Journal of Medical Screening最新文献

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.

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.

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.

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.

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.