Cancer risk rises as patients wait for diagnostic testing

April 10, 2018, Perelman School of Medicine at the University of Pennsylvania

The longer a patient with a positive screening result waits for diagnostic testing, the worse their cancer outcomes may become, according to a literature review of breast, cervical, colorectal, and lung studies in the journal CA: A Cancer Journal for Clinicians led by researchers at the Perelman School of Medicine at the University of Pennsylvania.

After a patient receives a positive cancer screening result, the next recommended step is a follow-up evaluation with diagnostic testing, a CT scan for example, which is key to confirm the absence or presence of cancer(s) and the severity of any that may be present.

The authors, an interdisciplinary team of cancer experts from the Population-Based Research Optimizing Screening Through Personalized Regimens Consortium, urge who receive a positive screening to schedule a diagnostic as soon as feasible. Articles considered were published between January 1998 and December 2017, conducted in an average-risk population, except in , and used study designs that provided empirical evidence and evaluated the key question.

Although the findings of this research follow the longstanding conventional wisdom, this literature review backs up this message with patient outcome data. The authors make clear that each patient's cancer trajectory is different and there is no established timeframe that is OK to wait before a without risk of cancer progression.

"To ignore these findings is not patient-centered," said Chyke Doubeni, MD. "The longer a patient waits, the less likely they are to get the diagnostic testing done. There is also the risk that precancerous or early tumors will become more advanced cancers that are more difficult or impossible to cure."

The paper offers suggested targets for each of the four cancers within which diagnostic testing should be performed. The targets range from 60-90 days, but were not able to ascribe a certain number of risk points based on exactly how long a patient waits. For example, on average, cervical cancer takes longer to progress than lung cancer does, but the authors caution against ascribing a safe period to wait or saying it's safe to wait a little longer if you have cervical cancer vs another type based on the limited body of knowledge to date.

The National Academy of Medicine has identified improving the timeliness and patient-centeredness of care as an important unmet health priority. Screening is proven to reduce the risk of death from some cancers and is currently recommended at grade A or B by the US Preventive Services Task Force in eligible persons for breast, cervical, colorectal, and lung cancers, which enables full coverage of those services under the Affordable Care Act.

Future research will aim to identify the appropriate data to identify time intervals during which it is potentially safe to wait before undergoing diagnostic testing.

Doubeni and his colleagues note that prompt diagnostic testing may also reduce mortality risk, and may also reduce worries about uncertainty about the procedure. Additionally, sooner is better, as provider or system delays in follow-up may increase the likelihood that diagnostic testing may not occur at all, such as changes in patient contact information or insurance coverage changes.

Based on the few direct studies cited, overall, there is evidence that if you wait longer than 60-90 days, generally will progress. This is not surprising biologically, but the paper provides guidance on how to set metrics to measure improvement. Next steps for the research will seek out the most effective interventions to reduce the time to diagnosis for vulnerable and minority populations, and any patients who have barriers to timely follow up.

Explore further: Evidence suggests that patient navigators and provider reminders may improve follow-up after positive fecal blood test

More information: Chyke A. Doubeni et al. Timely follow-up of positive cancer screening results: A systematic review and recommendations from the PROSPR Consortium, CA: A Cancer Journal for Clinicians (2018). DOI: 10.3322/caac.21452

Related Stories

Evidence suggests that patient navigators and provider reminders may improve follow-up after positive fecal blood test

October 9, 2017
Interventions, such as patient navigators and provider reminders, may improve follow-up colonoscopy rates after a positive fecal blood test. Follow-up is an important step in effective screening for colorectal cancer. Findings ...

How have HPV vaccines affected cervical cancer screening?

June 7, 2017
A new review looks at cervical cancer screening in the era of HPV vaccination. The review notes that trials have demonstrated the efficacy and safety of vaccines against HPV infection, but the complete effect of HPV vaccination ...

Screening, HPV vaccine can prevent cervical cancer: FDA

February 8, 2017
(HealthDay)—Women can reduce their risk of cervical cancer through vaccination and screening, the U.S. Food and Drug Administration says.

Follow-up times for colorectal cancer screening abnormalities lag behind others

December 18, 2015
Follow-up times of abnormal screening exams were shorter for breast cancer than they were for colorectal and cervical cancers, according to a recent study involving more than one million individuals who underwent these screenings. ...

Outreach interventions improve colorectal cancer screening

September 5, 2017
Outreach and notification to patients and physicians improved colorectal cancer (CRC) screening among patients who were not up-to-date or nonadherent with CRC screening, according to two studies published by JAMA.

Cancers caught during screening colonoscopy are more survivable

July 13, 2015
Patients whose colorectal cancer (CRC) is detected during a screening colonoscopy are likely to survive longer than those who wait until they have symptoms before having the test, according to a study in the July issue of ...

Recommended for you

10-year follow-up after negative colonoscopies linked to lower colorectal cancer risk

December 17, 2018
Ten years after a negative colonoscopy, Kaiser Permanente members had 46 percent lower risk of being diagnosed with and were 88 percent less likely to die from colorectal cancer compared with those who did not undergo colorectal ...

Survivors of childhood Hodgkin lymphoma face high long-term risk of solid cancers

December 17, 2018
New research refines existing evidence that survivors of childhood Hodgkin lymphoma face an elevated risk of developing various types of solid tumors many years later. In addition, certain subgroups of patients have an especially ...

Immunotherapy combo not approved for advanced kidney cancer patients on the NHS

December 14, 2018
People with a certain type of advanced kidney cancer will not be able to have a combination of two immunotherapy drugs on the NHS in England.

New drug seeks receptors in sarcoma cells, attacks tumors in animal trials

December 13, 2018
A new compound that targets a receptor within sarcoma cancer cells shrank tumors and hampered their ability to spread in mice and pigs, a study from researchers at the University of Illinois reports.

Surgery unnecessary for many prostate cancer patients

December 13, 2018
Otherwise healthy men with advanced prostate cancer may benefit greatly from surgery, but many with this diagnosis have no need for it. These conclusions were reached by researchers after following a large group of Scandinavian ...

Lethal combination: Drug cocktail turns off the juice to cancer cells

December 12, 2018
A widely used diabetes medication combined with an antihypertensive drug specifically inhibits tumor growth—this was discovered by researchers from the University of Basel's Biozentrum two years ago. In a follow-up study, ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.