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Dunlop KLA, Singh N, Robbins HA, Zahed H, Johansson M, Rankin NM, Cust AE. Implementation considerations for risk-tailored cancer screening in the population: A scoping review. Prev Med 2024; 181:107897. [PMID: 38378124 PMCID: PMC11106520 DOI: 10.1016/j.ypmed.2024.107897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 02/10/2024] [Accepted: 02/14/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Risk-tailored screening has emerged as a promising approach to optimise the balance of benefits and harms of existing population cancer screening programs. It tailors screening (e.g., eligibility, frequency, interval, test type) to individual risk rather than the current one-size-fits-all approach of most organised population screening programs. However, the implementation of risk-tailored cancer screening in the population is challenging as it requires a change of practice at multiple levels i.e., individual, provider, health system levels. This scoping review aims to synthesise current implementation considerations for risk-tailored cancer screening in the population, identifying barriers, facilitators, and associated implementation outcomes. METHODS Relevant studies were identified via database searches up to February 2023. Results were synthesised using Tierney et al. (2020) guidance for evidence synthesis of implementation outcomes and a multilevel framework. RESULTS Of 4138 titles identified, 74 studies met the inclusion criteria. Most studies in this review focused on the implementation outcomes of acceptability, feasibility, and appropriateness, reflecting the pre-implementation stage of most research to date. Only six studies included an implementation framework. The review identified consistent evidence that risk-tailored screening is largely acceptable across population groups, however reluctance to accept a reduction in screening frequency for low-risk informed by cultural norms, presents a major barrier. Limited studies were identified for cancer types other than breast cancer. CONCLUSIONS Implementation strategies will need to address alternate models of delivery, education of health professionals, communication with the public, screening options for people at low risk of cancer, and inequity in outcomes across cancer types.
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Affiliation(s)
- Kate L A Dunlop
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
| | - Nehal Singh
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Hilary A Robbins
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Hana Zahed
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Mattias Johansson
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Nicole M Rankin
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia; Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
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Mumuni S, O’Donnell C, Doody O. The Risk Factors and Screening Uptake for Prostate Cancer: A Scoping Review. Healthcare (Basel) 2023; 11:2780. [PMID: 37893854 PMCID: PMC10606491 DOI: 10.3390/healthcare11202780] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVES The purpose of this scoping review was to identify the risk factors and screening uptake for prostate cancer. DESIGN Scoping review. METHODS Arksey and O'Malley's framework guided this review; five databases (Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycINFO, Academic Search Complete and Cochrane Library) and grey literature were searched. Screening was undertaken against predetermined inclusion criteria for articles published before July 2023 and written in English. This review is reported in line with PRISMA-Sc. RESULTS 10,899 database results were identified; 3676 papers were removed as duplicates and 7115 papers were excluded at title and abstract review. A total of 108 papers were full-text reviewed and 67 were included in the review. Grey literature searching yielded no results. Age, family history/genetics, hormones, race/ethnicity, exposure to hazards, geographical location and diet were identified as risk factors. Prostatic antigen test (PSA), digital rectal examination (DRE), transrectal ultrasound (TRUS), magnetic resonance imaging (MRI), magnetic resonance spectroscopic imaging (MRSI) and prostate biopsy were identified as screening/diagnostic methods. The evidence reviewed highlights moderate knowledge and screening uptake of prostate cancer with less than half of men reporting for PSA screening. On the other hand, there is a year-to-year increase in PSA and DRE screening, but factors such as poverty, religion, culture, communication barriers, language and costs affect men's uptake of prostate cancer screening. CONCLUSION As prostate cancer rates increase globally, there is a need for greater uptake of prostate cancer screening and improved health literacy among men and health workers. There is a need to develop a comprehensive prostate cancer awareness and screening programme that targets men and addresses uptake issues so as to provide safe, quality care. STRENGTHS AND LIMITATIONS OF THIS STUDY (1) A broad search strategy was utilised incorporating both databases and grey literature. (2) The PRISMA reporting guidelines were utilised. (3) Only English language papers were included, and this may have resulted in relevant articles being omitted.
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Affiliation(s)
- Seidu Mumuni
- Department of Nursing and Midwifery, University of Limerick, V94 T9PX Limerick, Ireland; (S.M.); (C.O.)
| | - Claire O’Donnell
- Department of Nursing and Midwifery, University of Limerick, V94 T9PX Limerick, Ireland; (S.M.); (C.O.)
