Journal of Medical Screening最新文献

ObjectivePeople with abdominal aortic aneurysms (AAA) are at risk of aneurysm rupture, which is immediately life-threatening. People diagnosed with AAA that are a sub-threshold size for intervention undergo regular ultrasound surveillance in England. However, surveillance may cause psychosocial problems such as anxiety. We aimed to use an AAA-specific measure of quality of life to identify the characteristics of people in surveillance with AAA-related psychosocial problems.SettingIn the National Health Service (NHS) in England, all men are screened for AAA aged 65. They undergo annual surveillance if a small AAA is detected (3-4.4 cm) and three-monthly surveillance if a medium AAA is detected (4.5-5.4 cm). Men with larger AAAs are referred to vascular services.MethodsA postal survey of men in AAA surveillance from five regional screening centres was conducted using the e-PAQ-AAA quality of life measure which included the Psychological Consequences of Screening Questionnaire.ResultsThe response rate was 64% (734/1156). The majority of men reported no AAA-related anxiety or impact on daily living, and no screening-related psychological consequences. However, 11% (29/257) of men in three-monthly surveillance reported having AAA-related anxiety most or all of the time. Men with higher levels of anxiety and physical, emotional or social consequences of surveillance tended to be younger, from more socially deprived communities, have poorer physical health, and have relatively larger and faster-growing AAAs.ConclusionsPsychosocial problems related to AAA surveillance were not common but did affect a minority of men significantly. An intervention would be beneficial in helping men in AAA surveillance to manage such problems.

ObjectiveTo analyze trends in recommending continuation of lung cancer screening across different risk factors and demographic groups using data from the National Lung Screening Trial (NLST).MethodsThis retrospective cohort study utilized de-identified NLST data from August 2002 to April 2004 and follow-up data collected through December 31, 2009, with 24,924 participants. Multivariable logistic regression was performed to assess the odds of continued low-dose computed tomography (LDCT) screening based on variables such as alcohol consumption, age, sex, race, ethnicity, education, diagnosis of chronic obstructive pulmonary disease (COPD), emphysema, chronic bronchitis, or pneumonia, occupational history, family history of lung cancer, and a previous cancer diagnosis for another type of cancer. Participants receiving chest X-rays, a previous diagnosis of lung cancer, or those with incomplete data were excluded from the analysis.ResultsParticipants who consumed five or more alcoholic drinks per day (OR = 2.19), identified as Asian (OR = 3.59) or Native American, Alaskan Native, or Pacific Islander (OR = 2.37), and multiracial participants (OR = 2.15) had significantly higher odds of the reporting radiologist to recommend continued screening compared to Caucasians, while Black participants had lower odds (OR = 0.85). Factors such as family history of lung cancer or respiratory diseases like chronic bronchitis, COPD, and emphysema reduced the odds of the reporting radiologist recommending continued screening.ConclusionsThe study highlights differences in lung cancer screening recommendations among demographic groups at the time the NLST data were collected. Given the evolving guidelines and practices for LDCT screening, further research is needed to understand how these patterns compare to current trends. It is noted that global lung cancer screening programs vary in their approach, offering comparisons with lung cancer prevention worldwide.

ObjectiveBreast cancer screening facilitates the early detection of breast cancer and can reduce mortality among women. However, during the COVID-19 pandemic, regular screening was postponed or interrupted. This study investigated the effect of the pandemic on breast cancer screening and diagnosis rates.MethodsThis single-center, retrospective cohort study enrolled women aged 40-69 years. Mammography was performed at our hospital or in outreach screening vehicles. Follow-up rate, time to follow-up, time to diagnosis, cancer detection rate (CDR), positive predictive value (PPV), and cancer staging were compared between pre-pandemic (2017-2019) and pandemic (2020-2022) periods.ResultsA similar number of participants were screened during the pandemic (N = 77,901) and pre-pandemic periods (N = 75,403). However, mobile screening significantly increased from 89.4% to 94.9% during the pandemic. Education level, rate of self-examination of breasts, and the proportion of participants with a family history of breast cancer were higher during the pandemic than in the pre-pandemic period. Time to follow-up and time to diagnosis were significantly shorter during the pandemic than in the pre-pandemic period. No significant differences were observed in PPV, CDR, cancer staging, and rate of invasive carcinoma between the two periods.ConclusionDuring the pandemic, participants were more likely to promptly return for follow-up. The use of outreach screening vehicles and increased awareness for individuals with low education levels are crucial for maintaining screening volumes in the pandemic recovery period. Outreach screening strategies may serve as an alternative in a future pandemic crisis.

It is claimed that polygenic risk scores will transform disease prevention, but a typical polygenic risk score for a common disease only detects 11% of affected individuals at a 5% false positive rate. This level of screening performance is not useful. Claims to the contrary are either due to incorrect interpretation of the data or other influences. Implementation of polygenic risk scores would divert resources from population-wide approaches that address the major disease burden in the average-risk majority to the follow-up of the many false positive results in those designated at high polygenic risk.

