Showing papers in "Journal of Medical Screening in 2010"

Absolute numbers of lives saved and overdiagnosis in breast cancer screening, from a randomized trial and from the Breast Screening Programme in England

Abstract: Setting The Swedish Two-County randomized trial of mammographic screening for breast cancer, and the UK Breast Screening Programme in England, ages 50-69 years. Methods We estimated the absolute numbers of deaths avoided and additional cases diagnosed in the study group (active study population) of the Swedish Two-County Trial, by comparison with the control group (passive study population). We estimated the same quantities for the mortality and incidence rates in England (1974-2004 and 1974-2003, respectively). We used Poisson regression for statistical inference. Results A substantial and significant reduction in breast cancer mortality was associated with screening in both the Two-County Trial (P , 0.001) and the screening programme in England (P , 0.001). The absolute benefits were estimated as 8.8 and 5.7 breast cancer deaths prevented per 1000 women screened for 20 years starting at age 50 from the Two-County Trial and screening programme in England, respectively. The corresponding estimated numbers of cases overdiagnosed per 1000 women screened for 20 years were, respectively, 4.3 and 2.3 per 1000. Conclusions The benefit of mammographic screening in terms of lives saved is greater in absolute terms than the harm in terms of overdiagnosis. Between 2 and 2.5 lives are saved for every overdiagnosed case.

Breast and cervical cancer screening programme implementation in 16 countries.

Abstract: Objectives There is a continuing need to monitor and evaluate the impact of organized screening programmes on cancer incidence and mortality. We report results from a programme assessment conducted within the International Cancer Screening Network (ICSN) to understand the characteristics of cervical screening programmes within countries that have established population- based breast cancer screening programmes. Methods In 2007-2008, we asked 26 ICSN country representatives to complete a web-based survey that included questions on breast and cervical cancer screening programmes. We summarized information from 16 countries with both types of organized programmes. Results In 63% of these countries, the organization of the cervical cancer screening programme was similar to that of the breast cancer screening programme in the same country. There were differences in programme characteristics, including year established (1962-2003 cervical; 1986-2002 breast) and ages covered (15-70þ cervical; 40-75þ breast). Adoption of new screening technologies was evident (44% liquid-based Pap tests; 13% human papillomavirus (HPV)-triage tests cervical; 56% digital mammography breast). There was wide variation in participation rates for both programme types (,4-80% cervical; 12-88% breast), and participation rates tended to be higher for cervical (70-80%) than for breast (60-70%) cancer screening programmes. Eleven ICSN member countries had approved the HPV vaccine and five more were considering its use in their organized programmes. Conclusion Overall, there were similarities and differences in the organization of breast and cervical cancer screening programmes among ICSN countries. This assessment can assist established and new screening programmes in understanding the organization and structure of cancer screening programmes.

Effect of gender, age and deprivation on key performance indicators in a FOBT-based colorectal screening programme

Abstract: ObjectivesTo assess the effect of gender, age and deprivation on key performance indicators in a colorectal cancer screening programme.SettingBetween March 2000 and May 2006 a demonstration pilot of biennial guaiac faecal occult blood test (gFOBT) colorectal screening was carried out in North-East Scotland for all individuals aged 50-69 years.MethodsThe relevant populations were subdivided, by gender, into four age groups and into five deprivation categories according to the Scottish Index of Multiple Deprivation (SIMD), and key performance indicators analysed within these groups.ResultsIn all rounds, uptake of the gFOBT increased with age (P < 0.001), decreased with increasing deprivation in both genders (P < 0.001), and was consistently higher in women than in men in all age and all SIMD groups. In addition, increasing deprivation was negatively associated with uptake of colonoscopy in men with a positive gFOBT (P < 0.001) although this effect was not observed in women. Positivity rates increased with a...

Endorsement by the primary care practitioner consistently improves participation in screening for colorectal cancer: a longitudinal analysis.

Abstract: ObjectivesTo investigate the effect of general practice (GP) and general practitioner (GPR) endorsement for faecal occult blood test (FOBT)-based screening on maintenance of participation in screen...

