The edition · Top Clinical Updates
Multicancer blood test did not reduce late-stage cancer in NHS-Galleri
The 142,000-person English trial found three annual rounds of a blood-based multicancer test did not lower stage III–IV diagnoses. Also: stopping beta-blockers years after MI, arthrodesis for hallux rigidus, parental B12 and birth defects, and a methaemoglobinaemia outbreak traced to a fuel additive.
The edition in brief
NHS-Galleri randomised 142,250 people aged 50 to 77 in England to have their blood tested with a multicancer early-detection test or stored. After three annual rounds, stage III or IV cancer across 12 cancer types was no less common with testing (incidence rate ratio 1.03, 95% CI 0.92 to 1.14). Stage IV cancer was 14% lower (0.86, 0.74 to 1.00), a secondary end point at the edge of significance. The test should not be offered as a screening tool outside trials. A pooled analysis of ABYSS and SMART-DECISION (6238 patients a median 3.6 years after MI, LVEF 40% or more, no heart failure) found stopping beta-blockers non-inferior to continuing for death, MI, stroke or cardiovascular hospitalisation (17.2% vs 15.9%, HR 1.09). A Finnish trial found first metatarsophalangeal arthrodesis cut walking pain by 5 points on a 10-point scale against watchful waiting at 12 months. A Shanghai cohort associated higher parental vitamin B12 before conception with fewer birth defects. In Italy, 82 migrants presented with severe methaemoglobinaemia after skin exposure to fuel-contaminated seawater; N-methylaniline, a petrol additive, was the cause, and two died.
NHS-Galleri: no fall in stage III–IV cancer after three rounds
Do not use a multicancer blood test for screening; the largest trial showed no fall in late-stage cancer.
Arthrodesis beats watchful waiting for painful hallux rigidus
Refer adults with hallux rigidus and persistent walking pain for arthrodesis rather than prolonged watchful waiting.
Parental vitamin B12 before conception and birth defects
Check and correct B12 deficiency in women planning pregnancy, especially vegetarians, while keeping folic acid standard.
Petrol additive behind severe methaemoglobinaemia in sea migrants
In cyanosis with saturations that do not rise on oxygen, check co-oximetry and ask about fuel or chemical skin exposure.
Reading 'no difference' in a screening trial
Judge any screening test by randomised effect on late-stage disease or death, not by how many cancers it detects.
Stopping beta-blockers years after MI with preserved LVEF
Review long-term beta-blockers after MI; stopping is reasonable when LVEF is 40% or more and there is no other indication.
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