Showing papers in "Journal of Medical Screening in 2019"
TL;DR: Within a well-organised colorectal cancer screening programme, changing the test from gFOBT to FIT markedly increased participation, especially among men, and in the younger age group, with a lower cut-off in women than men.
Abstract: ObjectiveUsing quantitative Faecal Immunochemical Test (FIT) in colorectal cancer screening enables adjustment of the cut-off for a positive test. As men have higher stool blood levels and higher p...
25 citations
TL;DR: Increases in colonoscopy rates were confined to ages 45–54, whereas colorectal cancer incidence rates rose in those aged 40–44, 45–49, and 50–54.
Abstract: ObjectiveIn the United States, colorectal cancer incidence has increased in adults under age 55. Although debate remains about whether this rise is a result of increased detection because of more c...
24 citations
TL;DR: Organized CRC screening programmes are highly cost-effective, irrespective of the test selected, and a sequential approach with FS and FIT appears the most cost- effective option.
Abstract: ObjectiveSeveral European countries are implementing organized colorectal cancer (CRC) screening programmes using faecal immunochemical test (FIT) and/or flexible sigmoidoscopy (FS), but the cost-e...
19 citations
TL;DR: Integrated CPCS has the potential to identify all, or nearly all, individuals with familial hypercholesterolaemia in the population at low cost and is currently better than either method of familialhypercholesterolemia detection alone.
Abstract: ObjectiveTo integrate child–parent screening and cascade testing into a single pathway-child-parent cascade screening (CPCS), for the identification of familial hypercholesterolaemia in the populat...
18 citations
TL;DR: Offering disinclined women a same-gender practitioner, either by choice or default, increased subsequent intention, while an opposite gender default did not negatively affect intention.
Abstract: ObjectivesA large proportion of women have a preference for a same-gender endoscopy practitioner. We tested how information about practitioner gender affected intention to have bowel scope screenin...
16 citations
TL;DR: A home-based screening program using infant stool colour cards with a passive distribution strategy could be highly cost-effective when administered at a low unit cost and with a reasonable screening performance.
Abstract: ObjectiveBiliary atresia, a rare newborn liver disease, is the most common cause of liver-related death in children and the main indication for paediatric liver transplantation. Early detection and...
14 citations
TL;DR: The screening program in Morocco requires better organization, a pragmatic system of inviting the target population, improved compliance to diagnosis, treatment, and follow-up, improved provider training, better quality assurance systems, and an effective health information system with appropriate linkages for monitoring and evaluation.
Abstract: ObjectivesTo report the key outcomes of evaluation of the national cervical cancer screening program in Morocco, and describe its organization, status of implementation, performance, and major chal...
12 citations
TL;DR: Whether changes in mammographic technique and screening policy have improved mammographic sensitivity, and elongated the mean sojourn time, since the introduction of biennial breast cancer screening in Nijmegen, the Netherlands, in 1975 is investigated.
Abstract: ObjectivesWe investigated whether changes in mammographic technique and screening policy have improved mammographic sensitivity, and elongated the mean sojourn time, since the introduction of bienn...
11 citations
TL;DR: A one-year delay in the implementation of human papillomavirus screening would miss the opportunity to prevent 581 cases of cervical cancer, and lead to a loss of 1595 quality-adjusted life years, a measurable loss that should be considered in prioritising decision-making in screening.
Abstract: ObjectiveIt often takes considerable time for sufficient evidence to accumulate to support implementation of new methods in routine screening. Where national screening programmes are already effect...
9 citations
TL;DR: Specific worries about cancer may be differentially associated with participation across screening programmes, as interventions to optimise informed participation may be improved if the specific worries associated with low participation in each programme are understood.
Abstract: ObjectiveSome degree of general worry about cancer may facilitate screening participation, but specific worries about the potential consequences (e.g. treatment, death) may act as deterrents. No st...
9 citations
TL;DR: An existing probability model for periodic screening was expanded by performing simultaneous estimation of age group-dependent and sensitivity at preclinical onset time, and the expanded model performed well in terms of bias, standard deviation, and coverage probability.
Abstract: ObjectiveIn evaluating the efficacy of cancer screening programmes, sojourn time (duration of the preclinical detectable phase) and sensitivity of the screening test are the two key parameters. Stu...
TL;DR: This research provides tentative support for FOBT as a teachable moment for increasing vigorous physical activity and there was limited evidence for spontaneous improvement in multiple health behaviours following participation.
