Journal of Medical Screening最新文献

ObjectiveTo examine spoilt faecal immunochemical test kit data for associations with ethnicity, gender, socioeconomic deprivation and age. Colorectal cancer outcomes in New Zealand remain poor compared with other countries, with diagnostic delays contributing to inequities. A proportion of faecal immunochemical test kits returned to the National Bowel Screening Programme are spoilt due to participant errors, causing further delays.MethodsA cross-sectional analysis was conducted on National Bowel Screening Programme data from 2012 to 2022, which includes all participants aged 60-74 years who returned a spoilt faecal immunochemical test kit. Spoilt kit reasons were compared by ethnicity using chi-square tests, and logistic regression assessed associations with demographic factors.ResultsOf 432,885 returned kits, 32,754 (8.2%) were spoilt. Asians had the highest proportion spoilt (10.7%), followed by Pacific Peoples (9.2%), Europeans (7.2%) and Māori (6.8%). Compared with Europeans, Asians had 53% higher odds and Pacific Peoples 19% higher odds of returning a spoilt kit, while Māori had slightly reduced odds. Men and participants living in higher deprived quintiles also had increased odds of spoiling a kit. While missing collection dates were the primary reason for spoilt kits (53.2%), transit delays emerged as a disproportionate barrier for Māori (25.6%), while Pacific Peoples (17.5%) experienced rates similar to Europeans (18.2%).ConclusionsExisting interventions appear to benefit Māori in reducing errors, yet they remain vulnerable to systemic issues like transit delays. The program faces a challenge: addressing the higher rates of participant errors among the Asian and Pacific populations, while simultaneously mitigating the impact of postal infrastructure on Māori.

ObjectiveTo evaluate the performance of the universal newborn hearing screening programme in Malaysian public hospitals following the introduction of national key performance indicators in 2022.MethodsA cross-sectional analysis was conducted using aggregated universal newborn hearing screening data from 48 public hospitals for 2022 (288,543 live births) and 2023 (308,272). Performance indicators included screening coverage, timeliness of screening (by 28 days), initial referral rates, loss to follow-up, and age at screening, diagnosis, and intervention. The prevalence of confirmed hearing loss was also estimated.ResultsMedian screening coverage increased from 72.0% (IQR = 54.3) in 2022 to 88.4% (IQR = 16.7) in 2023, and the proportion of hospitals completing screening within 1 month increased from 71.1% to 93.6% (p = .004). Median initial referral rates remained high and unchanged (8.3% vs. 7.9%, p = .767), and mean loss to follow-up after screening was similarly stable (23.5% vs. 23.1%, p = .797). Median age at screening decreased from 9 to 5 days (p < .001), whereas median age at diagnostic confirmation remained approximately 4 months, and mean age at intervention exceeded 7 months in both years. The prevalence of confirmed hearing loss was 2.95 per 1000 live births in 2022 and 2.85 per 1000 in 2023.ConclusionsThe introduction of national key performance indicators led to improved coverage and earlier screening. However, screening specificity, follow-up completion and downstream timeliness remain key challenges. Strengthening screening specificity, follow-up coordination, and diagnostic and intervention capacity is necessary to ensure timely care across the full Early Hearing Detection and Intervention pathway.

ObjectivesTo evaluate the efficacy of non-invasive prenatal testing in detecting sex chromosome aneuploidies.MethodsA total of 67,099 pregnant women were recruited in this retrospective observational study at Peking Union Medical College Hospital; 300 cases at high risk of sex chromosome aneuploidies were screened and 36 cases refused invasive prenatal diagnosis after detailed prenatal genetic counselling. The clinical data and prenatal diagnosis results were collected.Results101 cases were in accordance with non-invasive prenatal testing results after invasive prenatal diagnosis: 95 cases had follow-up confirmation with abnormal sex aneuploidies (14 for monosomy X; 36 for 47, XXY; 22 for trisomy X and 23 for 47, XYY). The total positive predictive value was 38.26% (101/264). The accuracy of different Z scores was calculated, respectively, with positive predictive value ranging from 33.96% to 41.38% and a decreased sensitivity with rise of the Z score.ConclusionsNon-invasive prenatal testing is an effective screening method for sex chromosome trisomy, rather than monosomy X, with relatively high accuracy. Z score = 3 is an optimum risk threshold in sex chromosome aneuploidies.

