In 1998, the American Heart Association convened Prevention Conference V to examine strategies for the identification of high-risk patients who need primary prevention. Among the strategies discussed was the measurement of markers of inflammation.1 The Conference concluded that “many of these markers (including inflammatory markers) are not yet considered applicable for routine risk assessment because of: (1) lack of measurement standardization, (2) lack of consistency in epidemiological findings from prospective studies with endpoints, and (3) lack of evidence that the novel marker adds to risk prediction over and above that already achievable through the use of established risk factors.” The National Cholesterol Education Program Adult Treatment Panel III Guidelines identified these markers as emerging risk factors,1a which could be used as an optional risk factor measurement to adjust estimates of absolute risk obtained using standard risk factors. Since these publications, a large number of peer-reviewed scientific reports have been published relating inflammatory markers to cardiovascular disease (CVD). Several commercial assays for inflammatory markers have become available. As a consequence of the expanding research base and availability of assays, the number of inflammatory marker tests ordered by clinicians for CVD risk prediction has grown rapidly. Despite this, there has been no consensus from professional societies or governmental agencies as to how these assays of markers of inflammation should be used in clinical practice.

On March 14 and 15, 2002, a workshop titled “CDC/AHA Workshop on Inflammatory Markers and Cardiovascular Disease: Applications to Clinical and Public Health Practice” was convened in Atlanta, Ga, to address these issues. The goals of this workshop were to determine which of the currently available tests should be used; what results should be used to define high risk; which patients should be tested; and the indications for which the tests would be most useful. These …

Markers of Inflammation and Cardiovascular Disease Application to Clinical and Public Health Practice: A Statement for Healthcare Professionals From the Centers for Disease Control and Prevention and the American Heart Association

Medical practice is constantly changing. The rate of change is accelerating, and physicians can be forgiven if they often find it dizzying. How can physicians learn about new information and innovations, and decide how (if at all) they should modify their practice? Possible sources include summaries from the medical literature (review articles, practice guidelines, consensus statements, editorials, and summary articles in "throwaway" journals); consultation with colleagues who have special expertise; lectures; seminars; advertisements in medical journals; conversations with representatives from pharmaceutical companies; and original articles in journals and journal supplements. Each of these sources of information might be valuable, though each is subject to its own particular biases. 1,2 Problems arise when, as is often the case, these sources of information provide different suggestions about patient care. See also p 2093. Without a way of critically appraising the information they receive, clinicians are relatively helpless in deciding what new information

https://hopkinsmedicine.org/gim/_pdf/jama/17-screening.pdf

Users' Guides to the Medical Literature

Worldwide, some 240 million people have chronic hepatitis B virus (HBV), with the highest rates of infection in Africa and Asia. Our understanding of the natural history of HBV infection and the potential for therapy of the resultant disease is continuously improving. New data have become available since the previous APASL guidelines for management of HBV infection were published in 2012. The objective of this manuscript is to update the recommendations for the optimal management of chronic HBV infection. The 2015 guidelines were developed by a panel of Asian experts chosen by the APASL. The clinical practice guidelines are based on evidence from existing publications or, if evidence was unavailable, on the experts' personal experience and opinion after deliberations. Manuscripts and abstracts of important meetings published through January 2015 have been evaluated. This guideline covers the full spectrum of care of patients infected with hepatitis B, including new terminology, natural history, screening, vaccination, counseling, diagnosis, assessment of the stage of liver disease, the indications, timing, choice and duration of single or combination of antiviral drugs, screening for HCC, management in special situations like childhood, pregnancy, coinfections, renal impairment and pre- and post-liver transplant, and policy guidelines. However, areas of uncertainty still exist, and clinicians, patients, and public health authorities must therefore continue to make choices on the basis of the evolving evidence. The final clinical practice guidelines and recommendations are presented here, along with the relevant background information.

/pdf/asian-pacific-clinical-practice-guidelines-on-the-management-za5qxgu5i6.pdf

Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update.

This article summarizes the phenomenon of cancer overdiagnosis—the diagnosis of a “cancer” that would otherwise not go on to cause symptoms or death. We describe the two prerequisites for cancer overdiagnosis to occur: the existence of a silent disease reservoir and activities leading to its detection (particularly cancer screening). We estimated the magnitude of overdiagnosis from randomized trials: about 25% of mammographically detected breast cancers, 50% of chest x-ray and/or sputum-detected lung cancers, and 60% of prostate-specific antigen–detected prostate cancers. We also review data from observational studies and population-based cancer statistics suggesting overdiagnosis in computed tomography–detected lung cancer, neuroblastoma, thyroid cancer, melanoma, and kidney cancer. To address the problem, patients must be adequately informed of the nature and the magnitude of the trade-off involved with early cancer detection. Equally important, researchers need to work to develop better estimates of the magnitude of overdiagnosis and develop clinical strategies to help minimize it.

