Journal of Medical Screening最新文献

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.

ObjectivesPrimary human papillomavirus (HPV) testing in cervical screening offers the opportunity for women to be given a choice between HPV self-sampling and traditional clinician screening. This study assessed attitudes towards a choice and anticipated future preference among women who had collected a vaginal self-sample alongside their usual cervical screen.SettingThirty-eight general practices across five areas in England.MethodsOverall, 2323 women (24-65 years; response rate: 48%) completed a survey after collecting a self-sample and having a clinician screen at their GP practice. We asked which test they preferred and assessed attitudes to being offered a choice. We explored age, education, ethnicity and screening experience as predictors of attitudes towards a choice and anticipated future choice.ResultsMost participants felt they would like a choice between self-sampling and clinician screening (85%) and thought this would improve screening for them (72%). However, 23% felt it would be difficult to choose, 15% would worry about making a choice, and nearly half would prefer a recommendation (48%). Compared with women with degree-level education, those with fewer qualifications were more likely to say they would worry about having a choice or would not want a choice (p < 0.001). The majority said they would choose to self-sample at home if offered a choice in the future (69%; n = 1602/2320).ConclusionsSelf-sampling is likely to be popular, but offering a choice could cause worry for some people and many would prefer a recommendation. Supporting people to make a choice will be important, particularly for those with lower levels of education.

ObjectivesObesity levels and mortality from breast cancer are higher in more deprived areas of the UK, despite lower breast cancer incidence. Supplemental imaging for women with dense breasts has been proposed as a potential improvement to screening, but it is not clear how stratification by percentage mammographic density (%MD) would be reflected across socioeconomic groups. This study aims to clarify the associations between breast composition (dense and fatty tissue) and socioeconomic status in a multi-ethnic screening population.MethodsDemographic characteristics were collected for 62,913 participants in a UK breast screening programme (age, ethnicity, Index of Multiple Deprivation (IMD)). Automated mammographic measurements were derived: dense volume (DV), non-dense volume (NDV) and percent density (%MD). Correlations between deprivation and mammographic composition were examined before and after adjustment for age, ethnicity and NDV, using non-dense breast volume as a proxy for body mass index (BMI).ResultsThere was negligible correlation between deprivation and DV (r = 0.017; P < 0.001 in all cases), but NDV increased with increasing deprivation (Pearson r = 0.101). Correlations were weaker in the Asian and Chinese ethnic groups. %MD decreased with deprivation (r = -0.094) and adjustment for ethnicity did not alter the association between %MD and IMD (relative change, most to least deprived quintile IMD: 1.18; 95% confidence interval: 1.16, 1.21).ConclusionsDeprivation-related differences in %MD in the screening population are largely explained by differences in breast fat volume (NDV) which reflects BMI. Women in more deprived areas, where obesity and breast cancer mortality rates are higher, have increased breast adiposity and may miss out on risk-adapted screening if stratification is based solely on %MD or BIRADS classification.

ObjectiveBiliary atresia (BA) is a liver disease of infancy characterized by obstruction of the biliary tree. Infants with BA have the best outcomes when identified early and the Kasai portoenterostomy is performed before 45 days of life (DoL). In our hospital system, the average age at Kasai was 60 DoL. To address the problem of late presentation, we implemented a two-stage BA screening strategy utilizing direct bilirubin (DB).MethodsNew institutional policies were established that all newborns were tested at 24-48 h of life, and those with levels ≥0.5 mg/dL were followed further. The infant's primary care provider was contacted to recommend a repeat DB at 2 weeks of life. If the repeat DB was ≥1.0 mg/dL, the patient was evaluated by gastroenterology.ResultsOver the 16 months, 3880 infants were born and 3861 (99.5%) were screened; 53 infants (1.3%) had DB levels ≥0.5 mg/dL initially. Upon repeat testing at 2 weeks, there were three groups of infants: not retested (n = 1), retested <1.0 mg/dL (n = 40), and retested ≥1.0 mg/dL (n = 12). The average time to be seen by gastroenterology was 4.3 days or 18.3 DoL.DiscussionThe screening included a series of steps that needed to be implemented effectively. Screening had a net false positive rate of 0.3% (12 out of 3861) and identified causes of cholestasis other than BA. BA was excluded by 28 DoL on average. Our results can provide a template for other institutions interested in implementing a BA screening protocol in their practice.