- Health Research Institute, Department of Nursing and Midwifery, University of Limerick, V94 T9PX Limerick, Ireland
| | - Owen Doody
- Health Research Institute, Department of Nursing and Midwifery, University of Limerick, V94 T9PX Limerick, Ireland
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Abedi AR, Mafi AR, Tabatabaeimehr SY, Nozari H, Allameh F. Systematic Evaluation of Studies in the Fields of Diagnosis and Management of Prostate Cancer in Coronavirus Disease 2019 Era. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2023. [DOI: 10.5812/ijcm-130922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Background: Prostate cancer is one of the most common cancers worldwide. The proper management of this cancer during the coronavirus disease 2019 (COVID-19) or similar outbreaks could be a serious challenge. Proper timing of surgery, radiotherapy, and other medical modalities are essential in providing the most effective treatment. Objectives: This systematic review aimed at evaluating the proper management of prostate cancer during the COVID-19 outbreak. Methods: This study was conducted from 2019 to 2022. An internet search was conducted using the keywords: Diagnosis, management, radical prostatectomy, radiotherapy, hormone ablation therapy, chemotherapy and prostate cancer, and COVID-19. The visited databases included PubMed, Scopus, Web of Sciences, Google Scholar, and Scientific Information Database. The review was performed based on the preferred reporting items for a systematic review and meta-analyses (PRISMA) guidelines. Results: Postponing the biopsy for up to three months and adopting of non-invasive diagnostic methods were likely reasonable during the COVID-19 pandemic. Patients with cancer were more prone to severe injuries and were more likely to have serious complications. Surgery, radiation therapy, brachytherapy, palliative radiation, hormone ablation therapy, and chemotherapy were among the pre-institutional treatments that had to be performed according to medical protocols as well as health and professional guidelines. Conclusions: It was recommended that the prostate cancer screening should not be performed for asymptomatic men during the COVID-19 outbreak. It was also suggested that the treatment should be performed in the shortest possible time and in the safest way.
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Effectiveness of a Community Health Worker-Led Intervention on Knowledge, Perception, and Prostate Cancer Screening among Men in Rural Kenya. Adv Prev Med 2022; 2022:4621446. [PMID: 35979267 PMCID: PMC9377835 DOI: 10.1155/2022/4621446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/23/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background Globally, an increase in mortality from prostate cancer (PC) remains a big challenge with disparities existing with a slight preponderance among men in low and middle-income countries. Prostate cancer is a leading cause of mortality among men in sub-Saharan Africa. In Kenya, despite the majority of men presenting with advanced prostate cancer for treatment, knowledge and screening for prostate cancer is low. The study aimed to examine the effectiveness of a community health worker-led education intervention on knowledge, perception, and PC screening. Methods This was a quasiexperimental study among Kenyan men aged 40–69 years. The intervention site was Gatundu North subcounty and the control site was Kiambu subcounty in Kiambu County. Stratified random sampling was applied to select 288 respondents per arm of the study. We used a pretested interviewer-administered questionnaire to collect data at baseline and 6 months postintervention. Pearson's chi-square test was used for data analysis. Results Awareness of prostate cancer significantly increased postintervention (P < 0.05). The proportion of respondents who had good knowledge of prostate cancer increased significantly from 49% to 76.4%(P < 0.05) in the intervention arm. The proportion of respondents with a high perception of self-vulnerability increased significantly from 26% to 42.1% (P < 0.05). The proportion of men who had undergone PC screening significantly increased from 4.5% to 20.4% (P < 0.05) in the intervention arm. In postintervention, there was a statistically significant difference in the proportion of men screened for prostate cancer in the intervention and control arm (P < 0.05). Conclusion Health education by community health workers during household visits increased awareness and knowledge, perception, and uptake of PC screening. Utilization of community health worker delivered education is an effective strategy that requires to be adopted to enhance screening.
