Overdiagnosis and overtreatment of early detected prostate cancer

Early detection of prostate cancer is associated with the diagnosis of a considerable proportion of cancers that are indolent, and that will hardly ever become symptomatic during lifetime. Such overdiagnosis should be avoided in all forms of screening because of potential adverse psychological and somatic side effects. The main threat of overdiagnosis is overtreatment of indolent disease. Men with prostate cancer that is likely to be indolent may be offered active surveillance. Evaluation of active surveillance studies and validation of new biological parameters for risk assessment are expected

CANCER EPIDEMIOLOGY

Aim: The early diagnosis and treatment of lung cancer are important for the prognosis of patients with lung cancer. This study was undertaken to investigate patient and doctor delays in the diagnosis and treatment of NSCLC and the factors affecting these delays. Materials and methods: A total of 1016 patients, including 926 (91.1%) males and 90 (8.9%) females with a mean age of 61.5 +/- 10.1 years, were enrolled prospectively in this study between May 2010 and May 2011 from 17 sites in various Turkish provinces. Results: The patient delay was found to be 49.9 +/- 96.9 days, doctor delay was found to be 87.7 +/- 99.6 days, and total delay was found to be 131.3 +/- 135.2 days. The referral delay was found to be 61.6 +/- 127.2 days, diagnostic delay was found to be 20.4 +/- 44.5 days, and treatment delay was found to be 24.4 +/- 54.9 days. When the major factors responsible for these delays were examined, patient delay was found to be more frequent in workers, while referral delay was found to be more frequent in patients living in villages (p < 0.05). We determined that referral delay, doctor delay, and total delay increased as the number of doctors who were consulted by patients increased (p < 0.05). Additionally, we determined that diagnostic and treatment delays were more frequent at the early tumour stages in NSCLC patients (p < 0.05). Discussion: The extended length of patient delay underscores the necessity of educating people about lung cancer. To decrease doctor delay, education is a crucial first step. Additionally, to further reduce the diagnostic and treatment delays of chest specialists, multidisciplinary management and algorithms must be used regularly. (C) 2015 Elsevier Ltd. All rights reserved

Factors affecting patients&rsquo; comfort during fiberoptic bronchoscopy and endobronchial ultrasound

Fatma Yıldırım,1 Şevket &Ouml;zkaya,2 Ahmet Selim Yurdakul1 1Department of Pulmonary Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey; 2Department of Pulmonary Medicine, Faculty of Medicine, Bahcesehir University, Istanbul, Turkey Objective: This study investigated the factors that can affect the comfort of patients who underwent diagnostic fiberoptic bronchoscopy (FOB) and diagnostic endobronchial ultrasonography (EBUS) for the first time and the effect of the patients&rsquo; anxiety level on their comfort during the procedure. Materials and methods: We recorded the demographics of the patients, the medications they used previously, the anesthesia applied during the procedure, the experience of the operator, the insertion technique of the bronchoscope, the types of the bronchoscopic interventions during the procedure, the duration of the procedure, and the anxiety levels of the patients before the session. Patients&rsquo; discomfort level before and after the procedure and anxiety levels before the procedure were evaluated using a visual analog scale (VAS), and willingness for repeating FOB and EBUS was assessed using a questionnaire. Results: We found that longer examination time, higher anxiety level before the procedure, the nasal insertion of bronchoscope, and higher number of interventions are related to the increased discomfort during FOB and EBUS. Patients&rsquo; willingness for repeating FOB and EBUS increased as the level of discomfort decreased during the procedure. Conclusion: The patient&rsquo;s anxiety level should be determined using a questionnaire before the FOB and EBUS procedures, and the operator should adjust their procedure according to the patients&rsquo; anxiety level. Keywords: patient comfort, fiberoptic bronchoscopy, endobronchial ultrasound, patient anxiety, preprocedure questionnaire, patient willingnes

Tracheal Papilloma Treated with Cryotherapy and Interferon-α: A Case Report and Review of the Literature.

Tracheal papilloma (TP) is characterized by papillomatous growth of the bronchial epithelium that involves the trachea as a response to Human Papilloma Virus (HPV) infection. A 40-year-old male, with 3-month history of progressive dyspnea was admitted to our hospital, and there were no any other respiratory symptoms. Physical examination was unremarkable. Chest computed tomography (CT) showed that there was a papillomatous mass at the distal trachea. The lesion occupied 80% of tracheal lumen. This patient received cryotherapy and mechanical debridement under general anesthesia and postoperative pathology showed endotracheal papillomatosis. Patient was treated with interferon-α (IFN-α) and he showed no recurrence at the 8th month of his therapy