Eurocat Website Data on Prenatal Detection Rates of Congenital Anomalies

Abstract: The EUROCAT website www.eurocat-network.eu publishes prenatal detection rates for major congenital anomalies using data from European population-based congenital anomaly registers, covering 28% of the EU population as well as non-EU countries. Data are updated annually. This information can be useful for comparative purposes to clinicians and public health service managers involved in the antenatal care of pregnant women as well as those interested in perinatal epidemiology.

Ethnic disparities in knowledge of cancer screening programmes in the UK

Abstract: Objective The aim of the study was to examine awareness of the three National Cancer Screening Programmes (breast, cervical, bowel) among white and ethnic minority groups in the UK.Setting Data were from two surveys in which the screening questions were added: (i) the Office of National Statistics (ONS) Opinions Survey, carried out in September and October 2008; and (ii) the Ethnibus (TM) survey of the main ethnic minority groups in England, conducted in October and November 2008.Methods The ONS sample consisted of 2216 adults selected using stratified probability sampling to obtain a population-representative sample. The Ethnibus (TM) sample was obtained by quota sampling and included 1500 adults from the six largest ethnic minority groups in England (Indian, Pakistani, Bangladeshi, Caribbean, African and Chinese). Participants completed questions on awareness of cancer screening programmes as part of the wider Cancer Awareness Measure (CAM) in home-based, face-to-face interviews.Results Awareness of breast and cervical cancer screening was high in the white ONS participants (89% breast and 84% cervical), lower in the ONS ethnic minority sample (74% for both breast and cervical) and lowest in the Ethnibus (TM) sample (69% breast and 66% cervical). Ethnic disparities persisted after controlling for age, gender and occupational group. In both groups, knowledge of breast and cervical screening was lower among men and more socioeconomically deprived groups. Awareness of the new bowel cancer screening programme was less than 30% in both white and ethnic minority groups.Conclusions Ethnic disparities in knowledge of breast and cervical cancer screening should be addressed. Strategies to engage ethnic minority and socioeconomically deprived groups in bowel cancer screening should be instigated to avoid the emergence of disparities.

A fall-off in cervical screening coverage of younger women in developed countries

Abstract: ObjectivesTo analyse cervical screening coverage data by age over time in a number of developed countries throughout the world, with specific emphasis on trends for younger women and on age differentials between younger and older womenMethodsRoutinely collected cervical screening statistics and survey data were collected on the proportion of women who have undergone cervical screening with cytology in seven countries in the period 1995 to 2005ResultsData for the 25-29 age group were examined Coverage fell in most countries, in three by more than 5 percentage points In two countries while overall coverage rose in the period, the rise was not as steep in the youngest group of women Data for each available 5-year age group for the different countries shows a similar gradient in most, regardless of the absolute level of coverage Although the trend is not uniform in every country, it appears that generally the gap between coverage of younger women and coverage of older women increased, sometimes dramatic

Implementing Neonatal Screening for Haemoglobinopathies in the Netherlands

Abstract: Background The birth prevalence of severe haemoglobinopathies such as sickle cell disease (SCD) in the Netherlands has been estimated to be at least 50 newborns per year. Neonatal screening for SCD was added to the Dutch screening programme in January 2007. We here evaluated three high performance liquid chromatography (HPLC) systems for application in neonatal screening for haemoglobinopathies, and present the results of a subsequent pilot screening programme. Methods The Variant NewBorn Screening (Vnbs) HPLC system (Bio-Rad) was validated by analysing 131 blood samples and blood mixtures. Subsequently, the performance of the G7 (Tosoh BioScience) and Ultra (Primus Corporation) was compared with the Vnbs. The three HPLC analysers were tested in a pilot screening programme on 21,969 dried blood spot samples from the routine Dutch neonatal screening programme. Results The pilot screening resulted in 188 abnormal patterns. The three HPLC devices presented comparable within- and between-run precision and detected the abnormal samples similarly. The high throughput, sampling systems, presentation of results, and integration of the chromatograms, however, were different. Conclusion All three analysers detected the same abnormal haemoglobins satisfactorily, but integrated the chromatograms with variable imprecision. Comparison of the results suggested that the Bio-Rad Vnbs was the preferred system. However, software adjustments were required to improve the diagnostic potential of this device for screening for b- and a-thalassaemia.

