Many transplant recipients miss important cancer screenings
Tuesday, June 27, 2017
Routine cancer screenings are recommended for everyone, but a new study shows that most solid organ transplant recipients (SOTR) do not get cancer screenings as recommended. However, the involvement of a primary care provider or transplant specialist may help boost compliance with life-saving preventive screenings.
Solid organ transplants, which include kidney, liver, heart, lung, pancreas and intestine, have become increasingly common in the United States. Surgeons performed more than 18,000 kidney transplants in 2012, along with 6,781 liver transplants, 2,407 heart transplants, 1,795 lung transplants, 1,043 pancreas transplants and 106 intestine transplants.
SOTRs are at elevated risk for cancer due to immunosuppression and oncogenic viral infections. In 2011, a study published in JAMA evaluated the risk of cancer in a cohort of 175,732 SOTRs and found that kidney, liver, heart or lung transplant recipients have an increased risk for diverse infection-related and unrelated cancers.
A 2016 study published in JAMA Oncology shows the incidence of cancer death is 2.84 times higher than that of the general population, making cancer the second highest cause of death in SOTRs. In their conclusion, the authors of that study said advances in prevention and clinical surveillance were necessary to reduce the burden of cancer mortality in solid organ transplant recipients.
The American Cancer Society (ACS) issues guidelines for the early detection of cancer. They recommend all women ages 45 to 54 have annual mammograms and that women 55 and older can undergo breast cancer screening every two years. ACS recommends colorectal cancer screenings every five to 10 years, depending on the type of screening used, or fecal testing for cancer annually. Women under the age of 65 should undergo cervical cancer screening every three to five years.
Men and women who have other health considerations, including the receipt of a solid organ transplant, may require more frequent screening.
In the new study, published online in the American Journal of Transplantation, researchers from St. Michael's Hospital in Toronto wanted to determine how many SOTRs participated in these breast, cervical and colorectal cancer screening tests.
To find out, they assessed a population-based cohort of SORTs in Ontario between 1997 and 2010 for factors associated with screening. Of those included in the study, 4,436 SOTRs were eligible for colorectal cancer screening, 2,252 for cervical cancer screening and 1,551 were eligible for breast cancer screening.
During the observation period, the investigators found that 77.5 percent of SOTRs were not up to date for colorectal cancer screening, 69.8 percent were behind on cervical cancer screenings and 91.4 percent of transplant recipients were late for breast cancer screening. SOTRs with fewer comorbidities were more likely to be up to date.
The study did have at least one limitation, however, in that the data did not allow the researchers to differentiate between preventive and diagnostic screenings.
The research results showed an association between assessment by a primary care provider (PCP) and becoming current with cancer screening. Continuity of care provided by a transplant specialist also boosted screening compliance.
"Cancer screening for most SOTR does not adhere to standard recommendations," the authors write. "Involvement of PCPs in post-transplant care and continuity of care at a transplant center may improve the uptake of screening."
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