Journal of Medical Screening最新文献

{"title":"Breast cancer mortality during the COVID-19 pandemic.","authors":"Camilla Mattiuzzi, Giuseppe Lippi","doi":"10.1177/09691413241278129","DOIUrl":"https://doi.org/10.1177/09691413241278129","url":null,"abstract":"<p><p>Several lines of evidence suggest that breast cancer screening and treatment may have been compromised during the early phase of the COVID-19 pandemic. Using data from the US Centers for Disease Control and Prevention (CDC) WONDER database, we estimated the age-adjusted mortality rates for female breast cancer between 2018 and 2023. We found that the age-adjusted death rate for breast cancer decreased gradually from 2018 to 2019 and 2020. This downward trend reversed in 2021, with an increase in breast cancer mortality, which then declined further in 2022 and 2023. These findings indicate that breast cancer mortality may have increased slightly in 2021, possibly as a result of limited access to screening and timely treatment during the first phase of the COVID-19 pandemic, although the age-adjusted mortality rate continued to decline in the following two years.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":" ","pages":"9691413241278129"},"PeriodicalIF":2.6,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127251","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":"Examining the impact of COVID-19 disruptions on population-based breast cancer screening in Ireland.","authors":"Jessica O'Driscoll, Therese Mooney, Paul Kearney, Yvonne Williams, Suzanne Lynch, Alissa Connors, Aideen Larke, Sorcha McNally, Ann O'Doherty, Laura Murphy, Kathleen E Bennett, Patricia Fitzpatrick, Maeve Mullooly, Fidelma Flanagan","doi":"10.1177/09691413241232899","DOIUrl":"10.1177/09691413241232899","url":null,"abstract":"<p><strong>Objective: </strong>Many population-based breast screening programmes temporarily suspended routine screening following the COVID-19 pandemic onset. This study aimed to describe screening mammography utilisation and the pattern of screen-detected breast cancer diagnoses following COVID-19-related screening disruptions in Ireland.</p><p><strong>Methods: </strong>Using anonymous aggregate data from women invited for routine screening, three time periods were examined: (1) January-December 2019, (2) January-December 2020, and (3) January-December 2021. Descriptive statistics were conducted and comparisons between groups were performed using chi-square tests.</p><p><strong>Results: </strong>In 2020, screening mammography capacity fell by 67.1% compared to 2019; recovering to 75% of mammograms performed in 2019, during 2021. Compared to 2019, for screen-detected invasive breast cancers, a reduction in Grade 1 (14.2% vs. 17.2%) and Grade 2 tumours (53.4% vs. 58.0%) and an increase in Grade 3 tumours (32.4% vs. 24.8%) was observed in 2020 (<i>p</i> = 0.03); whereas an increase in Grade 2 tumours (63.3% vs. 58.0%) and a reduction in Grade 3 tumours (19.6% vs. 24.8%) was found in 2021 (<i>p</i> = 0.02). No changes in oestrogen receptor-positive or nodal-positive diagnoses were observed; however the proportion of oestrogen/progesterone receptor-positive breast cancers significantly increased in 2020 (76.2%; <i>p</i> < 0.01) and 2021 (78.7%; <i>p</i> < 0.001) compared to 2019 (67.8%).</p><p><strong>Conclusion: </strong>These findings demonstrate signs of a grade change for screen-detected invasive breast cancers early in the pandemic, with recovery evident in 2021, and without an increase in nodal positivity. Future studies are needed to determine the COVID-19 impact on long-term breast cancer outcomes including mortality.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":" ","pages":"182-190"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11330080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177640","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":"Risk stratification in medical screening.","authors":"Nicholas J Wald, Stephen W Duffy, Allan Hackshaw","doi":"10.1177/09691413241255623","DOIUrl":"10.1177/09691413241255623","url":null,"abstract":"","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":" ","pages":"119-120"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155510","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 prognostic potential of mammographic growth rate of invasive breast cancer in the Nijmegen breast cancer screening cohort.","authors":"Jim Peters, Jos A A M van Dijck, Sjoerd G Elias, Johannes D M Otten, Mireille J M Broeders","doi":"10.1177/09691413231222765","DOIUrl":"10.1177/09691413231222765","url":null,"abstract":"<p><strong>Objectives: </strong>Insight into the aggressiveness of potential breast cancers found in screening may optimize recall decisions. Specific growth rate (SGR), measured on mammograms, may provide valuable prognostic information. This study addresses the association of SGR with prognostic factors and overall survival in patients with invasive carcinoma of no special type (NST) from a screened population.