Medicare will cover annual lung cancer screening with low-dose computed tomography in high-risk patients, the Centers for Medicare & Medicaid Services announced last week.
To be covered, beneficiaries must meet the following conditions:
- be asymptomatic and aged 55 to 77;
- be either currently smoking or have stopped smoking within the past 15 years;
- have a smoking history of 30 or more pack-years;
- have a written order from a clinician obtained during a lung cancer screening counseling and shared decision-making visit, which includes information on the procedure’s risks and benefits.
High body mass index (BMI) may be to blame for nearly 4% of all cancer cases, a Lancet Oncology study finds. These cancers include colon, rectal, esophageal, ovarian, uterine, and breast. This link seems to be higher among women than men. Highly developed nations had the most high-BMI-related cancers: North America accounted for about a quarter of all such cases.
Cytisine, a partial agonist of nicotinic acetylcholine receptors, helps smokers quit tobacco more effectively than nicotine-replacement therapy (NRT), according to a New England Journal of Medicine study. The plant-based agent has been used for smoking cessation in Eastern Europe for decades but is largely unavailable elsewhere.
Some 1300 adult daily smokers who were motivated to quit smoking were randomized to receive cytisine tablets for roughly 3.5 weeks or NRT (patches plus gum or lozenges) for 8 weeks. Both groups also received behavioral support via three brief telephone calls over 8 weeks.
The primary outcome — self-reported continuous abstinence at 1 month — was higher with cytisine than with NRT. Similarly, abstinence rates favored cytisine at 2 and 6 months. Cytisine was associated with more adverse events (mostly nausea, vomiting, and sleep disorders), but only 5% of participants discontinued the drug because of side effects.
An editorialist notes that cytisine is inexpensive and, if made widely available, could make smoking cessation pharmacotherapy affordable for many smokers.
Daily low-dose aspirin for a minimum of 5 years appears to have more
benefits than harms in terms of cancer prevention.
The review found reduced cancer incidence and mortality at doses
between 75 and 325 mg per day, starting between ages 50 and 65, with
longer duration of use appearing to confer the greatest benefits.
The researchers found substantial benefit in terms of colorectal,
esophageal, and gastric cancer incidence and mortality. Reductions in
breast, lung, and prostate cancers were more modest.
As expected, aspirin use was associated with increased risk for
bleeding events, but the cancer-prevention benefits outweighed this
-Annals of Oncology
The addition of three-dimensional breast imaging, to digital
mammography is associated with increased cancer detection rates,
compared with digital mammography alone, according to an industry-
funded, retrospective study in JAMA.
The authors note: “The association with fewer unnecessary tests and
biopsies, with a simultaneous increase in cancer detection rates,
would support the potential benefits of tomosynthesis as a tool for
screening. However, assessment for a benefit in clinical outcomes is
High red meat consumption (1.6 servings per day) in early adulthood is
associated with a 22% increased risk for breast cancer, according to
longer-term follow-up from the Nurses Health Study II, published in BMJ.
Swapping out red meat for poultry or legumes one meal a day was
associated with significant risk reductions.
The authors conclude: “Consistent with the American Cancer Society
guidelines, replacement of unprocessed and processed red meat with
legumes and poultry during early adulthood may help to decrease the
risk of breast cancer.”
Eradicating Helicobacter pylori in asymptomatic, healthy adults
reduces the incidence of subsequent gastric cancer.
Researchers identified six randomized, controlled trials that assessed
the effect of eradication therapy on stomach cancer incidence 2 or
more years later in adults who tested positive for H. pylori but had
no symptoms and were healthy. A variety of eradication therapies were
used. Control groups received placebo or no therapy.
The authors conclude: “It seems likely that the benefit of searching
for and eradicating H. pylori in healthy asymptomatic individuals will
outweigh any potential harms, especially in populations at high risk
of gastric cancer. However, results from further trials in different
populations are urgently needed.”
CVS Caremark has announced plans to stop selling tobacco products at
all of its pharmacies by Oct. 1.
A JAMA viewpoint, co-written by CVS’s chief medical officer, notes
that pharmacy chains, including CVS, are adding retail health clinics
to assist in treating chronic conditions like hypertension,
hyperlipidemia, and diabetes, “all conditions exacerbated by smoking.”
The article continues: “Although the sale of tobacco products in CVS
pharmacies produces more than $1.5 billion in revenues annually, the
financial gain is outweighed by the paradox inherent in promoting
health while contributing to tobacco-related deaths.”
Several medical societies, including the American Lung Association,
came out in support of the move and encouraged other pharmacies to
In other anti-smoking news, the FDA is about to release a new anti-
smoking campaign aimed at high-risk youth aged 12 to 17. “The Real
Cost” will target teens’ concerns, such as the cosmetic consequences
Analysis that corrects for hysterectomy rates indicates risk in women
older than 65 is higher than previously thought.
Hysterectomy is common in the U.S., and the vast majority of these
surgeries involve removal of the cervix as well as the uterus. Because
total hysterectomy protects women from future invasive cervical cancer
(ICC), hysterectomy rates affect estimates of ICC incidence.
In contrast to the relative decline in uncorrected ICC rates with age,
rates corrected for hysterectomy continued to rise after age 39,
peaking among women aged 65 to 69. In addition, correction revealed
greater disparity in ICC incidence between white women and black
women, with the latter group having higher incidence than previously
Current guidance (NEJM JW Womens Health Apr 12 2012) states that, in
women older than 65 with adequate recent screening, further screening
can be discontinued (because of low rates of invasive cervical cancer
as well as high false-positive rates for cytologic changes reflecting
atrophy of the lower genital tract in this population). Given that
hysterectomy-corrected ICC rates in older women are substantially
higher than the uncorrected rates underlying these recommendations, I
agree with the authors of this analysis that the existing guidelines
should be reviewed.
Rositch AF et al., Cancer 2014 May 12
The American Society of Clinical Oncology has released three
guidelines on treating problems commonly encountered by adult cancer
survivors: chemotherapy-induced peripheral neuropathy, anxiety and
depression, and fatigue. The guidelines are published in the Journal
of Clinical Oncology.
To treat chemotherapy-induced peripheral neuropathy, clinicians may
offer patients duloxetine. The group declined to make official
recommendations on tricyclic antidepressants, gabapentin, and a
topical gel (comprising baclofen, amitriptyline, and ketamine), but
said they may be reasonable options in certain patients.
Patients should be periodically evaluated for depression and anxiety,
and compliance with treatments should be assessed regularly. After 8
weeks, if symptoms have not improved, clinicians should try a new
Patients should be screened for fatigue at the time of cancer
diagnosis and routinely thereafter, at least annually. They should be
educated about ways to manage fatigue, such as through physical
activity (150 minutes of moderate aerobic weekly plus two to three
strength training sessions), cognitive behavioral therapy, and
mindfulness-based approaches like yoga and acupuncture.