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Fearington FW, Zhao CY, Romero-Brufau S, Moore EJ, Price DL, Tasche KK, Yin LX, Kunkel ET, Kisiel JB, Giridhar KV, Routman DM, Van Abel KM. Addressing positive multi-cancer early detection tests in head and neck Surgery: Experience with head and neck work up for high-risk referrals. Oral Oncol 2024; 152:106809. [PMID: 38621326 DOI: 10.1016/j.oraloncology.2024.106809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES Blood-based multi-cancer early detection (MCED) tests are now commercially available. However, there are currently no consensus guidelines available for head and neck cancer (HNC) providers to direct work up or surveillance for patients with a positive MCED test. We seek to describe cases of patients with positive MCED tests suggesting HNC and provide insights for their evaluation. METHODS Retrospective chart review of patients referred to Otolaryngology with an MCED result suggesting HNC. Patients enrolled in prospective MCED clinical trials were excluded. Cancer diagnoses were confirmed via frozen-section pathology. RESULTS Five patients were included (mean age: 69.2 years, range 50-87; 4 male) with MCED-identified-high-risk for HNC or lymphoma. Only patient was symptomatic. After physical exam and follow-up head and neck imaging, circulating tumor HPV DNA testing, two patients were diagnosed with p16 + oropharyngeal squamous cell carcinomas and underwent appropriate therapy. A third patient had no evidence of head and neck cancer but was diagnosed with sarcoma of the thigh. The remaining two patients had no evidence of malignancy after in-depth workup. CONCLUSIONS In this retrospective study, 2 of 5 patients referred to Otolaryngology with a positive MCED result were diagnosed with HPV + oropharyngeal squamous cell carcinoma. We recommend that positive HNC MCED work up include thorough head and neck examination with flexible laryngoscopy and focused CT or MRI imaging. Given the potential for inaccurate MCED tissue of origin classification, PET/CT may be useful in specific situations. For a patient with no cancer identified, development of clear guidelines is warranted.
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Affiliation(s)
| | - Conan Y Zhao
- Mayo Clinic Alix School of Medicine, 200 1(st) St SW, Rochester, MN, USA
| | - Santiago Romero-Brufau
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - Eric J Moore
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - Daniel L Price
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - Kendall K Tasche
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - Linda X Yin
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - Elizabeth T Kunkel
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - John B Kisiel
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - Karthik V Giridhar
- Department of Oncology, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, 200 1(st) St SW, Rochester, MN, USA.
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Machii R, Takahashi H, Miyazawa J, Nakayama T. Cancer screening in Japan 2 years after the COVID-19 pandemic: Changes in participation, 2017-2021. Prev Med Rep 2024; 39:102649. [PMID: 38375089 PMCID: PMC10875236 DOI: 10.1016/j.pmedr.2024.102649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/21/2024] Open
Abstract
Objectives The impact of the coronavirus disease (COVID-19) pandemic on cancer screening has become a global concern; compared with pre-pandemic levels, the number of individuals who underwent population-based cancer screening in Japan decreased by 10-30% in fiscal year (FY)2020. Therefore, it is important to monitor subsequent changes in the number of participants. Methods This descriptive study analysed data from a national database to determine changes from 2017 to 2021 in the number of people screened for gastric cancer (upper gastrointestinal [UGI] series or endoscopy), colorectal cancer (faecal immunochemical test), lung cancer (chest X-ray), breast cancer (mammography), and cervical cancer (Pap smear). Results Compared with the pre-pandemic period (FY 2017-2019), the number of participants in screening programmes in FY2021 decreased maximally for the gastric cancer UGI series (2.8 million to 2.2 million; -23.3 %), followed by those for lung cancer (7.9 million to 7.3 million; -8.2 %), colorectal cancer (8.4 million to 7.8 million; -7.3 %), breast cancer (3.1 million to 3.0 million; -4.5 %), and cervical cancer (4.3 million to 4.1 million; -3.2 %). Conversely, the number of people screened for endoscopic gastric cancer screening increased (1.0 million to 1.2 million; +13.1 %). Conclusions The number of participants, which decreased sharply immediately after the onset of the COVID-19 pandemic, recovered only slightly in FY2021 and did not return to pre-pandemic levels yet, except for endoscopic gastric cancer screening. Therefore, the impact of this decline in participation in cancer-detection programmes and changes in mortality should be monitored carefully.
