Non-compliance with the initial screening exam visit in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial

Level of Education Matters in Regard to Participants' Compliance With Screening in the National Lung Screening Trial

PURPOSE

The success of cancer screening depends on patient adherence to the screening program. The purpose of this study is to assess how the level of education might affect participants' compliance with screening in the National Lung Screening Trial (NLST).

MATERIALS AND METHODS

Secondary data analyses of the participants in the NLST were performed. A total of 50,104 participants were included in this study. Participants who enrolled in the trial but refused the initial screening were compared with those who completed the screening. A multivariate logistic regression model was used to assess the association between participant noncompliance and education level.

RESULTS

A total of 3712 (7.41%) participants refused lung cancer screening in the NLST. Compared with the reference group, participants with an education level of eighth grade or less (odds ratio [OR]: 2.1, CI: 1.68-2.76), ninth-11th grade (OR: 1.9, CI: 1.7-2.34), high school graduates (OR: 1.3, CI: 1.22-1.54), after high school training (OR: 1.1, CI: 1-1.31), or an associate's degree (OR: 1.2, CI: 1.07-1.36) had significantly higher odds of refusing lung cancer screening. Participants with a bachelor's degree showed no significant association with compliance with screening (OR: 0.9, P = 0.86). Multivariate regression analysis also showed that younger, single, male participants with a longer duration of smoking history had significantly higher odds of refusing the screening.

CONCLUSION

A lower level of education was significantly associated with refusing lung cancer screening. A strategic targeted approach for this group might be necessary to promote their compliance rate.

Social determinants of health and US cancer screening interventions: A systematic review

There remains a need to synthesize linkages between social determinants of health (SDOH) and cancer screening to reduce persistent inequities contributing to the US cancer burden. The authors conducted a systematic review of US-based breast, cervical, colorectal, and lung cancer screening intervention studies to summarize how SDOH have been considered in interventions and relationships between SDOH and screening. Five databases were searched for peer-reviewed research articles published in English between 2010 and 2021. The Covidence software platform was used to screen articles and extract data using a standardized template. Data items included study and intervention characteristics, SDOH intervention components and measures, and screening outcomes. The findings were summarized using descriptive statistics and narratives. The review included 144 studies among diverse population groups. SDOH interventions increased screening rates overall by a median of 8.4 percentage points (interquartile interval, 1.8-18.8 percentage points). The objective of most interventions was to increase community demand (90.3%) and access (84.0%) to screening. SDOH interventions related to health care access and quality were most prevalent (227 unique intervention components). Other SDOH, including educational, social/community, environmental, and economic factors, were less common (90, 52, 21, and zero intervention components, respectively). Studies that included analyses of health policy, access to care, and lower costs yielded the largest proportions of favorable associations with screening outcomes. SDOH were predominantly measured at the individual level. This review describes how SDOH have been considered in the design and evaluation of cancer screening interventions and effect sizes for SDOH interventions. Findings may guide future intervention and implementation research aiming to reduce US screening inequities.

Implications of Regionalizing Care in the Developing World: Impact of Distance to Referral Center on Compliance to Biopsy Recommendations in a Brazilian Prostate Cancer Screening Cohort

Given growing specialization in medical care, optimal care may require regionalization, which may create access barriers. We tested this within a large prostate cancer (PC) screening program in Brazil. In 2004-2007, Barretos Cancer Hospital prospectively screened men for PC throughout rural Brazil. Men with abnormal screen were referred for follow-up and possible biopsy. We tested the link between distance from screening site to Barretos Cancer Hospital and risk of noncompliance with showing up for biopsy, PC on biopsy and, among those with PC, PC grade using crude and multivariable logistic regression analysis. Among 10,467 men undergoing initial screen, median distance was 257 km (IQR: 135-718 km). On crude and multivariable analyses, farther distance was significantly linked with biopsy noncompliance (OR/100 km: 0.83, P < 0.001). Among men who lived within 150 km of Barretos Cancer Hospital, distance was unrelated to compliance (OR/100 km: 1.09, P=0.87). There was no association between distance and PC risk or PC grade (all P > 0.25). In Brazil, where distances to referral centers can be large, greater distance was related to reduced biopsy compliance in a PC screening cohort. Among men who lived within 150 km, distance was unrelated to compliance. Care regionalization may reduce access when distances are large.

