evidence-based tests with quality assurance of the entire screening process including diagnosis and management of patients with screen-detected lesions. In this context, multidisciplinary evidence-based guidelines for quality assurance in colorectal cancer screening and diagnosis have been developed by experts in a project coordinated by the IARC. The full guideline document covers the entire process of population-based screening. It consists of 10 chapters and over 250 recommendations, graded according to the strength of the recommendation and the supporting evidence. The 450-page guidelines and the extensive evidence base have been published by the European Commission. The content of the executive summary is presented here to promote international discussion and collaboration by making the principles and standards recommended in the new EU Guidelines known to a wider professional and scientific community. Following these recommendations has the potential to enhance the control of colorectal cancer through improvement in the quality and effectiveness of screening programmes and services. Disclosure: All authors have declared no conflicts of interest.
89IN
CANCER REGISTRIES IN SUPPORT OF PLANNING AND ASSESSING POPULATION BASED ONCOLOGY OUTCOMES
J.W. Coebergh Department of Public Health, Erasmus MC, Rotterdam AND Comprehensive Cancer South (IKZ) Eindhoven, NETHERLANDS The about 200 population-based cancer registries in Europe are currently in an upswing thanks to an ERA-net FP7 project named EUROCOURSE www.eurocourse. org that aims to strengthen their infrastructure in order to better serve the clinical oncology and public health communities and policymakers to solidify & improve prevention ( primary and through mass screening), cure (including quality of care) and care (both survivorship and palliative) in various ways: - clarifying widely diverging governance and budgets, despite uniform operational methodology and training needs of both data collectors and data analysts, which warrants valid, neutral, safe and integer data gathering and timely information ‘production’ on all aspects of incidence and prognosis of the cancers ‘that be’ both through on-line and peer-reviewed reporting and with a new European dataportal at IARC - promoting enrichment by linkages with other data sources, e.g. vital statistics and research, e.g. EPIC-study, and occupational, screening and clinical cohorts, with due attention to, traditionally very well kept, data protection (alas hampered by unwarranted obstacles in certain memberstates (a sequel from an unfortunate dictatorial past + incorrect interpretation of EU directive 95/46). - allowing registries to be sampling frame for in-depth studies of quality of care (adherence to guidelines/best practice?) both process and outcome carried out with more speed/urgency than usual because also needed in areas/parts of Europe without registry coverage, i.e. in or within more than 50% of the EU, especially in larger memberstates) not only of first line treatments due to increasing application of targeted drugs and survivorship in the various phases of the disease - allowing depth via strategic collaborations with clinical, etiological, screening databases (stakeholders), promoting the cost-effectiveness of a rich infrastructure serving many users (Nordic ‘model’) versus the current threat of fragmentation by tumourspecific clinical databases (at risk for becoming data cemetaries) With the tree as metaphor a landscape of registries is shown, remaining close to its clinical roots. Major European references Comment: Lancet Oncology 2005;6:193-5 Trends: Eur J Cancer 2008;44:1345-89 Recent data: Eur J Cancer 2010;46:765-81. Disclosure: The author has declared no conflicts of interest.
© European Society for Medical Oncology 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: [email protected].
Downloaded from http://annonc.oxfordjournals.org/ by guest on June 5, 2016
The recognition that infection with certain human papillomavirus (HPV) types is a necessary cause of cervical cancer has opened new fronts for the prevention of this disease. Primary prevention is now possible via immunization and secondary prevention has gained impetus with the availability of HPV DNA testing. Although universal vaccination of teenagers and young women is a desirable policy, even with high uptake a substantial reduction in the burden of cervical cancer is unlikely for at least 10–15 years. To achieve cost-effective reductions, screening and immunization must be considered as integrated approaches. Several novel options are possible. If the nonavalent vaccine proves to be effective, a screen and vaccine strategy in older women is attractive, and raises the possibility of virtually eliminating cervix cancer in 5-10 years. New approaches for triage following primary HPV-based screening are also being developed and promise to substantially reduce referrals for non-progressive infections. These include HPV typing, p16 and methylation of viral and human genes. Lastly, the use of self sampling is likely to increase in vaccinated women with less frequent HPV-based tests. New collection devices and transport media will be needed to facilitate this. Disclosure: J. Cuzick: Advisory boards for Abbott, Becton-Dickinson, Roche, GenProbe, Qiagen, Glaxo Smith Kline, Merck.
