A recent study by ITA investigators led by Amy Knudsen, PhD suggests that it may be reasonable to rescreen for colorectal cancer with methods other than colonoscopy following an initial negative exam. Using a microsimulation model of colorectal cancer, researchers found that rescreening at age 60 with colonoscopy every 10 years, CT colonography (aka “virtual colonoscopy”) every 5 years, or fecal occult blood testing (FOBT) or fecal immunochemical testing (FIT) every year greatly reduced the risk for colorectal cancer compared with no further screening. All rescreening strategies provided roughly the same benefit in terms of life-years gained compared with no further screening. However, rescreening with CT colonography, FOBT, or FIT reduced the risk for complications and cost less than rescreening with colonoscopy. The authors estimate that for every person who switches to FOBT or FIT following a negative initial colonoscopy, $450 to $495 could be saved over his or her lifetime. On a population level, switching could lead to savings of $3 billion.
Dr. Susannah L. Rose, PCORT alumna, was part of a collaborative team to examine how clinical-trial funding effects the interpretation of trial results by physicians. Currently, all major clinical trials now include disclosures detailing who funded the study to ensure transparency. However, is it possible that this transparency is actually hurting research? One might assume that the methodological rigor of the study matters to physicians more than the disclosure. However, in a new study, researchers at have found that pharmaceutical industry sponsorship of a research study negatively influences physicians’ perceptions of the study and their willingness to believe and act on the research findings. This study was published in the September 20, 2012 issue of the New England Journal of Medicine (NEJM).
Dr. Pamela McMahon and ITA research staff collaborated with other mathematical modelers as part of the National Cancer Institute’s Cancer Intervention and Surveillance Modeling Network to the special issue of Risk Analysis: The Impact of the Reduction in Tobacco Smoking on U.S. Lung Cancer Mortality (1975-2000): Collective Results from the Cancer Intervention and Surveillance Modeling Network. This monograph quantifies the impact of changes in smoking behaviors on lung cancer mortality based on detailed reconstructions of cigarette smoking histories for people born from 1890 to 1970. The issue details how this modeling was accomplished as well as describing how many lung cancer deaths have been averted due to declines in smoking and how many more deaths could have been averted had tobacco control efforts been perfect in eradicating cigarette smoking just after the first Surgeon Generals’ report.
Dr. Steven Pearson of the Institute for Clinical and Economic Review at the ITA recently published an editorial with colleagues in the New England Journal of Medicine titled “The Ethics of Early Evidence – Preparing for a Possible Breakthrough in Alzheimer’s Disease.” Researchers recently demonstrated the drug bexarotene is effective in treating Alzheimer’s disease in a mouse model with significant reversal of neural and cognitive defects. While the results from this animal study are premature to recommend for treatment in humans, bexarotene has already been approved by the FDA for other uses such as treatment of non-Hodgkin’s lymphoma and therefore physicians could prescribe it for off-label indications. The authors outline the ethical issues that are raised in this situation through case studies and highlight the importance of a stakeholder group to provide guidance on how to address the potential demand for this drug.
The New York Times recently spotlighted a scientific publication by Dr. Chin Hur and other ITA research staff that investigated clinical risk factors to better identify which patients should be screening for Barrett’s Esophagus. In a case-controlled study of 434 patients with Barrett’s Esophagus, researchers found that current use of aspirin reduced the risk of Barrett’s Esophagus by almost half. Aspirin has been documented to reduce the incidence of esophageal cancer, most likely through inhibiting the COX-2 enzyme as increased expression of COX-2 has been detected in patients with Barrett’s Esophagus and esophageal cancer. Further studies are needed to understand more about the relationship between the dosage and duration of aspirin use and the risk of Barrett’s Esophagus.