Journal of Medical Screening最新文献

ObjectivesTo assess variation in fecal hemoglobin concentration according to year and season of fecal immunochemical test screening in Sweden, the detection rate of advanced neoplasia, and factors that could influence fecal immunochemical test positivity including sex, age, comorbidity, and laboratory testing quality.MethodsWe performed a cross-sectional analysis of participants in the fecal immunochemical test arm of the randomized controlled trial SCREESCO between March 2014 and December 2019 and of participants in the screening program of Stockholm-Gotland, Sweden, who underwent a one-sample fecal immunochemical test between October 2015 and October 2024.ResultsA total of 33,232 individuals from SCREESCO and 315,664 individuals from the Stockholm-Gotland screening program were included. Fecal immunochemical test hemoglobin concentrations were generally higher in the winter but this varied over calendar years. In SCREESCO, the median fecal immunochemical test concentration was 0.0 μg hemoglobin/g feces in December 2015, 1.0 μg hemoglobin/g feces in June and 5.0 μg hemoglobin/g feces in December 2016, and 0.0 μg hemoglobin/g feces in June 2017. This was paralleled by a similar variation in the Stockholm-Gotland screening program. In months with higher fecal immunochemical test positivity in SCREESCO, there was a higher number of colonoscopies and a lower rate of advanced neoplasia detected. Male sex, higher age, and higher comorbidity were also associated with higher fecal immunochemical test positivity.ConclusionsThe variation in the number of colonoscopies and detection rate of advanced neoplasia paralleled the seasonal variation in fecal immunochemical test and warrants further studies on seasonal variation of fecal immunochemical test to optimize fecal immunochemical test-based colorectal cancer screening.

Objective: Colorectal cancer (CRC) is the second leading cause of cancer-related mortality in the UK. Early identification and timely intervention rely heavily on the faecal immunohistochemical test (FIT). However, FIT diagnostic accuracy varies, with a sensitivity ranging between 85% and 94% and a noteworthy negative predictive value (NPV) of 99%. The objective of this study was to evaluate the diagnostic accuracy of FIT in detecting CRC and advanced adenomas in patients referred through the 2-week wait (2WW) referral pathway following the National Institute for Health and Care Excellence (NICE) NG12 criteria. Method: A retrospective analysis was conducted on 1841 patients who were referred through the 2WW pathway. Data on clinical characteristics, FIT test positivity (faecal haemoglobin ≥ 10 µg/g), and subsequent investigations were obtained. The sensitivity, specificity, positive predictive value (PPV), and NPV were calculated based on the presence of adenomas (≥10 mm) or malignancies. Results: Positive FIT results were observed in 73.4%, negative FIT in 25.9%, and 0.65% of patients lacked FIT availability. The sensitivity, specificity, PPV, and NPV for CRC detection compared to the presence of advanced adenoma or CRC were 96.49% vs. 93.6%, 26.56% vs. 30.2%, 7.31% vs. 21.8%, and 99.18% vs. 95.8%, respectively. Conclusion: FIT showed the expected performance for CRC detection with an NPV of 99.18%, but a negative FIT result should not exclude investigation with colonoscopy due to a 4.2% likelihood of missing advanced adenomas. There is still a need for other types of testing for CRC screening.

BackgroundLung cancer is a leading cause of cancer-related mortality in India, with most cases diagnosed at advanced stages. Low-dose computed tomography (LDCT) screening has been shown to enhance early detection and improve survival rates, but its cost-effectiveness in India remains unclear.ObjectiveTo evaluate the cost-effectiveness of LDCT screening for lung cancer compared to chest X-ray (CXR) and no screening in India using a Markov model.MethodsA Markov model simulated the natural progression of lung cancer, comparing LDCT, CXR, and no screening in a high-risk hypothetical population in the age group of 30 to 65 years. The model incorporated transition probabilities, costs, and quality-adjusted life years (QALYs) with data from published literature, cancer registries, and Global Cancer Observatory. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB). Sensitivity analyses, including probabilistic sensitivity analysis, threshold analysis, and budget impact, were conducted to evaluate model robustness.ResultsLDCT screening yielded the highest effectiveness (23.71 QALYs), compared to 19.82 for CXR and 13.43 for no screening. Although LDCT incurred the highest cost (₹380064.75), it also provided the highest NMB (₹5232241.18), making it the most cost-effective option. The ICER for LDCT (₹36429.44) remained below the willingness-to-pay threshold, confirming its economic viability. Sensitivity analyses further validated LDCT's robustness across scenarios.ConclusionLDCT is a cost-effective strategy for lung cancer screening in India, offering significant health benefits despite higher costs. Policymakers should consider integrating LDCT into national cancer screening programs, with further research needed to optimise screening intervals and target populations.

