CancerNetwork Honors World Health Day by Looking at Recent Breakthroughs in Cancer Prevention, Screening

This day each year, the World Health Organization celebrates ‘World Health Day,’ which is aimed at creating awareness of specific health themes and priority areas of concern.

In honor of World Health Day, CancerNetwork® spotlighted recent findings in medicine aimed at reducing cancer burden through lifestyle choices and by preventative and screening measures.

Aspirin for Colorectal Cancer Prevention

Earlier this year, we reported on a study in JAMA Oncology indicating that individuals who began using aspirin before age 70 years and continued using the agent later in life had a reduced risk of developing colorectal cancer (CRC).

Another study published this year in JNCI: Journal of the National Cancer Institute has further demonstrated that long-term regular intake of baby aspirin, which was defined as at least 15 times per month, prior to diagnosis of CRC was associated with a reduced risk of death from cancer due to its ability to inhibit tumor spread prior to discovery.¹

“More evidence is needed, but this association between baby aspirin and lower death rates is highly significant,” said study author Jane C. Figueiredo, PhD, who is an epidemiologist at Cedars-Sinai Medical Center.² “These findings may provide an inexpensive lifestyle option to people seeking to prevent colorectal cancer, or to improve their prognoses if they are diagnosed.”

The investigators believe low-dose aspirin works by irreversibly preventing the production of thromboxane A2 by platelets, which inhibits the spread and metastasis of tumor cells.

“There are potential harms associated with aspirin use,” Figueiredo said, since daily use may increase the risk of allergic reaction and internal bleeding. “There really needs to be a conversation between clinicians and patients about both the risks and benefits. These studies and our results really add to that conversation.”

Role of Diet in Development of Colorectal, Breast Cancer

Other research has emerged linking lifestyle choices with the risk of developing CRC and breast cancer later in life. For instance, a large population-based case-control study published in Clinical Nutrition suggested an association between consumption of ultra-processed foods and drinks with the development of these cancers.^3,4

Study author Dora Romaguera, of the Institut d’Investigació Sanitària Illes Balears, said this is rationalized “by a low intake of fiber, fruits, and vegetables, which are known to offer protection against CRC, among people who eat a lot of ultra-processed foods, but also by the additives and other substances with carcinogenic potential typically used in processed food products.”

“We found differences in terms of their intake of energy, fiber, energy density, and saturated fatty acids,” said another study author Sílvia Fernández. “Consumption of ultra-processed foods and beverages was higher among colorectal and breast cancer cases than in the controls.”

Foods that were most common in diets of the subjects studied included sugary beverages (35%), sugary products (19%), ready-to-eat foods (16%), and processed meats (12%), the latter of which has already been categorized as carcinogenic by the International Agency for Research on Cancer.

Genes Indicating Higher Cervical Cancer Risk

The presence of certain oncogenic drivers, such germline BRCA1/2 mutations, come with a known increased risk of certain cancers. New research published in Lancet Oncology has identified 3 genes that are now considered linked with an increased risk of cervical cancer.⁵

“Over 70% of people are infected with [human papillomavirus] over their lifetime, yet most women clear the infection and only a small fraction go on to develop abnormal pre-cancerous cervical cells; even fewer develop cervical cancer,” lead study author Sarah J. Bowden, MBBCh, of Imperial College London, said in a press release.⁶ “Previous studies suggest around 30% of the risk of developing cervical cancer is genetic. This study is the first to confidently identify gene variants that may be associated with an elevated risk of cervical cancer.”

Data from 150,000 European women with cervical cancer revealed that common variants of PAX8 and CLPTM1L as well as genes in the HLA region were associated with an increased risk of developing this tumor type.

“Increased genetic information could also lead to new drugs in the future,” said Bowden, adding that management of pre-cancerous abnormalities leaves room for improvement. “If we knew more about the interaction between genetics and HPV, we might be able to develop new drugs to treat these abnormalities at an early stage.”

Screening for Melanoma With Family Risk

Routine skin cancer screenings and patient education about self-exams amongst individuals with an elevated family risk of melanoma has been shown to be associated with a higher likelihood of being diagnosed at earlier stages of melanoma.

These results were taken from a study published in Cancer Epidemiology, Biomarkers, & Prevention examining cases of melanoma from the National Cancer Institute (NCI) Familial Melanoma Study and the Surveillance, Epidemiology, and End Results (SEER) registries.⁷ 

“Whole-body screening for melanoma is currently routine for individuals at high risk for melanoma. These individuals include members of melanoma-prone families, categorized as having at least 2 relatives who have had melanoma, and those with inherited pathogenic gene variants that increase melanoma risk,” study author Michael Sargen, MD, of the Division of Cancer Epidemiology and Genetics at the National Cancer Institute (NCI) of the National Institutes of Health (NIH), said in a press release.⁸ “However, the benefit of screening in melanoma-prone families has not been previously quantified.”