</p><p><strong>Methods: </strong>In this historic cohort study, 293 women with NST were identified from all participants in the Nijmegen screening program (2003-2007). Information on clinicopathological factors was retrieved from patient files and follow-up on vital status through municipalities. On consecutive mammograms, tumor volumes were estimated. After comparing five growth functions, SGR was calculated using the best-fitting function. Regression and multivariable survival analyses described associations between SGR and prognostic factors as well as overall survival.</p><p><strong>Results: </strong>Each one standard deviation increase in SGR was associated with an increase in the Nottingham prognostic index by 0.34 [95% confidence interval (CI): 0.21-0.46]. Each one standard deviation increase in SGR increased the odds of a tumor with an unfavorable subtype (based on histologic grade and hormone receptors; odds ratio 2.14 [95% CI: 1.45-3.15]) and increased the odds of diagnosis as an interval cancer (versus screen-detected; odds ratio 1.57 [95% CI: 1.20-2.06]). After a median of 12.4 years of follow-up, 78 deaths occurred. SGR was not associated with overall survival (hazard ratio 1.12 [95% CI: 0.87-1.43]).</p><p><strong>Conclusions: </strong>SGR may indicate prognostically relevant differences in tumor aggressiveness if serial mammograms are available. A potential association with cause-specific survival could not be determined and is of interest for future research.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":" ","pages":"166-175"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11330081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139652141","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":"Effects of health education on screening rate of first-degree relatives of cancer patients: A systematic review and meta-analysis.","authors":"Jiaxun Kang, Shanshan Wang, Jingna Yi, Qiushi Zhang","doi":"10.1177/09691413241233993","DOIUrl":"10.1177/09691413241233993","url":null,"abstract":"<p><strong>Objective: </strong>To synthesize the effects of educational intervention on the screening rate of first-degree relatives of cancer patients.</p><p><strong>Methods: </strong>A total of eight Chinese and English databases were searched (PubMed, Embase, Cochrane Library, CINAHL, Web of Science, Scopus, Medline and China Biology Medicine disc) from the time of library establishment to June 2023, for randomized controlled trials investigating the effects of educational intervention on screening rate of first-degree relatives of cancer patients. Two researchers independently screened and evaluated the quality of studies. RevMan 5.3 software was used to calculate the pooled effect size.</p><p><strong>Results: </strong>Thirteen studies involving 5628 participants were chosen to include in the meta-analysis. The results revealed that health education can increase screening rate of first-degree relatives of cancer patients (RR = 1.39, 95% CI = 1.16-1.65, P = 0.0002). The effect shown after short-term follow-up (≤6 months) was insignificant in terms of improving screening rate (RR = 1.46, 95% CI = 0.94-2.26, P = 0.09), but after long-term follow-up (＞6 months) the improvement was greater (RR = 1.37, 95% CI = 1.13-1.65, P = 0.002).</p><p><strong>Conclusion: </strong>Health education is effective in increasing the screening rate of first-degree relatives of cancer patients. The effect is more evident after long-term than short-term follow-up.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":" ","pages":"121-133"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139974416","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":"Reducing inequalities by supporting individuals to make informed decisions about accepting their breast screening invitations.","authors":"Sarah L Nicholson, Heidi Douglas, Stephen Halcrow, Patsy Whelehan","doi":"10.1177/09691413241230925","DOIUrl":"10.1177/09691413241230925","url":null,"abstract":"<p><strong>Objectives: </strong>Individuals from deprived areas are less likely to attend breast screening. Inequalities in the coverage of breast screening are associated with poorer cancer outcomes. Individuals who have a positive first experience are more likely to attend subsequent mammograms. This work evaluates the provision of an additional telephone call to individuals who have never attended breast screening, to establish whether this increases attendance.</p><p><strong>Setting and methods: </strong>1423 patients from four general practitioner practices within socially deprived areas of National Health Service Tayside (UK) comprised the study population. In addition to their standard appointment letter, individuals were to receive a call at least 24 h prior to their appointment. The call identified barriers to screening, and offered a supportive, problem-solving approach to overcoming these barriers. Data collected included: age, Scottish Index of Multiple Deprivation, first-time invite or previous non-attender, if contactable, duration of call, number of days prior to appointment, and confirmation appointment letter was received. The primary outcome was attendance at the screening.