Publications by authors named "Skates S"

Background: The ovarian cancer (OC) preclinical detectable phase (PCDP), defined as the interval during which cancer is detectable prior to clinical diagnosis, remains poorly characterised. We report exploratory analyses from the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS).

Methods: In UKCTOCS between Apr-2001 and Sep-2005, 101,314 postmenopausal women were randomised to no screening (NS) and 50,625 to annual multimodal screening (MMS) (until Dec-2011) using serum CA-125 interpreted by the Risk of Ovarian Cancer Algorithm (ROCA).

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  • Annual low-dose CT scans can detect early-stage lung tumors in smokers and lower cancer death rates by 20%, but many eligible patients don’t get screened.
  • Mazzone and his team have developed a blood test that analyzes cfDNA to identify individuals who might benefit from further CT imaging.
  • This pre-screening approach aims to improve screening rates and focus resources on those at higher risk for lung cancer.
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Purpose: Sybil is a validated publicly available deep learning-based algorithm that can accurately predict lung cancer risk from a single low-dose computed tomography (LDCT) scan. We aimed to study the effect of image reconstruction parameters and CT scanner manufacturer on Sybil's performance.

Materials And Methods: Using LDCTs of a subset of the National Lung Screening Trial participants, which we previously used for internal validation of the Sybil algorithm (test set), we ran the Sybil algorithm on LDCT series pairs matched on kilovoltage peak, milliampere-seconds, reconstruction interval, reconstruction diameter, and either reconstruction filter or axial slice thickness.

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  • - The Mercy Halo Ovarian Cancer Test (OC Test) is a new screening method that detects ovarian cancer by analyzing proteins found on tumor-associated extracellular vesicles in blood, aiming for both high sensitivity and specificity.
  • - In a study involving 397 women, the OC Test showed impressive results: 97% specificity and sensitivity for high-grade serous carcinoma (HGSC), and it also identified 73.5% of non-HGSC ovarian cancer cases.
  • - Compared to the conventional cancer antigen 125, the OC Test resulted in fewer false positives among patients with non-cancerous conditions, indicating its potential for effective ovarian cancer screening.
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Background: Ovarian cancer remains the deadliest of the gynecologic cancers in the United States. There have been limited advances in treatment strategies that have seen marked increases in overall survival. Thus, it is essential to continue developing and validating new treatment strategies and markers to identify patients who would benefit from the new strategy.

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Background: Multiple antigens, autoantibodies (AAb), and antigen-autoantibody (Ag-AAb) complexes were compared for their ability to complement CA125 for early detection of ovarian cancer.

Methods: Twenty six biomarkers were measured in a single panel of sera from women with early stage (I-II) ovarian cancers (n = 64), late stage (III-IV) ovarian cancers (186), benign pelvic masses (200) and from healthy controls (502), and then split randomly (50:50) into a training set to identify the most promising classifier and a validation set to compare its performance to CA125 alone.

Results: Eight biomarkers detected ≥ 8% of early stage cases at 98% specificity.

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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).

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  • The UKCTOCS study aimed to explore the symptoms of preclinical invasive epithelial ovarian cancer (iEOC) in women, particularly by comparing symptoms between those diagnosed through screening (PC) and those diagnosed clinically (CD).
  • Out of 1133 women diagnosed with iEOC, those in the PC group were younger at diagnosis and reported fewer symptoms overall compared to the CD group, although abdominal symptoms were common in both groups.
  • The research suggests that early signs of tubo-ovarian cancer might be more complex than previously thought, highlighting the need to reassess what symptoms should trigger medical evaluation for better early detection.
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Abstract: Randomised controlled trials are challenging to deliver. There is a constant need to review and refine recruitment and implementation strategies if they are to be completed on time and within budget. We present the strategies adopted in the United Kingdom Collaborative Trial of Ovarian Cancer Screening, one of the largest individually randomised controlled trials in the world.

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The emerging field of liquid biopsy stands at the forefront of novel diagnostic strategies for cancer and other diseases. Liquid biopsy allows minimally invasive molecular characterization of cancers for diagnosis, patient stratification to therapy, and longitudinal monitoring. Liquid biopsy strategies include detection and monitoring of circulating tumor cells, cell-free DNA, and extracellular vesicles.

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  • * The LINE-1 ORF1p protein is overexpressed in various cancers and has negligible expression in normal tissues, indicating its potential as a highly specific blood-based cancer biomarker.
  • * Advanced digital immunoassays can detect low levels of ORF1p in plasma, showing promise for early detection of ovarian cancer and monitoring treatment responses in gastroesophageal cancers, suggesting it could be a valuable tool for cancer diagnosis and prognosis.
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Background: In UKCTOCS, there was a decrease in the diagnosis of advanced stage tubo-ovarian cancer but no reduction in deaths in the multimodal screening group compared with the no screening group. Therefore, we did exploratory analyses of patients with high-grade serous ovarian cancer to understand the reason for the discrepancy.

Methods: UKCTOCS was a 13-centre randomised controlled trial of screening postmenopausal women from the general population, aged 50-74 years, with intact ovaries.