88IN
abstracts
evidence based answers to critical questions on cancer screening and prevention
86IN
HPV ELIMINATION OF CERVICAL CANCER: THE NOVEL OPTIONS IN VACCINATION AND SCREENING
J. Cuzick Centre for Cancer Prevention, Queen Mary University of London, London, UNITED KINGDOM
87IN
PROSTATE CANCER: WHAT ARE THE PROSPECTS AND GUIDELINES FOR SCREENING AND PREVENTION?
H. De Koning Public Health, Erasmus MC, Rotterdam, NETHERLANDS The European Randomized Study of Screening for Prostate Cancer (ERSPC) showed a significant prostate cancer mortality reduction in the screening group of 21% after a median follow-up of 11 years, and of 29% in screened men when adjusted for selection bias. However, PSA screening is associated with considerable unfavorable effects. In the ERSPC screening group, cumulative incidence of prostate cancer was 7.4%, versus 5.1% in the control group. A proportion of the screen-detected tumors (10-56%) would never have led to clinical symptoms but these over-diagnosed cancers are frequently treated with associated risks of adverse effects. Furthermore, because of a long lead-time, estimated 5-12 years, men have to live longer with those effects. Two specific studies on quality of life after prostate cancer treatment have been performed for men participating in Rotterdam and Sweden. Pre-operatively 1-2% of the men were incontinent and 31-40% impotent. After 18-52 months 6-16% of the radical prostatectomy patients and 3% of the radiation therapy patients were incontinent. Six to 52 months after radical prostatectomy, 83-88% of pre-operatively potent men became impotent, compared with 42-66% of the men receiving radiation therapy. In this lecture the effects of screening strategies on prostate cancer mortality and quality of life will be quantified, using the well-validated MISCAN-model, developed by our institute, and hereby using results from the ERSPC. The implications of our results are that the benefit of PSA screening is diminished by loss of QALYs, that is dependent primarily on post-diagnosis long-term utility assumptions. Longer follow-up data from both the ERSPC and quality of life and cost-effectiveness analyses are essential for making universal recommendations regarding screening, but it is possible that limited testing of middle-aged men with relatively long intervals is a cost-effective public health policy. Disclosure: The author has declared no conflicts of interest.
SCREENING FOR COLORECTAL CANCER: EUROPEAN GUIDELINES
N. Segnan1, J. Patnick2, L. von Karsa3 1 Head, Department of Cancer Screening and Unit of Cancer Epidemiology, CPO Piemonte and S.Giovanni University Hospital, Turin, ITALY, 2Nhs Breast Screening Programme, Oxford University, Sheffield, UNITED KINGDOM, 3Quality Assurance Group, International Agency for Research on Cancer, Lyon Cedex, FRANCE Screening for colorectal cancer: European guidelines for quality assurance According to the most recent estimates by the International Agency for Research on Cancer (IARC) colorectal cancer (CRC) is the most common cancer in Europe and it is one of the most causes of cancer death in Europe. Worldwide CRC ranks third in incidence and fourth in mortality with an estimated 1.2 million cases and 0.6 million deaths annually. In the 27 Member States of the European Union (EU), CRC ranks first in incidence and second in mortality in both sexes, with approximately 334 000 new cases and 149 000 deaths estimated for men and women combined in 2008. Even in those Member States in the lower range of age-standardised rates of CRC, the burden of disease is significant compared to other regions of the world. CRC is therefore an important health problem across the EU. Screening is an important tool in cancer control in countries with a significant burden of CRC, provided the screening services are of high quality. The EU recommends population-based screening for breast, cervical and colorectal cancer using evidence-based tests with quality assurance of the entire screening process including diagnosis and management of patients with screen-detected lesions. In this context, multidisciplinary evidence-based guidelines for quality assurance in colorectal cancer screening and diagnosis have been developed by experts in a project coordinated by the IARC. The full guideline document covers the entire process of population-based screening. It consists of 10 chapters and over 250 recommendations, graded according to the strength of the recommendation and the supporting evidence. The 450-page guidelines and the extensive evidence base have been published by the European Commission. The content of the executive summary is presented here to promote international discussion and collaboration by making the principles and standards recommended in the new EU Guidelines known to a wider professional and scientific community. Following these recommendations has the potential to enhance the control of colorectal cancer through improvement in the quality and effectiveness of screening programmes and services. Disclosure: All authors have declared no conflicts of interest.
