Journal of Medical Screening最新文献

{"title":"The Risk-Screening Converter.","authors":"Nicholas J Wald, Stephen W Duffy, Allan Hackshaw","doi":"10.1177/09691413221149640","DOIUrl":"https://doi.org/10.1177/09691413221149640","url":null,"abstract":"Despite being documented it is not widely recognized that important causal risk factors of potential significance in the primary prevention of disease usually make poor screening tests. This arises because the quantitative association between causal risk factors and disease is usually too small for the risk factor to be a useful screening test. Two examples are the measurement of serum cholesterol as a screening test for heart attacks and blood pressure measurement as a screening test for stroke. While these risk factors are the drivers of heart attacks and strokes throughout the world, when considered as screening tests, they typically have detection rates (sensitivities) for a 5% false positive rate (DR5) of no more than 15% to 20%. Even non-causal risk factors have been invoked as screening tests when their screening performance is poor, for example, coronary calcification as a possible test for coronary heart disease. There is a numerical relationship between measures widely used in investigating causal risk factors such as relative risk or odds ratios and measures of screening performance such as the DR5. A web-based Risk–Screening Converter is available on the Medical Screening Society website (https://www.medicalscreeningsociety.com/rsc.asp). The Risk–Screening Converter converts measures identified as risk factors in epidemiological studies which have a Gaussian distribution into measures of screening performance of potential tests and vice versa. The Converter can be used to determine whether measures such as the odds ratio across the highest and lowest quintile groups of a risk factor are large enough to be considered as a screening test. For example, the Risk–Screening Converter can be used to show that cholesterol is not a good screening test for ischaemic heart disease. In a study of the concentration of total cholesterol in men with a future ischaemic heart disease event the odds ratio between the highest and lowest quintile groups of the distribution of serum total cholesterol was approximately 3.3, similar to the results from other studies. When this odds ratio is entered into the Risk–Screening Converter (see Figure 1) an estimated DR5 of 11.2% is obtained showing that serum cholesterol measurement in adults is not a good screening test for ischaemic heart disease despite it being widely used for this purpose. The Converter has been used in a study to assess the incremental value of polygenic risk scores (PRS) over traditional risk factor scores in the prediction of coronary heart disease events. The study used the results from five cohorts. The cohort with the most discriminatory PRS reported an odds ratio of 4.51 between the highest and lowest quintile groups of the distribution of PRS. The Converter was used in the study to show that this odds ratio corresponds to a false positive rate of 77.1% at a 90% detection rate (FPR90), which is equivalent to a DR5 of 13.5%. The Converter shows that adding a PRS to traditional risk scor","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":"30 1","pages":"1-2"},"PeriodicalIF":2.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10710996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of population-based screening of sickle cell disease through the primary health care system in tribal areas of India.","authors":"Bontha V Babu,&nbsp;Yogita Sharma,&nbsp;Parikipandla Sridevi,&nbsp;Shaily B Surti,&nbsp;Manoranjan Ranjit,&nbsp;Deepa Bhat,&nbsp;Jatin Sarmah,&nbsp;Godi Sudhakar","doi":"10.1177/09691413221123131","DOIUrl":"https://doi.org/10.1177/09691413221123131","url":null,"abstract":"<p><strong>Objective: </strong>To describe the development and implementation of a population-based screening programme for sickle cell disease (SCD) implemented in 12 SCD-endemic and tribal-dominated primary/community health centres (PHCs/CHCs) across six districts of India.</p><p><strong>Setting: </strong>India reports a huge burden of SCD, especially among indigenous (tribal) communities. However, there is no state-led SCD programme in many places, and systematic screening is absent. This situation necessitates developing a model of population screening.</p><p><strong>Methods: </strong>This programme was meant to screen all people and was carried out in three tiers. The first tier was a symptomatic survey carried out by community health workers. Regular health workers then screened those referred by sickle cell solubility test at sub-health centres as the second tier. The third tier was confirmation by haemoglobin electrophoresis at PHCs/CHCs. Communities were mobilised and prepared to accept the screening. Capacity building of health facilities was ensured through training and supply of equipment and material.