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Hawranek C, Maxon J, Andersson A, Van Guelpen B, Hajdarevic S, Numan Hellquist B, Rosén A. Cancer Worry Distribution and Willingness to Undergo Colonoscopy at Three Levels of Hypothetical Cancer Risk—A Population-Based Survey in Sweden. Cancers (Basel) 2022; 14:cancers14040918. [PMID: 35205668 PMCID: PMC8870195 DOI: 10.3390/cancers14040918] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Cancer worry is a known health concern in cancer patients and people with a genetic predisposition to cancer. We measured how worried people, in general, are about developing cancer to describe levels in non-affected individuals. In total, 943 respondents completed a survey containing the Cancer Worry Scale (CWS) and hypothetical questions asking if they would attend a colonoscopy screening at a 5, 10, or 70 percent lifetime risk of developing bowel cancer. Unaffected individuals scored a mean of 9.46 on the six-item CWS. Women scored significantly higher than men (9.91 vs. 9.06). Women and parents had higher cancer worry than men and people without children when ruling out differences in education, age, and country of birth. People who worried more were also more inclined to undergo a colonoscopy screening, and intention increased with higher levels of hypothetical risk. These data may be helpful in future work on cancer worry and cancer prevention. Abstract Purpose: We describe levels of cancer worry in the general population as measured with the Cancer Worry Scale (CWS) and investigate the association with colonoscopy screening intentions in three colorectal cancer risk scenarios. Methods: The data were sourced through a population-based survey. Respondents (n = 943) completed an eight-item CWS and questions on colonoscopy screening interest at three hypothetical risk levels. Results: Respondents without a personal cancer history (n = 853) scored 9.46 on the six-item CWS (mean, SD 2.72). Mean scores were significantly higher in women (9.91, SD 2.89) as compared to men (9.06, SD 2.49, p < 0.001). Linear regression showed higher cancer worry in women and those with children when controlling for education, age group, and country of birth. High cancer worry (six-item CWS mean >12) was identified in 25% of women and in 17% of men. Among those, 71% would attend a colonoscopy screening compared to 52% of those with low cancer worry (p < 0.001, 5% CRC-risk). Conclusions: The distribution of cancer worry in a general population sample showed higher mean scores in women, and levels overlapped with earlier findings in cancer-affected samples. Respondents with high cancer worry were more inclined to undergo a colonoscopy screening, and intention increased with higher levels of hypothetical risk.
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Affiliation(s)
- Carolina Hawranek
- Department of Radiation Sciences, Oncology, Umeå University, SE-901 87 Umeå, Sweden; (J.M.); (A.A.); (B.V.G.); (B.N.H.); (A.R.)
- Correspondence: ; Tel.: +46-76-69-60-648
| | - Johan Maxon
- Department of Radiation Sciences, Oncology, Umeå University, SE-901 87 Umeå, Sweden; (J.M.); (A.A.); (B.V.G.); (B.N.H.); (A.R.)
| | - Andreas Andersson
- Department of Radiation Sciences, Oncology, Umeå University, SE-901 87 Umeå, Sweden; (J.M.); (A.A.); (B.V.G.); (B.N.H.); (A.R.)
| | - Bethany Van Guelpen
- Department of Radiation Sciences, Oncology, Umeå University, SE-901 87 Umeå, Sweden; (J.M.); (A.A.); (B.V.G.); (B.N.H.); (A.R.)
- Wallenberg Centre for Molecular Medicine, Umeå University, SE-901 87 Umeå, Sweden
| | - Senada Hajdarevic
- Department of Nursing, Umeå University, SE-901 87 Umeå, Sweden;
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, SE-901 87 Umeå, Sweden
| | - Barbro Numan Hellquist
- Department of Radiation Sciences, Oncology, Umeå University, SE-901 87 Umeå, Sweden; (J.M.); (A.A.); (B.V.G.); (B.N.H.); (A.R.)
| | - Anna Rosén
- Department of Radiation Sciences, Oncology, Umeå University, SE-901 87 Umeå, Sweden; (J.M.); (A.A.); (B.V.G.); (B.N.H.); (A.R.)