Overdiagnosis in Cancer

The fourth edition of the European guidelines for quality assurance in breast cancer screening and diagnosis was published by the European Commission in 2006. The present supplements to the fourth edition have been produced by the same groups of experts originally established under the Europe Against Cancer programme that have developed and updated the guidelines since the early 1990s. Over the years, the scope and the depth of the multidisciplinary guidelines have expanded, and recommendations and protocols have been updated to keep pace with developments in the field. The present supplements lay a cornerstone for a new, completely revised fifth edition of the guidelines

/pdf/european-guidelines-for-quality-assurance-in-breast-cancer-34igkumbby.pdf

European guidelines for quality assurance in breast cancer screening and diagnosis

1. How screening started 2. What screening is, and is not 3. What screening does 4. Measuring what screening does 5. Implementing screening 6. Quality assuring screening programmes 7. Day to day management of screening for public health practitioners and programme managers 8. Making screening policy

Screening: Evidence and Practice

CLINICAL SCENARIO You are a family physician seeing a 47year-old woman and her husband of the same age. They are concerned because a friend recently found out that she had bowel cancer and has urged them both to undergo screening with fecal occult blood tests (FOBTs) because, she says, prevention is much better than the cure she is now undergoing. Both your patients have no family history of bowel cancer and no change in bowel habit. They ask whether you agree that they should be screened. You know that trials of FOBT screening have demonstrated that screening can reduce mortality from colorectal cancer (CRC), but you also recall that FOBTs can have a high false-positive rate that then requires investigation by colonoscopy. You are unsure whether screening these relatively young, asymptomatic people at average risk of bowel cancer is likely to do more good than harm. You decide to check the literature to see if there are any guidelines or recommendations about screening for CRC that might help you.

Users' guides to the medical literature. XVII. How to use guidelines and recommendations about screening

Objective: To determine the frequency of different outcomes in women participating in cervical screening Design: Analysis of screening records from 348 419 women, and modelling of cases of cervical cancer and deaths with and without screening Setting: Cervical screening programme in Bristol Results: For every 10 000 women screened from 1976 to 1996, 1564 had abnormal cytology, 818 were investigated, and 543 had abnormal histology One hundred and seventy six had persistent abnormality for two years or more In the absence of screening 80 women would be expected to develop cancer of the cervix by 2011, of whom 25 would die With screening 10 of these deaths would be avoided Comparison of cumulative abnormality rates with numbers expected to develop cancer in the absence of screening suggests that at least 80% of high grade dyskaryosis and of high grade dysplasia would not progress to cancer The lifetime risk of having abnormal cytology detected could be as high as 40% for women born since 1960 Conclusions: Screening is labour and resource intensive It involves treatment for many women not destined to develop invasive cancer The increased intervention rate for cervical abnormality in England is due to change in practice, not a cohort effect, and is probably the reason for the marked fall in incidence and mortality during the 1990s For other cancers there is scope for major iatrogenic harm from screening because of invasive tests and treatments What is already known on this topic Since the mid-1980s incidence of and mortality from cervical cancer in women born since the 1930s in England and Wales has fallen; screening is the most likely explanation For each death prevented many women have to be screened and many are treated who would not have developed a problem What this study adds In the NHS cervical screening programme around 1000 women need to be screened for 35 years to prevent one death Over 80% of women with high grade cervical intraepithelial neoplasia will not develop invasive cancer, but all need to be treated For each death prevented, over 150 women have an abnormal result, over 80 are referred for investigation, and over 50 have treatment Before the 1988 relaunch of screening with strict quality standards, for each death prevented there were 57 000 tests and 1955 women had abnormal results

https://www.bmj.com/content/bmj/326/7395/901.full.pdf

Outcomes of screening to prevent cancer: analysis of cumulative incidence of cervical abnormality and modelling of cases and deaths prevented

Detection rates for abnormal cervical smears: what are we screening for?

People testing negative must stick to infection control recommendations

https://www.bmj.com/content/bmj/371/bmj.m4787.full.pdf

Angela E Raffle

Papers

Screening: Evidence and Practice

Users' guides to the medical literature. XVII. How to use guidelines and recommendations about screening

Outcomes of screening to prevent cancer: analysis of cumulative incidence of cervical abnormality and modelling of cases and deaths prevented

Detection rates for abnormal cervical smears: what are we screening for?

Lateral flow tests cannot rule out SARS-CoV-2 infection.