Journal of Medical Screening最新文献

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.

ObjectivesColonoscopy surveillance is often performed in post-polypectomy cohorts, likely altering colorectal cancer (CRC) outcomes, but this is often not addressed in CRC incidence analyses. We examined CRC incidence post-endoscopic screening, accounting for surveillance.MethodsWe examined UK Flexible Sigmoidoscopy Screening Trial participants who had no, low-risk, or high-risk (≥10 mm, ≥3 adenomas, adenomas with villous features/high-grade dysplasia) distal polyps at screening. Participants with high-risk polyps had an index colonoscopy and 81% had ≥1 surveillance colonoscopies post-screening; <1% of those with no/low-risk polyps had an index or surveillance colonoscopy. We examined CRC incidence over 21 years by anatomic subsite and sex. Standardised incidence ratios (SIRs) compared incidence to general population incidence.ResultsOf 39,417 participants, 29,792 (76%), 8162 (21%), and 1463 (4%) had no, low-risk, and high-risk polyps, respectively. In the high-risk group, all-site CRC incidence was non-significantly different from that in the general population, when including all participants, just those who attended surveillance, or just those who did not attend surveillance (SIRs: 0.81 [95% confidence interval: 0.60-1.07]; 0.75 [0.54-1.03]; 1.12 [0.56-2.01], respectively). Without surveillance, compared to the general population, distal cancer incidence was lower among women and men without polyps (SIRs: 0.30 [0.24-0.37]; 0.24 [0.20-0.29], respectively) and women and men with low-risk polyps (SIRs: 0.52 [0.34-0.76]; 0.27 [0.19-0.37], respectively); proximal cancer incidence was lower among men without polyps (SIR: 0.75 [0.64-0.88]), non-significantly different among women without polyps (SIR: 1.07 [0.93-1.22]) and men with low-risk polyps (SIR: 1.22 [0.98-1.51]), but higher among women with low-risk polyps (SIR: 2.22 [1.77-2.76]).ConclusionsWomen with low-risk distal polyps at flexible sigmoidoscopy screening had double the risk of proximal colon cancer, compared to the general population.

BackgroundLow-dose computed tomography screening reduces lung cancer-specific mortality in high-risk individuals. Lung cancer risk factors overlap with comorbid diseases, highlighting the significance of frailty and comorbidities for lung cancer screening (LCS). Here, we describe the prevalence of frailty and comorbidity in those invited for LCS and evaluate their associations with response to telephone risk assessment invitation and subsequent uptake of LCS.MethodsAnalysis was based on the intervention arm of the Yorkshire Lung Screening Trial, where ever-smoked individuals aged 55-80 were invited to telephone risk assessment followed by community-based LCS if at higher risk. The electronic frailty index (eFI) was used to compute individual frailty scores (categorised as fit, mild, moderate and severe) and derive comorbidity data.ResultsOf 27,761 individuals invited, 24.1% (n = 6702), 8.5% (n = 2353) and 1.7% (n = 459) had mild, moderate and severe frailty, respectively. Over half responded to the invitation to telephone risk assessment (n = 14,523, 52.5%) with frailty associated with a higher response rate compared to fit individuals: adjusted odds ratio (OR_adj) 1.34, 95% confidence interval (CI) 1.26-1.42 for mild frailty; OR_adj 1.28, 95%CI 1.16-1.40 for moderate frailty; and OR_adj 1.32, 95%CI 1.08-1.61 for severe frailty. Similar patterns were seen with comorbidity counts. After assessment, moderate (OR_adj 0.75, 95%CI 0.59-0.96) and severe (OR_adj 0.67, 95%CI 0.43-1.04) frailty were associated with reduced screening uptake.ConclusionThe presence of frailty was associated with increased response to LCS invitation. Given the strong association between frailty and reduced life expectancy, these results suggest that people with potentially more life years to be gained from LCS may be less inclined to take part. Further research is needed to explore the interactions between frailty and LCS decision-making to inform future invitation strategies.

ObjectiveTo assess the performance of APTIMA^® HPV E6/E7 mRNA assay (AHPV) with HPV 16 and 18/45 genotyping (AHPV-GT) and cytology in detecting cervical cancer and precancer in HIV positive and negative women in South Africa.MethodsA multicentre cross-sectional study was performed in women aged 25-64 (n = 992) with cytology and AHPV with AHPV-GT reflex testing. All screen-positive and a random subset of screen-negative women were referred for colposcopy and biopsy.ResultsOn cytology, low-grade squamous intraepithelial lesion (LSIL) or higher was found in 9.7% of HIV negative and 35.8% of HIV positive women. HPV mRNA positivity was 19.5% (4.4% HPV 16, 2.8% HPV 18/45, and 6.9% other high-risk HPV) in HIV negative women, compared to 45.8% (9.4% HPV 16, 9.7% HPV 18/45, and 27.6% other high-risk HPV) in HIV positive women. The prevalence of histological abnormalities in HIV negative vs HIV positive women was 24.3 vs 46.0% for cervical intraepithelial neoplasia (CIN) 2+, 10.2 vs 24.1% for CIN3+, and 1.4 vs 2.4% for invasive squamous cell carcinoma. AHPV sensitivity for detection of CIN3 + performed the best: 69.0% (95% confidence interval (CI) 56.8-81.1) in HIV negative vs 81.4% (95% CI 73.7-89.0) in HIV positive women, followed by ASCUS + (atypical squamous cells of undetermined significance) cytology: 58.6% (95% CI 45.7-71.6) vs 76.5% (95% CI 68.1-84.8). The best positive predictive value for CIN2 + was for AHPV-GT16, followed by AHPV-GT16,18/45 and cytology LSIL+: HIV-negative women 84.0% (95% CI 68.9-99.1); 76.9% (95% CI 63.3-90.6); 75.0% (95 CI% 61.2-88.9) and HIV-positive women 92.5% (95% CI 84.1-100); 86.8% (95% CI 79.1-94.6); 84.0% (95% CI 77.6-90.3).ConclusionSignificantly more HPV infection and cytological/histological abnormalities and advanced disease were seen in HIV positive women. The lower than expected clinical sensitivities of all screening tests are comparable to HPV DNA sensitivities reported in similar populations. AHPV with AHPV-GT performed better than cytology as a screening and triage test.

