Normal Risk Ovarian Screening Study: 21-Year Update.

PURPOSE: The Normal Risk Ovarian Screening Study (NROSS) tested a two-stage screening strategy in postmenopausal women at conventional hereditary risk where significantly rising cancer antigen (CA)-125 prompted transvaginal sonography (TVS) and abnormal TVS prompted surgery to detect ovarian cancer. METHODS: A total of 7,856 healthy postmenopausal women were screened annually for a total of 50,596 woman-years in a single-arm study (ClinicalTrials.gov identifier: NCT00539162). Serum CA125 was analyzed with the Risk of Ovarian Cancer Algorithm (ROCA) each year. If risk was unchanged and <1:2,000, women returned in a year. If risk increased above 1:500, TVS was undertaken immediately, and if risk was intermediate, CA125 was repeated in 3 months with a further increase in risk above 1:500 prompting referral for TVS. An average of 2% of participants were referred to TVS annually. RESULTS: Thirty-four patients were referred for operations detecting 15 ovarian cancers and two borderline tumors with 12 in early stage (I-II). In addition, seven endometrial cancers were detected with six in stage I. As four ovarian cancers and two borderline tumors were diagnosed with a normal ROCA, the sensitivity for detecting ovarian and borderline cancer was 74% (17 of 23), and 70% of ROCA-detected cases (12 of 17) were in stage I-II. NROSS screening reduced late-stage (III-IV) disease by 34% compared with UKCTOCS controls and by 30% compared with US SEER values. The positive predictive value (PPV) was 50% (17 of 34) for detecting ovarian cancer and 74% (25 of 34) for any cancer, far exceeding the minimum acceptable study end point of 10% PPV. CONCLUSION: While the NROSS trial was not powered to detect reduced mortality, the high specificity, PPV, and marked stage shift support further development of this strategy.

Need a bag? A review of public policies on plastic carrier bags - Where, how and to what effect?

The plastic carrier bag epitomises many of the features that have transformed plastics into a material that defines our contemporary modern culture. The versatility, durability, strength and low cost have made it into an indispensable companion for consumers. In parallel with plastic becoming an increasingly contested material, the plastic carrier bag has emerged as a controversial object in many jurisdictions. This paper explores where, how and to what extent public authorities in different cases across the globe regulate plastic carrier bags. The number of public policies on plastic carrier bags has more than tripled since 2010, and they are now found on all continents, ranging from the municipal to the intergovernmental level. They mainly come in the form of either bans or levies, with the former being predominant. There have been many examples of policies leading to reduced consumption of plastic carrier bags, however this paper also identifies key challenges, including resistance towards plastic carrier bag regulations, uncertainty in measuring the effects, and the undesired side-effects. Far from being a simple issue, public policies on plastic carrier bags highlight the complexity of governing plastics.