Flexible sigmoidoscopy screening for colorectal cancer: uptake in a population-based pilot programme.

Abstract: ObjectiveThe aim of this study was is to examine uptake of population-based, flexible sigmoidoscopy (FS) screening delivered by nurses in a socioeconomically and ethnically diverse area of London, England.MethodsAll adults aged 58 and 59 years registered at 34 general practices in North London (n = 2260) were mailed an invitation to attend FS screening at the local hospital.ResultsIn total, 45% (1024/2260) accepted the invitation and attended, 5% (114/2260) accepted the invitation but failed to attend, 5% (111/2260) accepted the invitation but were unable to attend within the time-frame of the pilot study, 7% (165/2260) declined the offer, 27% (602/2260) did not respond, and 11% (244/2260) were ineligible or did not receive the invitation. Among those eligible to be screened, the uptake rate was 51% (1024/2016). Uptake did not differ by gender, but people living in the most affluent quintile of areas had a substantially higher uptake rate (63%) than those living in the most deprived quintile (38%).Conclus...

Perianal condylomas, anal squamous intraepithelial neoplasms and screening: a review of the literature.

Abstract: Anal squamous intraepithelial lesions (ASILs) are the precursors to anal cancer. Human papillomavirus infection has a direct link to ASIL formation and is responsible for up to 80% of anal cancers. But while much importance has been focused on targeting cancer precursors in the cervix, relatively little concern has been afforded to the anal canal. With the advent of cervical Pap smear screening in various regions, the incidence of cervical cancer has declined. However, marked similarities in the biological and pathological profiles of cervical cancer and anal cancer mean that anal cancer should be preventable in the same way - by curbing the progression of ASIL to cancer. This article explores the literature on ASILs and the growing problem of anal cancer in the community, along with the literature surrounding the current progress towards implementing a screening programme for ASIL in the future.

Mortality reductions produced by sustained prostate cancer screening have been underestimated.

Abstract: Background/Rationale: PSA-based screening in the recently reported European Randomized Study of Screening for Prostate Cancer (ERSPC) was reported to have reduced the rate of death from prostate cancer by a mere 20%. However, this number is an underestimate, caused by (i) including in the 20% the years before the impact of the first screen become manifest, and (ii) not having full information for the follow-up years where the effects of the screening are most apparent. The first of these sources of error can be avoided by using time-specific measures. This article reports the results of a re-analysis of the results of this trial using this form of analysis. Methods: Mortality rate ratios for each of follow-up years 1-12 were derived from the yearly numbers of prostate cancer deaths and numbers of men being followed in each arm of the ERSPC. To reduce statistical noise, they were based on moving 3-year intervals. In addition, to further reduce the statistical noise, a smooth rate ratio curve was fitted to the yearly data in order to measure the steady state reduction in mortality, and to identify the time at which it reached this level. Results: A re-analysis of the prostate cancer deaths in the first 12 years of follow-up in the ERSPC suggests that the sustained reduction in prostate cancer mortality may be as much as 50%. A more precise estimate cannot be made until the critical data from 2007 and 2008 -- and beyond -- are included in the analysis. Discussion: Re-analysis of the ERSPC data suggests that if screening is carried out for several years, and if follow-up is pursued until the reduction becomes manifest, the reduction in mortality will be 50-60%. An analysis that includes the 2007-2008 follow-up data is required to quantify more precisely the impact of this intervention.

Distribution of Nuchal Translucency in Antenatal Screening for Down's Syndrome:

Abstract: ObjectiveTo determine whether the standard deviation of nuchal translucency (NT) measurements has decreased over time and if so to revise the estimate and assess the effect of revising the estimate of the standard deviation on the performance of antenatal screening for Down's syndrome.SettingData from a routine antenatal screening programme for Down's syndrome comprising 106 affected and 22,640 unaffected pregnancies.MethodsNT measurements were converted into multiple of the median (MoM) values and standard deviations of log10 MoM values were calculated in affected and unaffected pregnancies. The screening performance of the Combined and Integrated tests (that include NT measurement) were compared using previous and revised estimates of the standard deviation.ResultsThe standard deviation of NT in unaffected pregnancies has reduced over time (from 1998 to 2008) (e.g. from 0.1329 to 0.1105 [log10 MoM] at 12–13 completed weeks of pregnancy, reducing the variance by about 30%). This was not observed in affec...