IntroductionThis study sought to determine participation by eligible Irish Travellers, a minority ethnic group, in the cancer screening programmes in Ireland (bowel, breast and cervical screening) and to determine barriers/facilitators to screening.MethodologyThis study was co-designed with the National Cancer Control Programme (NCCP) and Pavee Point Traveller and Roma Centre, Ireland. A survey questionnaire, adapted from the NCCP's 2022 National Survey on Cancer Awareness, was disseminated to Travellers via Traveller Community Health Workers (TCHWs).ResultsA total of 574 survey questionnaires were distributed across 12 different Primary Health Care Traveller Projects in the Republic of Ireland and 483 (84%) were returned completed; 148 (30.6%) were from men and 306 (63.1%) from women (6.3%, missing data). High proportions had ever attended breast (72.6%) and cervical (65.4%) screening. Bowel screening uptake was low in both men (12.5%) and women (19.2%). Low proportions recalled receiving an invitation to programmes. The faecal immunochemical test test used in the BowelScreen programme prompted embarrassment as a barrier in eligible men (62.5%); embarrassment was lower in women for bowel (38.5%), breast (32.9%) and cervical (30.4%) screening. Fear was the second highest barrier. The main facilitators of screening attendance were talking to TCHW and an invitation respectively, particularly in women eligible for bowel (50%; 53.8%), breast (49.3%; 50.7%) and cervical screening (47.6%; 48.2%), but lower in men (25%; 37.5%); 25% cited the family doctor as facilitator.ConclusionTravellers face barriers accessing mainstream health services; easy access to screening must be ensured. The TCHW is a key facilitator. There is a need for universal ethnic identifiers to facilitate routine monitoring of participation and outcomes for Travellers in screening.

ObjectiveGP list inflation occurs when the number of patients registered at a GP practice exceeds the number of residents. It may be associated with out-of-date patient contact data, affecting invitations for cancer screening. We examined whether bowel, breast and cervical screening coverage was associated with list inflation after adjusting for deprivation and ethnicity.MethodsWe used ecological data, with GP practice the unit of analysis. Outcomes were NHS Fingertips 2019-2020 screening programme performance data. List inflation/deflation was calculated as the difference between GP-registered patients in July 2021 and Office for National Statistics population estimates in their Lower Super Output Areas (LSOA). Percentage White population was calculated using census (2021) data. Index of multiple deprivation (IMD) score was available from NHS Fingertips. Linear regression models were used to examine correlations between outcomes and list inflation before and after adjustment for deprivation and ethnicity.ResultsThe study included 6085 GP practices covering the whole of England. Median list inflation was 8.6% (interquartile range (IQR) 4.7%-16.9%). List inflation was a significant independent predictor of screening coverage. For each 10 percentage points increase in list inflation, coverage declined as follows: -1.96% (95% CI: -2.19, -1.73), -2.20% (95% CI: -2.39, -2.02), -0.99% (95% CI: -1.15, -0.84) and -1.59% (95% CI: -1.75, -1.43) for breast, cervical (aged 25-49), cervical (aged 50-64) and bowel cancer screening, respectively.ConclusionsIt is important to control for variations in list inflation as well as population demographics when comparing screening programme coverage. Uptake improvement initiatives should include strategies for overcoming issues with out-of-date registration data.

IntroductionMulticancer detection (MCD) tests generally target selected cancer sites, but may also have some detection ability at other sites; they additionally typically give a predicted cancer signal origin (CSO) for positive tests. Positive predictive value (PPV) is a widely used metric assessing performance of single-cancer screening tests. The aim here was to define PPVs in a number of ways in the MCD context, create a prototypical MCD test, and show the qualitative and quantitative properties of these PPV metrics.MethodsPPVs were defined based on which subjects were included in the numerator and denominator. PPV_ALL, PPV_T, and PPV_CSO each have as denominator all subjects with positive screens, and as numerators all subjects with any cancer diagnosis, diagnosis at any targeted site, and diagnosis at the predicted CSO site, respectively. Predicted CSO site-specific PPVs were defined similarly, except with denominator subjects with a given cancer site as predicted CSO. MCD performance data taken from a case-control study and population incidence rates were used to determine sensitivity, specificity, CSO accuracy, and cancer prevalence values of a prototypical MCD test for which PPV were calculated. A range of sensitivity rates for nontargeted cancer sites were assessed.ResultsPPV_ALL increased and PPV_T decreased as sensitivity for nontargeted sites increased. Predicted site-specific PPVs depended primarily on cancer site CSO accuracy, not on site population prevalence.ConclusionsPPVs can be defined in multiple ways for MCD tests. Their usefulness depends on the clinical context. Companies offering MCD tests can consider discussing the clinical usefulness of various PPVs with clinicians to decide what metrics to include on test reports.

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.