No Additional Benefit Found for Personalized Intervention to Promote Regular Mammography Screening
Two different interventions did not significantly increase regular mammography screening in a large randomized study.
Behavioral interventions, such as personalized mailings, have been reported to increase one-time cancer screening. However, few studies have examined the impact of behavioral interventions on regular or on-going participation in screening exams.
Sally Vernon, Ph.D., of the University of Texas School of Public Health in Houston and colleagues assigned 5,500 female veterans to one of three interventions designed to encourage annual mammograms - a baseline survey plus a targeted mailing, a baseline survey plus a targeted mailing that was tailored to individual participants, or the baseline survey alone. The investigators then looked to see how many women in each group had completed two mammograms as recommended during the three-year follow-up period.
Neither the targeted mailing nor the targeted and tailored mailing was associated with a statistically significant increase in the percentage of women who had regular mammograms compared to the survey-only group.
Noting that two other trials have recently reported similar findings, the authors write, "Collectively, these findings and ours provide little support for an additional benefit of using tailored interventions, either mailed or by telephone, to increase regular mammography screening."
In an accompanying paper by Deborah del Junco, Ph.D., of the University of Texas Health Science Center in Houston and colleagues, the researchers report that the results of the intervention trial are likely to be internally valid and applicable to the larger population. They assessed the validity of the trial by including two additional control groups in the study design and by comparing the characteristics of study participants with those of nonparticipants. The investigators found that the baseline survey by itself did not influence subsequent mammography screening rates. In addition, they found that mammography rates actually decreased in the final study year in the veteran population.
"Similar rates of mammography coverage and compliance in the US female population and the decline reported for the US female population between 2000 and 2005 lend additional support to the generalizability of our results," the authors write.
Viral DNA Testing Is Cost-Effective for Cervical Cancer Screening
Adjustment of cervical cancer screening protocols as a woman ages may be cost-effective, regardless of whether she has been vaccinated against the human papillomavirus (HPV) that causes cervical cancer.
Since the release of cervical cancer screening guidelines in 2001 and 2003, more data has become available showing that HPV DNA-based testing is more effective in detecting precancerous changes in a woman's cervix than standard cytology (Pap) tests. With these data and the development of a vaccine that prevents two types of HPV infection, analyses are needed that estimate both the effectiveness and cost of different screening strategies for U.S. women.
Using information about the frequency with which girls of different ages become infected with HPV and the likelihood that a persistent infection will lead to cancer, Sue J. Goldie, M.D., of Harvard School of Public Health in Boston and colleagues mathematically modeled the impact of each available screening technique in vaccinated and unvaccinated women. While a number of acceptable strategies were identified, the researchers found that the most cost-effective screening protocols for both vaccinated and unvaccinated women included cytology during the early part of a woman's life, followed by HPV DNA-based screening after age 30. This strategy differs from most commonly used screening practices.
The investigators emphasized that the frequency of screening could be reduced in vaccinated individuals and the switch to DNA-based screening delayed by five years, relative to unvaccinated women. The researchers estimated that cervical cancer risk could be reduced by an additional 30 percent in future generations of American women provided there is high vaccine coverage in preadolescent girls, continued screening in vaccinated and unvaccinated women, and targeted efforts to recruit and screen women with historically poor access to cervical cancer prevention.
"Our findings indicate that it may be worthwhile to consider strategies that differ according to age and vaccination status and to revisit screening options recommended for older women," the authors write.
In an accompanying editorial, Nancy Kiviat, M.D., of Harborview Medical Center in Seattle, and colleagues write "The analyses presented [here] will undoubtedly support the urgently needed development of screening recommendations for the immediate future."
Interleukin Plays a Role in Ovarian Cancer Growth
Patients whose tumors produced high levels of interleukin-8 (IL-8) protein had a worse outcome than those with less IL-8. Blocking expression of IL-8 in mouse models of ovarian cancer slowed tumor growth by reducing blood vessel growth.
IL-8 expression is elevated in many human tumors. Previous work indicated that the protein stimulates tumor growth, blood vessel development, and metastasis in animal models. Suppressing its activity with antibody therapy slowed tumor growth in those models.
In the current study, Anil Sood, M.D., of the University of Texas M. D. Anderson Cancer Center in Houston and colleagues tested 102 human ovarian cancer tumor samples for IL-8 expression. Of those, 43 (42 percent) had high levels of the protein and 69 (58 percent) had low or no IL-8 expression. The researchers found that the women whose tumors had higher levels of IL-8 were more likely to have advanced disease and poorer survival.
When the team used small-interfering RNAs to block IL-8 gene expression in animal models of ovarian cancer, they saw that tumor growth was substantially reduced. The slowed growth appeared to be due to less blood vessel development.
"Our findings suggest that IL-8 may be a potential therapeutic target in ovarian cancer," the authors write.
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