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Affiliation(s)
- Ryoko Machii
- Division of Screening Assessment and Management, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Hirokazu Takahashi
- Division of Screening Assessment and Management, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Jin Miyazawa
- Division of Screening Assessment and Management, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Tomio Nakayama
- Division of Screening Assessment and Management, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
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Kim JY, Hong J, Yoon J, Park J, Kim TH. Regularity of cervical cancer screening in Korea: analysis using national public data for 12 years. J Gynecol Oncol 2024; 35:e18. [PMID: 37921602 PMCID: PMC10948977 DOI: 10.3802/jgo.2024.35.e18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/04/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE To assess the frequency of regular uptake of national cervical cancer screening (CCS) program and identify associated factors among Korean women. METHODS This study is a fundamental investigation that employs openly accessible public data of Korea through secondary data analysis. A cohort of 4,663 women from the 2007-2012 Korean National Health and Nutrition Examination Survey, was followed up for up to 12 years (2007-2018) to obtain the frequency of national CCS. Compliance level with CCS was categorized, and an ordinal logistic regression model was employed to investigate the contributing factors. RESULTS The regular uptake of CCS in South Korea was low at 18.9%. The trend of regular screening showed significant association with various factors, including age (40-59 years), household income (100%-150% bracket), occupation (service workers), place of residence (small to medium sized cities), education level (middle school graduates), marital status (married), and possession of private insurance. Moreover, individuals with a history of non-cervical cancer or carcinoma in situ of the cervix, a family history of cervical cancer, or a higher frequency of general check-ups demonstrated a stronger adherence to regular CCS uptake. CONCLUSION Our findings revealed that regular participation in CCS in Korea was lower than anticipated, with factors such as socioeconomic status, personal history of gynecologic issue, and frequency of general health check-ups playing influential roles. However, further research, including an exploration of unexamined psychological barriers to screening, is necessary to gain a better understanding the reasons behind the reduced rates of regular CCS among Korean women.
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Affiliation(s)
- Jong-Yeup Kim
- Department of Biomedical Informatics, Konyang University College of Medicine, Daejeon, Korea
| | - Jeeyoung Hong
- Department of Biomedical Informatics, Konyang University College of Medicine, Daejeon, Korea
| | - Juhee Yoon
- Department of Obstetrics and Gynecology, Konyang University College of Medicine, Daejeon, Korea
| | - Jinsol Park
- Department of Obstetrics and Gynecology, Konyang University College of Medicine, Daejeon, Korea
| | - Tae-Hyun Kim
- Department of Obstetrics and Gynecology, Konyang University College of Medicine, Daejeon, Korea.
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Layet F, Murungi T, Ashaba N, Kigongo E, Opollo MS. Factors associated with utilization of cervical cancer screening services among HIV-positive women aged 18 to 49 years at Lira regional referral hospital, Northern Uganda. BMC Womens Health 2024; 24:114. [PMID: 38347497 PMCID: PMC10863236 DOI: 10.1186/s12905-024-02957-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/07/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Women with HIV have a higher risk of getting cervical cancer due to induced immunosuppression. Though this burden could be avoided through early identification and appropriate management, there is a paucity of information about the utilization of cervical cancer screening (CCS) services in Lira City, Uganda. This study investigated the level and factors associated with the utilization of cervical cancer screening services among HIV-positive women aged 18 to 49 years at Lira Regional Referral Hospital, Lira City, Uganda. METHODS We conducted a facility-based cross-sectional study employing quantitative techniques. We used consecutive sampling to recruit 297 HIV-positive women at the ART clinic of Lira Regional Referral Hospital. A structured researcher-administered questionnaire was used to collect data. Descriptive statistics were performed to summarize the data. A modified Poisson regression using robust standard errors was performed to ascertain the factors associated with the utilization of cervical cancer screening. Prevalence ratios at 95% confidence intervals were reported. RESULTS Out of 297 respondents, 175(58.9%) utilized cervical cancer screening in this study. The factors found to be associated with CCS were; having ever heard of CCS (Adjusted Prevalence Ratio [PR] 1.80, 95% CI 1.31-2.49, p < 0.001), knowing where CCS is done (Adjusted PR 1.99, 95% CI 1.42-2.81, p < 0.001), fear of CCS outcomes (Adjusted PR 0.67, 95% CI 0.54-0.84,p < 0.001), not knowing whether CCS is beneficial or not (Adjusted PR 0.39, 95% CI 0.20-0.75,p = 0.005) and having friends/relatives who screened for cervical cancer (Adjusted PR 1.31, 95% CI 1.09-1.59, p = 0.005). CONCLUSION The level of utilization of cervical cancer screening services among HIV-positive women was suboptimal. Implementation of structured interventions aimed at improving cervical cancer screening awareness among HIV-positive women is crucial. Additionally, to increase opportunities for screening and knowledge on cervical cancer prevention, screening programs can target HIV-positive women during their routine clinic visits.