ObjectiveEvidence is scarce about whether colorectal cancer screening can affect the quality of life of participants, particularly in terms of novel screening strategies in Eastern populations.MethodsFrom 2018 to 2021, the TARGET-C trial randomly allocated 19,373 participants to one of three screening strategies: (A) one-time colonoscopy; (B) annual faecal immunochemical test with positives referred for colonoscopy; and (C) annual risk-adapted screening with low-risk participants referred for faecal immunochemical test and high-risk participants referred for colonoscopy. Two rounds of follow-up after baseline screening were conducted over the 3-year period. Based on the TARGET-C, a EuroQol five-dimensional questionnaire-based quality of life survey was administrated to the participants, and utility scores and related changes were used as the main outcomes.ResultsTaking by-strategy utility scores for participants before being screened at baseline as the comparators (n = 2921), the changes in utility scores after baseline screening were -0.008 (P < 0.050) for strategy A, 0.006 (P < 0.050) for strategy B and 0.000 (P > 0.050) for strategy C, and the overall difference in quality of life changes among the three strategies was significant (P < 0.001). Taking the same comparators as above, the changes in utility scores for participants in the second round of follow-up (n = 9201) were 0.011 (P < 0.050), 0.011 (P < 0.050) and 0.005 (P < 0.050), respectively, and the overall difference was neither clinically meaningful nor statistically significant (P = 0.113).ConclusionsNone of the three colorectal cancer screening strategies had a major effect on the participants' quality of life over the 3 years. Within one round of screening, incorporating risk-adapted screening and/or faecal immunochemical test might offset the quality of life impact from colonoscopy screening.

BackgroundPhysically Disabled women face multiple barriers to cervical screening, contributing to lower uptake and increased health inequalities. Human papillomavirus self-sampling has been shown to increase screening participation in under-screened populations, but little is known about its acceptability for Disabled women.MethodsA cross-sectional online survey was conducted with 1493 UK-based participants who identified as having a physical disability, impairment, condition, or difference that makes cervical screening difficult or impossible. Participants completed questions on the acceptability of human papillomavirus self-sampling, attitudes and beliefs relating to self-sampling, and future screening preferences. Descriptive statistics and multinomial logistic regression were used to analyse responses.ResultsMost participants reported that they would be able to carry out self-sampling themselves (63.3%) and would be willing for a healthcare professional to use a self-sampling kit on their behalf (59.1%). Many (70.5%) had concerns about not performing the test correctly. Around half (53.0%) would prefer self-sampling at home if offered a screening choice. Women who had never attended screening, or who had delayed/missed appointments, were significantly more likely to prefer self-sampling (odds ratios 13.11 and 5.25, respectively) than women who had always attended. Approximately a fifth of participants (18.7%) would prefer a non-speculum clinician-taken test.ConclusionHuman papillomavirus self-sampling was acceptable to many physically Disabled women and preferred over conventional screening, particularly among those who had delayed/missed screening or never attended. Implementation should include tailored accessible instructions to support human papillomavirus self-sampling, disability-informed clinical support, and consideration of non-speculum clinician-taken samples to ensure equitable access and reduce inequalities in cervical screening.

ObjectivesTo quantify the harms participants are willing to accept for varying benefits from cancer screening following provision of information.MethodsWe conducted an online discrete choice experiment with two samples of the UK public. Attributes were number of cancer diagnoses and deaths prevented (benefits) and overdiagnoses, false positives and false negatives (harms) for a population who are/are not screened for an unspecified cancer over their lifetimes. After selecting the best-fitting conditional logistic regression model for each sample, we used latent class analysis to investigate preference heterogeneity and calculated the probability that each class/group would take up screening with different benefit and harm levels.ResultsIn total, 1018 participants completed the discrete choice experiment. Cancer deaths prevented was the most important attribute, followed by the number of false positively/negatively detected cancers; cancers prevented and overdiagnosed were deemed relatively unimportant. Three latent classes were identified. The largest class (approximately two-thirds) chiefly opted for screening, focusing on deaths prevented; this group would strongly prefer screening participation even with harms only (probability 76%-92%). Approximately a quarter of each sample traded off benefits and harms; this group would likely take up screening with outcomes like those of colorectal screening (68%-87%).ConclusionsA minority of the public express preferences for screening that are influenced by trading-off potential benefits/harms, but most have strong preferences for cancer screening, focusing on the associated reduction of cancer deaths. The findings emphasise public health responsibility in appraising or generating evidence on benefits and harms to support decisions about the introduction or modification of screening programmes.