ObjectiveThe psychological consequences of being aware of an increased risk of developing abdominal aortic aneurysm as a first-degree relative of a person with abdominal aortic aneurysm are hitherto unexplored. This study investigates the awareness of heritability and anxiety in male and female adult offspring of abdominal aortic aneurysm patients compared to controls. Health-related quality of life among participants with aortic pathology was compared to participants with normal aortic diameters.MethodsThis was a cross-sectional point prevalence study based on the participants examined in the Detecting Abdominal Aortic Aneurysm in First Degree Relatives Trial (DAAAD; 752 adult offspring, 756 matched controls), 2020-2022. Questionnaires about health-related quality of life and study-specific questions regarding awareness of heritability were collected prior to the aortic ultrasound.ResultsAttendance rate was higher among individuals with heredity compared to controls (67% vs. 52%, p < 0.001). Of 1508 adult offspring examined, 65% reported having a close relative with abdominal aortic aneurysm (6% in controls). Female adult offspring reported higher awareness of heritability than controls (38% vs. 12%, p < 0.001), as did males (32% vs. 8%, p < 0.001). A slight majority of participants with awareness reported anxiety (54% of female offspring; 51% of male). There were no measured differences in health-related quality of life between the groups when standard health-related quality of life instruments were used.ConclusionThe higher-than-expected proportion of adult offspring with awareness of heritability and anxiety about such risk indicates that we fail to communicate risk to this group appropriately via the current channels of information within the healthcare system. This calls for the development of dedicated strategies for improved communication of abdominal aortic aneurysm risk to patients and their next of kin.

Several lines of evidence suggest that breast cancer screening and treatment may have been compromised during the early phase of the COVID-19 pandemic. Using data from the US Centers for Disease Control and Prevention (CDC) WONDER database, we estimated the age-adjusted mortality rates for female breast cancer between 2018 and 2023. We found that the age-adjusted death rate for breast cancer decreased gradually from 2018 to 2019 and 2020. This downward trend reversed in 2021, with an increase in breast cancer mortality, which then declined further in 2022 and 2023. These findings indicate that breast cancer mortality may have increased slightly in 2021, possibly as a result of limited access to screening and timely treatment during the first phase of the COVID-19 pandemic, although the age-adjusted mortality rate continued to decline in the following two years.

ObjectivesTo explore how women aged 50-69 invited to BreastScreen Norway perceived the information provided along with the invitation letter, as well as time spent on reading this information.MethodsAn anonymous questionnaire was sent, as a paper-based form along with a physical invitation letter, or as a link to a digital form in a digital invitation letter, to 84,543 women invited to BreastScreen Norway in 2022. The paper-based forms were handed in upon screening attendance. The women were invited to screening by physical or digital invitation including an information leaflet describing benefits and harms, or a link to similar information on a webpage. The questionnaire assessed women's perception of the information and time spent on reading it. Responses were presented by screening invitation type (physical/digital).ResultsA total of 9.9% (8355/84,543) of the women responded to the questionnaire. Among women invited by a physical letter, information about the screening examination and about benefits and harms was considered sufficient by 90% (4338/4797) and 89% (4246/4790), respectively, and 92% (4246/4790) reported the information to be sufficient to make an informed decision on participation. Among those invited digitally, the percentages were 83% (2788/3379), 78% (2618/3369), and 88% (2962/3370), respectively. About 59% (4807/8169) spent <5 min reading the information.ConclusionsMost of the respondents perceived the information received upon invitation to BreastScreen Norway sufficient to make an informed decision on participation and used <5 min to read the information. The results should be interpreted with caution due to the low response rate.

IntroductionThe implementation of cervical cancer screening and human papillomavirus (HPV) vaccination has significantly reduced cervical cancer rates. However, it remains the fourth most common cancer among women globally. Barriers to screening include personal, health system, and insurance factors.MethodsTo address these barriers, a "Saturday Pap smear Clinic" was established to increase accessibility. The study included female patients aged 21 to 65 from Southeast Minnesota, USA, who attended the clinic from September 2021 to April 2023.ResultsA total of 357 women attended the Saturday clinic, with a median age of 44 years; 70.6% were White. Abnormal Pap smear results were found in 13.8% of attendees, with 7.8% testing positive for HPV. Additional health maintenance was addressed. The majority of patients had a physician primary care provider (58.3%), followed by residents (26.3%), and nurse practitioner/physician associates (15.4%).DiscussionThe clinic demonstrated a high fill rate of 86.15%, indicating demand for non-traditional appointment times. Despite this, disparities in access were noted, with primarily White and English-speaking women utilizing the clinic. The clinic showed improved outcomes compared to national screening rates, highlighting the importance of timely preventative care.