Abstract: Objectives Population-based cancer screening has been described as a teachable moment for behaviour change. This research examined the effect of faecal occult blood testing (FOBT) participation on smoking, alcohol consumption, fruit and vegetable consumption and physical activity. Setting Data were from screening-naive men within the English Longitudinal Study of Ageing, receiving their first FOBT invitation (n = 774). Four waves of data were included in analyses (wave 4, 2008/2009 - wave 7, 2014/2015). Baseline data were from the wave prior to FOBT invitation, and follow-up data were from the next consecutive wave (two years later). Methods The effects of FOBT participation, time and group-by-time interactions on health behaviours were investigated using generalised estimating equations. Almost two-thirds of the sample (62.5%; n = 484) had participated in FOBT. Results Screening participants were less likely to smoke (odds ratio (OR): 0.45, 95% confidence interval (CI): 0.29-0.68) and more likely to meet fruit and vegetable consumption guidelines (OR: 1.70, 95% CI: 1.14-2.55). Smoking decreased over time (OR: 0.74, 95% CI: 0.62-0.89), but adherence to alcohol guidelines also decreased (OR: 0.71, 95% CI: 0.53-0.91). A group-by-time interaction was found for vigorous physical activity; the odds of taking part in vigorous physical activity increased for FOBT participants, but decreased for non-participants (OR: 1.40, 95% CI: 1.01-1.95). Conclusions This research provides tentative support for FOBT as a teachable moment for increasing vigorous physical activity. However, overall, there was limited evidence for spontaneous improvement in multiple health behaviours following participation.
TL;DR: In the Prostate, Lung, Colorectal, and Ovarian cancer screening trial, there was a small but significant reduction in overall mortality in men, and in both sexes combined, and a smallbut-significant reduction in Overall mortality excluding trial cancer deaths in men.
Abstract: ObjectiveTo assess the secondary outcome of overall mortality in the randomized Prostate, Lung, Colorectal, and Ovarian cancer screening trial.MethodsIn the Prostate, Lung, Colorectal, and Ovarian ...
TL;DR: In this article, the authors conducted a Delphi study among policymakers, researchers, and program coordinators who were experts in breast, cervical, or colorectal cancer screening to identify the most important indicators to be collected and reported.
Abstract: _Objective:_ To maximize benefits and reduce potential harms of organized cancer screening programs in Europe, monitoring, quality assurance, and evaluation of long-term impact are required. We aimed to identify the most important indicators to be collected and reported. The study was designed to establish a consensus within a European-level working group and suggest a manageable list of key indicators.
_Methods:_ We conducted a Delphi study among policymakers, researchers, and program coordinators who were experts in breast, cervical, or colorectal cancer screening. Study participants evaluated the importance of screening indicators on a 5-point Likert scale.
_Results:_ The top 10 indicators by study participants were interval cancer rate, detection rate, screening attendance, screening coverage, cancer incidence, cause-specific mortality, proportion of persons attending further assessment after a positive screen test result, proportion of persons attending a treatment after diagnosis, invitation coverage, and distribution of cancers by mode of detection. Performance indicators were generally considered more important than outcome indicators. Subgroup analyses by cancer types showed similar results, and only cervical cancer screening experts had slightly different preferences. Subgroup analyses by experts’ roles indicated that policymakers found different indicators important compared with researchers or program coordinators, probably because of their different point of view on screening.
_Conclusion:_ The implication of our priority ranking is twofold: it serves as an initial guidance for countries that have not yet established a system to collect data, and as a checklist for those where data collection is already established, to assess the comprehensiveness of their system.
TL;DR: A single item measure of cancer worry intensity appeared to be most parsimonious for explaining variance in colorectal cancer screening intention and uptake.
Abstract: ObjectivesMany studies of cancer worry use items measuring frequency or intensity. Little is known about how each of these relate to cancer screening uptake. This study compared the association bet...
TL;DR: A 44-month country-wide prospective study using data from 13 newborn screening laboratories in England demonstrates a positive predictive value of 91.7%, with a specificity of 99.9% and a sensitivity of 98.5%.
Abstract: ObjectiveBeta thalassaemias are a group of hereditary red cell disorders resulting in a reduced or absent production of the main adult haemoglobin, adult haemoglobin. In England, the NHS Sickle Cel...
TL;DR: HrHPV positive slides were more likely to be rated up over the referral threshold than negative slides at the second review when hrHPV status was known, and this may have implications for referrals of women with low-grade lesions.