</p><p><strong>Results: </strong>Initial observation based on six months' data revealed that out of the 110,754 tribal population of 12 PHCs/CHCs, 8418 (7.6%) were identified in the symptomatic survey. Subsequently, 9416 people, including the above 8418, underwent the solubility test, and 2607 (27.7%) were found to be positive. Of these, 1978 (78.9%) underwent electrophoresis. About 64.2% were found to be positive for sickle haemoglobin (233 (18.4%) SCD and 1036 (81.6%) SCD trait).</p><p><strong>Conclusions: </strong>The study demonstrates the feasibility of establishing a population-based screening programme in the primary health care system. It is easy to implement in tribal habitations as part of the proposed national SCD/haemoglobinopathies programme.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":"30 1","pages":"28-35"},"PeriodicalIF":2.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10708534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptability of alternative technologies compared with faecal immunochemical test and/or colonoscopy in colorectal cancer screening: A systematic review.","authors":"Omar Ali, Sunnia Gupta, Kate Brain, Kate J Lifford, Shantini Paranjothy, Sunil Dolwani","doi":"10.1177/09691413221109999","DOIUrl":"10.1177/09691413221109999","url":null,"abstract":"<p><strong>Objective: </strong>Colorectal cancer (CRC) is the third most common cancer and the second largest cause of cancer-related death worldwide. Current CRC screening in various countries involves stool-based faecal immunochemical testing (FIT) and/or colonoscopy, yet public uptake remains sub-optimal. This review assessed the literature regarding acceptability of alternative CRC screening modalities compared to standard care in average-risk adults.</p><p><strong>Method: </strong>Systematic searches of MEDLINE, EMBASE, CINAHL, Cochrane and Web of Science were conducted up to February 3^rd, 2022. The alternative interventions examined were computed tomography colonography, flexible sigmoidoscopy, colon capsule endoscopy and blood-based biomarkers. Outcomes for acceptability were uptake, discomfort associated with bowel preparation, discomfort associated with screening procedure, screening preferences and willingness to repeat screening method. A narrative data synthesis was conducted.</p><p><strong>Results: </strong>Twenty-one studies met the inclusion criteria. Differences between intervention and comparison modalities in uptake did not reach statistical significance in most of the included studies. The findings do suggest FIT as being more acceptable as a screening modality than flexible sigmoidoscopy. There were no consistent significant differences in bowel preparation discomfort, screening procedure discomfort, screening preference and willingness to repeat screening between the standard care and alternative modalities.</p><p><strong>Conclusion: </strong>Current evidence comparing standard colonoscopy and stool-based CRC screening with novel modalities does not demonstrate any clear difference in acceptability. Due to the small number of studies available and included in each screening comparison and lack of observed differences, further research is needed to explore factors influencing acceptability of alternative CRC modalities that might result in improvement in population uptake within different contexts.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":"30 1","pages":"14-27"},"PeriodicalIF":2.6,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/dd/e4/10.1177_09691413221109999.PMC9925898.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10722760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why are most colorectal cancers diagnosed outside of screening? A retrospective analysis of data from the English bowel screening programme.","authors":"Robert Stephen Kerrison,&nbsp;Andrew Prentice,&nbsp;Sarah Marshall,&nbsp;Christian von Wagner","doi":"10.1177/09691413221100969","DOIUrl":"https://doi.org/10.1177/09691413221100969","url":null,"abstract":"<p><strong>Objective: </strong>Despite several interventions to increase participation in England, most colorectal cancers (CRCs) are diagnosed outside of the screening programme. The aims of this study were to better understand why most CRCs are diagnosed externally, the extent to which this is due to suboptimal uptake of screening, and the extent to which it is due to other factors, such as false-negative test results.</p><p><strong>Setting / methods: </strong>We performed a clinical audit of 1011 patients diagnosed with CRC at St Mark's Hospital (Harrow, UK) between January 2017 and December 2020. Data on the diagnostic pathway and screening history of individuals were extracted from the bowel cancer screening system and assessed using descriptive statistics.