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Background: Ovarian and tubal cancers are lethal gynaecological cancers, with over 50% of the patients diagnosed at advanced stage.

Trial Design: Randomised controlled trial involving 27 primary care trusts adjacent to 13 trial centres based at NHS Trusts in England, Wales and Northern Ireland.

Methods: Postmenopausal average-risk women, aged 50-74, with intact ovaries and no previous ovarian or current non-ovarian cancer.

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  • * The Long INterspersed Element-1 (LINE-1) open reading frame 1 protein (ORF1p) is found to be overexpressed in various cancers but not in normal tissues, highlighting its potential as a specific cancer biomarker.
  • * Researchers have developed highly sensitive digital immunoassays to detect ORF1p in blood samples, showing promise for early detection of ovarian cancer and improved monitoring of gastric and esophageal cancers, positioning it as a valuable multi-cancer biomarker.
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Long interspersed element 1 (LINE-1) open reading frame 1 protein (ORF1p) expression is a common feature of many cancer types, including high-grade serous ovarian carcinoma (HGSOC). Here, we report that ORF1p is not only expressed but also released by ovarian cancer and primary tumor cells. Immuno-multiple reaction monitoring-mass spectrometry assays showed that released ORF1p is confidently detectable in conditioned media, ascites, and patients' plasma, implicating ORF1p as a potential biomarker.

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Background: Our study aimed to establish 'real-world' performance and cost-effectiveness of ovarian cancer (OC) surveillance in women with pathogenic germline variants who defer risk-reducing bilateral salpingo-oophorectomy (RRSO).

Methods: Our study recruited 875 female -heterozygotes at 13 UK centres and via an online media campaign, with 767 undergoing at least one 4-monthly surveillance test with the Risk of Ovarian Cancer Algorithm (ROCA) test. Surveillance performance was calculated with modelling of occult cancers detected at RRSO.

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Despite advances in proteomic technologies, clinical translation of plasma biomarkers remains low, partly due to a major bottleneck between the discovery of candidate biomarkers and costly clinical validation studies. Due to a dearth of multiplexable assays, generally only a few candidate biomarkers are tested, and the validation success rate is accordingly low. Previously, mass spectrometry-based approaches have been used to fill this gap but feature poor quantitative performance and were generally limited to hundreds of proteins.

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More than 75% of cancer-related deaths occur from cancers for which we do not screen. New screening liquid biopsies may help fill these clinical gaps, although evidence of benefit still needs to be assessed. Which lessons can we learn from previous efforts to guide those of the future? Screening trials for ovarian, prostate, pancreatic, and esophageal cancers are revisited to assess the evidence, which has been limited by small effect sizes, short duration of early-stage disease relative to screening frequency, study design, and confounding factors.

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Background: The measurement of serum HE4 levels has emerged as a sensitive and specific biomarker for epithelial ovarian cancers (EOCs). However, serum levels in women diagnosed with various histologic subtypes of EOC and in women with metastatic non-ovarian primary malignancies have not been widely reported.

Objective: The goal of this study was to identify how serum HE4 levels vary in women diagnosed with different histologic subtypes of EOC and non-ovarian malignancies.

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Since March 2020, the United States has lost over 580,000 lives to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19. A growing body of literature describes population-level SARS-CoV-2 exposure, but studies of antibody seroprevalence within school systems are critically lacking, hampering evidence-based discussions on school reopenings. The Lake Central School Corporation (LCSC), a public school system in suburban Indiana, USA, assessed SARS-CoV-2 seroprevalence in its staff and identified correlations between seropositivity and subjective histories and demographics.

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  • Ovarian cancer remains a serious health issue, particularly for postmenopausal women; the UKCTOCS trial was initiated to evaluate if screening could lower mortality rates associated with the disease.
  • The study involved over 202,000 postmenopausal women who were randomly assigned to one of three groups: multimodal screening, transvaginal ultrasound screening, or no screening, and data was collected over a median follow-up period of 16.3 years.
  • Results showed that the detection rates of ovarian and tubal cancer were similar across all groups, indicating that neither type of screening significantly impacted the mortality from these cancers.
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  • Randomized trials for ovarian cancer screening haven't shown a reduction in mortality, but they provide useful data on screening effectiveness.
  • In the UKCTOCS trial, 44,799 women were screened annually with transvaginal ultrasound over nearly a decade, leading to 280,534 screenings and 960 surgeries from positive results.
  • Out of detected cancers, 37.5% of invasive epithelial cases were at Stage I/II, but the overall sensitivity of the ultrasound was low (68.5%) suggesting it may not be effective as a first line screening method in the general population.
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  • The study revisits the analysis methods for long-term mortality outcomes in a cancer screening trial, due to advancements in statistical methods and new evidence regarding delayed effects.
  • In consultation with experts, three analysis options were considered, with most advocating for a new method that accounts for delayed mortality effects.
  • The final decision was to use the Versatile test for better accuracy, highlighting the need for improved consensus on mortality outcome reporting in cancer trials.
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