̽��ֱ�� of Cambridge - screening

Safety screens

cjb250 — Wed, 03 Feb 2021 10:52:24 +0000

Since the start of October, a dedicated team drawn from across the ̽��ֱ�� and its Colleges has been running an innovate programme to screen its students for COVID-19. Getting it up and running in time may have been a Herculean task, but its success has been remarkable.

Early detection and treatment of type 2 diabetes may reduce heart disease and mortality

cjb250 — Mon, 18 May 2015 14:00:37 +0000

̽��ֱ��study, led by researchers at the ̽��ֱ�� of Michigan and the MRC Epidemiology Unit, ̽��ֱ�� of Cambridge, used data from the ADDITION-Europe study of diabetes screening and treatment, which it combined with a computer simulation model of diabetes progression. This revealed that screening followed by treatment led to a reduced risk of cardiovascular disease or death within a 5-year follow-up period when compared to patients having no screening.

̽��ֱ��ADDITION-Europe study enrolled people 40 to 69 years of age without known diabetes from 343 general practices in the United Kingdom, Denmark, and the Netherlands. ̽��ֱ��study had two objectives: firstly, to determine if routine screening for type 2 diabetes was feasible; secondly, to determine if early, intensive, treatment of high blood sugar and cardiovascular risk factors such as blood pressure, cholesterol status and smoking in those diagnosed with type 2 diabetes reduced the risk of events such as stroke, heart attack, angioplasty, heart bypass surgery, amputation and death.

̽��ֱ��researchers found that screening was feasible, but that intensive treatment did not yield statistically significant benefits over routine care, most likely because of the overall high quality of routine diabetes care delivered in general practice.

An important question is what impact screening followed by treatment has on the later health outcomes of people with undiagnosed type 2 diabetes, as previous research indicates that in Europe onset of the disease typically occurs six years before its clinical diagnosis. Because all participants in ADDITION-Europe were screened for type 2 diabetes at the start of the study, the researchers could not determine what difference would have been observed had screening and treatment for T2DM been compared with no screening, and therefore no treatment, until the time of eventual clinical diabetes diagnosis.

To answer this question the authors used the Michigan Model for Type 2 Diabetes, which simulates the progression of diabetes and its complications, co-morbidities, quality-of-life, and costs, and provides estimates of cardiovascular events and mortality.

In order to assess the impact of a delay in diagnosis and treatment for type 2 diabetes, the researchers simulated scenarios where screening did not take place and there was either a three-year or six-year delay before diagnosis, after which routine care was initiated.

At 10 years after baseline, the simulations predicted that with a delay of 3 years in diagnosis and treatment 22.4 % of those with type 2 diabetes would experience a cardiovascular disease event, such as stroke or heart bypass surgery, which rose to 25.9% with a delay of six years. However, if screening and routine care had been implemented, the simulation predicted only 18.4% would experience a cardiovascular disease event at 10 years after baseline. ̽��ֱ��simulated incidence of all-cause mortality was 16.4% with a delay of three years and 18.2% with a delay of six years, compared to 14.6% for screening and treatment.

This means that over 10 years, the model predicts that for people with undiagnosed type 2 diabetes, screening would be associated with a 29% reduction in relative risk of a cardiovascular disease event compared with a delay of six years in diagnosis and treatment. This amounts to a 7.5% reduction in the absolute risk of adverse cardiovascular outcome in this population. ̽��ֱ��comparable change in all-cause mortality was 20% relative risk and 3.6% absolute risk reduction.

Before they used the Michigan model to assess the impact of a delay in diagnosis and treatment for type 2 diabetes, the authors first evaluated its ability to predict the previous outcomes of ADDITION-Europe by simulating the impact of the intensive treatment and routine care on the composite cardiovascular outcome and all-cause mortality, and comparing these two scenarios. ̽��ֱ��results were similar to those of ADDITION-Europe, with little difference between the intensive treatment and routine care scenarios.

Professor William Herman of the ̽��ֱ�� of Michigan, first author on the paper, said: “Comparing the results of our simulations with the real-world data gave us confidence that our model successfully predicts the impact of delaying diagnosis of type 2 diabetes on future cardiovascular health outcomes.

“Diabetes can be debilitating for patients and costly for healthcare. This research shows that the early identification of diabetes has major health benefits, and supports the introduction of measures such as screening to reduce the time between development of type 2 diabetes and its treatment.”

Professor Nick Wareham, senior author on the paper and Director of the MRC Epidemiology Unit, ̽��ֱ�� of Cambridge, added: “This work shows the value of public health modelling to assess impacts and interventions for diseases such as type 2 diabetes that pose an increasing public health challenge.

“ADDITION-Europe is a large, high quality study, but even so there are limitations in how much direct clinical observation can tell us about the costs and benefits of screening. Computer simulations add an extra dimension which we hope will guide future research as well as the development of public health policy.”

̽��ֱ��authors caution that, even without a diabetes diagnosis, individuals might in the interim receive treatment for conditions such as blood pressure or cease smoking, so that the outcomes might be somewhat less pronounced than their model predicts. However, they note that the model assumes that, as in ADDITION-Europe, all participants were recruited from primary care, and were thus already receiving medical care, so this distortion is not expected to be large.

