Risultati per: Guida allo screening del cancro del colon-retto

Previsti 200mila euro per il 2025 e 800mila per il 2026

Objectives
Glaucoma is a major cause of irreversible blindness in India; however, if detected early, its progression can be either prevented or stabilised through appropriate medical or surgical treatment. We aim to evaluate the cost–utility of various models for population-based glaucoma screening at primary health centres in India. We also assess the potential impact of the implementation of a population-based screening programme on overall costs of care for glaucoma.

Design
Cost–utility analysis using a mathematical model comprising a decision tree and Markov model was conducted to simulate relevant costs and health outcomes over a lifetime horizon.

Setting
Screening services were assumed to be delivered at primary health centres in India.

Participants
A hypothetical cohort of different target population groups in terms of age groups and risk of glaucoma (age group 40–75 years, 50–75 years, 40–75 years age group at high risk of glaucoma, 50–75 years age group at high risk of glaucoma) were included in comparative screening strategies.

Interventions
The exclusive intervention scenarios were 12 screening strategies based on different target population groups (age group 40–75 years, 50–75 years, 40–75 years age group at high risk of glaucoma, 50–75 years age group at high risk of glaucoma), screening methods (face-to-face screening and artificial intelligence-supported face-to-face screening) and screening frequencies for 40–75 years aged population (annual vs once every 5 years screening), in comparison to usual care scenario. The usual care scenario (current practice) implied opportunistic diagnosis by the ophthalmologists at higher levels of care.

Primary and secondary outcomes
The primary outcome was the incremental cost–utility ratio for each of the screening strategies in comparison to usual care. The secondary outcomes were per person lifetime costs, lifetime out-of-pocket expenditures, life years and quality-adjusted life-years (QALYs) in all screening scenarios and usual care.

Findings
Depending on the type of screening strategy, the gain in QALY per person ranged from 0.006 to 0.046 relative to usual care. However, the screening strategies, whether adjusted for specific age groups, patient risk profiles, screening methods or frequency, were not found to be cost-effective. Nonetheless, annual face-to-face screening strategies for individuals aged 40–75 years could become cost-effective in a scenario of strengthened public financing and provisioning, such that at least 67% of those seeking care for confirmatory diagnosis and treatment use government-funded facilities, in conjunction with 60% availability of medications at government hospitals.

Conclusions
Enhancing continuity of care following screening through either strengthening of public provisioning or strategic purchasing of care could make glaucoma screening interventions not only cost-effective, but also potentially cost-saving.

Introduction
Pancreatic cancer is a devastating disease and one of the top causes of cancer death worldwide. Over 30% of cases are potentially avoidable, and while screening for this disease should be possible, the current methods, without risk stratification to detect high-risk groups, are unlikely to detect these individuals. A tailored screening pathway could be applied to individuals with a germline genetic cause of pancreatic cancer, which may account for around 10% of cases.

Methods and analysis
EUROPAC, although having international reach, is described here in relation to the UK only. This national prospective observational study has run for several decades but was modified into the current trial in 2019, which aims to recruit and screen 10 000 individuals with either familial pancreatic cancer or hereditary pancreatitis (HP). Applicants are assessed for eligibility by generating an individual pedigree and by attributing a family risk score (FR). Individual risk is assessed according to age. Individuals over 40 with an FR >30 are offered baseline imaging and then three yearly triplets of annual endoscopic ultrasound (EUS) and an MRI (in the third year). Those with an FR >60 are offered both EUS and MRI yearly. HP patients are screened by CT and/or MRI dependent on risk stratification using the presence of diabetes, smoking or alcohol consumption. Low-risk (absence of these factors) patients have a CT every 2 years, and high-risk (one or more of the above factors) patients have alternate yearly screening with CT, then MRI. Biospecimens are collected at pragmatic intervals with first sampling at registration to support future biomarker development to detect pancreatic cancer early. Detection of early-stage pancreatic cancer and actionable lesions will be evaluated.

Ethics and dissemination
The EUROPAC study has been reviewed and approved by the Yorkshire and Humber Research Ethics Committee (Ref 19/YH/0250). Study results will be disseminated through national and international symposium presentations and published in peer-reviewed, open-access journals. All participants provided informed consent prior to entering the study.

Trial registration number
ISRCTN62546421

Top Ten US Cancer Centers make screening recommendations inconsistent with those of the USPSTF recommendations, with cancer centers generally recommending more screening and omitting a nuanced discussion of benefits and risks. Given the national and international reputation of these cancer centers, their recommendations can have important population level implications, including confusion in the public.