</p><p><strong>Results: </strong>446/1011 (44.1%) patients diagnosed with CRC were eligible for screening at the time of diagnosis. Of these, only 115/446 (25.8%) were diagnosed through screening. Among those diagnosed via non-screening pathways, 210/331 (63.4%) had never taken part in screening, 31/331 (9.4%) had taken part but were not up to date, and 89/331 (26.9%) had taken part and were up-to-date (of these, 82/89 [92.2%] had received a normal or weak positive test result, and 5/89 [5.6%] had received a positive result and declined colonoscopy).</p><p><strong>Conclusion: </strong>Nearly two-thirds of screening eligible patients diagnosed through a non-screening pathway had never taken part in screening. This represents the single largest source of inefficiency within the screening programme, followed by missed findings and inconsistent participation. Given the improved outcomes associated with screen-detected cancers, there is a strong public health mandate to encourage participation.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":"29 4","pages":"224-230"},"PeriodicalIF":2.9,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9574422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9222085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colorectal cancer mortality after randomized implementation of FIT-based screening - a nationwide cohort study.","authors":"Sisse Helle Njor,&nbsp;Mette Bach Larsen,&nbsp;Bo Søborg,&nbsp;Berit Andersen","doi":"10.1177/09691413221102212","DOIUrl":"https://doi.org/10.1177/09691413221102212","url":null,"abstract":"<p><strong>Objective: </strong>Evidence of reduction in colorectal cancer (CRC) mortality following CRC screening based on the faecal immunochemical test (FIT) is insufficient. This study aimed to analyse if CRC mortality was reduced after implementing FIT-based screening.</p><p><strong>Setting: </strong>The Danish national CRC screening programme.</p><p><strong>Methods: </strong>This nationwide cohort study included residents aged 50-71 years invited to the prevalence round of the screening programme. Invitation order was decided by randomising on birth month; the first two birth months to be invited were classified as invited and the five last were classified as not-yet-invited and given a pseudo invitation data. Follow-up was from (pseudo)invitation date until 31 December 2017, emigration or death. Relative risk (RR) of CRC death was calculated with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>A total of 897,812 residents were included (29% invited and 71% not-yet-invited). The median follow-up was 3.3 years. The RR of CRC death at end of follow-up was 0.83 (95% CI 0.66; 1.03) among those invited to screening compared with those not yet invited. For men aged 60-71 years, this RR was 0.68 (95% CI 0.49; 0.94). For those participating in screening compared with a similar group of not-yet-invited residents, the RR was 0.71 (95% CI 0.46-1.08). For male participants aged 60-71 years, this RR was 0.49 (95% CI 0.27-0.89). For women and men aged 50-59 years, RRs were small and statistically non-significant.</p><p><strong>Conclusion: </strong>This nationwide study showed that even within a median follow-up of only 3.3 years, implementing FIT-based CRC screening reduced CRC mortality among older men.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":"29 4","pages":"241-248"},"PeriodicalIF":2.9,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10454475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One or two faecal immunochemical tests in an organised population-based colorectal cancer screening programme in Murcia (Spain).","authors":"Carlos Tourne-Garcia,&nbsp;Francisco Perez-Riquelme,&nbsp;Olga Monteagudo-Piqueras,&nbsp;Callum G Fraser,&nbsp;Pedro Yepes-Garcia","doi":"10.1177/09691413221094919","DOIUrl":"https://doi.org/10.1177/09691413221094919","url":null,"abstract":"<p><strong>Objective: </strong>Roll-out of population-based colorectal cancer (CRC) screening with faecal immunochemical test (FIT) is limited by availability of further investigations, particularly colonoscopy and examination of excised lesions. Our objective was to assess whether variation in number of faecal samples and threshold adjustment can optimise resource utilisation and CRC detection rate.</p><p><strong>Methods: </strong>Three different screening strategies were compared for the same FIT threshold using a quantitative FIT system: one FIT, positive when <u>></u>20 µg Hb/g faeces; two FIT, positive when either was <u>></u>20 µg Hb/g faeces; and two FIT, positive when the mean was <u>></u>20 µg Hb/g faeces. We calculated changes in the size of population the provider could invite to screening for an equal number of screening positive results, and CRC and adenoma detected.</p><p><strong>Results: </strong>In our setting, Region of Murcia, south of Spain (not fully rolled out screening programme), changing the usual strategy of two FIT, positive when either to positive when the mean was <u>></u>20 µg Hb/g faeces, would increase population invited by 37.81% with the same number of positive results (which would generate a CRC detection rate of 19.2%). In a fully rolled out programme, changing the strategy from one to two FIT (positive when the mean is <u>></u>20 µg Hb/g faeces), would increase CRC detection rate by 4.64% with an increase of only 13.34% in positive FIT.