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Qin W, Hamler TC, Miller DB. Self-efficacy and importance of participation reasons as predictors for prostate cancer screening intention in African American men. ETHNICITY & HEALTH 2022; 27:316-328. [PMID: 32046530 DOI: 10.1080/13557858.2020.1724269] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 12/01/2019] [Indexed: 06/10/2023]
Abstract
Objective: African American men have higher lifetime risk of developing prostate cancer (PCa), and face more health burdens from this disease due in part to limited participation in cancer screening. Therefore, it is important to study psychosocial factors associated with screening intention in African American men. Guided by social cognitive theory, the current study aims to examine the role of self-efficacy and importance of participation reasons as predictors of PCa screening intention in African American men.Design: This is a primary analysis using data collected from African American men in northeast Ohio and the Southeastern United States. PCa screening intention and self-efficacy were measured by single-item questions. Importance of participation reasons was measured in four domains: psychological, convenience, awareness, and medical. Hierarchical binary logistic regression was used to predict PCa screening intention in African American men.Results: The sample size was 174. The average age was 46.52. Adding self-efficacy and reasons for participation significantly improved prediction for PCa screening intention in African American men (Δχ2 = 55.28, p < .001). The final model had χ2 = 69.63 (p < .001). Higher self-efficacy (OR = 2.56, p < .05), more perceived importance of psychological reasons (OR = 2.42, p < .001) and medical reasons (OR = 1.10, p < .05) were significant predictors. Also, the perceived chance of developing PCa predicted higher odds of PCa screening intention.Conclusions: Enhancing self-efficacy might be an important intervention focus for African American men to improve PCa screening intention. In addition, the findings suggest that African American men intend to have PCa screening because they experience worries or physical symptoms, and unlikely because it is convenient to get screening or recommended by family members and friends. Thus, intervention efforts could focus on enhancing PCa knowledge and informed decision-making about PCa screening among African American men.
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Affiliation(s)
- Weidi Qin
- Jack, Joseph, Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Tyrone C Hamler
- Jack, Joseph, Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - David B Miller
- Jack, Joseph, Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
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Colón OR, Bolajoko O, Odedina F, Odedina F. Comparison of health access, lifestyle, prostate cancer knowledge and screening among black men residing in West Africa and the USA. Ecancermedicalscience 2021; 15:1309. [PMID: 34824632 PMCID: PMC8580715 DOI: 10.3332/ecancer.2021.1309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Indexed: 12/09/2022] Open
Abstract
Background In Blacks, late presentation, lack of knowledge, health infrastructural deficiencies and socio-demographic characteristics, which result in poor outcomes, are the bane of cancers. This study evaluated health access and lifestyle association with prostate cancer (PCa) knowledge and screening among black men. Methodology This study used data from the Prostate Cancer Transatlantic Consortium familial cohort study. Data were gathered from a cross-sectional survey of 500 community-dwelling black men in Nigeria, Cameroon, and the USA. Information on socio-demographics, health care access, PCa knowledge score and screening behaviour was obtained, and the association between these variables was evaluated. Results The majority (81.6%) were Nigerian. The age ranges were 35–49 (55.2%) and ≥65 (8.4%). The income distribution of the respondents showed that 23.3% earned <$1,000 and 30.7% (>$2,000) monthly. Only 43% had health insurance coverage, and 12% had accessed a doctor in 12 months. Respondents relied on orthodox medicine (50.8%), neighbourhood pharmacy (10.6%), self-medication (5%) and neighbourhood nurse (24.6%). The participants had either poor (45.2%) or very poor (23.2%) dietary patterns. Most (66.67%) do not engage in physical activity and about 33.33% engage in some exercises. Moreover, 87.8% and 78.3% have never had a digital rectal examination (DRE) and prostate-specific antigen (PSA) screening in their lifetime, respectively, while 6.8% and 1.6% had DRE last 1 year and 2 years, respectively. Furthermore, 65.2%, 19.8% and 15% of the respondents had poor, fair and good knowledge of PCa, respectively. Health care coverage (p < 0.001), medical care habit (p = 0.001), routine checkup (p = 0.013) were significantly associated with respondents’ PCa knowledge. Routine checkup (p < 0.001) and country (p < 0.001) were significantly related to PSA screening. Conclusion The study showed that PCa screening uptake was poor among the respondents and country of residence was associated with PCa screening behaviours. Healthcare coverage was significantly associated with PCa knowledge.
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Affiliation(s)
- Orlando Rivera Colón
- School of Kinesiology and Physical Therapy, Department of Health Sciences, University of Central Florida, Orlando, Florida, USA
| | - Opeyemi Bolajoko
- Nutrition and Dietetics Department, Federal University of Agriculture, PMB 2240, Abeokuta, Ogun State, Nigeria
| | - Folakemi Odedina
- Department of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Folakemi Odedina
- School of Kinesiology and Physical Therapy, Department of Health Sciences, University of Central Florida, Orlando, Florida, USA.,Nutrition and Dietetics Department, Federal University of Agriculture, PMB 2240, Abeokuta, Ogun State, Nigeria.,Department of Pharmacy, University of Florida, Gainesville, Florida, USA.,Prostate Cancer Transatlantic Consortium
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Mbugua RG, Oluchina S, Karanja S. Prostate cancer awareness and screening among men in a rural community in Kenya: a cross-sectional study. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-020-00108-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
Globally, prostate cancer ranks as the second most frequently diagnosed cancer among men with the highest mortality rates being in Asia and Africa. The screening rates have been very low among men from developing countries with the majority presenting in advanced stages of the disease. The study aimed to assess the awareness of prostate cancer and screening among men aged 40–69 years in a rural community in Kenya.