Is human papillomavirus screening preferable to current policies in vaccinated and unvaccinated women? A cost-effectiveness analysis

Abstract: ... Objectives Italy was the first European nation to offer free vaccination against human papillomavirus (HPV) types 16 and 18. The vaccination is actively encouraged and is available free of charge to 11- year-old girls. The introduction of new technologies such as HPV DNA testing and HPV vaccination requires cost-effectiveness analysis of cervical cancer strategies in Italy for both vaccinated and unvaccinated women. Methods A calibrated Markov model was developed to describe the natural history of HPV infection and cervical carcinogenesis. We performed a microsimulation generating the life histories of 10 million women. Changes in these life histories occur as consequences of prevention strategies. We estimated costs of screening activities using an activity-based costing analysis. We assessed lifetime risk due to cervical cancer, lifetime costs and quality-adjusted life-expectancy (QALE) for 18 scenarios. Strategies varied by screening interval (three and five years), primary and triage test (Pap test and HPV DNA test), and HPV 16 and 18 vaccination. Results The current screening policy (Pap test every three years) is more costly and less effective than HPV DNA test and Pap test triage every five years. For unvaccinated women an HPV DNA test every five years with a Pap test triage was cost-effective (ICER E5753/QALE). Vaccination followed by the same screening strategy was cost-effective (ICER E23,951/QALE) for women who are eligible to be vaccinated. Conclusions Our findings strongly support changing the Pap screening policy to the use of HPV DNA as a primary test with Pap test triage for both vaccinated and unvaccinated women.

Randomized Controlled Trial of Mammographic Screening from Age 40 (‘age’ Trial): Patterns of Screening Attendance:

Abstract: BackgroundThe Age trial was a randomized controlled trial to study the effect on breast cancer mortality of invitation to annual mammography from age 40 to 41. Uptake of invitation to screening mammography in UK women aged below 50 is of interest, particularly in the light of the recent announcement that the national breast screening programme will begin inviting women from age 47.MethodsThe trial took place in 23 National Health Service breast screening units in England, Wales and Scotland between 1991 and 2004. Data on invitation and attendance during 13 years of trial fieldwork were analysed. The participants were 53,884 women in the intervention arm of the Age trial who were randomized to receive annual invitation to mammography from age 40 or 41 up to age 48. The trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN24647151.ResultsUptake of invitation to routine screening was 68% at first round and 69% at subsequent rounds. A total of 43,709 women in the interven...

The efficacy of a neonatal screening programme in decreasing the hospitalization rate of patients with G6PD deficiency in southern Iran.

Abstract: ObjectiveTo investigate whether a neonatal screening programme for G6PD deficiency has decreased hospitalization for acute haemolytic attack in the Fars province of southern Iran.MethodsA total of 850 patients registered with G6PD deficiency were included in the study. Variables including age, sex, time and cause of hospitalization, cause of haemolytic crisis, positive history of blood transfusion, G6PD enzyme deficiency, blood urea nitrogen (BUN) and creatinine were recorded based on a standard questionnaire. All patients were analysed for G6PD enzyme level based on a quantitative test. ResultsFive hundred and fifty-three patients were hospitalized before the introduction of the neonatal screening programme (2001-2004) and 297 afterwards (2005-2008). Of those patients hospitalized after the introduction of the screening programme, 237 were wrongly classified as normal and 60 were recorded as having G6PD enzyme deficiency by the neonatal screening programme. The main causes of haemolytic crisis in G6PD-de...

Effect of temperature changes on the occurrence of congenital hypothyroidism.

Abstract: ObjectiveTo investigate an association between seasonal changes in temperature and the prevalence of congenital hypothyroidism (CH) in the Southwest of Iran.MethodsA prospective two-year study cond...

Disease-specific mortality may underestimate the total effect of prostate cancer screening.

