Journal of Medical Screening最新文献

Background: The COVID-19 pandemic significantly impacted the delivery of cancer screening. The resulting decrease in outpatient visits and cancellations of non-urgent procedures have negatively affected colorectal cancer (CRC) screening. We aimed to determine the effect of the pandemic on CRC screening at a safety-net hospital and a private health system based in New York City.

Methods: We identified individuals eligible for CRC screening aged 50 to 75 years presenting for outpatient care at a safety-net public hospital and private health system in April through September of 2019 and 2020. The primary outcome was the proportion of screening-eligible patients seen in primary care who underwent CRC screening.

Results: The safety-net hospital had 516 (6.1% of screening-eligible individuals) and 269 (4.3%) screening tests completed in 2019 and 2020, respectively (p < 0.01). Fecal immunochemical tests (FIT) accounted for 69.6% of screening in 2019 and 88.1% in 2020. Colonoscopy accounted for 20.3% of screening in 2019 and 11.9% in 2020. The private health system had 39 (0.7%) and 21 (0.6%) screening tests completed in 2019 and 2020, respectively (p = 0.48). FIT accounted for 61.9% of screening in 2019 and 57.1% in 2020. Colonoscopy accounted for 38.1% of screening in 2019 and 42.9% in 2020.

Conclusion: Absolute numbers of screening tests decreased for both institutions during the COVID-19 pandemic. We observed a decrease in screening uptake and increase in proportional FIT use in the safety-net hospital but no change in the private health system.

Objectives: When evaluating potential new cancer screening modalities, estimating sensitivity, especially for early-stage cases, is critical. There are methods to approximate stage-specific sensitivity in asymptomatic populations, both in the prospective (active screening) and retrospective (stored specimens) scenarios. We explored their validity via a simulation study.

Methods: We fit natural history models to lung and ovarian cancer screening data that permitted estimation of stage-specific (early/late) true sensitivity, defined as the probability subjects screened in the given stage had positive tests. We then ran simulations, using the fitted models, of the prospective and retrospective scenarios. Prospective sensitivity by stage was estimated as screen-detected divided by screen-plus interval-detected cancers, where stage is defined as stage at detection. Retrospective sensitivity by stage was estimated based on cancers detected within specified windows before clinical diagnosis with stage defined as stage at clinical diagnosis.

Results: Stage-specific true sensitivities estimated by the lung cancer natural history model were 47% (early) and 63% (late). Simulation results for the prospective setting gave estimated sensitivities of 81% (early) versus 62% (late). In the retrospective scenario, early/late sensitivity estimates were 35%/57% (1-year window) and 27%/49% (2-year window). In the prospective scenario, most subjects with negative early-stage screens presented as other than early-stage interval cases. Results were similar for ovarian cancer, with estimated prospective sensitivity much greater than true sensitivity for early stage, 84% versus 25%.

Conclusions: Existing methods for approximating stage-specific sensitivity in both prospective and retrospective scenarios are unsatisfactory; improvements are needed before they can be considered to be reliable.

Couple screening aims to identify couples with an increased risk of having a child affected with an autosomal recessive or X-linked disorder, in order to facilitate informed reproductive decision making. Both expectant parents should be screened as a single entity, instead of individual testing. Carrier testing was typically performed for a few relatively common recessive disorders associated with significant morbidity, reduced life expectancy and often because of a considerably higher carrier frequency in a specific population for certain diseases. However, new genetic testing technologies enable the expansion of screening to multiple conditions, genes and sequence variants. There are multiple reproductive options for screening couples at risk, particularly when genetic traits are detected in the preconception period.

Controversy surrounding recommendations for supplemental screening (ultrasound and magnetic resonance screening) in women with dense breasts exists, as the long-term benefits from these additional modalities may not outweigh the harms. This study aimed to examine factors associated with supplemental screening intentions following a hypothetical breast density notification in a population of women who have not been routinely notified. Australian women of breast screening age participated in an online randomised experimental study where they were presented with one of two breast density notifications (with or without health literacy-sensitive information) and asked their screening intentions. After adjusting for covariates in multivariable analyses, women in both groups (n = 940) who indicated higher levels of breast cancer worry, had private health insurance, had a family history of breast cancer, and had a greater number of times previously attending mammography screening had higher intentions for supplemental screening. Understanding women's supplemental screening intentions following notification of dense breasts has important implications for health systems with breast screening considering the impacts of widespread notification. Personal, clinical and psychological factors should be considered when discussing both the benefits and harms of supplemental screening with women with dense breasts.

Objective and setting: Accurate monitoring of interval cancers is important both for quality improvement and education and is a key parameter of breast screening quality assurance. Issues in relation to communication regarding interval cervical cancer in the Irish cervical screening programme were found, prompting interval cancer process review in all cancer screening programmes. An international survey to examine international consensus on interval breast cancer audit processes was conducted to inform Irish processes.

Methods: A survey of 24 international population-based breast screening programmes was done to determine which undertook audit of interval breast cancer; if yes, they were asked (1) how they undertake audit, (2) if they obtain individual consent for audit and inform women of audit results, and (3) if disclosure of audit results occurs.

Results: Response was 71% (17/24). Of these, 71% (12/17) have a programmatic audit process to calculate the interval cancer rate (ICR). Of these, ten also carry out radiological reviews, three using a blinded review. Two inform patients that audit is taking place; two provide choice to be in the audit; nine state that routine screening consent covers audit. For two of the five that have an open disclosure policy for medical incidents, this policy applies to screening interval cancers. One other country/region has an open disclosure policy for category 3 interval cancers only. Five have legal protection for interval cancers arising in the screened population.

Conclusion: While consistency in providing aggregate programmatic audits exists, there is no consistent approach to individual interval cancer reviews or results disclosure.

Objectives: To evaluate the performance of breast cancer screening and early diagnosis during the pandemic, compared to the pre-pandemic period.Setting: The public referral centre for screening in Campinas, São Paulo State, Brazil.

Methods: This is an audit study of performance screening and diagnostic indicators. Two periods were analysed: 2019, the pre-COVID period, and 2020, the COVID period. All women who underwent mammography in these periods were included. Indicators were compared between periods, and the US Breast Cancer Surveillance Consortium benchmarks were used as a reference.

Results: A comparison between the periods shows a reduction of 57.4% in screening and 4.4% in diagnosis using mammography. Cancer detection rate per 1000 screening mammograms dropped from 4.62 to 2.83 (p  =  0.031), while it increased from 84.43 to 89.36 in diagnosis mammograms (p  =  0.701), higher than the reference (34.4, p < 0.001). With regard to diagnosis, the proportion of minimal cancers was reduced (p  =  0.005) and was lower than the reference (40.0%, p < 0.001), along with the proportion of node-negative invasive cancers (p < 0.001). The mean size of invasive tumours was similar in the two periods (32.50 mm and 33.40 mm, p  =  0.808) but larger than the reference value (16.50 mm, p < 0.001). Recall rate was lower in the COVID period (22.55% vs. 27.37%, p  =  0.015).

Conclusion: The COVID pandemic caused an overall decrease in breast screening and detection of breast cancer cases, although the reduction in number of diagnosis mammograms performed was minimal. Tumour mean size was large in both periods, the pandemic highlighting a previous profile of detection at an advanced stage.