Comments on Current
Risk Assessment Research

Sharing Test Results with the Family

Dr. Angela Bradbury, Director of the Risk Assessment Program, comments on her recently published article from Cancer, January, 2012 titled “When parents disclose BRCA 1/2 test results: Their communication and perceptions of offspring response.” This research helps answer the question: If you had BRCA testing, would you share these results with your children?

“Many parents struggle with the decision of whether, and when to tell their minor children the results of their BRCA1/2 test. This research confirms that many parents do share their BRCA1/2 test results, and most parents do not feel their child has experienced distress as a result of this disclosure, although this varies by their test result and their child’s age. A better understanding of how minor children respond to the information could provide opportunities to promote adaptive psychosocial responses and encourage the adoption of preventive health behaviors in adolescence and throughout the life span.”

Last Revised: 03/2012

News on Melanoma

New Diagnostic Tool for Melanoma
Diagnosing melanoma in its early stages can be difficult, often
leading to needless biopsies. Currently, standard practice is
to visually inspect the skin and determine if suspicious lesions
warrant a biopsy. In an effort to improve this process, MELA
Sciences, Inc. has developed a handheld device that takes an
image of a concerning lesion and compares it to a database
of cancerous and non-cancerous lesions. When studied, the
device identified 112 of 114 melanomas. The FDA has begun
review of the device and in November 2010, an advisory panel
voted in favor of the use of the device. A full review is now
pending. Fox Chase is also studying early detection methods by
focusing on automated systems that can detect subtle changes
in moles over time in the hopes that this will lead to even
earlier detection of melanomas.

Updated Prostate Cancer Screening Guidelines

“The American Cancer Society prostate cancer screening guidelines were revised in two ways.  One is that the guidelines place more emphasis on patients being involved in the decision-making process about whether to go forward with screening for prostate cancer or not.  The second emphasis is on making the screening strategy more flexible by having the digital rectal examination be optional and stretching the interval between PSA tests to longer than yearly for low-risk men.  These revisions are based upon findings from large randomized trials that found little to no benefit to annual PSA screening in average-risk men.  The point of controversy is whether men may undergo unnecessary tests, procedures, and treatment with potential for sexual and urinary side-effects if found to have low-grade prostate cancer that would not lead to death.  However, it is also known that men at high-risk for prostate cancer may develop the disease at a young age and may develop aggressive disease which can lead to death.  Therefore, the challenge is to identify which men will develop lethal prostate cancer and have those men undergo screening while preventing unnecessary tests in low or average-risk men.  The Prostate Cancer Risk Assessment Service of the Risk Assessment Program at Fox Chase Cancer Center is focused on providing men with a balanced discussion regarding screening and cancer risk counseling as well as performing vital research to move closer to more accurate prediction for aggressive prostate cancer in order to personalize prostate cancer early detection."
— Dr. Veda Giri, Director, Prostate Cancer Risk

Lung Cancer News

Dr Borghaei, Director of Lung Cancer risk assessment, reports that lung cancer screening is back in the news.
One of the major issues that we deal with in lung cancer is the fact that the disease is difficult to detect in an early stage. Lung cancers that are detected at an early stage are considered to be curable with standard surgery although some patients might require additional treatment such as chemotherapy after surgery. Currently, there are no universally accepted tests for lung cancer screening. Computed tomography scans (CT scans), highly sensitive and relatively easy, are used commonly in the diagnosis, initial staging and follow up of patients with either a history of lung cancer or abnormal findings on routine chest x-rays.

A recent study conducted by the National Cancer Institute (NCI) and the American College of Radiology suggests that the use of low dose CT scans (low radiation dose) in people who are considered to be at high risk of developing lung cancer as a result of their smoking history, can lead to an improvement in the overall survival of the screened group by detecting early-stage lung cancers. Overall more than 53,000 people between the ages of 55 and 74 were enrolled in this particular trial. Half of them received screening with low-dose CT scans and the other half with traditional chest x-rays. They were all either current or former heavy smokers without evidence of cancer. The imaging studies were conducted once a year for three years. There is a reported 20% reduction in lung cancer mortality in the CT arm of the study. This high percentage of reduction in lung cancer mortality has never been reported in other screening studies.

Although we have to wait for the final publication of the study, the use of low-dose CT scans in patients at high risk of developing lung cancer could become a standard of care.