Journal of Medical Screening最新文献

Background and objectivesLung cancer remains the leading cause of cancer-related death globally and in Belgium. Annual screening with low-dose computed tomography significantly reduces lung cancer-specific mortality in high-risk populations. Despite robust evidence supporting lung cancer screening, large-scale implementation in Belgium is still lacking. The 'Zuid-Oost Rand Antwerpen Lung Cancer Screening' (ZORALCS) study aims to evaluate the feasibility of introducing a regional lung cancer screening program in Flanders, specifically targeting high-risk adults with a history of heavy smoking. The primary objective is to assess the participation rate. Secondary objectives include evaluating each step of the screening and smoking cessation process.MethodsThe ZORALCS study is a 4-year, prospective, non-randomized, population-based feasibility study. It targets all adults aged 55-74 in the South-East Region of Antwerp (ZORA), inviting 25,885 individuals by regular post. Respondents who have smoked over 100 cigarettes in their lifetime complete an online questionnaire including the PLCO_m2012 and HUNT risk prediction models. Those meeting risk thresholds (PLCO_m2012  1.51% or HUNT ≥0.64%) are invited to give informed consent and undergo annual low-dose computed tomography scans for 2 years. Local authorities, healthcare professionals, and digital support services assist participants throughout the process. Scans are read by radiologists with AI support, following the latest European guidelines. Participants who currently smoke or recently quit (<1 year) are enrolled in the 'TAbakoloog gestuurde of MInimale ROokSTOPinterventie bij longkankerscreening' (TAMIRO-STOP) randomized controlled trial to receive tailored smoking cessation support.Expected outcomesFindings will help identify barriers, guide policy development, and support future national lung cancer screening implementation.

Lung cancer screening (LCS) also identifies incidental esophageal abnormalities. We report the extent of incidentally found esophageal cancers during our initial 4 years of LCS in a VA (Veterans Affairs) population. A retrospective chart review of a single-center VA Medical Center LCS program in the underserved Southern Appalachia was performed. Esophageal findings of asymptomatic patients and subsequently diagnosed esophageal cancers were recorded and compared to the symptomatically-detected cancers. During the initial 4 years, 3,893 Veterans were screened. Of our healthcare system's detected esophageal cancers, 19% were detected by LCS asymptomatically, with a prevalence of 0.26%. During the same time, the prevalence of symptomatically-detected cancers was 0.097%. The prevalence of the LCS-detected asymptomatic cancers was 2.7× higher than the symptomatic cancers (p = 0.004). The LCS-detected esophageal cancers showed a significantly lower stage (p = 0.025). Strikingly, the number of stage IV cases was only 10% in the LCS group compared to 43% in the symptomatically-detected group. Lung cancer screening in a rural Veteran population identifies esophageal cancers more often than in unscreened Veterans. About 1/389 Veterans undergoing LCS was found to have an asymptomatic esophageal cancer. LCS-detected esophageal cancer presented at a lower stage. LCS programs should be vigilant regarding incidental esophageal findings.

ObjectiveMulticancer detection (MCD) tests use blood specimens to screen for various cancers with the hope of reducing cancer mortality. Various companies are developing MCD tests, each with a different technology. For evaluating k MCD tests, a traditional design randomizes participants to either a group with no MCD testing or one of k groups each receiving a different immediate (administered at blood draw) MCD test. To reduce sample size, investigators can store some specimens for delayed MCD testing. A standard stored specimen (SSS) design randomizes participants to either a control group with k different delayed MCD tests applied to the same stored specimen or one of k groups each receiving a different immediate MCD test. Our goal was to further increase efficiency via a novel design and analysis.MethodsThe efficient stored specimen (ESS) design randomizes participants to delayed MCD testing, as in the SSS design, or a single group with k different immediate MCD tests applied to the same specimen. We developed a simple method to separately evaluate each MCD test when any positive MCD test yields a work-up.ResultsThe sample size per randomization group is the same for the ESS and SSS designs. For evaluating k MCD tests, the ESS design involves 2 randomization groups while the SSS design involves k + 1 randomization groups of the same size.ConclusionThe ESS design is superior to the SSS design because, without additional assumptions, it substantially reduces sample size when evaluating multiple MCD tests.

ObjectiveAttendance as well as re-attendance is important for an effective screening program for breast cancer. We aimed to evaluate re-attendance among women with a false positive versus negative screening result in BreastScreen Norway.MethodsThe study sample included 3,990,388 screening examinations performed between 1996 and 2021 among women with an invitation to the subsequent screening examination available, that is, women eligible for re-attendance in the period 1998-2023. Mixed logistic regression was used to analyze the association between screening results, including negative versus any false positive, and negative versus false positive with or without a needle biopsy, and attendance in the subsequent screening round. We adjusted for screening history and age.ResultsCrude attendance rates in the subsequent screening round were 90.8% for those with a negative result and 88.3% for those with a false positive result. The adjusted odds ratio (OR) for re-attendance after a false positive result was 0.91 (95% CI: 0.87-0.93) using a negative screening result as the reference. Also using negative screening result as the reference, adjusted OR for re-attendance among those with a false positive screening result without a needle biopsy was 0.93 (95% CI: 0.91-0.96) while it was 0.85 (95% CI: 0.82-0.87) for those with a false positive result including a biopsy.ConclusionsWomen invited to BreastScreen Norway re-attended screening less often after a false positive compared to a negative result. The benefits of regular attendance should be communicated to women targeted for breast cancer screening.

ObjectiveWe sought to evaluate the presentation and outcomes of patients with a diagnosis of colorectal cancer (CRC) at an academic Canadian center to identify strategies to improve the existing screening system for CRC.SettingRoyal Alexandra Hospital, Edmonton, Alberta, Canada.MethodsWe performed a prospective cohort study. Data collected included: patient demographics, presentation, treatment, and outcomes 1 year after study completion.ResultsOne hundred consecutive patients were included with a median age of 68 years (SD = 13.3). Most (58%) participants were male and 25% had a first-degree family history of CRC. Only 26% of CRC presentations were identified through screening. Of the screened patients, 81% had stage 0-2 disease, all underwent surgery and there were no deaths in this group 1 year after recruitment.In contrast, 74% of patients presented with symptoms, including bleeding (26%), anemia (22%), and obstruction (19%). Thirty-six (49%) received elective surgery, 33 (45%) underwent emergency surgery, and 5 (7%) did not receive surgery. One year after recruitment, 21 patients (28%) in this group were deceased. Within the symptomatic cohort, 55% of patients were outside the age range recommended for screening, 22% did not have a family physician, and 50% had not been offered regular screening.ConclusionsDespite an established screening program, a significant proportion of patients diagnosed with CRC at our center were not diagnosed via screening. Patients presenting with symptoms were more likely to have advanced disease, require more urgent surgeries, and experience worse outcomes compared to their screened counterparts. The current provincial approach to screening for CRC needs to be improved.