Abstract: ObjectivesTo study the difference between the disease-specific and excess mortality rate in the European Randomized Study of Screening for Prostate Cancer section Rotterdam.MethodsA total of 42,376 men were randomized to systematic screening or usual care. The excess number of deaths was defined as the difference between the observed number of deaths in the prostate cancer (PC) patients and the expected number of deaths up to 31 December 2006. The expected number was derived from mortality of all study participants before a possible diagnosis with PC. The disease-specific mortality rate was based on the number of men who died from PC. The excess mortality rate based on the arm-specific excess number of deaths and the disease-specific mortality rate were compared between the two study arms.ResultsThe overall mortality rate was not significantly different between the intervention and the control arms of the study: RR 1.02 (95% CI 0.98–1.07). The disease-specific mortality rate was 0.42 men per 1000 person-y...

Risk factors for colonic perforation after screening computed tomographic colonography: a multicentre analysis and review of the literature.

Abstract: BackgroundComputed tomographic (CT) colonography (or ‘virtual’ colonoscopy) has become an increasingly popular tool for colorectal cancer screening. Colonic perforation, an uncommon complication, i...

Absolute numbers of lives saved and overdiagnosis in breast cancer screening.

Abstract: Duffy et al. provide estimates of overdiagnosis (i) and lives saved (ii) based on data from the Two-County Trial. Both might be debated. Their model distinguishes the prevalence of overdiagnosed cancer (PO) from the prevalence of true cancer (PT). One equation of the model gives the total prevalence when screening starts in the intervention group: PO þ PT 1⁄4 0.0068 [A]. Another equation gives the total prevalence of diagnosed cancer in the control group at the end of the trial: PO þ 1.35 PT 1⁄4 0.0085 [B]. Factor 1.35 takes into account time trend and ageing from the beginning to the end of the trial. Equations [A] and [B] are satisfied for PO amounting to 0.0019, that is 29% of the total prevalence at the beginning of the trial in the intervention group. This figure is apparently consistent with results from previous publications about overdiagnosis in Norway and in Sweden. Actually it is not: previously published estimates are restricted to the increase of the proportion of cancer overdiagnosis due to screening; overdiagnosed cancer that also occurs without screening is not included in these estimates. Equation B is debatable. Without giving to PO another weighting factor than 1, the authors imply that PO is constant over age and over time. Suppose now that prevalence of overdiagnosed cancer (PO) is not constant over age neither over time as is, and for example that it is increased by a factor 1.2. Here is the corresponding equation: 1.2 PO þ 1.35 PT 1⁄4 0.0085 [C]. From equations [A] and [C], PO would amount to 0.0045, that is 67% of the total prevalence at the baseline screening examination. The number of lives saved based on the Two-County Trial has also been debated. Both points raised here might contribute to get a number of overdiagnosed cancer per life saved by screening closer to previously published estimates. Bernard Junod and Jean Pierre Spinosay

A randomized double-blind crossover trial to investigate the efficacy of screening for adult hypothyroidism.

Abstract: ObjectiveTo assess the value of population screening for adult hypothyroidism.SettingHealthy people attending for a general health assessment.MethodsA thyroid-stimulating hormone (TSH) measurement was performed on people attending for a general health assessment (women aged 50–79 [35–49 with a family history of thyroid disease] and men aged 65–79). Those with TSH levels above 4.0 mU/L were invited to join a randomized double-blind crossover trial of thyroxine and placebo, each given in random order for four months. On entry a second blood sample was collected for a TSH measurement after the end of the trial to determine whether this would help select individuals for thyroxine treatment. The daily thyroxine dose started at 50 µg and if necessary was increased to achieve a TSH level of 0.6–2.0 mU/L.ResultsThere were 341 (8%) people with a TSH level above 4.0 mU/L, 110 met eligibility criteria (64 agreed to participate), and 56 (49 women, 7 men) completed the trial. Among the 15 individuals with a repeat TSH...

Screening for cervical cancer with the human papillomavirus test in an area of central Italy with no previous active cytological screening programme.

Abstract: ObjectiveWe report performance indicators and costs of the first round of a cervical cancer screening programme based on the human papillomavirus (HPV)-DNA test.MethodsWe implemented a demonstratio...