Some noteworthy studies have questioned the use of ChatGPT, a free artificial intelligence program that has become very popular and widespread in recent times, in different branches of medicine. In this study, the success of ChatGPT in detecting breast cancer on mammography (MMG) was evaluated. The pre-treatment mammographic images of patients with a histopathological diagnosis of invasive breast carcinoma and prominent mass formation on MMG were read separately into two ChatGPT subprograms: Radiologist Report Writer (P1) and XrayGPT (P2). The programs were asked to determine mammographic breast density, tumor size, side, and quadrant, the presence of microcalcification, distortion, skin or nipple changes, and axillary lymphadenopathy (LAP), and BI-RADS score. The responses were evaluated in consensus by two experienced radiologists. Although the mass detection rate of both programs was over 60%, the success in determining breast density, tumor size and localization, microcalcification, distortion, skin or nipple changes, and axillary LAP was low. BI-RADS category agreement with readers was fair for P1 (κ:28%, 0.20< κ ≤ 0.40) and moderate for P2 (κ:58%, 0.40< κ ≤ 0.60). In conclusion, while the XrayGPT application can detect breast cancer with a mass appearance on MMG images better than the Radiologist Report Writer application, the success of both is low in detecting all other related features. This casts doubt over the suitability of current large language models for image analysis in breast screening.

ObjectiveA better understanding of factors associated with cervical cancer screening can inform strategies for cervical cancer prevention. This study examined the relationship between age at human papillomavirus (HPV) vaccination and participation in cervical cancer screening among a nationally representative sample of women in the United States.MethodsWe utilized data from the National Survey of Family Growth for the years 2015-2019 focusing on women aged 18-24 vaccinated against HPV. Age at first HPV immunization was analyzed as both a dichotomous (vaccinated at 9-12 vs. 13-23 years) and a continuous variable. The outcome measured was ever having a Pap smear. Multivariable logistic regression that accounted for complex survey design was employed to estimate adjusted prevalence ratios and differences from average marginal predictions.ResultsThe study comprised 981 individuals, representing 6.05 million women. Over half of the study population had a Pap test (57.4%). Women vaccinated at ages 9-12 were less likely to participate in screening compared to those vaccinated at ages 13-23 [risk difference: -9.1, 95% confidence interval (CI) -16.7 to -1.5)] which translates into 120,260 fewer women nationwide getting cervical cancer screening. Each 1-year increase in age at first vaccination was associated with a 1.1% (95% CI, -0.1 to 2.4%) higher probability of having a Pap test, but this linear trend was not statistically significant.ConclusionsOur study underscores the importance of promoting cervical cancer screening not only among unvaccinated women but also among those who received the HPV vaccine at the recommended ages of 9-12.

The United Kingdom was one of the first countries in the world to have a fully rolled out colorectal cancer screening programme and, although the four constituent countries have taken somewhat different approaches, they all commenced with guaiac faecal occult blood testing and have all now transitioned to faecal immunochemical testing. In this Commentary, we trace the development of the Scottish Bowel Screening Programme, with reference to the other UK programmes, reflect on its successes and shortcomings, and make suggestions for the future.

ObjectivesOrganized cervical cancer screening reduces cervical cancer incidence and mortality and is widely implemented across Europe. However, non-organized cervical cancer testing remains common. Frequent testing may lead to overdiagnosis and unnecessary treatment, especially among young women. This study aims to identify factors influencing young women's participation in organized cervical cancer screening and non-organized cervical cancer testing.MethodsWe surveyed 1411 women aged 15-35 living in Finland, assessing their knowledge and attitudes toward cervical cancer testing. Survey responses were linked to sociodemographic registry data and cervical cancer testing records. Descriptive statistics of survey responses and logistic regression were used to identify factors influencing participation in both organized screening and non-organized testing.ResultsHuman papillomavirus vaccination status, medical contraception use, and gynecologist visit frequency were key predictors of non-organized testing. Human papillomavirus-vaccinated women were 50% less likely to undergo non-organized testing compared to those unvaccinated. Medical contraception users were 5.3 times more likely compared to non-users, and frequent gynecologist visitors were 1.5 times more likely to undergo non-organized testing compared to infrequent visitors. For organized screening, women with tertiary education were 4.1 times more likely to participate than those with primary education. Women appreciated the flexibility in screening times and locations. Human papillomavirus awareness was high with 91.3% of respondents having heard of the virus.ConclusionsTo address non-organized testing among young women, comprehensive education about human papillomavirus and cervical cancer screening is essential, both for screened women and healthcare professionals. Aligning screening practices with women's preferences may improve adherence to organized screening, ultimately benefiting public health outcomes.