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Affiliation(s)
- Florence Layet
- Faculty of Public Health, Lira University, Lira City, Uganda
| | - Tom Murungi
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, P.O Box 1035, Lira City, Uganda.
| | - Nasser Ashaba
- Faculty of Public Health, Lira University, Lira City, Uganda
| | - Eustes Kigongo
- Faculty of Public Health, Lira University, Lira City, Uganda
| | - Marc Sam Opollo
- Faculty of Public Health, Lira University, Lira City, Uganda
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Kim DS, Hong J, Ryu K, Lee SH, Cho H, Yu J, Lee J, Kim JY. Factors Affecting Adherence to National Colorectal Cancer Screening: A 12-Year Longitudinal Study Using Multi-Institutional Pooled Data in Korea. J Korean Med Sci 2024; 39:e36. [PMID: 38288537 PMCID: PMC10825459 DOI: 10.3346/jkms.2024.39.e36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/23/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Consistent uptake of colorectal cancer (CRC) screening is important to reduce the incidence and mortality from advanced-stage CRC and increase the survival rate of the patients. We conducted a longitudinal study to determine the factors affecting CRC screening compliance in Korean adults using individual-level linked data from the Korean National Health and Nutrition Examination Survey, Korean National Health Insurance Service, and Korean Health Insurance Review and Assessment Service. METHODS We selected 3,464 adults aged 50-79 years as the study population and followed them for 12 years (January 2007-December 2018). The outcome variable was the level of adherence to CRC screening, categorized as nonadherent, intermittently adherent, and consistently adherent. An ordinal logistic regression model was designed to determine the socioeconomic factors, family history of CRC, and medical conditions that could facilitate the consistent uptake of CRC screening. RESULTS The results showed a significant and positive association between consistent uptake of CRC screening and the 100-150% income category (odds ratio [OR], 1.710; 95% confidence interval [CI], 1.401-2.088); clerical, sales and service job category (OR, 1.962; 95% CI, 1.582-2.433); residency at medium-sized cities (OR, 1.295; 95% CI, 1.094-1.532); high-school graduation (OR, 1.440; 95% CI, 1.210-1.713); married status (OR, 2.281; 95% CI, 1.946-2.674); use of employment-based national health insurance (OR, 1.820; 95% CI, 1.261-2.626); use of private insurance (OR, 2.259; 95% CI, 1.970-2.589); no disability (OR, 1.428; 95% CI, 1.175-1.737); family history of CRC (OR, 2.027; 95% CI, 1.514-2.714); and history of colorectal neoplasm (OR, 1.216; 95% CI; 1.039-1.422). CONCLUSION The lack of regular participation in CRC screening programs in the Republic of Korea was found to be an issue that requires attention. Policies on CRC screening must place increased emphasis on strengthening educational and public relations initiatives.
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Affiliation(s)
- Dae Sung Kim
- Division of Gastroenterology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Jeeyoung Hong
- Biomedical Research Institute, Konyang University Medical Center, Daejeon, Korea
| | - Kihyun Ryu
- Division of Gastroenterology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Sang Hyuk Lee
- Division of Gastroenterology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Hwanhyi Cho
- Division of Gastroenterology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Jehyeong Yu
- Healthcare Data Science Center, Konyang University Hospital, Daejeon, Korea
| | - Jieun Lee
- Healthcare Data Science Center, Konyang University Hospital, Daejeon, Korea
| | - Jong-Yeup Kim
- Department of Biomedical Informatics, Konyang University College of Medicine, Daejeon, Korea.
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Jarvis H, Mi L, Patel B, Cube RP, Pruthi S, Vegunta S. Factors Influencing Patient Confidence in Screening Mammography. J Am Board Fam Med 2024; 36:942-951. [PMID: 38171581 DOI: 10.3122/jabfm.2023.230055r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/07/2023] [Accepted: 07/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND We aimed to assess factors associated with patients' confidence in the ability of screening mammography to detect breast cancer. METHODS Data were analyzed from a cross-sectional, prospective survey conducted in 2017 of women without a breast cancer history who were undergoing screening mammography at our institution. RESULTS In total, 390 women completed the survey questions relevant to this study. Most respondents were 46 years or older (89.7%), White (87.6%), and college-educated (66.1%). Approximately 80% of respondents reported having confidence in the ability of screening mammography to detect breast cancer. Factors significantly associated with lower confidence in screening mammography were higher education (P = .01) and dense breast tissue (P < .001). Age (P = .12), race (P = .64), family history of breast cancer (P = .17), prior abnormal mammogram (P = .07), and mammogram frequency (P = .42) were nonsignificant. Women with a college education or higher were less likely to report confidence in routine mammography than women with less education (odds ratio [OR]= 0.43; 95% CI, 0.20-0.84; P = .02). Compared with women who reported their breast tissue as not dense, women who were aware they had increased breast density (OR = 0.16; 95% CI, 0.04-0.49; P = .004) or were unaware whether they had increased breast density (OR = 0.17; 95% CI, 0.04-0.51; P = .005) reported less confidence in screening mammography. DISCUSSION Most respondents were confident in the ability of screening mammography to detect breast cancer. Confidence was inversely associated with education level and self-reported increased breast density. CONCLUSIONS These findings highlight the importance of continued patient education about the effectiveness of screening mammography for patients with dense breast tissue.