Abstract: Objective: Several studies have shown that there is an upward shift in the classification of cervical cytology when high-risk human papillomavirus (hrHPV) status is known to be positive. The Netherlands implemented primary hrHPV screening with reflex cytology as the primary screening test in 2017. Prior to implementation of the new programme, we investigated whether knowledge of hrHPV status influences cytology rating. Methods: Using a set of 200 cytology slides that had been previously tested, two pairs of cytotechnicians rated 100 slides per pair twice: first without knowledge of hrHPV status and then, after a wash-out period of two months, with knowledge of hrHPV status. Results: We found that hrHPV positive slides were more likely to be rated up over the referral threshold (i.e. from negative for intraepithelial lesion or malignancy to atypical squamous cells of undetermined significance+) than hrHPV negative slides at the second review when hrHPV status was known (relative risk = 3.2; 95% confidence interval: 1.3–7.9). Conclusions: If the same upward shift in ratings were to be observed in the national programme, it may have implications for referrals of women with low-grade lesions.
TL;DR: Active follow-up led to higher bowel screening participation in Māori and Pacific but not in Asian ethnicities and was more effective in high deprivation subjects.
Abstract: ObjectiveTo test whether a telephone follow-up service for high-needs ethnic groups increases bowel screening participation in non-responders to postal invitations.MethodsMāori, Pacific, and Asian ...
TL;DR: Breast cancer mortality declines occurring since the advent of screening mammography in New Zealand are consistent with other incidence-based and aggregate studies of screening Mammography in populations, individual-based cohort studies, and randomized controlled trials.
Abstract: ObjectiveTo investigate trends in breast cancer mortality in New Zealand women, to corroborate or negate a causal association with service screening mammography.MethodCumulated mortality rates from...
TL;DR: There was substantial variation in screening sensitivity according to breast cancer subtypes, and Tailoring screening according to women’s subtype risk factors might eventually lead to more efficient programs.
Abstract: ObjectiveIn mammography screening, interval cancers present a problem. The metric ‘screening sensitivity’ monitors both how well a programme detects cancers and avoids interval cancers. To our know...
TL;DR: In the Scottish programme over a decade, initial guaiac faecal occult blood test positivity increased in participants aged 50, which may be associated with changes in lifestyle and might have implications for screening clinical outcomes, including positive predictive value.
Abstract: ObjectivesChanges in the prevalence of faecal occult blood test positivity over time have not been previously reported, but could have important implications. This study examined the positivity of ...
TL;DR: Breast cancers detected through screening are diagnosed at an earlier stage and have a greater proportion of subtypes, with better outcome, than non-screen-detected breast cancer.
Abstract: ObjectiveTo compare characteristics and survival of New Zealand European, Māori, and Pacific women with screen-detected vs. non-screen-detected breast cancer.MethodsWomen aged 45–69 diagnosed with ...
TL;DR: Uptake, positivity, yield of colorectal cancer (CRC), and positive predictive value (PPV) for CRC, advanced adenomas (AAs), and advanced coloreCTal neoplasia (ACN) were reduced following prior offer of FS screening.
Abstract: ObjectiveTo investigate the outcomes of biennial guaiac faecal occult blood test (gFOBT) screening after once-only flexible sigmoidoscopy (FS) screening.MethodsBetween 1994 and 1999, as part of the...
TL;DR: Increases in breast cancer incidence following introduction of mammography screening in women aged 50–64 did not persist and over-diagnosis is not inevitable in population mammography Screening programmes.
Abstract: ObjectiveTo investigate the impact of population mammography screening on breast cancer incidence trends in New Zealand.MethodsTrends in age-specific rates of invasive breast cancer incidence (1994...
TL;DR: This study documents, for the first time, the declining proportion of older women choosing Down’s syndrome serum screening and subsequent impact on screening performance.
Abstract: ObjectiveTo quantify changes in the proportion of women aged 35 and older choosing serum screening for Down’s syndrome over time and the effect on false positive and detection rates.MethodsFrom Rho...
TL;DR: The use of the D/I ratio is inappropriate in predicting effect, and it is recommended that the D-I ratio be used as a component in the estimation of overdiagnosis in screening for invasive cancer.
Abstract: ObjectiveWe aimed to introduce a concept of overdiagnosis with actual formulae. In screening for invasive cancer, the detection proportion to incidence rate (D/I) ratio is used as an intermediate i...
