JNCI Journal of the National Cancer Institute最新文献

Background: Large-scale randomized controlled trials (RCTs) have established compelling evidence that screening by flexible sigmoidoscopy reduces colorectal cancer (CRC) incidence. Reported incidence results include cancers that were already prevalent and yet undiagnosed, but no longer preventable at screening. We aimed to derive, disentangle and fully disclose early-detection and long-term prevention effects of screening sigmoidoscopy from published trial results.

Methods: We used data from three large-scale RCTs from the United Kingdom (UKFSST), Italy (SCORE) and the US (PLCO), which included a total number of 359,198 participants. For each trial and each length of follow-up, we derived the numbers and proportions of CRC cases that were either early detected or prevented among screening attenders.

Results: In the UKFSST, which reported the longest follow-up data, screening sigmoidoscopy prevented 64% (95% CI 59-69%) of incident distal CRC that would have been expected in the absence of screening during a median of 21.3 years. Within follow-up periods between 10 and 12 years, the proportions of distal CRC cases that were either early-detected or prevented among screening users ranged between 67% (95% CI 61-72%) in the PLCO and 80% (95% CI 68-89%) in the SCORE trial, with approximately equal shares of early-detected and prevented cases in the SCORE and the PLCO trials, and a higher share of prevented cases in the UKFSST.

Conclusions: A single screening sigmoidoscopy prevents two out of three incident cancers in the distal colon and rectum over a period of more than 20 years, on top of early-detecting prevalent cases at screening.

Recognizing the interconnectedness between social determinants of health (SDOH) and biological factors associated with cancer, the research community is working to identify and refine biological markers of SDOH that can help us better understand this complex interaction. The National Academies of Science, Engineering, and Medicine convened a workshop with the intent of exploring this interaction and how these factors affect cancer onset and cancer-related health outcomes.1 Workshop presentations and discussions provided an overview of biological effectors and SDOH; emerging research in these areas, including the development and validation of biomarkers and strategies to improve the evidence base for monitoring, diagnosing, policy, research, and clinical practice opportunities to improve health and address the impact of SDOH on cancer risk, diagnosis, and outcomes.

The HPV-Automated Visual Evaluation Consortium is validating a cervical screening strategy enabling accurate cervical screening in resource-limited settings. A rapid, low-cost human papillomavirus (HPV) assay permits sensitive HPV testing of self-collected vaginal specimens; HPV-negative women are reassured. Triage of positive participants combines HPV genotyping (4 groups in order of cancer risk) and visual inspection assisted by automated cervical visual evaluation that classifies cervical appearance as severe, indeterminate, or normal. Together, the combination predicts which women have precancer, permitting targeted management to those most needing treatment. We analyzed CIN3+ yield for each HPV-Automated Visual Evaluation risk level (HPV genotype crossed by automated cervical visual evaluation classification) from 9 clinical sites (Brazil, Cambodia, Dominican Republic, El Salvador, Eswatini, Honduras, Malawi, Nigeria, and Tanzania). Data from 1832 HPV-positive participants confirmed that HPV genotype and automated cervical visual evaluation classification strongly and independently predict risk of histologic CIN3+. The combination of these low-cost tests provided excellent risk stratification, warranting pre-implementation demonstration projects.