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Affiliation(s)
- Hannah Jarvis
- From the Student, Mayo Clinic Alix School of Medicine-Arizona campus, Mayo Clinic College of Medicine and Science, Scottsdale, AZ (HJ); Department of Radiology (BP and RPC), Mayo Clinic, Phoenix, AZ (BP); Breast Diagnostic Clinic (SP) and Mayo Clinic Cancer Center (SP), Mayo Clinic, Rochester, MN (RPC); Division of Clinical Trials and Biostatistics (LM) and Division of Women's Health Internal Medicine (SV), Mayo Clinic, Scottsdale, AZ (SP); University Hospitals Cleveland Medical Center, Cleveland, OH (LM); Hannah Jarvis, MD, is now with University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Lanyu Mi
- From the Student, Mayo Clinic Alix School of Medicine-Arizona campus, Mayo Clinic College of Medicine and Science, Scottsdale, AZ (HJ); Department of Radiology (BP and RPC), Mayo Clinic, Phoenix, AZ (BP); Breast Diagnostic Clinic (SP) and Mayo Clinic Cancer Center (SP), Mayo Clinic, Rochester, MN (RPC); Division of Clinical Trials and Biostatistics (LM) and Division of Women's Health Internal Medicine (SV), Mayo Clinic, Scottsdale, AZ (SP); University Hospitals Cleveland Medical Center, Cleveland, OH (LM); Hannah Jarvis, MD, is now with University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Bhavika Patel
- From the Student, Mayo Clinic Alix School of Medicine-Arizona campus, Mayo Clinic College of Medicine and Science, Scottsdale, AZ (HJ); Department of Radiology (BP and RPC), Mayo Clinic, Phoenix, AZ (BP); Breast Diagnostic Clinic (SP) and Mayo Clinic Cancer Center (SP), Mayo Clinic, Rochester, MN (RPC); Division of Clinical Trials and Biostatistics (LM) and Division of Women's Health Internal Medicine (SV), Mayo Clinic, Scottsdale, AZ (SP); University Hospitals Cleveland Medical Center, Cleveland, OH (LM); Hannah Jarvis, MD, is now with University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Regino P Cube
- From the Student, Mayo Clinic Alix School of Medicine-Arizona campus, Mayo Clinic College of Medicine and Science, Scottsdale, AZ (HJ); Department of Radiology (BP and RPC), Mayo Clinic, Phoenix, AZ (BP); Breast Diagnostic Clinic (SP) and Mayo Clinic Cancer Center (SP), Mayo Clinic, Rochester, MN (RPC); Division of Clinical Trials and Biostatistics (LM) and Division of Women's Health Internal Medicine (SV), Mayo Clinic, Scottsdale, AZ (SP); University Hospitals Cleveland Medical Center, Cleveland, OH (LM); Hannah Jarvis, MD, is now with University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Sandhya Pruthi
- From the Student, Mayo Clinic Alix School of Medicine-Arizona campus, Mayo Clinic College of Medicine and Science, Scottsdale, AZ (HJ); Department of Radiology (BP and RPC), Mayo Clinic, Phoenix, AZ (BP); Breast Diagnostic Clinic (SP) and Mayo Clinic Cancer Center (SP), Mayo Clinic, Rochester, MN (RPC); Division of Clinical Trials and Biostatistics (LM) and Division of Women's Health Internal Medicine (SV), Mayo Clinic, Scottsdale, AZ (SP); University Hospitals Cleveland Medical Center, Cleveland, OH (LM); Hannah Jarvis, MD, is now with University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Suneela Vegunta
- From the Student, Mayo Clinic Alix School of Medicine-Arizona campus, Mayo Clinic College of Medicine and Science, Scottsdale, AZ (HJ); Department of Radiology (BP and RPC), Mayo Clinic, Phoenix, AZ (BP); Breast Diagnostic Clinic (SP) and Mayo Clinic Cancer Center (SP), Mayo Clinic, Rochester, MN (RPC); Division of Clinical Trials and Biostatistics (LM) and Division of Women's Health Internal Medicine (SV), Mayo Clinic, Scottsdale, AZ (SP); University Hospitals Cleveland Medical Center, Cleveland, OH (LM); Hannah Jarvis, MD, is now with University Hospitals Cleveland Medical Center, Cleveland, OH.
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Yogendran L, Meis L, Burnside E, Schrager S. Management of Women at High Risk for Breast Cancer. J Am Board Fam Med 2024; 36:1029-1032. [PMID: 37857439 DOI: 10.3122/jabfm.2023.230064r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Primary care clinicians screen for breast cancer risk factors and assess the risk level of their patients. Women at high risk for breast cancer (eg, 5-year risk of at least 3% or lifetime risk of ≥20%) are eligible for enhanced screening and/or chemoprophylaxis. However, many clinicians do not identify women at high risk and offer appropriate referrals, screening, or chemoprophylaxis. METHODS We reviewed a sample of 200 charts of women ages 35 to 50 years old with a family history of breast cancer. We identified factors that contribute to their risk for breast cancer and used the Tyrer-Cuzick Risk Assessment Calculator to determine their personal lifetime risk. We then assessed whether these patients received counseling for chemoprophylaxis, referrals, or screening. We also looked for correlations between combinations of risk factors and increased lifetime risk. RESULTS Out of 200 charts reviewed, 71 women were identified as high risk for breast cancer (lifetime risk of ≥20%). Of those 71 women, just 17 were referred to a high-risk clinic for enhanced screening and/or chemoprophylaxis. Three risk factors, mammographic breast density of category C or D, first degree relatives with breast cancer, and age first given birth if after 30 years old had a significant impact on lifetime risk for breast cancer. DISCUSSION Primary care clinicians can use these independent risk factors as cues to pursue a more formal calculation of a woman's lifetime risk for breast cancer and make appropriate referrals for enhanced screening and chemoprophylaxis counseling if indicated.
