Journal of Medical Screening最新文献

ObjectiveTo determine the validity of a screening algorithm based on combination of clinical examination and pulse oximetry, for early detection of congenital heart disease (CHD) in term newborns. CHD is the most frequent major congenital anomaly, with prevalence of 6-12 per 1000 live births. Clinical examination alone may fail to detect CHD in more than 50% of affected newborns. Recent studies have concluded that pulse oximetry has a high sensitivity and specificity as a screening tool for critical CHD.SettingJSS Hospital, Mysuru, Karnataka, India.MethodsIn this prospective observational study, all term neonates delivered at the hospital were included. The screening algorithm consisted of seven clinical parameters and pulse oximetry screening guidelines recommended by the American Academy of Paediatrics. Term newborns with the presence of any one of the above parameters in the algorithm were considered screen-positive. Echocardiography was done in all screen positives. Newborns were classified into those with and without CHD, based on echocardiography findings at birth and clinical examination and echocardiography findings at follow-up at 6 weeks.ResultsAmong 1009 term neonates included in the study, CHD was detected in 57 (5.6%) with cyanotic CHD in 12. The sensitivity and specificity of combined screening to detect CHD was 71.93% and 95.8%, respectively. The positive predictive value was 50.62% and the negative predictive value was 98.28%.ConclusionScreening for CHD with a simple comprehensive algorithm, integrating clinical evaluation and pulse oximetry, has moderate sensitivity and high specificity in detecting CHD in term newborns. Further work is needed to evaluate this form of screening.

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.

ObjectivesGuidelines advise repeat screening within four months if Papanicolaou (Pap) results are unsatisfactory for evaluation. This utilizes healthcare system resources and may decrease patient satisfaction due to needing a second clinic appointment. We assessed unsatisfactory Pap test (UPT) rates and associations with clinician and patient characteristics to inform future interventions to decrease UPTs.SettingMultisite midwestern United States primary care practice.MethodsRetrospective analysis of women aged 21-65 with a Pap between 7/1/2021 and 6/30/2023. Bivariate and multivariable logistic regression analyses were conducted to assess for associations between UPTs and clinician gender, degree, residency status, and experience.ResultsOf 51,195 Paps completed, 2.3% were unsatisfactory. Female clinicians performed the most Pap tests (83.2%) with slightly less likelihood of UPTs compared with male clinicians (p = 0.015). There was no significant difference comparing physicians to advanced practice providers in UPTs (p = 0.18). Residency training level did not affect UPT rates (p = 0.95). Clinician experience was associated with higher UPT rates in first and fourth quartiles (least and most Paps performed) compared to middle two quartiles (p = 0.004). UPTs were more likely among women aged  > 50 years old (p < 0.001), married (p < 0.001), and Asian (p < 0.001).ConclusionsClinician characteristics played a small role in predicting UPTs but patient age may be the factor most amenable to intervention to lower UPTs. Transitioning to primary human papillomavirus (HPV) screening in peri/post-menopausal women could decrease UPTs given Paps are performed on the clinician-collected cervical specimen only if HPV testing is positive.

ObjectivesComparisons and optimization of screening programs are based on quality indicators (QI), but these are not well standardized and commonly not published. We report 13 QIs used for cervical screening in Sweden. These are decided on by the authorities and reported by the Swedish National Cervical Screening Registry that collects all data and calculates the QIs. The QIs as well as trends discovered and observations made during recent years, including effects of the COVID-19 pandemic, are summarized.SettingSweden. All units involved in cervical screening export all individual data to the screening registry.MethodsAll data on screening invitations, cervical samples with human papillomavirus (HPV), cytology and histopathology results, as well as population data, cervical cancer cases and mortality, were collected. The 13 QIs were calculated.ResultsThe HPV screening test had a high population coverage of 83%, with most primary screenings using self-sampling. Follow-up for women with CIN2+ (cervical intraepithelial neoplasia) in cytology within 3 months was 60%, increasing to 95% or more after 1 year. The incidence and mortality of cervical cancer have decreased in recent years. Some QIs became outdated due to program changes, and there was significant variability between regions.ConclusionsThe population coverage of the HPV screening test was not affected by the cancellation of screening appointments during the pandemic, because of switching to primary self-sampling. Improving follow-up of screen-positives and boosting population test coverage using HPV self-sampling are key areas for potential improvement.

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.

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.

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.