</p><p><strong>Conclusions: </strong>In a population-based CRC screening programme, smart use of number of FITs and positivity threshold can increase population invited and CRC detection without increasing the number of colonoscopies and pathological examinations needed.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":"29 4","pages":"231-240"},"PeriodicalIF":2.9,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10386293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Newborn screening for abnormal haemoglobins in Jamaica: Practical issues in an island programme.","authors":"Graham R Serjeant,&nbsp;Beryl E Serjeant,&nbsp;Karlene P Mason,&nbsp;Felicea Gibson,&nbsp;Ruth-Ann Gardner,&nbsp;Lansford Warren,&nbsp;Ian R Hambleton,&nbsp;Swee L Thein,&nbsp;Margit Happich,&nbsp;Andreas E Kulozik","doi":"10.1177/09691413221111209","DOIUrl":"https://doi.org/10.1177/09691413221111209","url":null,"abstract":"Objective To report the diagnostic challenges of newborn screening for abnormal haemoglobins. Setting Cord blood samples from 13 hospitals in southwest Jamaica taken in 2008–2019. Methods Blood spots, collected from the umbilical cord, were analysed by high pressure liquid chromatography (HPLC) to reveal phenotypes for HbSS and HbCC, but genotype confirmation may require parental studies or gene sequencing. Such cases that were successfully traced were analysed in this follow-up study. Results HPLC screening of 121,306 samples detected HbAS in 11,846 (9.8%), HbAC in 4508 (3.7%) and other electrophoretic abnormalities in 1090 babies. Among 101 previously unconfirmed cases, 34/90 (38%) with HPLC evidence of a HbSS phenotype had other genotypes, and 7/11 (64%) with a HbCC phenotype had other genotypes. Syndromes from the interaction of β thalassaemia occurred in 112 babies (85 with HbS, 27 with HbC) and of genes for hereditary persistence of fetal haemoglobin (HPFH) in 18 (12 with HbS, 6 with HbC). Variants other than HbS and HbC occurred in 270 babies, 16 in combination with either HbS or HbC, and 254 as traits. Most variants are benign even when inherited with HbS, although HbO Arab, HbD Punjab, or Hb Lepore Washington, which occurred in 6 cases, may cause sickle cell disease. Conclusions Genes for β thalassaemia and HPFH are common in western Jamaica and when associated with HbS may present diagnostic challenges in newborns, as HbF and HbA2 have not reached diagnostic levels. Family and DNA studies may be necessary for genotype confirmation.","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":"29 4","pages":"219-223"},"PeriodicalIF":2.9,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10761708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lymphoproliferative disease detected by breast cancer screening.","authors":"Efrat Luttwak,&nbsp;Yafit Segman,&nbsp;May Saban,&nbsp;Odit Gutwein,&nbsp;Irit Avivi,&nbsp;Chava Perry,&nbsp;Alina Filiavich,&nbsp;Nadav Sarid","doi":"10.1177/09691413221109988","DOIUrl":"https://doi.org/10.1177/09691413221109988","url":null,"abstract":"<p><strong>Objective: </strong>To determine the rate of lymphoproliferative disease (LPD) in women undergoing routine breast cancer screening (BCS). BCS can reveal pathologies other than carcinoma that involve the breast and lymph tissue. The few studies that have described cases in which BCS led to the diagnosis of LPD were based on small series and focused on imaging rather than clinical characteristics.</p><p><strong>Setting and methods: </strong>A multi-center retrospective study in Israel, investigating LPD rate and characteristics among women diagnosed with LPD via BCS.</p><p><strong>Results: </strong>Thirty-four patients out of 14,400 consecutive women undergoing BCS at Tel Aviv Sourasky Medical Center during the study period were diagnosed with LPD, suggesting a diagnosis rate of 0.24%. The enlarged cohort (n = 45), including 11 patients that were retrieved from the databases of three other centers, demonstrates a predominant histological diagnosis of non-aggressive LPD (n = 33). Thirty-four (76%) had a suspicious axillary lymph node, and 11 had a breast lesion. The median maximal lesion size was 1.95 cm (range 0.8-6.5). Disease was localized in 60% of patients (stage 1 and 1E). Univariate analysis revealed that lymphocyte count was inversely associated with aggressive histology. At median follow-up of 39 months, all but three patients were alive. These three had been diagnosed with non-aggressive LPD which had never been treated and died from unrelated causes.</p><p><strong>Conclusions: </strong>The LPD detection rate via BCS was 2.36 per 1000 screens. The majority of LPDs were non-aggressive. Nearly a third were aggressive, most detected at an early stage, and the clinical outcome was generally favorable.