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Affiliation(s)
- Lashika Yogendran
- From the University of Wisconsin Department of Family Medicine and Community Health (LY, SS); University of Wisconsin School of Medicine and Public Health (LM); University of Wisconsin Department of Radiology (EB)
| | - Lindsey Meis
- From the University of Wisconsin Department of Family Medicine and Community Health (LY, SS); University of Wisconsin School of Medicine and Public Health (LM); University of Wisconsin Department of Radiology (EB)
| | - Elizabeth Burnside
- From the University of Wisconsin Department of Family Medicine and Community Health (LY, SS); University of Wisconsin School of Medicine and Public Health (LM); University of Wisconsin Department of Radiology (EB)
| | - Sarina Schrager
- From the University of Wisconsin Department of Family Medicine and Community Health (LY, SS); University of Wisconsin School of Medicine and Public Health (LM); University of Wisconsin Department of Radiology (EB).
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Golden SE, Currier JJ, Ramalingam N, Patzel M, Shannon J, Davis MM, Slatore CG. Primary Care Providers Experiences Implementing Low-Dose Computed Tomography Recommendations for Lung Cancer Screening. J Am Board Fam Med 2024; 36:952-965. [PMID: 38092437 DOI: 10.3122/jabfm.2023.230109r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE Describe primary care providers' (PCPs) barriers and facilitators to implementation of lung cancer screening programs in rural settings. METHODS We conducted qualitative interviews with PCPs practicing in rural Oregon from November 2019 to September 2020. The interview questions and analytic framework were informed by the 2009 Consolidated Framework for Implementation Research. We used inductive and deductive approaches for analysis. RESULTS We interviewed 15 key participants from 12 distinct health care systems. We identified several Consolidated Framework for Implementation Research factors affecting lung cancer screening implementation. 1) Most PCPs did not have workflows to assist in discussing screening and relied on their memory and knowledge of the patient's history to prompt discussions. PCPs supported screening and managed the patient throughout the process. 2) PCPs reported several patient-level barriers, including geographic access to lung cancer screening scans and out-of-pocket cost concerns. 3) PCPs reported that champions are necessary to create opportunities for local practices to adopt lung cancer screening programs. CONCLUSIONS Rural-practicing PCPs were supportive of lung cancer screening, however workflow processes, time challenges, and patient-reported barriers remain impediments to improved screening in their clinics. We identified several areas for improvement in lung cancer screening implementation in rural primary care practices, ranging from designing clinic workflows and processes to designating clinic staff to support referral, screening, and follow-up care for patients.
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Affiliation(s)
- Sara E Golden
- From the Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Portland, OR (SFG, CGS), Division of Oncological Sciences, Oregon Health & Science University (OHSU); Portland, OR (JC, JS), Oregon Rural Practice-based Research Network, OHSU; Portland, OR, (NPR, MP, MMD), Department of Family Medicine, OHSU; Portland, OR (MMD), OHSU-PSU School of Public Health, OHSU; Portland, OR (MMD), Division of Pulmonary, Allergy, & Critical Care Medicine, OHSU; Portland, OR (CGS), Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System; Portland, OR (CGS).
