The value of a genetic counselor: improving identification of cancer genetic counseling patients with chart review.

Advances in genetics are changing cancer care and requiring institutions to maximize the unique skills of genetics professionals. The identification of genetic syndromes is vital for prevention and management of families with high cancer risks. Despite this, high risk individuals who qualify are often not referred. Genetic counselors could review oncology charts to improve identification. A genetics assessment tool developed by NCI Community Cancer Centers Program was used to perform self-assessment of the genetics program. A weekly report of all new oncology patients was provided to a genetic counselor for chart review. In 2010, 58 % of all eligible patients (n = 152) were offered a genetics evaluation. In 2011 this improved to 70 % (n = 167), which was a statistically significant difference, X (2)(1) = 5.13, p = 0.02. By cancer site, ovarian cancer referrals also showed statistically significant improvement, X (2)(1) = 6.36, p = 0.01. Breast and colon referrals were improved but not significant. Over 10 months, 129 patients were identified through the chart review program. Three were confirmed to have a genetic mutation for a hereditary cancer syndrome. An average week included review of 73 charts for 10 medical oncologists, 4 radiation oncologists, and 4 pediatric oncologists which generated 60-80 min of work for the genetic counselor. This program improved patient identification and quality, and allowed physicians to become more aware of opportunities for genetic counseling and more patients to receive genetic counseling and testing.

Diagnostic evaluation following a positive lung screening chest radiograph in the Prostate, Lung, Colorectal, Ovarian (PLCO) Cancer Screening Trial.

Lung cancer is the major cause of cancer mortality. One of the aims of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) was to determine if annual screening chest radiographs reduce lung cancer mortality. We enrolled 154,900 individuals, aged 55-74 years; 77,445 were randomized to the intervention arm and received an annual chest radiograph for 3 or 4 years. Participants with a positive screen underwent diagnostic evaluation under guidance of their primary physician. Methods of diagnosis or exclusion of cancer, interval from screen to diagnosis, and factors predicting diagnostic testing were evaluated. One or more positive screens occurred in 17% of participants. Positive screens resulted in biopsy in 3%, with 54% positive for cancer. Biopsy likelihood was associated with a mass, smoking, age, and family history of lung cancer. Diagnostic testing stopped after a chest radiograph or computed tomography/magnetic resonance imaging in over half. After a second or subsequent positive screen, evaluation stopped after comparison to prior radiographs in over half. Of 308 screen-detected cancers, the diagnosis was established by thoracotomy/thoracoscopy in 47.7%, needle biopsy in 27.6%, bronchoscopy in 20.1% and mediastinoscopy in 2.9%. Eighty-four percent of screen-detected lung cancers were diagnosed within 6 months. Diagnostic evaluations following a positive screen were conducted in a timely fashion. Lung cancer was diagnosed by tissue biopsy or cytology in all cases. Lung cancer was excluded during evaluation of positive screening examinations by clinical or radiographic evaluation in all but 1.4% who required a tissue biopsy.

Myositis Ossificans Presenting as a Tumor of the Cervical Paraspinal Muscles.

Myositis ossificans (MO) is a benign heterotopic bone formation within muscle or soft tissue that is predominantly initiated by trauma. The diagnostic challenge is to distinguish it from bone and soft tissue malignancies. The most common location of MO is the muscles of the thigh and the upper arm, whereas the neck is only rarely involved. A broad range of theories about the etiology of MO exists in the literature, but minor or major trauma can be found in almost every instance. We present a patient in which additional hybrid imaging with singlephoton emission tomography (SPECT) and computed tomography helped to confirm the diagnosis of MO in the paraspinal cervical muscles.

Baseline chest radiograph for lung cancer detection in the randomized Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial.

BACKGROUND: The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial was initiated in 1992 to examine cause-specific mortality reduction from screening for these four cancers in men and women. We report lung cancer detection results of the baseline screening round. METHODS: Of the 154,942 participants enrolled, who were aged 55-74 years with no history of PLCO cancers, 77,465 were randomly assigned to the intervention arm. Current or former smokers and never smokers in this arm received an initial single-view posterior-anterior chest radiograph. RESULTS: In the initial screen, 5991 (8.9%, 95% confidence interval [CI] = 8.7% to 9.2%) of radiographs were suspicious for lung cancer: 8.2% (95% CI = 7.9% to 8.5%) for women and 9.6% (95% CI = 9.3% to 10.0%) for men. Rates were highest for older age groups and for smokers. Among those 5991 participants with a positive screen, 206 (3.4%, 95% CI = 3.0% to 3.9%) underwent biopsy examination, 126 (61.2%, 95% CI = 54.5% to 67.8%) of whom were diagnosed with lung cancer within 12 months of the screen (59 in women and 67 in men). The positive predictive value was 2.1% (95% CI = 1.7% to 2.5%), and 1.9 lung cancers were detected per 1000 screens. Among these cancers, 44% (95% CI = 35% to 52%) were stage I non-small-cell lung cancer. High rates of lung cancer were found in current smokers (6.3 per 1000 screens) and in former smokers who had smoked within the past 15 years (4.9 per 1000 screens). The lung cancer detection rate among never smokers was 0.4 per 1000 screens; this group accounted for 11% (95% CI = 5.6% to 16.6%) of the cancers identified. CONCLUSIONS: In the baseline screen, nearly half the cancers were stage I. Whether this experience results in a reduction in lung cancer mortality is yet to be seen.

Intraoperative parathormone measurement in patients with primary hyperparathyroidism: a prospective clinical study.

BACKGROUND: The objective of this pilot study was to evaluate the use of intraoperative iPTH measurement in combination with bilateral neck exploration in patients with primary hyperparathyroidism. METHODS: A prospective study was conducted in a single centre university hospital in Switzerland comprising 33 patients with primary hyperparathyroidism undergoing neck surgery. No routine preoperative localisation studies were conducted. Intraoperative iPTH measurement was performed at defined times. Exploration was discontinued when iPTH fell below 15% of baseline. RESULTS: For all patients with adenoma the median serum iPTH decreased to 11.9% (standard deviation 5.5%) of baseline concentrations. All patients with hyperplasia achieved normocalcaemia. At median follow-up of 17.7 weeks neither recurrent nor persistent hypercalcaemia was observed. Eleven patients were explored unilaterally. CONCLUSION: Measurement of intraoperative serum iPTH is a helpful tool in the differentiation of single adenoma from hyperplastic glands. When we call for a strict 78% decrease in serum iPTH from base levels after 10 minutes, measurement of this marker protein even allows differentiation of single- from multi-glandular disease.