New cancer recommendations made by a National Cancer Institute (NCI) working group could reduce unnecessary treatment by eliminating the fear factor linked with some early-stage cancers. However, there is a need for diagnostic tests that can recognize whether these early conditions could become life-threatening, states an analyst with research and consulting firm GlobalData.
The NCI scientists recommended that words like cancer, neoplasia, and carcinoma should be removed from premalignant conditions in order to reduce the incidences of over diagnosis and to prevent patients from undergoing irrelevant surgery, radiation, or drug treatment.
“The implementation of this recommendation will help make patients and physicians more comfortable with refraining from unnecessarily treating benign disease,” says Cheryl S. Gradziel, PhD, oncology analyst with GlobalData. “The term cancer and its synonyms are alarming, which leads patients to strongly believe that premalignant conditions such as ductal carcinoma in situ or high-grade prostatic intraepithelial neoplasia should be treated aggressively, when this is often not the case.”
As people become more aware and screening for many common cancers increases, more tumors are being treated at early stages. But, those screenings have resulted in more frequent diagnoses of abnormalities that would never become life-threatening, which is what the NCI is trying to minimize by redefining the terms surrounding cancer.
In order to reduce the excessive treatment of low-risk diagnoses, GlobalData’s analyst argues for the importance of investing in tests that could determine early on if a condition will become malignant or not.
“There is ample market opportunity for such tests, and their approval and subsequent adoption will have the greatest impact towards reducing the overdiagnosis and overtreatment of cancers in the US,” says Gradziel.
Only half of Americans identified as ever having had hepatitis C received follow-up testing showing that they were still infected, according to a recent report issued by the Centers for Disease Control and Prevention (CDC).
“Many people who test positive on an initial hepatitis C test are not receiving the necessary follow-up test to know if their body has cleared the virus or if they are still infected,” said CDC Director Tom Frieden, MD, MPH. “Complete testing is critical to ensure that those who are infected receive the care and treatment for hepatitis C that they need in order to prevent liver cancer and other serious and potentially deadly health consequences.”
Testing for hepatitis C includes a blood test, called an antibody test, to determine if an individual has ever been infected with the virus. For people with a positive antibody test result, a follow-up test—called an RNA test—should be given to determine whether they are still infected so they can get needed care and treatment.
A small number of people with antibody-positive tests will have cleared the infection on their own, but most people with hepatitis C (about 80%) remain infected and can go on to develop significant health problems.
Researchers looked at data from eight areas across the nation funded by the CDC to conduct enhanced surveillance for hepatitis C virus infection. Of the hepatitis C cases reported in these areas (i.e., those cases with antibody-positive results), only 51%of the cases also included a follow-up (RNA) test result that identified current infection. Without follow-up testing, the other half are likely unaware if they are currently infected and therefore cannot get appropriate medical care.
Data included in this analysis also underscore the severe impact of hepatitis C among baby boomers. In the eight areas studied, 67% of all reported cases of current infection were among those born from 1945 through 1965. Deaths among people with hepatitis C also were more common among those born during these years (accounting for 72% of all reported deaths).
“Hepatitis C has few noticeable symptoms, and left undiagnosed it threatens the health of far too many Americans—especially baby boomers,” said John Ward, MD, director of CDC’s Division of Viral Hepatitis. “Identifying those who are currently infected is important because new effective treatments can cure the infection better than ever before, as well as eliminate the risk of transmission to others.”
Overall, approximately 3 million Americans are infected with hepatitis C and up to 3 out of 4 do not know they are infected. The vast majority of those affected are baby boomers, or those born from 1945 through 1965. Left untreated, hepatitis C can cause serious liver damage, including liver cancer. Hepatitis C is a leading cause of liver cancer and the most common indication for liver transplants. In fact, liver cancer is the fastest-rising cause of cancer-related death in the United States. Deaths from hepatitis C have nearly doubled over the past decade, now accounting for more than 15,000 deaths each year.
In light of increasing evidence that many patients are not receiving the follow-up test, as well as recent changes in testing technologies and the availability of new effective treatments for hepatitis C, the CDC is issuing updated guidance for health care providers on hepatitis C testing. These guidelines reinforce the recommended process for hepatitis C testing and underscore the importance of providers conducting follow-up RNA testing for all patients with a positive antibody test result in order to help ensure people infected with hepatitis C are properly tested and identified.
The CDC recommends that everyone in the United States born from 1945 through 1965 be tested for hepatitis C. The CDC also recommends that other populations at increased risk for hepatitis C get tested, including those who received blood transfusions or organ transplants before widespread screening of the blood supply began in 1992, or those who have ever injected drugs.
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