| | - Jessica J Currier
- From the Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Portland, OR (SFG, CGS), Division of Oncological Sciences, Oregon Health & Science University (OHSU); Portland, OR (JC, JS), Oregon Rural Practice-based Research Network, OHSU; Portland, OR, (NPR, MP, MMD), Department of Family Medicine, OHSU; Portland, OR (MMD), OHSU-PSU School of Public Health, OHSU; Portland, OR (MMD), Division of Pulmonary, Allergy, & Critical Care Medicine, OHSU; Portland, OR (CGS), Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System; Portland, OR (CGS)
| | - NithyaPriya Ramalingam
- From the Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Portland, OR (SFG, CGS), Division of Oncological Sciences, Oregon Health & Science University (OHSU); Portland, OR (JC, JS), Oregon Rural Practice-based Research Network, OHSU; Portland, OR, (NPR, MP, MMD), Department of Family Medicine, OHSU; Portland, OR (MMD), OHSU-PSU School of Public Health, OHSU; Portland, OR (MMD), Division of Pulmonary, Allergy, & Critical Care Medicine, OHSU; Portland, OR (CGS), Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System; Portland, OR (CGS)
| | - Mary Patzel
- From the Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Portland, OR (SFG, CGS), Division of Oncological Sciences, Oregon Health & Science University (OHSU); Portland, OR (JC, JS), Oregon Rural Practice-based Research Network, OHSU; Portland, OR, (NPR, MP, MMD), Department of Family Medicine, OHSU; Portland, OR (MMD), OHSU-PSU School of Public Health, OHSU; Portland, OR (MMD), Division of Pulmonary, Allergy, & Critical Care Medicine, OHSU; Portland, OR (CGS), Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System; Portland, OR (CGS)
| | - Jackilen Shannon
- From the Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Portland, OR (SFG, CGS), Division of Oncological Sciences, Oregon Health & Science University (OHSU); Portland, OR (JC, JS), Oregon Rural Practice-based Research Network, OHSU; Portland, OR, (NPR, MP, MMD), Department of Family Medicine, OHSU; Portland, OR (MMD), OHSU-PSU School of Public Health, OHSU; Portland, OR (MMD), Division of Pulmonary, Allergy, & Critical Care Medicine, OHSU; Portland, OR (CGS), Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System; Portland, OR (CGS)
| | - Melinda M Davis
- From the Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Portland, OR (SFG, CGS), Division of Oncological Sciences, Oregon Health & Science University (OHSU); Portland, OR (JC, JS), Oregon Rural Practice-based Research Network, OHSU; Portland, OR, (NPR, MP, MMD), Department of Family Medicine, OHSU; Portland, OR (MMD), OHSU-PSU School of Public Health, OHSU; Portland, OR (MMD), Division of Pulmonary, Allergy, & Critical Care Medicine, OHSU; Portland, OR (CGS), Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System; Portland, OR (CGS)
| | - Christopher G Slatore
- From the Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Portland, OR (SFG, CGS), Division of Oncological Sciences, Oregon Health & Science University (OHSU); Portland, OR (JC, JS), Oregon Rural Practice-based Research Network, OHSU; Portland, OR, (NPR, MP, MMD), Department of Family Medicine, OHSU; Portland, OR (MMD), OHSU-PSU School of Public Health, OHSU; Portland, OR (MMD), Division of Pulmonary, Allergy, & Critical Care Medicine, OHSU; Portland, OR (CGS), Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System; Portland, OR (CGS)
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Klugas A, Elsayed S, Rodriguez M, Verma S, Bateman A, Stack M. Effects of Academic Detailing, Panel Management and Mailed Multi-Target Stool-DNA Testing on Colorectal Cancer Screening. J Am Board Fam Med 2024; 36:933-941. [PMID: 38171582 DOI: 10.3122/jabfm.2023.230082r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Academic detailing, patient-panel management, and mailed, stool-based testing have each been utilized to increase colorectal cancer (CRC) screening in rural clinics. The effectiveness of combining these interventions to increase CRC screening during COVID-19 restrictions was unclear. METHODS We explored the effects of a multi-component intervention including academic detailing, active patient panel management, and mailed MT-sDNA testing on colorectal cancer screening in our rural family medicine clinic. Baseline interventions included EMR-based provider alerts and mailed patient reminders. Our intervention (March-May 2020) and follow-up periods (June-August 2020) coincided with the initial COVID-19 surge, giving us the opportunity to observe the effects of our intervention during COVID-19 restrictions. RESULTS A total of 407 patients were eligible and overdue for colorectal cancer screening. Our clinic's CRC screening rate increased significantly after intervention (69.7%) as compared with before (64.3%) (P = <0.01; 95%CI = 5.39-5.4). Our clinic's CRC screening rates increased significantly during the initial 3 months of the COVID-19 surge (67.8%) compared with the same period the prior year. (62.3%) (P = .003; 95%CI = 3.4-7.6). Our CRC screening rates increased after intervention (69.7%) compared with our regional health system (67%) (P = <0.01; 95%CI = 2.6-2.77). Our weekly stool-based CRC screening increased (94% increase) compared with other health systems nationally (61 to 83% decrease). DISCUSSION A multi-component intervention, including academic detailing, panel management, and mailed MT-sDNA testing, can lead to significant increases in CRC screening in a rural family medicine clinic, empowering providers to maintain an effective CRC screening outreach during COVID-19 related restrictions.