Durante la tappa fidardense dell’iniziativa Incra-Croce rossa

Con screening 159 decessi in meno all’anno per diagnosi tardiva

Dalla scuola al welfare aziendale fino alla vita nei borghi

This study employed several novel processes to establish an ML model with probability-scores superior to predictions of disease likelihood by specialists. However, the negligible improvement in interpretations by specialists after provision of probability-scores indicates this alone is insufficient to improve decision-making.

Objectives
To establish whether sports-branded screening is effective in identifying adults at risk of developing cardiovascular disease (CVD); to determine whether the public would engage with sports-branded health screening and what their experiences were.

Design
Convergent parallel mixed methods.

Setting
Mass screening at Liverpool Football Club Foundation events at four community centres.

Participants
100 participants (mean age 46.6 years (SD 14.7), range 20–84 years) were recruited, and their risk factors were identified. Of these, 62 were screened for their SCORE 2 CVD risk. Men and women were equally represented. Participants were predominantly white British (93%).

Interventions
A dedicated screening area was established at each venue. Data to calculate SCORE 2/OP risk scores were captured (gender, smoking status, age, blood pressure and lipids). Additional risk factors (glucose, incident atrial fibrillation and body mass index (BMI)) were measured to assess wider heart health. A purposive sample of 12 participants participated in a semistructured, one-to-one audio recorded interview about their experience.

Primary and secondary outcome measures
Outcomes were the SCORE 2 and SCORE 2/OP risk tool; ability to recruit participants and whether sports-branded screening was acceptable to participants.

Results
Participants ranged from 20 to 84 years with a mean age of 46.6 years. Men and women were equally represented. Participants were predominantly white British, with 41% and 40% recording a higher than normal total cholesterol and low-density lipoprotein cholesterol (LDL-C) level, respectively, and 36% recording lower than normal LDL-C level. 20% of participants recorded a blood pressure greater than 140/90 mm Hg and 21% of participants were smokers. Mean BMI was 29, ranging from 17.8 to 51, with 70% of the participants classified as overweight or obese. CVD risk ranged from

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Introduction
Cervical cancer remains a significant public health concern in Singapore, with current screening rates at 43%, well below the national target of 70%. In 2019, human papillomavirus (HPV) DNA testing was introduced into the national cervical cancer screening programme, but barriers to participation include embarrassment, privacy concerns and discomfort with clinician-sampled tests. Self-sampled HPV DNA testing offers a promising alternative by providing more privacy and convenience. This study aims to evaluate the impact of including self-sampled HPV DNA testing as an alternative to clinician-sampling on screening uptake, clinical outcomes and cost-effectiveness in primary care.

Methods and analysis
This pragmatic, open-label, two-arm randomised controlled trial employs a Zelen design. A total of 650 women aged 30–69 who are due for cervical cancer screening will be recruited from National Healthcare Group Polyclinics in Singapore. Participants will be randomly assigned to either the intervention arm (offering both self-sampling and clinician-sampling) or the usual care arm (clinician-sampling only). The primary outcome is the proportion of participants in each arm detected with high-risk HPV. Secondary outcomes include the proportion of participants in each arm who undergo cervical cancer screening (uptake), are referred for colposcopy and are detected with CIN 2/3 or cervical cancer, as well as cost-effectiveness. Acceptability and feasibility of self-sampling will be evaluated through post-screening questionnaires.

Ethics and dissemination
Ethical approval was granted by the National Healthcare Group Domain Specific Review Board. Study results will be disseminated through peer-reviewed journals, healthcare conferences and shared with policymakers to guide potential inclusion of self-sampling in Singapore’s national cervical cancer screening programme. Findings from this trial will provide crucial evidence for the potential inclusion of self-sampling in Singapore’s national cervical cancer screening programme, which could increase screening rates and improve public health outcomes.

Trial registration number
ClinicalTrials.gov: NCT06528184.

To the Editor A recent study about newborn screening using genome sequencing for early actionable conditions highlighted the potential of early detection for actionable genetic disorders. However, genomic sequencing is a “double-edged sword,” providing substantial benefits while introducing complex challenges related to technology, ethics, and privacy.

In Reply The comments from Dr Wu and colleagues regarding our recently published article highlight important technical, clinical, and ethical considerations in the use of genomic sequencing for newborn screening.

Comunità Sant’Egidio, ‘opportunità concreta per migliorare accesso alle cure’