Risultati per: Lo screening oncologico: come aumentare l’adesione

Introduction
Lung cancer screening (LCS) using low-dose CT has been demonstrated to reduce lung cancer-related mortality in large randomised controlled trials. Moving from trials to practice requires answering practical questions about the level of expertise of CT readers, the need for double reading as in trials and the potential role of artificial intelligence (AI). In addition, most LCS studies have predominantly included male participants with women being under-represented, even though the benefit of screening is greater for them. Thus, this study aims to compare the performance of a single CT reading by general radiologists trained in LCS using AI as a second reader to that of a double reading by expert thoracic radiologists, in a campaign for low-dose CT screening in high-risk women.

Methods and analysis
This observational cohort study will recruit 2400 asymptomatic women aged between 50 and 74 years, current or former smokers with at least a 20 pack-year smoking history, in 4 different French district areas. Assistance with smoking cessation will be offered to current smokers. An initial low-dose CT scan will be performed, with subsequent follow-ups at 1 year and 2 years. The primary objective is to compare CT scan readings by a single LCS-trained, AI-assisted radiologist to that of an expert double reading. The secondary objectives are: to evaluate the performance of AI as a stand-alone reader; the adherence to screening of female participants; the influence on smoking cessation; the psychological consequences of screening; the detection of chronic obstructive pulmonary disease (COPD), coronary artery disease and osteoporosis on low-dose CT scans and the costs incurred by screening.

Ethics and dissemination
Ethics approval was obtained from the Comité de Protection des Personnes Sud-Est 1 (ethics approval number: 2021-A02265-36 with an amendment on 15 July 2022). Trial results will be disseminated at conferences, through relevant patient groups and published in peer-reviewed journals.

Trial registration number
NCT05195385.

Chiu et al recently investigated the long-term effectiveness of national faecal immunochemical test (FIT) screening for colorectal cancer (CRC).1 They demonstrated reduced risk of advanced-stage CRC and its mortality with larger reductions in distal CRC as compared with proximal CRC. An additional outcome of the CRC screening programme may be early detection of other diseases, such as inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD). The prevalence of IBD is up to 1% in westernised countries.2 3 However, symptoms of IBD vary and may increase time to diagnosis.4 Correct and early diagnosis is important to improve treatment outcomes and patients’ quality of life.5 Although early markers of IBD, such as antimicrobial antibodies and serum proteins, are emerging,6 7 colonoscopy still remains one of the only methods to detect early IBD. Since…

New England Journal of Medicine, Volume 387, Issue 23, Page 2126-2137, December 2022.

Annals of Internal Medicine, Volume 175, Issue 12, Page JC140, December 2022.

Nearly a quarter of physicians do not believe that a patient’s life expectancy should be a metric for halting cancer screening, despite guidelines that recommend against routine cancer screening when life expectancy is less than 10 years. What’s more, less than half of physicians are convinced the overscreening is a major problem among older adults.

Annals of Internal Medicine, Ahead of Print.

Presentato il 5/o Rapporto di Cittadinanzattiva e Federfarma

This review examines the current FDA regulatory process for artificial intelligence products used in breast cancer screening and suggests system improvements.

This cohort study assesses the association of prostate-specific antigen screening with incidence of metastatic prostate cancer in the Veterans Health Administration (VHA) from 2005 to 2019.

Circulation, Volume 146, Issue 22, Page 1730-1732, November 29, 2022.

Introduction
Colonoscopy quality can vary depending on endoscopist-related factors. Quality indicators, such as adenoma detection rate (ADR), have been adopted to reduce variations in care. Several interventions aim to improve ADR, but these fall into several domains that have traditionally been difficult to compare. We will conduct a systematic review and network meta-analysis of randomised controlled trials evaluating the efficacies of interventions to improve colonoscopy quality and report our findings according to clinically relevant interventional domains.