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Affiliation(s)
- Arturas Klugas
- From the MSU/MyMichigan Medical Center Alma Family Medicine Residency Program, Alma, MI (AK, MS); Family Medicine Residency-McLaren Flint (SE); Western Michigan University Homer Stryker M.D. School of Medicine-Sports Medicine Fellowship, Kalamazoo, MI (MR); Michigan State University College of Human Medicine (SV); University of the West Indies at Mona, Mona, Saint Andrews, Jamaica (AB)
| | - Sara Elsayed
- From the MSU/MyMichigan Medical Center Alma Family Medicine Residency Program, Alma, MI (AK, MS); Family Medicine Residency-McLaren Flint (SE); Western Michigan University Homer Stryker M.D. School of Medicine-Sports Medicine Fellowship, Kalamazoo, MI (MR); Michigan State University College of Human Medicine (SV); University of the West Indies at Mona, Mona, Saint Andrews, Jamaica (AB)
| | - Michael Rodriguez
- From the MSU/MyMichigan Medical Center Alma Family Medicine Residency Program, Alma, MI (AK, MS); Family Medicine Residency-McLaren Flint (SE); Western Michigan University Homer Stryker M.D. School of Medicine-Sports Medicine Fellowship, Kalamazoo, MI (MR); Michigan State University College of Human Medicine (SV); University of the West Indies at Mona, Mona, Saint Andrews, Jamaica (AB)
| | - Shourya Verma
- From the MSU/MyMichigan Medical Center Alma Family Medicine Residency Program, Alma, MI (AK, MS); Family Medicine Residency-McLaren Flint (SE); Western Michigan University Homer Stryker M.D. School of Medicine-Sports Medicine Fellowship, Kalamazoo, MI (MR); Michigan State University College of Human Medicine (SV); University of the West Indies at Mona, Mona, Saint Andrews, Jamaica (AB)
| | - Andre' Bateman
- From the MSU/MyMichigan Medical Center Alma Family Medicine Residency Program, Alma, MI (AK, MS); Family Medicine Residency-McLaren Flint (SE); Western Michigan University Homer Stryker M.D. School of Medicine-Sports Medicine Fellowship, Kalamazoo, MI (MR); Michigan State University College of Human Medicine (SV); University of the West Indies at Mona, Mona, Saint Andrews, Jamaica (AB)
| | - Matthew Stack
- From the MSU/MyMichigan Medical Center Alma Family Medicine Residency Program, Alma, MI (AK, MS); Family Medicine Residency-McLaren Flint (SE); Western Michigan University Homer Stryker M.D. School of Medicine-Sports Medicine Fellowship, Kalamazoo, MI (MR); Michigan State University College of Human Medicine (SV); University of the West Indies at Mona, Mona, Saint Andrews, Jamaica (AB)
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Frumer M, Aharony SM, Shoshany O, Kedar D, Baniel J, Golan S. Prostate-specific antigen level association with COVID-19 infection and vaccination. Clin Genitourin Cancer 2023; 21:e405-e411. [PMID: 37270370 PMCID: PMC10159928 DOI: 10.1016/j.clgc.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/29/2023] [Accepted: 05/01/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The associations among SARS-CoV-2 infection, vaccination and total serum prostate serum antigen (PSA) levels in men undergoing screening for prostate cancer are unknown. METHODS A retrospective analysis of data from a large health maintenance organization. Records of individuals aged 50 to 75 years with two serum PSA tests taken between March 2018 and November 2021 were included. Individuals with prostate cancer were excluded. Changes in PSA levels were compared between individuals who had at least 1 SARS-CoV-2 vaccination and/or infection between the two PSA tests and individuals who did not have an infection and were not vaccinated between the two PSA tests. Subgroup analyses were performed to assess the impact of the elapsed time between the event and the second PSA test on the results. RESULTS The study and control groups included 6,733 (29%) and 16 286 (71%) individuals, respectively. Although the median time between PSA tests was shorter in the study vs. the control group (440 vs. 469 days, P<.001), PSA elevation between the tests was higher in the study group (0.04 vs. 0.02, P<.001). The relative risk for PSA elevation ≥1 ng/dL was 1.22 (95% CI 1.1, 1.35). Among individuals who were vaccinated, PSA increased by 0.03 ng/dL (IQR -0.12, 0.28) and 0.09 ng/dL (IQR -0.05, 0.34) after 1 and 3 doses, respectively (P<.001). Multivariate linear regression showed that SARS-CoV-2 events (β 0.043; 95% CI 0.026-0.06) were associated with a greater risk for PSA elevation, after adjusting for age, baseline PSA and days between PSA tests. CONCLUSION SARS-CoV-2 infection and vaccinations are associated with a slight increase in PSA, with the third anti-COVID vaccine dose having a more prominent impact, but its clinical significance is unknown yet. Any significant increase in PSA must be investigated and cannot be dismissed as secondary to SARS-CoV-2 infection or vaccination.
