Journal of Medical Screening最新文献

{"title":"Age at breast cancer screening in women with intellectual disability.","authors":"Daniel Satgé, Motoi Nishi","doi":"10.1177/09691413221132674","DOIUrl":"https://doi.org/10.1177/09691413221132674","url":null,"abstract":"Dear Editors, Current guidelines for breast cancer screening in women with intellectual disability (WIDs) do not differ from those for women in the general population. However, research suggests that WIDs are younger and have more advanced disease at breast cancer diagnosis than women in the general population. Three studies conducted in France showed breast cancer appearing earlier (Table 1). A hospital survey in central France included 11 breast cancer cases in WIDs discovered at a mean age of 55.6 years, 7 years earlier than in the control cohort (62.4 years). Five of the 11 malignancies (45%) were discovered in women before the age of 50. The cases in WIDs however were at a more advanced stage than in the control cohort (American Joint Committee on Cancer: AJCC1, OR=3.2, p=0.010). A study including 1519 randomly selected institutions dedicated to disabled adults across the whole of France identified 13 breast cancer cases in WIDs (with age known). These were diagnosed at a mean age of 47.8 years, 15 years earlier than in the French population during the corresponding period, and eight (61%) were in women under 50 years at diagnosis. The third was a population-based study conducted in the south of France which analyzed breast cancers in 21 WIDs. The mean age at diagnosis was 7 years earlier (54.7 years vs 61.8 years) than for controls in the regional Cancer Registry. Seven tumors (33%) were diagnosed before 50 years of age. There was also a trend to greater tumor volume (more advanced T stage) (Jacot et al., article submitted). A literature search conducted by one of us (MN) on Japanese publication sources, using “Japan Medical Abstract Society” (ICHUSHI) which includes medical conference reports, with key words “breast cancer” and “intellectual disability” yielded five articles and abstracts published 2003–2018.Thefive Japanesewomen concerned were aged 38–61 (mean 46.6). According to the data of “Cancer Statistics”, Cancer Information Service, National Cancer Center, Japan (National Cancer Registry, Ministry of Health, Labor and Welfare)” in recent years (2016–2018), the mean age at diagnosis of female breast cancer in Japan is 62.4 years. Three of the five WIDs were younger than 50 years at diagnosis. In a US nationwide study of data collected during 2010, 384 breast cancers among 602 reproductive cancers in WIDs were treated almost seven years earlier, at a mean age of 61, compared to 67.8 years for women without intellectual disability. Mass screening is a precious opportunity to treat breast cancer early in WIDs. First, breast cancer which has a similar incidence compared to women in the general population is the most frequent malignancy in WIDs. Second, WIDs have greater risk factors such as being more frequently overweight or obese, less involved in physical exercise, more frequently nulliparous and rarely breast feeding. Third, many WIDs do not practice breast self-palpation and have difficulties expressing their pain and symptoms. Fou","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":"30 1","pages":"47-48"},"PeriodicalIF":2.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10718106","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":"Public health perspective on prostate-specific antigen screening: Implications of overdiagnosis and differences in health insurance systems across countries.","authors":"Takeshi Takahashi","doi":"10.1177/09691413221139960","DOIUrl":"https://doi.org/10.1177/09691413221139960","url":null,"abstract":"Of the guidelines (for men at average and high risk) listed in their table, the US Preventive Services Task Force (USPSTF) recommendations are made solely by public health physicians, while others are made mainly by urologists. In the US, the 2012 USPSTF’s Grade D recommendation (not recommended) was strongly opposed by the American Urological Association (AUA), claiming that PSA screening reduces cancer mortality. After being upgraded to Grade C in 2018, the AUA endorsed it and other guidelines have been adapted accordingly. However, in practice, information provided by hospitals to patients tends to have nuances in favor of PSA screening. In Europe, the European Association of Urology (EAU) recommends PSA screening, arguing that it reduces cancer mortality and that the risk-adapted strategy has solved the problem. Since prostate cancer is a cancer of the elderly, the risk of death from other causes is overwhelmingly higher than that from cancer. Improvements in cancer-specific mortality have no benefit unless overall survival (OS) changes. If only the cause of