ObjectivesUnited Kingdom (UK) guidelines recommend delaying cervical screening due during pregnancy to 12 weeks postnatal, despite a lack of supporting evidence. This questionnaire-based study aimed to determine the feasibility of a clinical study of cervical screening and urine self-sampling for human papillomavirus (HPV) at 6 weeks postnatal, as pilot work suggested this would improve uptake, if offered at the routine postnatal check-up.MethodsFemales who were pregnant/recently pregnant were invited to participate in a web-based questionnaire. Questions assessed acceptability of postnatal cervical screening at 6 weeks postnatal, analysed with chi-square, Fisher's exact and Mann-Whitney tests. Free-text responses were coded using the Theoretical Framework of Acceptability (TFA) to conduct a qualitative content analysis.ResultsAmong the 454 participants, 266 (58.6%) would be more likely to undergo cervical screening if offered at 6 weeks postnatal, and an even higher proportion expressed increased willingness if urine self-sampling were offered (n = 338; 74.4%). Two-thirds (308/454; 67.8%) would be willing to be screened at 6 weeks postnatal for a research study and 356/454 (78.4%) if it would be limited only to urine self-sampling. When considering screening modality, over half (245/454; 54%) would prefer urine self-sampling to cervical screening, although a fifth (93/454; 21%) preferred conventional sampling. Free-text responses were provided by 279 participants, and these highlighted that affective attitude and burden TFA constructs underpinned prospective acceptability of having screening at 6 weeks postnatal.ConclusionsOffering cervical screening at the 6-week postnatal check-up has potential to increase cervical screening participation. Most participants would be interested in taking part in the research. The feasibility of screening at 6 weeks postnatal and concurrent acceptability should be tested in pilot clinical studies.

The self-sampling human papillomavirus (HPV) test improves participation in cervical cancer screening. However, the ripple effect of this test on participation in the next screening round has not yet been examined. This study, a secondary analysis of the Accelerating Cervical Cancer Elimination by Self-Sampling test (ACCESS) trial, aims to clarify this effect. Women who had not participated in the cervical cancer screening program of Ichihara City for 3 years or more were included. The participants were randomly assigned to intervention (n = 7337) and control groups (n = 7770). In the initial round, the intervention group could perform a self-sampling HPV test or undergo cytology as the primary screening method, while the control group could undergo cytology only. In the next round, both groups could undergo cytology. In intention-to-screen analysis, screening uptake in the next round was 10.0% (95% confidence interval [CI]: 9.3%, 10.7%) in the intervention group and 10.2% (95% CI: 9.5%, 10.8%) in the control group, with no significant difference between groups (p = 0.717). In conclusion, offering a one-time self-sampling HPV test had no effect on screening uptake in the next round, suggesting that the test needs to be offered on an ongoing basis to continuously improve screening uptake.

ObjectiveTo study the implications of implementing artificial intelligence (AI) as a decision support tool in the Norwegian breast cancer screening program concerning cost-effectiveness and time savings for radiologists.MethodsIn a decision tree model using recent data from AI vendors and the Cancer Registry of Norway, and assuming equal effectiveness of radiologists plus AI compared to standard practice, we simulated costs, effects and radiologist person-years over the next 20 years under different scenarios: 1) Assuming a €1 additional running cost of AI instead of the €3 assumed in the base case, 2) varying the AI-score thresholds for single vs. double readings, 3) varying the consensus and recall rates, and 4) reductions in the interval cancer rate compared to standard practice.ResultsAI was unlikely to be cost-effective, even when only one radiologist was used alongside AI for all screening exams. This also applied when assuming a 10% reduction in the consensus and recall rates. However, there was a 30-50% reduction in the radiologists' screen-reading volume. Assuming an additional running cost of €1 for AI, the costs were comparable, with similar probabilities of cost-effectiveness for AI and standard practice. Assuming a 5% reduction in the interval cancer rate, AI proved to be cost-effective across all willingness-to-pay values.ConclusionsAI may be cost-effective if the interval cancer rate is reduced by 5% or more, or if its additional cost is €1 per screening exam. Despite a substantial reduction in screening volume, this remains modest relative to the total radiologist person-years available within breast centers, accounting for only 3-4% of person-years.