10 must read papers from the last year

Photo by Toa Heftiba on Unsplash

We are celebrating our first-year anniversary! We hope you have enjoyed our blog thus far.

To celebrate we thought we would highlight ten (18 but who’s counting 😉) key research publications in cancer screening and prevention over the last year or so. We’ve linked these publications to any mention of them in our (or other) blogs.

Don’t agree with our choices? Have we missed an important publication? Leave us a comment to let us know.

1. New cancer tests

CancerSEEK tests for a panel of proteins and mutations that provide a cancer signature in blood; (Cohen et al, Feb 2018). Read more on our blog: on CRUK’s science blog here and here; and on NCI’s blog. This one was so controversial that Cancer Research UK wrote two different blogs about it!

2. Vitamin D for the prevention of cancer

A large randomised controlled trial found that supplementation with vitamin D did not result in a lower incidence of invasive cancer or cardiovascular events compared to placebo. However, after excluding deaths within two years of randomisation there was a 25% reduction in deaths from cancer; (Manson et al, Jan 2019).

3. Aspirin for the primary prevention of cancer

There have been several publications on this subject over the past year. The primary endpoint of most aspirin studies is cardiovascular disease but data on cancer is also being collected. Results published over the last year cast doubt on aspirin’s role in cancer prevention. However, the results should be read considering that previous research found the effect of aspirin on cancer occurred more than 5 years after starting aspirin and not all studies have long term follow-up data. A major research project funded by CRUK and led by Queen Mary University is underway to understand the role of aspiring in cancer prevention better. Manuscripts on this topic published over the last year:

    • From the ASCEND Trial: i) a study in patients with Diabetes Mellitus found no difference between the aspirin group and the placebo group in the incidence of gastrointestinal tract cancer; (Bowman et al, Oct 2018)
    • From the ARRIVE Trial: i) a study of side effects in patients at moderate risk of cardiovascular disease and of bleeding found lower than expected side effect rate and no difference between the aspirin and the placebo group; (Gaziano et al, Sep 2018)
    • From the ASPREE Trial: i) Higher mortality, attributed to cancer-related deaths, was observed among healthy older adult in the aspirin group then in the placebo group; (McNeil, et al, Oct 2018). ii) two further analyses found that older adults in the aspirin group had higher risk of major bleeding with no significant lower risk of cardiovascular disease when compared to older adults on placebo. (MCNeil et al Oct 2018).
    • Finally a pooled analysis of several aspiring trials found that the effects of aspirin on sudden cardiac death and cancer showed dose–weight interactions, suggesting that a one-dose-fits-all strategy for daily aspirin is not optimal. (Rothwell et al, Jul 2018)

4. Aspirin to improve outcomes for patients with Barret’s oesophagus 

The AspECT trial published results suggesting that esomeprazole (a proton-pump inhibitor) and aspirin, especially in combination, improved outcomes in patients with Barrett’s oesophagus. (Jankowski et al, Jul 2018)

5. Cervical cancer control

Research published over the last year suggest elimination of cervical cancer is achievable.

    • Surveillance results from the National HPV Immunisation Programme in England report a decrease in prevalence of HPV infection over time since the start of the programme among 16-24 year old women; (Mesher et al, Jun 2018). Read more on our blog.
    • Surveillance of vaccinated women born in 1995 and 1996 in Scotland showed an 89% reduction (95% confidence interval 81% to 94%) in prevalent cervical intraepithelial neoplasia (CIN) grade 3 or worse disease compared to unvaccinated women born in 1988. (Palmer et al, Mar 2019).
    • Data modelling study suggests the impact of HPV vaccination and cervical screening makes elimination of cervical cancer achievable by the end of the century in 181 countries; (Simms et al, Feb 2019). Our thoughts on this here.
    • Evaluation of routine primary HPV screening, in England, confirmed increased detection of high-grade precancerous disease and cervical cancer, compared with liquid based cytology; (Rebolj et al, Feb 2019). Read more on our blog.

6. Smoking cessation

In a randomised controlled trial, E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy; (Hajek et al, Feb 2019). Read more on our blog.

7. Lung screening

Results of the NELSON trial were announced at ASCO in October 2018. Read more on our blog. Community based ‘Lung Health Check’ screening resulted in high rates of early stage lung cancer detection with minimisation of harms. (Crosbie, et al March 2019)

8. Artificial intelligence

Could this be the future? Researchers found that the average diagnostic performance (for melanoma detection) of 58 dermatologists was inferior to a deep learning convolutional neural networks (CNN). (Haenssle et al, Aug 2018)

9. Alcohol as a risk factor for cancer

A systematic analysis of alcohol use in 195 countries found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of alcohol consumption, and the level of consumption that minimises health loss is zero.  (Global Burden of Disease Study 2016 Alcohol Collaborators, Sep 2018).

Sir David Spiegelhalter was not impressed! To quote: “But claiming there is no ‘safe’ level does not seem an argument for abstention. There is no safe level of driving, but government do not recommend that people avoid driving.”

10. Analytic choices influence research results

Although not directly related to cancer prevention, this is a must read for researchers. A study involving 29 teams used the same data-set to address the same research questions. Surprisingly the teams produced a wide variety of results, leading author to conclude that significant variation in the results of analyses of complex data may be difficult to avoid. (Silberzahn et al, Aug 2018).  Commentary in blogs by Mad in America and The Health Care Blog.

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