death changes and the length of life remains the same, there is no need for early detection and treatment. In the UK, attempts to encourage PSA screening of high-risk populations, such as men of Black race, have been criticized. The prostate cancer mortality rate of 5.4 per 10,000 may become 10.8 in the high-risk group, but we don’t know how the screening group mortality rate would change, from 4.3 per 10,000 (according to USPSTF summary), and there would be no change in the OS. Higher risk does not necessarily mean greater benefit from screening. In addition, it is known that the mortality rate of prostate cancer is extremely low in Asians. Screening is less and less relevant, and the benefit, if any, will be even smaller. Urologists do not adequately understand the recommendations of public health physicians. One of the reasons why there is no PSA screening program in the UK is that the National Health Service, made up of many public health physicians, respects the fact that there is insufficient evidence of its efficacy and cost-effectiveness. The USPSTF does not recommend publically funded screening. Grade C recommendations are for private insurance coverage. In other words, in the US, you should be well informed, be convinced, pay, and take responsibility for the consequences yourself. The UK and Canada have public medical insurance and no PSA screening. In Japan, a group of public health physicians published a guideline in 2009 that is nearly identical to the 2018 USPSTF statement. Urologists were initially members of the group and involved in the development of the guideline, but they resigned because they were unhappy with the content and have since developed their own, recommending PSA screening for all age groups and almost identical to the 2012 AUA comments. Even after the AUA approved the USPSTF statement in 2018, it has yet to be revised. The prostate cancer mortality among J","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":"30 1","pages":"49-50"},"PeriodicalIF":2.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10718646","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":"The prevalence of comorbidity in the lung cancer screening population: A systematic review and meta-analysis.","authors":"Anas Almatrafi,&nbsp;Owen Thomas,&nbsp;Matthew Callister,&nbsp;Rhian Gabe,&nbsp;Rebecca J Beeken,&nbsp;Richard Neal","doi":"10.1177/09691413221117685","DOIUrl":"https://doi.org/10.1177/09691413221117685","url":null,"abstract":"<p><strong>Objective: </strong>Comorbidity is associated with adverse outcomes for all lung cancer patients, but its burden is less understood in the context of screening. This review synthesises the prevalence of comorbidities among lung cancer screening (LCS) candidates and summarises the clinical recommendations for screening comorbid individuals.</p><p><strong>Methods: </strong>We searched MEDLINE, EMBASE, EBM Reviews, and CINAHL databases from January 1990 to February 2021. We included LCS studies that reported a prevalence of comorbidity, as a prevalence of a particular condition, or as a summary score. We also summarised LCS clinical guidelines that addressed comorbidity or frailty for LCS as a secondary objective for this review. Meta-analysis was used with inverse-variance weights obtained from a random-effects model to estimate the prevalence of selected comorbidities.</p><p><strong>Results: </strong>We included 69 studies in the review; seven reported comorbidity summary scores, two reported performance status, 48 reported individual comorbidities, and 12 were clinical guideline papers. The meta-analysis of individual comorbidities resulted in an estimated prevalence of 35.2% for hypertension, 23.5% for history of chronic obstructive pulmonary disease (COPD) (10.7% for severe COPD), 16.6% for ischaemic heart disease (IHD), 13.1% for peripheral vascular disease (PVD), 12.9% for asthma, 12.5% for diabetes, 4.5% for bronchiectasis, 2.2% for stroke, and 0.5% for pulmonary fibrosis.</p><p><strong>Conclusions: </strong>Comorbidities were highly prevalent in LCS populations and likely to be more prevalent than in other cancer screening programmes. Further research on the burden of comorbid disease and its impact on screening uptake and outcomes is needed. Identifying individuals with frailty and comorbidities who might not benefit from screening should become a priority in LCS research.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":"30 1","pages":"3-13"},"PeriodicalIF":2.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/30/e3/10.1177_09691413221117685.PMC9925896.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9299241","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":"The Risk-Screening Converter.","authors":"Nicholas J Wald,&nbsp;Stephen W Duffy,&nbsp;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}