</p><p><strong>Results: </strong>Contact by phone was made with 678 (47.6%) of the study population. Of those, 483 (71.2%) attended their appointment, 122 (18%) cancelled and 73 (10.8%) did not attend (DNA), versus 344 (46.2%) attending, 34 (4.6%) cancelling and 367 (49.3%) not attending among those who were not able to be contacted. Those who received a call were more likely to attend their appointment and less likely to DNA compared to individuals not receiving the call.</p><p><strong>Conclusion: </strong>The intervention is simple and low cost; results indicate that the additional call may increase attendance and reduce DNA appointments at breast screening.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":" ","pages":"176-181"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724837","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":"Artificial intelligence for triaging of breast cancer screening mammograms and workload reduction: A meta-analysis of a deep learning software.","authors":"Debora Xavier, Isabele Miyawaki, Carlos Alberto Campello Jorge, Gabriela Batalini Freitas Silva, Maxwell Lloyd, Fabio Moraes, Bhavika Patel, Felipe Batalini","doi":"10.1177/09691413231219952","DOIUrl":"10.1177/09691413231219952","url":null,"abstract":"<p><strong>Objective: </strong>Deep learning (DL) has shown promising results for improving mammographic breast cancer diagnosis. However, the impact of artificial intelligence (AI) on the breast cancer screening process has not yet been fully elucidated in terms of potential workload reduction. We aim to assess if AI-based triaging of breast cancer screening mammograms could reduce the radiologist's workload with non-inferior sensitivity.</p><p><strong>Methods: </strong>PubMed, EMBASE, Cochrane Central, and Web of Science databases were systematically searched for studies that evaluated AI algorithms on computer-aided triage of breast cancer screening mammograms. We extracted data from homogenous studies and performed a proportion meta-analysis with a random-effects model to examine the radiologist's workload reduction (proportion of low-risk mammograms that could be theoretically ruled out from human's assessment) and the software's sensitivity to breast cancer detection.</p><p><strong>Results: </strong>Thirteen studies were selected for full review, and three studies that used the same commercially available DL algorithm were included in the meta-analysis. In the 156,852 examinations included, the threshold of 7 was identified as optimal. With these parameters, radiologist workload decreased by 68.3% (95%CI 0.655-0.711, <i>I</i>² = 98.76%, <i>p</i> < 0.001), while achieving a sensitivity of 93.1% (95%CI 0.882-0.979, <i>I</i>² = 83.86%, <i>p</i> = 0.002) and a specificity of 68.7% (95% CI 0.684-0.723, <i>I</i>² = 97.5%, <i>p</i> < 0.01).</p><p><strong>Conclusions: </strong>The deployment of DL computer-aided triage of breast cancer screening mammograms reduces the radiology workload while maintaining high sensitivity. Although the implementation of AI remains complex and heterogeneous, it is a promising tool to optimize healthcare resources.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":" ","pages":"157-165"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138802016","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 cervical cancer screening recommendations from US cancer centers: Assessing adherence to national guidelines.","authors":"Sophia Salingaros, Yiwey Shieh, Madelon L Finkel, Margaret Polaneczky, Deborah Korenstein, Jennifer L Marti","doi":"10.1177/09691413241238960","DOIUrl":"10.1177/09691413241238960","url":null,"abstract":"<p><p>Though widespread adoption of cervical cancer screening (CCS) in the US has been associated with a reduction in cervical cancer incidence and mortality, screening also carries with it potential risks. Newer national guidelines recommend decreased screening frequency to optimize the benefit/risk balance and to prevent over-screening. Here, we examined the alignment of US cancer center websites' public recommendations on CCS with national guidelines. We reviewed the websites of 1024 cancer centers accredited by the US Commission on Cancer during January-August 2022. We recorded the recommended frequency and type of CCS and any screening risks mentioned, comparing against national US Preventive Service Task Force (USPSTF) and American Cancer Society (ACS) guidelines. Of 1024 US cancer centers, 60% (610) provided CCS recommendations. Most centers are in alignment with the screening starting age (96%, 544/565) and stopping age (94%, 440/470) recommended by national guidelines. Of 508 centers specifying the frequency of standalone cervical cytology, 83% (419) recommended a screening interval of three years; however, 14% (73) recommended cervical cytology more frequently than the three-year interval recommended by the ACS/USPSTF. Screening risks were mentioned by 20% (124/610) of centers. Our findings highlight the importance of education on screening benefits and risks for physicians and patients to enable shared decision making based on evidence-based guidelines.