Risultati per: Indicazioni per gli screening oncologici

This cohort study investigates the performance of the International Myositis Assessment and Clinical Studies Group cancer screening recommendations in a community setting.

This Viewpoint discusses the potential risks and benefits for starting screening at 40 rather than 50 years of age and whether clinicians or patients should decide based on risk rather than age.

Dermatomyositis (DM) is an autoimmune disease of unknown etiology belonging to the family of idiopathic inflammatory myopathies (IIMs). The association of DM with cancer has long been established and there is increased prevalence of various cancers, including breast, ovarian, colorectal, lung, nasopharyngeal, and lung cancers. Cancers in IIMs are frequently diagnosed at later stages, making cancer the leading cause of death in adults with IIMs. Despite this increased prevalence of and worse prognosis associated with underlying cancer, screening recommendations for cancer detection in patients with IIM have been debated for many years, with wide variability in screening practices. This lack of clarity regarding ideal cancer screening practices became further complicated with the expanding knowledge of myositis-specific antibodies and their association with cancer risk, which raised the question of how to apply serology status to screening protocols. Finally, there has been a need to balance early cancer detection with avoidance of unnecessary screening procedures, given that cancer prevalence is best estimated at only 15% to 25% of patients with DM. Thus, applying screening to all patients is associated with many unnecessary procedures.

This Viewpoint explores how guideline groups can come together to agree on a framework that produces clear and unified recommendations.

Indagine sui pazienti, 1 su 5 rinuncia per orari o liste d’attesa

Annals of Internal Medicine, Ahead of Print.

Lugol’s chromoendoscopy (LCE)-based detection of esophageal squamous cell neoplasia (ESCN) is limited by low specificity. High-resolution microendoscopy (HRME) was shown to improve specificity and reduce unnecessary biopsies when used by academic endoscopists. In this international, randomized controlled trial, we determined the clinical impact, efficiency, and performance of HRME in true global health contexts with a range of providers.

Background
Population-based genetic screening and testing programmes have substantial potential to improve cancer-related outcomes through early detection and cancer prevention. Yet, genetic testing for cancer risk remains largely underused. This study aimed to describe barriers and facilitators to patient engagement at each stage of a California-based genetic screening programme, from completing the electronic screener to receiving the test and to identify potential improvements that could support precision medicine-based approaches to patient care.

Methods
We conducted 26 semistructured interviews among programme participants who did not complete the screener (n=9), those who did not receive the recommended test (n=7) and those who received a genetic test (n=10). Interviewees were selected from patients who recently received a mammogram through one of the participating Southern California clinics. Interviews were transcribed and coded using Atlas.ti. The study used a qualitative descriptive approach to identify similar and contrasting themes among the participant groups.

Results
This study found that barriers and facilitators to engagement were largely the same regardless of how far participants had moved through the process towards getting a genetic test. We identified four overarching themes: participants wanted clear communication of personal benefits at each stage; participants needed additional information and knowledge to navigate genetic screening and testing; a trusted provider could be instrumental in participants following a recommendation; and repetition and timing strongly impacted participants’ likelihood to engage.

Conclusions
Providing education about the benefits of genetic screening and testing to patients and their families, as well as clear communication about what each step entails may help patients engage with similar programmes. Strategies aimed at increasing coordination among a patient’s healthcare team can also help ensure information reaches patients in multiple ways, from multiple providers, to increase the likelihood that recommendations for testing come from trusted sources, which supports the uptake of genetic testing.

Tra le iniziative di Rachele Sacco anche il ‘bus rosa’

Annals of Internal Medicine, Ahead of Print.

Objective
To examine the feasibility of implementing remote atrial fibrillation (AF) self-screening among older people supported by a remote central monitoring system.

Design
Process evaluation of the Mass AF randomised clinical trial (ACTRN12621000184875) with one-to-one semistructured interviews using interview guides underpinned by the Critical Realism approach and coded using the UK Medical Research Council Guidance of Process Evaluation Framework.

Setting and participants
Community-dwelling people aged ≥75 years from both genders (ratio 1:1) and urban/rural (ratio 2:1) in Australia.

Interventions
Participants were provided handheld single-lead electrocardiogram (ECG) devices and trained to self-record ECGs once daily on weekdays for at least 6 months. A remote central team notified participants and general practitioners (GPs) of AF.

Primary feasibility outcomes
The strengths, weaknesses, opportunities and threats (SWOT) analysis examined enablers (ie, strengths and opportunities) and barriers (ie, weaknesses and threats).

Results
Overall, 200 participants; 98.5% completed the 6-month programme, 96% reported being satisfied with screening and 48 were interviewed: mean age 79 years, 54% male and 71% urban. 11 GPs were interviewed: 55% female and 64% urban. Programme participants trusted the remote monitoring system that supported the screening programme and provided follow-up pathways where required. GPs saw opportunities to introduce this self-screening programme to at-risk patients and improve patients’ risk profiles. Programme participants reported that after being trained to use the device, they felt empowered to do self-screening and found it convenient. GPs saw empowerment could enhance the doctor–patient relationship. Participants and GPs valued screening in diagnosing AF that would otherwise be missed in usual care, but the uncertainty of effective screening duration could be a barrier.

Conclusions
This screening programme was feasible with the reinforcement of the underpinning enablers. Several implementation strategies were identified using SWOT analysis, including leveraging the opportunity for GPs to introduce this screening programme to at-risk patients.

Trial registration number
ACTRN12621000184875.

Objectives
The objectives are to investigate the status of knowledge, attitudes and practices (KAP) and to identify factors related to KAP towards breast and cervical cancer screening among rural Chinese women aged 40–65 years.

Design and setting
This cross-sectional study was conducted from July to September 2020 in rural areas of eastern China.

Participants
This study involved 301 rural women aged 40–65 years.

Variables and outcomes
The questionnaire included demographic information and the KAP related to breast and cervical cancer screening. Multivariate linear regression analysis was used for the multifactor analysis.

Results
A total of 301 rural women aged 40–65 years participated in the survey. The overall score of KAP was (62.41±11.24), and the scores of each KAP domain relating to screening for breast and cervical cancer among participants in rural areas were (1.82±0.97), (44.52±7.20) and (16.06±4.56), respectively. The following factors were significantly associated with the total KAP Score relating to breast and cervical cancer screening among rural women aged 40–65 years, explaining 35% of the variance (p