Does plasma thiol and disulphide be a new marker for prostate cancer in prostate-specific antigen level between 10 and 20 ng/ml?

INTRODUCTION

We aimed to evaluate plasma thiol and disulphide levels as an additional marker to prostate specific antigen (PSA) in the diagnosis of prostate cancer (PCa).

METHODS

Between March 2017 and January 2018 prospective study was conducted among patients with PSA levels of 2.5-20 ng/mL without suspicion of malignancy in rectal examination and who underwent prostate needle biopsy. Patients were divided into two groups according to PSA level as 2.5-10 ng/mL (Group 1) and 10.01-20 ng/mL (Group 2). Diagnostic efficacy of thiol, disulphide and PSA levels were measured by ROC analysis.

RESULTS

A total of 76 patients were included in the study. There were 49 patients in group 1 and 27 patients in group 2. There was no significant difference between two groups in terms of PSA density and prostate size. In Group 1, area under curve (AUC) was higher in PSA than other parameters with statistically significant difference (p<.05). In group 2, AUC of native and total thiol was higher than PSA but there was no statistically significant difference for AUC in parameters.

CONCLUSIONS

We think that plasma thiol test may be used in diagnosis of prostate cancer while PSA levels between 10 to 20 ng/mL. However, further studies are required.

Design-corrected variation by centre in mortality reduction in the ERSPC randomised prostate cancer screening trial

Objectives To calculate design-corrected estimates of the effect of screening on prostate cancer mortality by centre in the European Randomised Study of Screening for Prostate Cancer (ERSPC). Setting The ERSPC has shown a 21% reduction in prostate cancer mortality in men invited to screening with follow-up truncated at 13 years. Centres either used pre-consent randomisation (effectiveness design) or post-consent randomisation (efficacy design). Methods In six centres (three effectiveness design, three efficacy design) with follow-up until the end of 2010, or maximum 13 years, the effect of screening was estimated as both effectiveness (mortality reduction in the target population) and efficacy (reduction in those actually screened). Results The overall crude prostate cancer mortality risk ratio in the intervention arm vs control arm for the six centres was 0.79 ranging from a 14% increase to a 38% reduction. The risk ratio was 0.85 in centres with effectiveness design and 0.73 in those with efficacy design. After correcting for design, overall efficacy was 27%, 24% in pre-consent and 29% in post-consent centres, ranging between a 12% increase and a 52% reduction. Conclusion The estimated overall effect of screening in attenders (efficacy) was a 27% reduction in prostate cancer mortality at 13 years' follow-up. The variation in efficacy between centres was greater than the range in risk ratio without correction for design. The centre-specific variation in the mortality reduction could not be accounted for by the randomisation method.

Baseline subject characteristics predictive of compliance with study-mandated prostate biopsy in men at risk of prostate cancer: results from REDUCE

Introduction

Study compliance is crucial when the study outcome is determined by an invasive procedure, such as prostate biopsy. To investigate predictors of compliance in study-mandated prostate biopsies, we analyzed demographic, clinical and reported lifestyle data from the REDUCE trial.

Methods

We retrospectively identified 8,025 men from REDUCE with at least 2-years of follow-up, and used multivariable logistic regression to test the association between baseline demographic and clinical characteristics and undergoing the study-mandated prostate biopsy at 2 years. We then examined whether missing any of these data was associated with undergoing a biopsy

Results

In REDUCE, 22% of men did not undergo a 2-year biopsy. On multivariable analysis, non-North American region was predictive of 42-44% increased likelihood of undergoing a 2-year biopsy (p≤0.001). Being enrolled at a center that enrolled >10 subjects (2^nd and 3^rd tertile) was associated with a 42-48% increased likelihood of undergoing a 2-year biopsy (p<0.001). Additionally, black race predicted 44% lower rate of on-study 2-year biopsy (OR=0.56; p=0.001). Finally, missing one or more baseline variables was associated with a 32% decreased likelihood of undergoing a 2-year biopsy (OR=0.68; p<0.001).

Conclusions

In REDUCE, men outside North America, those at higher volume centers, and those with complete baseline data were more likely to undergo study mandated 2-year biopsies. Given prostate biopsy is becoming increasingly utilized as an endpoint in trials that are often multi-national, regional differences in compliance should be considered when designing future trials. Likewise, efforts are needed to ensure compliance in low-volume centers or among subjects missing baseline data.