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":" ","pages":"201-204"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177641","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":"Deaths averted: An unbiased alternative to rate ratios for measuring the performance of cancer screening programs.","authors":"Wilber Deck, James A Hanley","doi":"10.1177/09691413231215963","DOIUrl":"10.1177/09691413231215963","url":null,"abstract":"<p><strong>Introduction: </strong>Screening trials and meta-analyses emphasize the ratio of cancer death rates in screening and control arms. However, this measure is diluted by the inclusion of deaths from cancers that only became detectable after the end of active screening.</p><p><strong>Methods: </strong>We review traditional analysis of cancer screening trials and show that ratio estimates are inevitably biased to the null, because follow-up (FU) must continue beyond the end of the screening period and thus includes cases only becoming detectable after screening ends. But because such cases are expected to occur in equal numbers in the two arms, calculation of the difference between the number of cancer deaths in the screening and control arms avoids this dilutional bias. This difference can be set against the number of invitations to screening; we illustrate by reanalyzing data from all trials of tomography screening of lung cancer (LC) using this measure.</p><p><strong>Results: </strong>In nine trials of LC screening from 2000 to 2013, a total of 94,441 high-risk patients were invited to be in screening or control groups, with high participation rates (average 95%). In the older trials comparing computed tomography to chest X-ray, 88,285 invitations averted 83 deaths (1068 per death averted (DA)). In the six more recent trials with no screening in the control group, 69,976 invitations averted 121 deaths (577 invitations per DA).</p><p><strong>Discussion: </strong>Screens per DA is an undiluted measure of screening's effect and it is unperturbed by the arbitrary duration of FU. This estimate can be useful for program planning and informed consent.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":" ","pages":"134-139"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11330079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138292365","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":"Clinical performance and utility: A microsimulation model to inform the design of screening trials for a multi-cancer early detection test.","authors":"James Y Dai, Jing Zhang, Jerome V Braun, Noah Simon, Earl Hubbell, Nan Zhang","doi":"10.1177/09691413241228041","DOIUrl":"10.1177/09691413241228041","url":null,"abstract":"<p><strong>Objectives: </strong>Designing cancer screening trials for multi-cancer early detection (MCED) tests presents a significant methodology challenge, as natural histories of cell-free DNA-shedding cancers are not yet known. A microsimulation model was developed to project the performance and utility of an MCED test in cancer screening trials.</p><p><strong>Methods: </strong>Individual natural history of preclinical progression through cancer stages for 23 cancer classes was simulated by a stage-transition model under a broad range of cancer latency parameters. Cancer incidences and stage distributions at clinical presentation in simulated trials were set to match the data from Surveillance, Epidemiology, and End Results program. One or multiple rounds of annual screening using a targeted methylation-based MCED test (Galleri<b>^Ⓡ</b>) was conducted to detect preclinical cancers. Mortality benefit of early detection was simulated by a stage-shift model.</p><p><strong>Results: </strong>In simulated trials, accounting for healthy volunteer effect and varying test sensitivity, positive predictive value in the prevalence screening round reached 48% to 61% in 6 natural history scenarios. After 3 rounds of annual screening, the cumulative proportions of stage I/II cancers increased by approximately 9% to 14%, the incidence of stage IV cancers was reduced by 37% to 46%, the reduction of stages III and IV cancer incidences was 9% to 24%, and the reduction of mortality reached 13% to 16%. Greater reductions of late-stage cancers and cancer mortality were achieved by five rounds of MCED screening.</p><p><strong>Conclusions: </strong>Simulation results guide trial design and suggest that adding this MCED test to routine screening in the United States may shift cancer detection to earlier stages, and potentially save lives.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":" ","pages":"140-149"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11330083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673576","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}