Journal of Medical Screening最新文献

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.

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.

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.

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.

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.