Cancer mortality in the 50 - 69 year age group before and after screening

Abstract: seem to imply that our data from the randomized trials are not empirical. Furthermore, it is not important for the ratio whether one looks at invited or attending women, as both benefits and harms increase among attendees. Duffy et al. claim that only 37% of breast cancers are screen-detected, based on a 200-word conference abstract where the sum of the relevant percentages is only 72%. They conclude that our estimate implies that virtually all screen-detected cancers are overdiagnosed, which they consider ‘absurd and frankly incredible’. However, it is well known that between one-half and two-thirds of cancers are detected through screening, e.g. 68% of cancers were screendetected in the relevant age groups in the UK in 2006, not 37%. Duffy et al. substantially overestimate benefits and underestimate harms. We also note that no conflicts of interest were declared. Tabár founded Mammography Education Inc, Arizona in 1980, which still exists, and in 1999, he declared an income of five million SEK in Sweden, which is an extraordinary amount according to Nordic standards. We believe that such an important conflict of interest should be declared.

Women's preferences for the delivery of the National Health Service Breast Screening Programme: a cross-sectional survey.

Abstract: ObjectiveTo elicit women's preferences for delivery of the National Health Service (NHS) Breast Screening Programme.DesignInterview survey.SettingPrivate households in the UK.PopulationFive hundred...

Down's syndrome: screening and antenatal diagnosis regionally in England and Wales 1989–2008:

Abstract: ObjectiveTo illustrate regional changes that occurred in screening for Down's syndrome (trisomy 21) in England and Wales from 1989 to 2008.MethodsThe National Down Syndrome Cytogenetic Register has...

Improving colorectal cancer screening outcomes: proceedings of the second meeting of the International Colorectal Cancer Screening Network, a global quality initiative.

Abstract: The International Colorectal Cancer Screening Network (ICRCSN) is a global consortium of initiatives delivering organized colorectal cancer (CRC) screening to their populations. The aim of the Network is to promote improvements in quality assurance (QA) and programme evaluation to maximize the benefit and to minimize the risk associated with CRC screening. ICRCSN currently includes 41 member initiatives from 27 countries. The ICRCSN held its second international meeting in Oxford in September 2008 with representatives from 24 countries. This report summarizes the presentations and discussions, the feedback from participants on their current and future needs and the potential role of the ICRCSN in supporting those needs.

Breast screening: why estimates differ by a factor of 20-25.

Abstract: Duffy et al. estimated that between 2 and 2.5 lives are saved for every overdiagnosed case, which is 20–25 times more favourable than the estimate from the Cochrane review of the randomized trials. They used a 38% reduction in breast cancer mortality from the Two-County trial, which is 2.5 times higher than the estimate based on all the trials. They also used UK data but contradict themselves. They consider the mortality stable in the unscreened age groups, but also report a significant 18% decline in breast cancer mortality in women aged under 50 years. The decline in the age group 50–69 years was 27%, and by using an unclear method described in a footnote, they concluded that screening conferred a further 28% mortality reduction. This disagrees starkly with data from Cancer Research UK: women aged 40–49 (who were never invited to screening) had the same decline in mortality (44%) as those aged 50–64. The graphs are misleading. Data for women below 50 years were lumped together, but as deaths from breast cancer before age 30 are extremely rare (12 cases in 2008), the graph is close to the x axis, which conceals the huge decline in mortality in young women. Data from the age group 50–64 years were combined with 65–69 years, although screening of older women did not start before 2001, which conceals that breast cancer mortality in the age group 50–64 years began to decline before the UK programme started in 1988. Duffy et al. substantially underestimate overdiagnosis. Firstly, they excluded carcinoma in situ, which was not stated in their paper. One of us asked Duffy on national radio whether he only included invasive cancer, which he confirmed. Secondly, they used an unverified model with incorrect assumptions. It is wrong to assume that essentially all incidence increase with screening represents earlier diagnosis. Thirdly, they adjusted for a compensatory decline in breast cancer incidence in women no longer screened, which did not exist for the years they examined. More updated numbers show an abrupt increase when screening was extended to the age group 65–70 years in 2001 (Figure 1 below), which is far bigger than any possible recent compensatory decline. We estimated 57% overdiagnosis in England and Wales. Duffy et al. estimated that only 12% of cancers are overdiagnosed. Duffy et al. say they estimated the benefit directly from empirical data and looked at women actually screened, which they consider partly explains the disagreement with us

Optional screening strategies for cervical cancer using standalone tests and their combinations among low- and medium-income populations in Latin America and Eastern Europe.

