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This cohort study examines the applicability of personalized colorectal cancer (CRC) screening with fecal-hemoglobin (f-Hb)-guided screening intervals to reduce the number of fecal immunological tests and colonoscopy, as well as determine if it demonstrates equivalent efficacy as universal biennial screening.
This cross-sectional study describes national- and state-level breast, cervical, and colorectal cancer screening use of more than 16 million adults served by federally qualified health centers and estimates the percentages of underscreened individuals in the US general population served by these centers.
Although much progress has been made in delivering cancer screening in the US, particularly for breast, cervical, and colorectal cancer, implementation remains suboptimal, particularly for populations experiencing systemic marginalization and economic disadvantage. Efforts to improve cancer screening implementation and reduce inequities are critical for achieving the goals of a just, high-performing health care system in the US.
Autore/Fonte: Science Advances
Introduction
Radiologist shortages threaten the sustainability of breast cancer screening programmes. Artificial intelligence (AI) products that can interpret mammograms could mitigate this risk. While previous studies have suggested this technology has accuracy comparable to radiologists most have been limited by using ‘enriched’ datasets and/or not considering the interaction between the algorithm and human readers. This study will address these limitations by comparing the accuracy of a workflow using AI alongside radiologists on a large consecutive cohort of examinations from a breast cancer screening programme. The study will combine the strengths of a large retrospective design with the benefit of prospective data collection. It will test this technology without risk to screening programme participants nor the need to wait for follow-up data. With a sample of 2 years of consecutive screening examinations, it is likely the largest test of this technology to date. The study will help determine whether this technology can safely be introduced into the BreastScreen New South Wales (NSW) population-based screening programme to address radiology workforce risks without compromising cancer detection rates or increasing false-positive recalls.
Methods and analysis
A retrospective, consecutive cohort of digital mammography screens from 658 207 examinations from BreastScreen NSW will be reinterpreted by the Lunit Insight MMG AI product. The cohort includes 4383 screen-detected and 1171 interval cancers. The results will be compared with radiologist single reading and the AI results will also be used to replace the second reader in a double-reading model. New adjudication reading will be performed where the AI disagrees with the first reader. Recall rates and cancer detection rates of combined AI–radiologist reading will be compared with the rates obtained at the time of screening.
Ethics and dissemination
This study has ethical approval from the NSW Health Population Health Services Research Ethics Committee (2022/ETH02397). Findings will be published in peer-reviewed journals and presented at conferences. The findings of this evaluation will be provided to programme managers, governance bodies and other stakeholders in Australian breast cancer screening programmes.
Objectives
To assess the yield and cost of implementing systematic screening for tuberculosis (TB) disease among people living with HIV (PLHIV) and initiation of TB preventive treatment (TPT) in Ghana.
Design
Prospective cohort study from August 2019 to December 2020.
Setting
One hospital from each of Ghana’s regions (10 total).
Participants
Any PLHIV already receiving or newly initiating antiretroviral treatment were eligible for inclusion.
Interventions
All participants received TB symptom screening and chest radiography. Those with symptoms and/or an abnormal chest X-ray provided a sputum sample for microbiological testing. All without TB disease were offered TPT.
Primary and secondary outcome measures
We estimated the proportion diagnosed with TB disease and proportion initiating TPT. We used logistic regression to identify factors associated with TB disease diagnosis. We used microcosting to estimate the health system cost per person screened (2020 US$).
Results
Of 12 916 PLHIV attending participating clinics, 2639 (20%) were enrolled in the study and screened for TB disease. Overall, 341/2639 (12.9%, 95% CI 11.7% to 14.3%) had TB symptoms and/or an abnormal chest X-ray; 50/2639 (1.9%; 95% CI 1.4% to 2.5%) were diagnosed with TB disease, 20% of which was subclinical. In multivariable analysis, only those newly initiating antiretroviral treatment were at increased odds of TB disease (adjusted OR 4.1, 95% CI 2.0 to 8.2). Among 2589 participants without TB, 2581/2589 (99.7%) initiated TPT. Overall, the average cost per person screened during the study was US$57.32.