Methods
This cross-sectional mixed-method survey was conducted among men aged 40–69 years. Data were collected using a pretested questionnaire among 576 men and a Focus Group Discussion guide among 44 men. The study was conducted in all the community units in Gatundu North and Kiambu Sub-counties, Kenya.
Results
Five hundred and seventy-six men participated with a response rate of 100%. Of the men interviewed, 84% had ever heard of prostate cancer. Slightly below half (40.6%) of the respondents had ever heard of prostate cancer screening. There was the existence of myths and misconceptions which predominantly associated prostate cancer with sexual behaviors. Overall, 57.3% of the respondents had a low level of awareness of prostate cancer. The prevalence of prostate cancer screening was 5%. Willingness to undergo screening in the future was high (81%) among the participants. The most frequently cited (56.9%) reason for lack of willingness to screen was the participant’s belief that they were well. Participants who were aware of prostate cancer screening were more likely to take up screening (OR = 8.472; 95% CI: 1.554- 46.186; P = 0.014).
Conclusion
Awareness of prostate cancer symptoms, treatment, and screening was low with the existence of myths and misconceptions. The level of prostate cancer screening was abysmally low. It is vital for the Ministry of Health, county governments, and other stakeholders to consider the use of multifaceted approaches to increase public awareness on prostate cancer to enhance informed shared decision making. The study provides relevant information for designing prevention and control programs for prostate cancer.
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The STHLM3-model, Risk-based Prostate Cancer Testing Identifies Men at High Risk Without Inducing Negative Psychosocial Effects. EUR UROL SUPPL 2021; 24:43-51. [PMID: 34337495 PMCID: PMC8317863 DOI: 10.1016/j.euros.2020.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/24/2022] Open
Abstract
Background The new STHLM3 test, combining protein markers, genetic markers, and clinical data to assess a man's prostate cancer (PCa) risk, has been investigated in Sweden within the frame of the STHLM3 trial. Objective To assess whether the STHLM3 test influences men's worry level, PCa knowledge, attitude, and health-related quality of life (HRQoL). Design setting and participants Invitations with login to the web survey were mailed to 10 000 men, 50-69 yr of age, who were eligible for the STHLM3 trial. The survey was sent 3 mo before invitation to the STHLM3 trial (baseline) and 5 mo after STHLM3 (follow-up). At baseline, the men were unaware of the upcoming invitation to STHLM3. The survey covered the following: PCa-specific worry and perceived vulnerability, knowledge about PCa, attitude toward PCa testing and health behavior, and HRQoL. Outcome measurements and statistical analysis Survey scores were compared between baseline and follow-up by using the nonparametric Wilcoxon-signed rank tests for paired samples. Analysis of covariance was performed for PCa risk group comparisons. Results and limitations A total of 994 men (10%) responded to our survey at baseline and follow-up, and were assessed as follows: low risk: 421 men; intermediate risk: 421 men; and high risk:152, of whom 59 were diagnosed with PCa after further investigation. In men assessed as having low and intermediate risk, level of worrying decreased at follow-up (p < 0.001), whereas no changes were observed in men at high risk. Moreover, no HRQoL changes were observed over time. The low response rate is the main limitation. Conclusions We found that the STHLM3 model, a risk-based PCa test, showed no negative impact on the well-being of men. Patient summary Since our results suggest that the risk-based screening as used in STHLM3 did not induce negative psychological effects on the participants, we can recommend this risk-based approach for population-based prostate cancer screening.