ObjectivesColorectal, breast, and cervical cancers are leading causes of morbidity and mortality among Canadian women. While organized screening programs aim to reduce this burden, participation rates remain suboptimal, particularly for colorectal cancer screening. This study examined factors associated with colorectal cancer screening uptake among women participating in breast and cervical cancer screening ('screen-aware" women), investigated patterns of concurrent participation across all three programs, and identified associated factors.MethodsCross-sectional data from the 2017 Canadian Community Health Survey were analyzed for women aged 50-69 eligible for breast cancer (mammography), cervical cancer (Pap smear), and colorectal cancer (fecal and/or endoscopy tests) screening (n = 10,426). Multivariable logistic regression evaluated factors associated with colorectal cancer screening among "screen-aware" women. Multinomial logistic regression assessed factors related to full (all three), partial (any two), single, or non-participation across screening programs, using "no screening" as the reference.ResultsAlthough the majority of women (87%) participated in at least one screening program, only 27% reported full participation. Colorectal cancer screening (53.7%) lagged behind breast and cervical cancer screening (∼64%). Among "screen-aware" women, older age (adjusted odds ratio 1.50, 95% confidence interval 1.31-1.71), higher income, self-rated health as "great" (adjusted odds ratio 1.31, 95% confidence interval 1.05-1.63), and having a regular healthcare provider (adjusted odds ratio 3.29, 95% confidence interval 2.45-4.40) were associated with higher colorectal cancer screening participation. Having multiple chronic conditions reduced colorectal cancer screening likelihood (adjusted odds ratio 0.72, 95% confidence interval 0.55-0.94). Higher income, self-rated health, having a regular healthcare provider, and physical activity increased the odds of full screening participation, while smoking and Asian identity reduced the odds.ConclusionsColorectal cancer screening uptake remains low among Canadian women, even those participating in other cancer screenings. Socioeconomic, health-related, and systemic factors influence concurrent screening participation. Tailored interventions addressing identified barriers and promoting equitable access to screening are crucial for improving cancer prevention efforts.

BackgroundThe effectiveness of an intervention such as cancer screening can be estimated by conducting a cohort study estimating the rate ratio between an exposed group invited to screening and a control group not invited to screening. A common issue is non-compliance, where not all individuals in the study group are exposed. Ignoring non-compliance can result in biased estimates of the exposure effect, but excluding non-exposed individuals may also be problematic as they may differ in risk profile from those who were exposed. A similar problem arises when members of the control group are inadvertently exposed (contamination). Observational studies face additional challenges due to confounding.ObjectiveTo report the development of a method to adjust rate ratio estimates in cohort studies for contamination and non-compliance, that also adjusts for confounding.MethodDerivation of the new method is outlined.ResultsThe method is illustrated in two examples.ConclusionThe results are comparable with a stratified estimate, but through the use of a Poisson regression model the range of possible analyses is extended, for example to tests of confounding factors and interaction.

ObjectivesCancer screening among older adults above 75 years of age is frequent despite generally not being recommended in evidence-based guidelines. We aimed to describe trends in prostate, cervical, breast, and colorectal cancer screening after the age of 75.SettingThis descriptive cross-sectional study analysed the 2007, 2012, 2017, and 2022 waves of the nationwide population-based Swiss Health Survey. Residents of Switzerland were invited through state-stratified multistage probability sampling.MethodsFor each wave, we calculated weighted overall and sex- and age-stratified proportions of any, prostate, cervical, breast, and colorectal cancer screening in the past 12 months explicitly for preventive non-symptomatic purposes among older adults above 75 years of age.ResultsAnalytical sample sizes ranged from 1450 (2007) to 2276 (2022). Across waves, populations aged and had increasing education levels. Over time, any cancer screening in the past 12 months was undertaken by one in four older adults aged above 75 (25.4% in 2007; 24.3% in 2022), where proportions were persistently higher among men (31.8% in 2007; 28.3% in 2022) than women (21.3% in 2007; 20.8% in 2022). In all waves, screening decreased with increasing age (2022: 29.7% among people aged 76-80, 14.8% among people aged 86 years and above). Prostate cancer screening decreased from 26.0% (2007) to 21.0% (2022), with no substantial changes for other screening types.ConclusionsCancer screening after the age of 75 has been frequent and stable across time despite not being recommended, emphasising the need for further evidence on screening effectiveness and harms among older adults.

PurposeCancer survivors and those with cardiovascular diseases have an increased risk of developing colorectal cancer and breast cancer. Undergoing colorectal cancer screening and mammogram uptake within the recommended intervals have the potential to improve early detection. However, the potential impact of cancer history and cardiovascular disease on colorectal cancer screening and mammogram uptake remains unexamined.MethodsWe conducted a cross-sectional analysis of 2019, 2021, and 2023 National Health Interview Survey data. Our outcomes of interest were up-to-date colorectal cancer screening and mammogram uptake. Our exposures of interest were cancer history and cardiovascular disease. We used weighted multivariable logistic regressions to examine these associations and adjusted for sociodemographic characteristics, healthcare access, and the year respondents took the survey.ResultsMost respondents had up-to-date colorectal cancer screening (73.1%) and mammogram uptake (77.8%). Most respondents did not report a history of cancer (colorectal cancer screening sample: 85.1%, mammogram uptake sample: 84.6%) or cardiovascular disease (colorectal cancer screening sample: 87.7%, mammogram uptake sample: 90.1%). Having a history of cancer was associated with increased odds of having up-to-date colorectal cancer screening (OR, 1.74, 95% CI, 1.56-1.95). However, respondents with cardiovascular disease, but no cancer history, had decreased odds of mammogram uptake (OR: 0.79, 95% CI: 0.68-0.91).DiscussionThe history of cancer was associated with increased colorectal cancer screening uptake. Contrarily, cardiovascular diseases were associated with decreased mammogram uptake. Generally, healthcare providers should emphasize the importance of up-to-date colorectal cancer screening and mammogram uptake. However, our findings suggest that primary care and educational initiatives tailored toward those with cardiovascular disease that aim to improve mammogram uptake are needed.