89IN
CANCER REGISTRIES IN SUPPORT OF PLANNING AND ASSESSING POPULATION BASED ONCOLOGY OUTCOMES
J.W. Coebergh Department of Public Health, Erasmus MC, Rotterdam AND Comprehensive Cancer South (IKZ) Eindhoven, NETHERLANDS The about 200 population-based cancer registries in Europe are currently in an upswing thanks to an ERA-net FP7 project named EUROCOURSE www.eurocourse. org that aims to strengthen their infrastructure in order to better serve the clinical oncology and public health communities and policymakers to solidify & improve prevention ( primary and through mass screening), cure (including quality of care) and care (both survivorship and palliative) in various ways: - clarifying widely diverging governance and budgets, despite uniform operational methodology and training needs of both data collectors and data analysts, which warrants valid, neutral, safe and integer data gathering and timely information ‘production’ on all aspects of incidence and prognosis of the cancers ‘that be’ both through on-line and peer-reviewed reporting and with a new European dataportal at IARC - promoting enrichment by linkages with other data sources, e.g. vital statistics and research, e.g. EPIC-study, and occupational, screening and clinical cohorts, with due attention to, traditionally very well kept, data protection (alas hampered by unwarranted obstacles in certain memberstates (a sequel from an unfortunate dictatorial past + incorrect interpretation of EU directive 95/46). - allowing registries to be sampling frame for in-depth studies of quality of care (adherence to guidelines/best practice?) both process and outcome carried out with more speed/urgency than usual because also needed in areas/parts of Europe without registry coverage, i.e. in or within more than 50% of the EU, especially in larger memberstates) not only of first line treatments due to increasing application of targeted drugs and survivorship in the various phases of the disease - allowing depth via strategic collaborations with clinical, etiological, screening databases (stakeholders), promoting the cost-effectiveness of a rich infrastructure serving many users (Nordic ‘model’) versus the current threat of fragmentation by tumourspecific clinical databases (at risk for becoming data cemetaries) With the tree as metaphor a landscape of registries is shown, remaining close to its clinical roots. Major European references Comment: Lancet Oncology 2005;6:193-5 Trends: Eur J Cancer 2008;44:1345-89 Recent data: Eur J Cancer 2010;46:765-81. Disclosure: The author has declared no conflicts of interest.
© European Society for Medical Oncology 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: [email protected].
Downloaded from http://annonc.oxfordjournals.org/ by guest on June 5, 2016
The recognition that infection with certain human papillomavirus (HPV) types is a necessary cause of cervical cancer has opened new fronts for the prevention of this disease. Primary prevention is now possible via immunization and secondary prevention has gained impetus with the availability of HPV DNA testing. Although universal vaccination of teenagers and young women is a desirable policy, even with high uptake a substantial reduction in the burden of cervical cancer is unlikely for at least 10–15 years. To achieve cost-effective reductions, screening and immunization must be considered as integrated approaches. Several novel options are possible. If the nonavalent vaccine proves to be effective, a screen and vaccine strategy in older women is attractive, and raises the possibility of virtually eliminating cervix cancer in 5-10 years. New approaches for triage following primary HPV-based screening are also being developed and promise to substantially reduce referrals for non-progressive infections. These include HPV typing, p16 and methylation of viral and human genes. Lastly, the use of self sampling is likely to increase in vaccinated women with less frequent HPV-based tests. New collection devices and transport media will be needed to facilitate this. Disclosure: J. Cuzick: Advisory boards for Abbott, Becton-Dickinson, Roche, GenProbe, Qiagen, Glaxo Smith Kline, Merck.
88IN
abstracts
evidence based answers to critical questions on cancer screening and prevention