A novel cancer prevention clinic established in Tel Aviv, Israel, in 2006 has proved feasible and successful for detecting a wide range of neoplastic lesions at an early stage, according to prospectively collected outcomes data.
The findings provide proof of concept for a “one-stop-shop” approach to cancer screening in a multidisciplinary outpatient setting, the authors said, adding that the approach has the potential to reduce morbidity and mortality and provide substantial cost savings.
The findings were published online January 20 in the Journal of Clinical Oncology.
The Integrated Cancer Prevention Center (ICPC) at the Tel Aviv Medical Center screened 8618 men and 8486 women between January 2006 and December 2019.
“By performing all the screening tests in one place and at one time (except for colonoscopy), patients avoid multiple appointments and by definition, participate in all screenings,” they add, noting that patient satisfaction was rated 8.35 on a 1-10 scale.
Study participants were self-referred asymptomatic individuals aged 20-80 years, with a mean age of 47 years at first visit to the ICPC. There, in a single visit, they received all cancer screenings currently recommended by the US Preventive Services Task Force, including breast, colon, cervical, and lung cancer, as well as some of the most common cancers including skin, ovarian, uterine, thyroid, cervical, testicular, oropharyngeal, and prostate cancer.
In total, 259 new malignant lesions were detected in 251 individuals.
Of these, 49 (19.8%) were stage 0, 113 (45.6%) were stage I, another 30 (12.1%) were stage II, while 25 (10.1%) were stage III, and 31 (12.5%) were stage IV.
Most of the cancers (74.5%) were diagnosed after the first visit, and 25.5% were diagnosed after subsequent visits. Seventeen cancers were missed, but only six of those were cancers for which the ICPC performs tests, the investigators note.
When compared with the Israeli general public based on national registry data, fewer cancers were detected at a metastatic stage among patients who visited the ICPC for screening, notes lead author Ezra Bernstein, MD, and colleagues.
For example, none of the breast cancers detected at the ICPC were metastatic at the time of detection vs 3.7% of those in the Israeli registry. The corresponding percentages were 6.7% vs 11.4% for lung cancer, 20.0% vs 46.2% for colon cancer, 5.6% v 10.5% for prostate cancer, and 0 vs. 8.5% for cervical/uterine cancers.
The team also compared their data with that from the United States general population. When compared with the average stage of detection in the US, detection was earlier — at stages 0-II — for breast (72.5% vs 67.1%), lung (86.7% vs 49.3%), prostate (91.7% vs 90.9%), and cervical/uterine (92.8% vs 86.4%).
“The only cancer not detected at earlier stages at the ICPC compared with the US registry was colon cancer (50% v 77.3%),” the investigators write. They speculate that “[t]his might be due to the fact that screening for colorectal cancer in the United States has been increasing, with almost 70% of 50-75 year olds being up to date with their colon cancer screening,” whereas in Israel, colon cancer screening is not as widely accepted and is most often performed using fecal immunochemical tests.
The authors comment that “although many patients get recommended screenings through their primary care provider, compliance with screening guidelines remains a major obstacle to early detection and cancer prevention.”
“An integrative one-stop-shop program such as the ICPC reduces patient barriers such as time and cost,” they point out.
“Initial participation in a program such as the ICPC needs to be encouraged through initiatives that promote the awareness and advantages of comprehensive cancer screening — removing barriers that influence cancer screening behavior such as screening cost, availability of sufficient health care facilities, and time requirements,” they comment.
“Participation can also be aided through health care legislation and insurance coverage, which could ease other barriers to screening,” they add.
The study had no specific funding. Bernstein reports no relevant financial relationships. Several co-authors have disclosed relationships with industry. The full list can be found with the original article.
J Clin Oncol. Published online January 20, 2023. Abstract
Sharon Worcester, MA, is an award-winning medical journalist based in Birmingham, Alabama, writing for Medscape, MDedge and other affiliate sites. She currently covers oncology, but she has also written on a variety of other medical specialties and healthcare topics. She can be reached at [email protected] or on Twitter: @SW_MedReporter
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