Abstract: Background The performance of cervical cancer (CC) screening can be improved by combining Pap smear with human papillomavirus (HPV) testing or visual methods, addressing local demographic, clinical and economic characteristics. Objectives To examine the performance of standalone and combined screening tools in populations with variable prevalence of cervical intraepithelial neoplasia (CIN) and CC. Methods Merged data-sets from the Latin American Screening Study and New Independent States cohorts provided results for 15,000 women, screened using Pap smear, HPV testing and visual inspection with acetic acid, in Brazil, Argentina, Russia, Belarus and Latvia. Bayesian correction for verification bias was used. Results At CIN2þ cut-off, HPV detection alone was the most sensitive technique. There was an improvement (88.5% to 92.7%) in Hybrid Capture 2 (HC2) sensitivity among women � 35 years old. Using HPV detection alone was the least specific screening tool, regardless of the age group (69.9% (95% CI 66.5-72.8%) and 86.4% (95% CI 84.6-88.2%), in , or � 35 years, respectively). Of the test combinations, Pap smear (LSIL threshold) with HC2 had the highest specificity (98.7%; 95% CI 98.3-99.0%). However, in women � 35 years, the sensitivity of Pap alone was superior to that of the combination. Conclusions The Pap test is a highly specific screening option in populations with medium-range CC prevalence. Combined testing for HPV in this scenario may yield slightly better positive predictive values in women � 35 years of age with LSIL, but at a high incremental cost.

Has cytology become obsolete as a primary test in screening for cervical cancer

Abstract: 1 Sankaranarayanan R, Nene BM, Shastri SS, et al. HPV screening for cervical cancer in rural India. N Engl J Med 2009;360:1385–94 2 Schiffman M, Wacholder S. From India to the world – a better way to prevent cervical cancer. N Engl J Med 2009;360:1453–5 3 Miller AB. Cervical cancer in rural India. Nat Rev Clin Oncol 2009;6:384–5 4 Suba EJ, Cibas ES, Raab SS. HPV screening for cervical cancer in rural India. N Engl J Med 2009;361:304 5 Lynge E, Rebolj M. Primary HPV-screening for prevention of cervical cancer – Overview of results from European trials. Nat Rev Clin Oncol 2009;6:699–706

A simple method to estimate the episode and programme sensitivity of breast cancer screening programmes.

Abstract: Background The estimation of breast cancer screening sensitivity is a major aim in the quality assessment of screening programmes. The proportional incidence method for the estimation of the sensitivity of breast cancer screening programmes is rarely used to estimate the underlying incidence rates. Methods We present a method to estimate episode and programme sensitivity of screening programmes, based solely on cancers detected within screening cycles (excluding breast cancer cases at prevalent screening round) and on the number of incident cases in the total target population (steady state). The assumptions, strengths and limitations of the method are discussed. An example of calculation of episode and programme sensitivities is given, on the basis of the data from the IMPACT study, a large observational study of breast cancer screening programmes in Italy. Results The programme sensitivity from the fifth year of screening onwards ranged between 41% and 48% of the total number of cases in the target population. At steady state episode sensitivity was 0.70, with a trend across age groups, with lowest values in women aged 50-54 years (0.52) and highest in those 65-69 (0.77). Conclusions The method is a very serviceable tool for estimating sensitivity in service screening programmes, and the results are comparable with those of other methods of estimation.

Risk of invasive cervical cancer and cervical intraepithelial neoplasia grade III in central Italy by area of birth.

Abstract: ObjectiveTo evaluate cervical cancer incidence among women born in different countries but residing in Italy.SettingWomen aged 25-59 from a central Italian population-based cancer registry.MethodsI...