TL;DR: In the screening program, 5.7% of individuals undergo invasive testing, comparable with the National Lung Screening Trial, however, in the invasive testing group, the Brock and Mayo calculators and Lung Cancer Screening Program clinical assessment all lacked clarity in distinguishing individuals who have a cancer from those with a benign abnormality.
Abstract: ObjectiveThe National Lung Screening Trial demonstrated the benefits of lung cancer screening, but the potential high incidence of unnecessary invasive testing for ultimately benign radiologic find...
TL;DR: It is prudent to wait for empirical results from trials such as MyPeBS before taking a view about the effectiveness, practicality and costeffectiveness of risk stratification in determining eligibility for breast screening.
Abstract: A recent paper by Pashayan et al. models a number of breast cancer screening scenarios and concludes that determination of eligibility using risk criteria such as single nucleotide polymorphism scores in addition to sex and age which are currently used could improve cost-effectiveness of the programme. While primary or secondary prevention is more cost-effective in groups at higher risk, two observations need to be made here: first, modelling exercises such as this necessarily depend on assumptions, which should be scrutinised carefully; second, there are other considerations in determining modes of healthcare delivery beyond using methods such as the cost per quality adjusted life-year (QALY). To consider the first issue, one can see from the unnumbered table in the paper that age-based screening always prevents a greater number of breast cancer deaths than further risk stratification, and for risk thresholds up to the 32nd percentile, the overall estimated costs are very similar, indicating a greater effect of age-based screening on mortality, at little, if any, extra cost. There are larger numbers of QALY’s in the regimens using further risk stratification, but this depends crucially on the assumed effect of breast cancer on quality of life, which is questionable. From the supplemental material in Pashayan et al., it appears that the authors assumed the same loss of utility quality adjustment for all breast cancers regardless of stage or treatment. This will bias QALY results against screening which detects disease at a stage when less aggressive treatment is necessary. In particular, the same quality adjustment should not be made for overdiagnosed cancers as for ‘true’ cancers. The former are screen-detected by definition and are characterised by early stage, with a considerably lower chance of treatment with mastectomy or chemotherapy. The assumption is also made that risk level does not affect overdiagnosis, but there is no assurance that increased risk will not increase the risk of overdiagnosed tumours. As regards the prevention of breast cancer death, the paper aims to base the estimates on the results of the UK Independent review, but it is apparent from the supplemental material that a 20% relative reduction was assumed associated with regular screening. The UK review found this for invitation to screening. The effect of being regularly screened is greater than this. This underestimate will in turn underestimate the effect of screening without risk stratification. The second issue relates to the quality of screening programmes. Current practice is to offer breast screening on the basis of the two most important risk factors of all: sex and age. As can be seen from the table in Pashayan et al., unless one chose a very high risk threshold, addition of further risk criteria would make little difference to outcomes or costs. One has to consider whether the additional complexity of additional risk criteria may detract from the performance of the programme as a whole, while only possibly conferring some benefit in cost-effectiveness. Risk stratification is itself a form of screening with its own potential false positives and false negatives. In relation to this, if risk estimation beyond age and sex is to be used to decide eligibility of an individual, the decision should be based on absolute risk rather than the percentile of the risk distribution on which the individual lies, as considered by Pashayan et al. If an intervention is not to be offered on the basis of estimated risk, the population excluded must have confidence that their absolute risk is low. Public health interventions at population level need to have transparent and comprehensible protocols of eligibility and delivery. The results of the modelling and risk stratification are therefore questionable. We would be prudent to wait for empirical results from trials such as MyPeBS before taking a view about the effectiveness, practicality and costeffectiveness of risk stratification in determining eligibility for breast screening. As things stand at present, the need for further risk stratification is not established. The objections to this are not simply attitudinal: there are unresolved scientific and public health objections, as noted above.
TL;DR: A triaging strategy based on HPV genotyping and liquid- based cytology for those positive only for the less oncogenic HPV types had test characteristics comparable with that of liquid-based cytology triage.
Abstract: ObjectiveCervical cancer is the second most common cancer in Thai women; human papillomavirus (HPV) is the main cause. This study aimed to determine the clinical performance of HPV mRNA compared wi...
TL;DR: Measuring height and weight at the time of routine mammographic screening is feasible, although logistical issues, particularly the added time/effort required of support staff, should be considered.
Abstract: ObjectivesBody mass index is a strong predictor of post-menopausal breast cancer risk and (negatively) confounds the association between mammographic breast density and breast cancer risk; however,...