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":"29 4","pages":"255-259"},"PeriodicalIF":2.9,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10395656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the impact of the COVID-19 pandemic on breast cancer screening and diagnosis rates: A rapid review and meta-analysis.","authors":"Jay Shen Ng, Daniel G Hamilton","doi":"10.1177/09691413221101807","DOIUrl":"10.1177/09691413221101807","url":null,"abstract":"<p><strong>Objective: </strong>The ongoing COVID-19 pandemic has caused an indefinite delay to cancer screening programs worldwide. This study aims to explore the impact on breast cancer screening outcomes such as mammography and diagnosis rates.</p><p><strong>Methods: </strong>We searched Ovid MEDLINE, Ovid Embase, medRxiv and bioRxiv between January 2020 to October 2021 to identify studies that reported on the rates of screening mammography and breast cancer diagnosis before and during the pandemic. The effects of 'lockdown' measures, age and ethnicity on outcomes were also examined. All studies were assessed for risk of bias using the Newcastle-Ottawa Scale (NOS). Rate ratios were calculated for all outcomes and pooled using standard inverse-variance random effects meta-analysis.</p><p><strong>Results: </strong>We identified 994 articles, of which 7 registry-based and 24 non-registry-based retrospective cohort studies, including data on 4,860,786 and 629,823 patients respectively across 18 different countries, were identified. Overall, breast cancer screening and diagnosis rates dropped by an estimated 41-53% and 18-29% respectively between 2019 and 2020. No differences in mammogram screening rates depending on patient age or ethnicity were observed. However, countries that implemented lockdown measures were associated with a significantly greater reduction in mammogram and diagnosis rates between 2019 and 2020 in comparison to those that did not.</p><p><strong>Conclusion: </strong>The pandemic has caused a substantial reduction in the screening and diagnosis of breast cancer, with reductions more pronounced in countries under lockdown restrictions. It is early yet to know if delayed screening during the pandemic translates into higher breast cancer mortality.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":"29 4","pages":"209-218"},"PeriodicalIF":2.6,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9127453/pdf/10.1177_09691413221101807.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10454463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of benefits and harms of adaptive screening schedules for lung cancer: A microsimulation study.","authors":"Pianpian Cao,&nbsp;Jihyoun Jeon,&nbsp;Rafael Meza","doi":"10.1177/09691413221118194","DOIUrl":"https://doi.org/10.1177/09691413221118194","url":null,"abstract":"<p><strong>Background: </strong>Although lung cancer screening (LCS) has been proven effective in reducing lung cancer mortality, it is associated with some potential harms, such as false positives and invasive follow-up procedures. Determining the time to next screen based on individual risk could reduce harms while maintaining health gains. Here, we evaluate the benefits and harms of LCS strategies with adaptive schedules, and compare these with those from non-adaptive strategies.</p><p><strong>Methods: </strong>We extended the Lee and Zelen risk threshold method to select screening schedules based on individual's lung cancer risk and life expectancy (adaptive schedules). We compared the health benefits and harms of these adaptive schedules with regular (non-adaptive) schedules (annual, biennial and triennial) using a validated lung cancer microsimulation model. Outcomes include lung cancer deaths (LCD) averted, life years gained (LYG), discounted quality adjusted life years (QALYs) gained, and false positives per LCD averted. We also explored the impact of varying screening-related disutilities.</p><p><strong>Results: </strong>In comparison to standard regular screening recommendations, risk-dependent adaptive screening reduced screening harms while maintaining a similar level of health benefits. The net gains and the balance of benefits and harms from LCS with efficient adaptive schedules were improved compared to those from regular screening, especially when the screening-related disutilities are high.</p><p><strong>Conclusions: </strong>Adaptive screening schedules can reduce the associated harms of screening while maintaining its associated lung cancer mortality reductions and years of life gained. Our study identifies individually tailored schedules that optimize the screening benefit/harm trade-offs.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":"29 4","pages":"260-267"},"PeriodicalIF":2.9,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/44/ac/10.1177_09691413221118194.PMC9574899.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10400636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}