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Zechmann S, Di Gangi S, Kaplan V, Meier R, Rosemann T, Valeri F, Senn O. Time trends in prostate cancer screening in Swiss primary care (2010 to 2017) - A retrospective study. PLoS One 2019; 14:e0217879. [PMID: 31194773 PMCID: PMC6565361 DOI: 10.1371/journal.pone.0217879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 05/20/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Following years of controversy regarding screening for prostate cancer using prostate-specific antigen, evidence evolves towards a more restrained and preference-based use. This study reports the impact of landmark trials and updated recommendations on the incidence rate of prostate cancer screening by Swiss general practitioners. Methods We performed a retrospective analysis of primary care data, separated in 3 time periods based on dates of publications of important prostate-specific antigen screening recommendations. 1: 2010-mid 2012 including 2 updates; 2: mid 2012-mid 2014 including a Smarter Medicine recommendation; 3: mid-2014—mid-2017 maintenance period. Period 2 including the Smarter Medicine recommendation was defined as reference period. We further assessed the influence of patient’s age and the number of prostate-specific-antigen (PSA) tests, by the patient and within each time period, on the mean PSA concentration. Uni- and multivariable analyses were used as needed. Results 36,800 men aged 55 to 75 years were included. 14.6% had ≥ 2 chronic conditions, 11.7% had ≥ 1 prostate-specific antigen test, (mean 2.60 ng/ml [SD 12.3]). 113,921 patient-years were covered. Data derived from 221 general practitioners, 33.5% of GP were women, mean age was 49.4 years (SD 10.0), 67.9% used prostate-specific antigen testing. Adjusted incidence rate-ratio (95%-CI) dropped significantly over time periods: Reference Period 2: incidence rate-ratio 1.00; Period 1: incidence rate-ratio 1.74 (1.59–1.90); Period 3: incidence rate-ratio 0.61 (0.56–0.67). A higher number of chronic conditions and a patient age between 60–69 years were significantly associated with higher screening rate. Increasing numbers of PSA testing per patient, as well as increasing age, were independently and significantly associated with an increase in the PSA value. Conclusion Swiss general practitioners adapted screening behavior as early as evidence of a limited health benefit evolved, while using a risk-adapted approach whenever performing multiple testing. Updated recommendations might have helped to maintain this decrease. Further recommendations and campaigns should aimed at older patients with multimorbidity, to sustain a further decline in prostate-specific antigen screening practices.
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Affiliation(s)
- Stefan Zechmann
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
- * E-mail:
| | - Stefania Di Gangi
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Vladimir Kaplan
- Department of Internal Medicine, Hospital Muri, Muri, Switzerland
| | - Rahel Meier
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Fabio Valeri
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
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Karlsson A, Jauhiainen A, Gulati R, Eklund M, Grönberg H, Etzioni R, Clements M. A natural history model for planning prostate cancer testing: Calibration and validation using Swedish registry data. PLoS One 2019; 14:e0211918. [PMID: 30763406 PMCID: PMC6375591 DOI: 10.1371/journal.pone.0211918] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/22/2019] [Indexed: 12/23/2022] Open
Abstract
Recent prostate cancer screening trials have given conflicting results and it is unclear how to reduce prostate cancer mortality while minimising overdiagnosis and overtreatment. Prostate cancer testing is a partially observable process, and planning for testing requires either extrapolation from randomised controlled trials or, more flexibly, modelling of the cancer natural history. An existing US prostate cancer natural history model (Gulati et al, Biostatistics 2010;11:707-719) did not model for differences in survival between Gleason 6 and 7 cancers and predicted too few Gleason 7 cancers for contemporary Sweden. We re-implemented and re-calibrated the US model to Sweden. We extended the model to more finely describe the disease states, their time to biopsy-detectable cancer and prostate cancer survival. We first calibrated the model to the incidence rate ratio observed in the European Randomised Study of Screening for Prostate Cancer (ERSPC) together with age-specific cancer staging observed in the Stockholm PSA (prostate-specific antigen) and Biopsy Register; we then calibrated age-specific survival by disease states under contemporary testing and treatment using the Swedish National Prostate Cancer Register. After calibration, we were able to closely match observed prostate cancer incidence trends in Sweden. Assuming that patients detected at an earlier stage by screening receive a commensurate survival improvement, we find that the calibrated model replicates the observed mortality reduction in a simulation of ERSPC. Using the resulting model, we predicted incidence and mortality following the introduction of regular testing. Compared with a model of the current testing pattern, organised 8 yearly testing for men aged 55–69 years was predicted to reduce prostate cancer incidence by 14% and increase prostate cancer mortality by 2%. The model is open source and suitable for planning for effective prostate cancer screening into the future.
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Affiliation(s)
- Andreas Karlsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | | | - Roman Gulati
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, United States of America
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Grönberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, United States of America
- Department of Health Services, University of Washington, Seattle, United States of America
- Department of Biostatistics, University of Washington, Seattle, United States of America
| | - Mark Clements
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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