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Rui Fu, Rinku Sutradhar, Qing Li, Timothy P. Hanna, Kelvin K.W. Chan, Jonathan C. Irish, Natalie Coburn, Julie Hallet, Anna Dare, Simron Singh, Ambica Parmar, Craig C. Earle, Lauren Lapointe-Shaw, Monika K. Krzyzanowska, Antonio Finelli, Alexander V. Louie, Nicole J. Look Hong, Ian J. Witterick, Alyson Mahar, David Gomez, Daniel I. McIsaac, Danny Enepekides, David R. Urbach, and Antoine Eskander

care, has been disrupted. Notably, cancer detection has declined dramatically. 1 Cancer types that depend heavily on routine screening for early detection were most impacted, because screening programs were suspended for months. 2 Delayed cancer

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Antoine Eskander, Qing Li, Jiayue Yu, Julie Hallet, Natalie G. Coburn, Anna Dare, Kelvin K.W. Chan, Simron Singh, Ambica Parmar, Craig C. Earle, Lauren Lapointe-Shaw, Monika K. Krzyzanowska, Timothy P. Hanna, Antonio Finelli, Alexander V. Louie, Nicole Look Hong, Jonathan C. Irish, Ian J. Witterick, Alyson Mahar, Christopher W. Noel, David R. Urbach, Daniel I. McIsaac, Danny Enepekides, and Rinku Sutradhar

. Local guidelines help shape the narrative around this prioritization, particularly regarding surgical case prioritization. 29 – 33 Fortunately, cancer detection did not differ on any sociodemographic factors. Future granular work looking at staging data

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Stephanie K. Patterson and Mitra Noroozian

mammography ranged between 0.27% and 0.47%. 44 – 47 Since then, an additional 12,202 patients with dense breasts have been evaluated with ultrasound, with similar cancer detection rates. 48 – 50 The ACRIN 6666 trial is the largest trial of screening

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Michelle L. McDonald and J. Kellogg Parsons

detection toward younger populations Explain how biomarkers and imaging studies might improve the specificity of prostate cancer detection Overview Prostate cancer remains the most commonly diagnosed noncutaneous cancer and the second leading

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Badar M. Mian

of a multicenter clinical trial of 6,630 men . J Urol 1994 ; 151 : 1283 – 1290 . 5 Chang JJ Shinohara K Bhargava V . Prospective evaluation of lateral biopsies of the peripheral zone for prostate cancer detection . J Urol 1998 ; 160

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Brady J. McKee, Shawn Regis, Andrea K. Borondy-Kitts, Jeffrey A. Hashim, Robert J. French Jr, Christoph Wald, and Andrea B. McKee

included in this analysis. Variables assessed included cancer detection rate (CDR), positive predictive value (PPV), suspicious predictive value (SPV), rate of infectious/inflammatory findings, rate of significant incidental findings, and false

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Christine M. Coticchia, Jiang Yang, and Marsha A. Moses

and posttranslationally modified forms of transthyretin as biomarkers for ovarian cancer detection in an independent study population . Cancer Epidemiol Biomarkers Prev 2006 ; 15 : 1641 – 1646 . 73. Gortzak-Uzan L Ignatchenko A Evangelou

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Stephanie K. Patterson

Large, randomized controlled trials have proven the efficacy of mammography in reducing breast cancer mortality. However, the known deficiencies of mammography have led to the development of new technologies. Magnetic resonance imaging (MRI), digital mammography, computer-assisted diagnosis, positron-emission tomography (PET), technetium 99m sestamibi, and expanding roles for breast ultrasound have been explored as tools in breast cancer detection and evaluation. This article discusses these modalities and their current uses.

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Constance D. Lehman, Wendy DeMartini, Benjamin O. Anderson, and Stephen B. Edge

Edited by Kerrin G. Robinson

Use of breast MRI in the preoperative evaluation of patients recently diagnosed with breast cancer has increased significantly over the past 10 years because of its well-documented high sensitivity for detecting otherwise occult breast cancer in the affected and contralateral breasts. However, published research reports on the impact of this improved cancer detection are limited. Equally important are growing concerns that the quality of breast MRI may vary significantly across practice sites, and therefore the published value of MRI may not be achieved for many patients. This article describes the peer-reviewed, published clinical research trials evaluating breast MRI in patients with newly diagnosed breast cancer on which the National Comprehensive Cancer Network (NCCN) practice guidelines are based. The current NCCN guidelines recommend that breast MRI be considered for patients with a newly diagnosed breast cancer to evaluate the extent of ipsilateral disease and to screen the contralateral breast, particularly for women at increased risk for mammographically occult disease. In addition, the guidelines indicate that breast MRI may be used for patients with axillary nodal adenocarcinoma to identify the primary malignancy. The guidelines stress the importance of having proper equipment, imaging technique, and provider training necessary to achieve high-quality breast MRI, and emphasize that MRI practice sites should have the ability to perform MRI-guided biopsy or needle localization. In addition to describing the data regarding use of breast MRI in women with newly diagnosed cancer, this article provides recommendations for the performance of high-quality breast MRI and suggestions for future research.

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Robert W. Carlson, Jonathan K. Larsen, Joan McClure, C. Lyn Fitzgerald, Alan P. Venook, Al B. Benson III, and Benjamin O. Anderson

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) are evidence- and consensus-based clinical practice guidelines addressing malignancies that affect more than 97% of all patients with cancer in the United States. The NCCN Guidelines are used extensively in the United States and globally. Use of the guidelines outside the United States has driven the need to adapt the guidelines based on local, regional, or national resources. The NCCN Guidelines Panels created, vetted, and continually update the NCCN Guidelines based on published scientific data on cancer detection, diagnosis, and treatment efficacy. The guidelines are developed within the context of commonly available resources, methods of payment, societal and cultural expectations, and governmental regulations as they exist in the United States. Although many of the cancer management recommendations contained in the NCCN Guidelines apply broadly from a global perspective, not all do. Disparities in availability and access to health care exist among countries, within countries, and among different social groups in the same country, especially regarding resources for cancer prevention, early detection, and treatment. In addition, different drug approval and payment processes result in regional variation in availability of and access to cancer treatment, especially highly expensive agents and radiation therapy. Differences in cancer risk, predictive biomarker expression, and pharmacogenetics exist across ethnic and racial groups, and therefore across geographic locations. Cultural and societal expectations and requirements may also require modification of NCCN Guidelines for use outside the United States. This article describes the adaptation process, using the recent Latin American adaptation of the 2013 NCCN Guidelines for Colorectal Cancer as an example.