Methods and analysis
We will search MEDLINE (Ovid), PubMed, EMBASE, CINAHL, Web of Science, Scopus and Evidence-Based Medicine from inception to September 2022. Four reviewers will screen for eligibility and abstract data in parallel, with two accordant entries establishing agreement and with any discrepancies resolved by consensus. The primary outcome will be ADR. Two authors will independently conduct risk of bias assessments. The analyses of the network will be conducted under a Bayesian random-effects model using Markov-chain Monte-Carlo simulation, with 10 000 burn-ins and 100 000 iterations. We will calculate the ORs and corresponding 95% credible intervals of network estimates with a consistency model. We will report the impact of specific interventions within each domain against standard colonoscopy. We will perform a Bayesian random-effects pairwise meta-analysis to assess heterogeneity based on the I2 statistic. We will assess the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework for network meta-analyses.

Ethics and dissemination
Our study does not require research ethics approval given the lack of patient-specific data being collected. The results will be disseminated at national and international gastroenterology conferences and peer-reviewed journals.

PROSPERO registration number
CRD42021291814.

Only 13% of patients who met all 2013 USPSTF screening eligibility criteria were screened.

Introduction
Cervical cancer (CC) causes thousands of deaths each year. Nearly 100% of cases are caused by oncogenic strains of human papillomavirus (HPV). In most industrialised countries, CC screening (CCS) is based on the detection of HPV infections. For many reasons including lower adherence to CCS, underserved women are more likely to develop CC, and die from it. We aim to demonstrate that the use of incentives could improve screening rates among this population.

Methods and analysis
Our cluster randomised, controlled trial will include 10 000 women aged 30–65 years eligible for CCS, living in deprived areas in four French departments, two mainlands and two overseas, and who did not perform physician-based HPV testing within the framework of the nationally organised screening programme. HPV self-sampling kit (HPVss) will be mailed to them. Two interventions are combined in a factorial analysis design ending in four arms: the possibility to receive or not a financial incentive of 20 and to send back the self-sampling by mail or to give it to a health professional, family doctor, gynaecologist, midwife or pharmacist. The main outcome is the proportion of women returning the HPVss, or doing a physician-based HPV or pap-smear test the year after receiving the HPVss. 12-month follow-up data will be collected through the French National Health Insurance database. We expect to increase the return rate of HPV self-samples by at least 10% (from 20% to 30%) compared with the postal return without economic incentive.

Ethics and dissemination
Ethics approval was first obtained on 2 April 2020, then on July 29 2022. The ethics committee classified the study as interventional with low risk, thus no formal consent is required for inclusion. The use of health insurance data was approved by the Commission Nationale Informatique et Libertés on 14 September 2021 (ref No 920276). An independent data security and monitoring committee was established. The main trial results will be submitted for publication in a peer-reviewed journal.

Trial registration number
NCT04312178.

Objectives
This research aimed to develop a simple and effective acute coronary syndrome (ACS) screening model in order to intervene early and focus on prevention in patients presenting with arteriosclerosis.

Design
A case–control study.

Setting
The study used a cross-sectional survey to collect data from 2243 patients who completed anonymous electronic medical record (EMR) data and coronary angiography was gathered at a hospital in Shandong Province between December 2013 and April 2016.

Participants
Adults 18 years old and above diagnosed as ACS or non-ACS according to the records in hospital EMR database, and with completed basic information (age and sex).

Predictors
54 laboratory biomarkers and demographic factors (age and sex).

Statistical analysis
A dataset without missing data of all patients’ laboratory indicators and demographic factors was divided into training set and validation set after being balanced. After the training set balanced, area under the curve of random forest (AUCRF) and least absolute shrinkage and selection operator (LASSO) regression were used for feature extraction. Then two set random forest models were established with the different feature sets, and the process of comparison and analysis was made to evaluate models for the optimal model including sensitivity, accuracy and AUC receiver operating characteristic curves with the internal validation set.

Main outcome measures
To establish an ACS screening model.

Results
An RF model with 31 features selected by LASSO with an AUC of 0.616 (95% CI 0.650 to 0.772), a sensitivity of 0.832 and an accuracy of 0.714 in the validation set. The other RF model with 27 features selected by AUCRF with an AUC of 0.621 (95% CI 0.664 to 0.785), a sensitivity of 0.849 and an accuracy of 0.728 in the validation set.

Conclusions
The established ACS screening model with 27 clinical features provides a better performance for practical solution in predicting ACS.