To evaluate the success of the intervention, the investigators compared differences in lesion size and stage in patients diagnosed with melanoma before and after enrollment. Results found that smaller lesions were discovered following intervention at 0.6 mm versus 1.1 mm in those enrolled after their diagnosis. In addition, those who were treated with intervention were more likely to present with T1 disease at diagnosis, at 83% and 40%, respectively.

“This suggests that the downward trend in melanoma thickness observed in the general population does not fully explain the reductions in thickness seen in melanoma-prone families, and that long-term surveillance may assist in the earlier diagnosis of melanoma in high-risk populations,” said Sargen.

Sophisticated Applications of Breast Mammography

Due to delayed preventative care resulting from the COVID-19 pandemic, investigators have been assessing best strategies to ensure patients still receive critical cancer screenings despite limited capacity at medical centers and patient fears.

A risk-based algorithm has been developed to maximize detection of breast cancer based on clinical factors, breast symptoms, breast cancer history, and age. Using this system, research showed that mammograms in patients categorized with a high or very-high rating for cancer risk (12%) accounted for 55% of diagnoses, whereas a very-low rating (44%) made up only 13% of cases.⁹

“What this means is that triaging individuals most likely to have cancer during periods of reduced capacity may be effective at detecting the most cancers with the fewest mammograms versus using a non-risk-based approach,” said Diana L. Miglioretti, PhD, of UC Davis Health. “Whether it is due to unexpected new surges in COVID-19 cases prompting new lockdowns or other emergencies such as cyberattacks or natural disasters like wildfires, the study results provide important guidance for navigating through any crisis that could impact the availability of mammograms.”

Even when there are no barriers to receiving mammography, the screening method is still associated with limitations, such as high rates of biopsies subsequent to positive screenings in patients without cancer. Another study published in Clinical Cancer Research found that using an apparent diffusion coefficient (ADC) of ≥1.5 × 10^-3 mm²/second in patients with a BI-RADS 4 rating by contrast-enhanced mammography was able to downgrade lesions with a sensitivity of 96.6%. These findings were able to reduce unnecessary biopsies in 32.6% of cases.^10,11

“Our finding can be used immediately for diagnostic purposes. It does not require a special centre—every registered radiology department would be able to use it straightaway,” study author Pascal AT. Baltzer of MedUni Vienna and Vienna General Hospital, said in a press release.

References

1. Figueiredo JC, Jacobs EJ, Newton CC, Guinter MA, Cance WG, Campbell PT. Associations of aspirin and non-aspirin non-steroidal anti-inflammatory drugs with colorectal cancer mortality after diagnosis. J Natl Cancer Inst. February 2, 2021. doi: 10.1093/jnci/djab008

2. Baby Aspirin Linked to Lower Risk of Colorectal Cancer Death. Cedars-Sinai website. March 29, 2021. Accessed April 3, 2021. https://ceda.rs/2PVgvRL

3. Romaguera D, Fernández-Barrés S, Gracia-Lavedán E, et al. Consumption of ultra-processed foods and drinks and colorectal, breast, and prostate cancer. Clin Nutr. 2021;40(4):1537-1545. doi: 10.1016/j.clnu.2021.02.033

4. Association Found Between Consumption of Ultra-Processed Foods and Drinks and Increased Colorectal Cancer Risk. News release. ISGlobal. March 23, 2021. Accessed April 3, 2021. https://bit.ly/3mpagld

5. Bowden SJ, Bodinier B, Kalliala I; FinnGen consortium. Genetic variation in cervical preinvasive and invasive disease: a genome-wide association study. Lancet Oncol. 2021;22(4):548-557. doi: 10.1016/S1470-2045(21)00028-0

6. Genes associated with increased risk of cervical cancer identified. News release. Imperial College London. March 29, 2021. Accessed April 3, 2021. https://bit.ly/3sPWeLZ

7. Sargen MR, Pfeiffer RM, Elder DE, et al. The Impact of Longitudinal Surveillance on Tumor Thickness for Melanoma-Prone Families with and without Pathogenic Germline Variants of CDKN2A and CDK4. Cancer Epidemiol Biomarkers Prev. 2021;30(4):676-681. doi: 10.1158/1055-9965.EPI-20-1521

8. Whole-body screening and ed. in melanoma-prone families may improve early detection rates. News release. American Association For Cancer Research. April 2, 2021. Accessed April 3, 2021. https://bit.ly/3fBzRWM

9. Catching more breast cancers when mammograms are limited. News release. UC Davis Comprehensive Cancer Center. March 25, 2021. Accessed April 3, 2021. https://bit.ly/31M1ZhU

10. Clauser P, Krug B, Bickel H, et al. Diffusion-weighted Imaging Allows for Downgrading MR BI-RADS 4 Lesions in Contrast-enhanced MRI of the Breast to Avoid Unnecessary Biopsy. Clin Cancer Res. 2021;27(7):1941-1948. doi: 10.1158/1078-0432.CCR-20-3037

11. Breast cancer screening recalls: simple MRI measurement of the breast could avoid 30% of biopsies. Medical University of Vienna website. March 1, 2021. Accessed April 3, 2021. https://bit.ly/3dBKLcB