Conclusion
In Ghana, systematic TB disease screening among PLHIV was of high yield and modest cost when combined with TPT. Our findings support WHO recommendations for routine TB disease screening among PLHIV.
Annals of Internal Medicine, Ahead of Print.
Annals of Internal Medicine, Ahead of Print.
Objectives
The aim of this study was to map and compare stakeholders’ perceptions of barriers towards cervical cancer screening for vulnerable women in seven European countries.
Design
In Collaborative User Boards, stakeholders were invited to participate to identify barriers towards participation in cervical cancer screening.
Setting
The study is nested in the European Union-funded project CBIG-SCREEN which aims to tackle inequity in cervical cancer screening for vulnerable women (www.cbig-screen.eu). Data collection took place in Bulgaria, Denmark, Estonia, France, Italy, Portugal and Romania.
Participants
Participants represented micro-level stakeholders covering representatives of users, that is, vulnerable women, meso-level stakeholders covering healthcare professionals and social workers, and macro-level stakeholders covering programme managers and decision-makers.
Methods
Across the seven countries, 25 meetings in Collaborative User Boards with a duration of 2 hours took place between October 2021 and June 2022. The meetings were video recorded or audio recorded, transcribed and translated into English for a qualitative framework analysis.
Results
120 participants took part in the Collaborative User Boards. Context-specific barriers were related to different healthcare systems and characteristics of vulnerable populations. In Romania and Bulgaria, the lack of a continuous screening effort and lack of ways to identify eligible women were identified as barriers for all women rather than being specific for women in vulnerable situations. The participants in Denmark, Estonia, France, Italy and Portugal identified providers’ lack of cultural and social sensitivity towards vulnerable women as barriers. In all countries, vulnerable women’s fear, shame and lack of priority to preventive healthcare were identified as psychological barriers.
Conclusion
The study provides an overview of stakeholders’ perceived barriers towards vulnerable women’s cervical cancer screening participation in seven European countries. The organisation of healthcare systems and the maturity of screening programmes differ between countries, while vulnerable women’s psychological barriers had several similarities.
The Task Force now recommends biennial screening for average-risk women who are 40 to 74.
We read with interest the recent work by Haifer et al,1 which highlighted the importance of donor selection in determining the clinical efficacy of treating ulcerative colitis (UC) using faecal microbiota transplantation (FMT), with one donor having 100% efficacy compared with a second donor (36% efficacy). Considering the impact of COVID-19 pandemic on FMT, updated guidance including patient selection, donor recruitment and selection, FMT procedures and stool manufacturing was provided by worldwide FMT experts in international guideline by Ianiro et al.2 The US Food and Drug Administration (FDA) has recommended that FMT donor screening must include a questionnaire specifically addressing risk factors for colonisation with multidrug-resistant organisms (MDROs) and stool testing for MDROs, including extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, vancomycin-resistant enterococci (VRE), carbapenem-resistant Enterobacteriaceae (CRE) and methicillin-resistant Staphylococcus aureus (MRSA) at minimum.3 The evolution of FMT and the introduction of essential donor screening requirements…
Screening plus explicit feedback to patients and clinicians didn’t appear to improve outcomes.
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The introduction of prostate-specific antigen (PSA)–based screening for prostate cancer in the early 1990s was followed by a nearly 2-decade long decline in prostate cancer metastasis and mortality. However, clinical trial data revealed that screening was associated with substantial harms. Under the traditional clinical approach in which elevated serum PSA triggered prostate biopsy, roughly 1 in 5 screened men underwent biopsies, with more than 75% found to be negative and a majority of positive biopsies harboring low-grade, clinically insignificant cancers. Prostate biopsies are uncomfortable for patients and carry a risk of bleeding and infection requiring hospitalization. Moreover, during a previous era in which a cancer diagnosis was inexorably linked to treatment, overdiagnosis (ie, detection of indolent cancers that would not have been detected during life in the absence of screening) and overtreatment resulted in significantly reduced quality of life. In 2012, the US Preventive Services Task Force (USPSTF) provided a grade D recommendation against the use of PSA screening, concluding that the benefits of PSA-based screening for prostate cancer do not outweigh the harms.