Reference
Herman, WH et al. Early detection and treatment of type 2 diabetes reduces cardiovascular morbidity and mortality: A simulation of the results of the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION-Europe). Diabetes Care (2015)

Screening to identify type 2 diabetes followed by early treatment could result in substantial health benefits, according to new research published today in Diabetes Care that combined large scale clinical observations and innovative computer modelling.

This work shows the value of public health modelling to assess impacts and interventions for diseases such as type 2 diabetes that pose an increasing public health challenge

Nick Wareham

Oskar Annermarken

Diabetes testing (crop)

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Genetic screening could improve breast cancer prevention

cjb250 — Wed, 08 Apr 2015 23:00:00 +0000

Improving the accuracy of risk analysis using genetic screening could guide breast cancer prevention in several ways – for instance by offering high-risk women increased monitoring, personalised advice and preventative therapies.

̽��ֱ��research, a collaboration of hundreds of research institutions led by the ̽��ֱ�� of Cambridge and the Institute of Cancer Research, London, showed that a test for differences in 77 separate letters of DNA code could indicate a woman’s risk of developing breast cancer.

̽��ֱ��study, the most definitive of its type conducted so far, was funded by a range of organisations including Cancer Research UK and Breakthrough Breast Cancer, and is published today in the Journal of the National Cancer Institute.

̽��ֱ��researchers came up with a ‘score’ for each woman based on the letters they had in each of the 77 positions of their DNA code, using one of the world’s biggest databases of genetic information – called the Collaborative Oncological Gene-Environment Study (COGS).

They found a significant link between the score – called a ‘polygenic risk score’ – and a woman’s breast cancer risk. For example, a woman in the top 20 per cent for polygenic risk score was 1.8 times more likely to develop breast cancer than the average woman.

A woman in the top one per cent for the polygenic risk score was more than three times more likely to develop breast cancer than average – corresponding to a risk for these women of around one in three.
̽��ֱ��researchers also delved into a range of other elements of each woman’s cancer – such as its type, and the age it was diagnosed. ̽��ֱ��genetic score was particularly good at predicting risk in women who developed oestrogen receptor positive disease, the type of disease most responsive to hormonal treatments such as tamoxifen.

Analysing this panel of 77 genetic markers – all of which had previously been linked with slight increases in breast cancer risk on their own – was much more accurate in defining risk than previous tests that used fewer markers.

Importantly, the study also suggests that using this genetic testing alongside current measures would make current risk screening methods more accurate. For example, the researchers showed that the risk score could predict breast cancer risk both in women with and without a family history of the disease.

Lifetime risk of breast cancer for women with a history of breast cancer in their close family was 24.4 per cent if they were in the highest-scoring fifth – compared with 8.6 per cent if they were in the lowest fifth.
But for women without a history of breast cancer in their close family, the risks were 16.6 and 5.2 per cent respectively.

Study co-leader Professor Montserrat Garcia-Closas, Professor of Epidemiology at the Institute of Cancer Research, London, said: “Our study is the most definitive so far to show the clear benefits of using genetic testing for a large number of genetic risk factors in identifying women at elevated risk of developing breast cancer. This type of testing could fit alongside other standard risk measures, such as family history and body mass index, to improve our ability to target the best preventive treatments and advice to those women most likely to benefit from them."

̽��ֱ��researchers say it is important to work out how this type of test could be used widely in a healthcare, rather than in a research setting. Currently available tests can analyse a handful of high-risk genes, but outside of looking for changes to these genes in women with a history of breast cancer in their close family, genetic testing is not widely offered to women.

Study co-leader Professor Douglas Easton, Director of the Centre for Cancer Genetic Epidemiology at the ̽��ֱ�� of Cambridge, said: “Breast cancer genes are rarely out of the news, but we’ve now reached a crucial stage at which all this research can be combined to help target screening and advice to those women who need them the most.

“There’s still work to be done to determine how tests like this could complement other risk factors, such as age, lifestyle and family history, but it’s a major step in the right direction that will hopefully see genetic risk prediction become part of routine breast screening in the years to come.”

Nell Barrie, Senior Science Communications Manager at Cancer Research UK, said: “This study shows how the genetic map of breast cancer that scientists have been building up over the years might be used to identify women most at risk, so we can take steps to reduce their chances of developing the disease or catch it at the earliest possible stage.”

Dr Matthew Lam, Senior Research Officer at Breakthrough Breast Cancer, said: “In recent years we’ve learnt so much about genetic risk factors of breast cancer – in fact Breakthrough researchers had a hand in discovering over 60 of the genetic markers associated with the disease. What’s great to see now is that these findings are starting to be translated into practical methods to predict risk on an individual basis.”

Adapted from a press release from the Institute of Cancer Research.

A test for a wide range of genetic risk factors could improve doctors’ ability to work out which women are at increased risk of developing breast cancer, a major study of more than 65,000 women has shown.

Breast cancer genes are rarely out of the news, but we’ve now reached a crucial stage at which all this research can be combined to help target screening and advice to those women who need them the most.

Doug Easton

Dr Steven Harmes. Baylor ̽��ֱ�� Medical Center, Dallas Texas

Color-enhancement show magnetic resonance image (MRI) of individual breast

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

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