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Affiliation(s)
- Michael Frumer
- Department of Urology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shachar Moshe Aharony
- Department of Urology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Shoshany
- Department of Urology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Kedar
- Department of Urology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jack Baniel
- Department of Urology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shay Golan
- Department of Urology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lee SH, Ojo AT, Halat M, Bleibdrey N, Zhang S, Chalmers R, Zimskind D. Impact of COVID-19 on hospital screening, diagnosis and treatment activities among prostate and colorectal cancer patients in Canada. Int J Health Econ Manag 2023; 23:345-360. [PMID: 37005943 PMCID: PMC10067511 DOI: 10.1007/s10754-023-09342-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/24/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Suspension of cancer screening and treatment programs were instituted to preserve medical resources and protect vulnerable populations. This research aims to investigate the implications of COVID-19 on cancer management and clinical outcomes for patients with prostate and colorectal cancer in Canada. METHODS We examined hospital cancer screening, diagnosis, treatment, length of stay, and mortality data among prostate and colorectal cancer patients between April 2017 and March 2021. Baseline trends were established with data between April 2017 and March 2020 for comparison with data collected between April 2020 and March 2021. Scenario analyses were performed to assess the incremental capacity requirements needed to restore hospital cancer care capacities to the pre-pandemic levels. RESULTS For prostate cancer, A 12% decrease in diagnoses and 5.3% decrease in treatment activities were observed during COVID-19 between April 2020 and March 2021. Similarly, a 43% reduction in colonoscopies, 11% decrease in diagnoses and 10% decrease in treatment activities were observed for colorectal cancers. An estimated 1,438 prostate and 2,494 colorectal cancer cases were undiagnosed, resulting in a total of 620 and 1,487 unperformed treatment activities for prostate and colorectal cancers, respectively, across nine provinces in Canada. To clear the backlogs of unperformed treatment procedures will require an estimated 3%-6% monthly capacity increase over the next 6 months. INTERPRETATION A concerted effort from all stakeholders is required to immediately ameliorate the backlogs of cancer detection and treatment activities. Mitigation measures should be implemented to minimize future interruptions to cancer care in Canada.
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12
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Hirsch EA, New ML, Brown SL, Malkoski SP. Results of a pilot risk-based lung cancer screening study: outcomes and comparisons to a Medicare eligible cohort. Discov Oncol 2023; 14:160. [PMID: 37642787 PMCID: PMC10465462 DOI: 10.1007/s12672-023-00773-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE Risk-based lung cancer screening holds potential to detect more cancers and avert more cancer deaths than screening based on age and smoking history alone, but has not been widely assessed or implemented in the United States. The purpose of this study was to prospectively identify patients for lung cancer screening based on lung cancer risk using the PLCOm2012 model and to compare characteristics, risk profiles, and screening outcomes to a traditionally eligible screening cohort. METHODS Participants who had a 6 year lung cancer risk score ≥ 1.5% calculated by the PLCOm2012 model and were ineligible for screening under 2015 Medicare guidelines were recruited from a lung cancer screening clinic. After informed consent, participants completed shared decision-making counseling and underwent a low-dose CT (LDCT). Characteristics and screening outcomes of the study population were compared to the traditionally eligible Medicare cohort with Fisher's Exact, t-tests, or Brown Mood tests, as appropriate. RESULTS From August 2016 to July 2019, the study completed 48 baseline LDCTs. 10% of LDCTs recommended further pulmonary nodule evaluation (Lung-RADs 3 or 4) with two early-stage lung cancers diagnosed in individuals that had quit smoking > 15 years prior. The study population was approximately 5 years older (p = 0.001) and had lower pack years (p = 0.002) than the Medicare cohort. CONCLUSION Prospective application of risk-based screening identifies screening candidates who are similar to a traditionally eligible Medicare cohort and future research should focus on the impact of risk calculators on lung cancer outcomes and optimal usability in clinical environments. This study was retrospectively registered on clinicaltrials.gov (NCT03683940) on 09/25/2018.
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Affiliation(s)
- Erin A Hirsch
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, 12700 E 19th Ave, Aurora, CO, 80045, USA.
| | - Melissa L New
- Pulmonary Section, Rocky Mountain Regional VA Medical Center, 1700 N. Wheeling Street, Aurora, CO, 80045, USA
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 E 19th Ave, Mail Stop C272, Aurora, CO, 80045, USA
| | - Stephanie L Brown
- University of Colorado Hospital, UCHealth Denver Metro, Aurora, CO, 80045, USA
| | - Stephen P Malkoski
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 E 19th Ave, Mail Stop C272, Aurora, CO, 80045, USA
- Department of Medicine, University of Washington, WWAMI - Spokane, 502 E Boone Ave, Spokane, WA, 99258, USA
- Sound Critical Care, Sacred Heart Medical Center, 101 W. 8th Avenue, Spokane, WA, 99204, USA
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Petrik AF, Coury J, Larson JH, Badicke B, Coronado GD, Davis MM. Data Challenges in Identifying Patients Due for Colorectal Cancer Screening in Rural Clinics. J Am Board Fam Med 2023; 36:118-29. [PMID: 36759133 DOI: 10.3122/jabfm.2022.220216R1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) incidence and mortality are disproportionately high among rural residents despite the availability of effective screening methods. Outreach activities can improve CRC screening rates but rely on accurate identification of patients due for screening. We report on data challenges in rural clinics and Medicaid health plans in Oregon in identifying patients eligible for CRC screening, in a large project implementing mailed fecal immunochemical tests (FIT) and patient navigation. METHODS We analyzed data from clinic intake surveys and administrative claims. Clinics were asked to identify total population numbers relevant to CRC screening and follow-up. Health plans also identified enrollees eligible for CRC screening in Spring, 2021. Clinic staff validated patient lists for eligibility using their electronic health records (EHR). RESULTS EHR features varied across the 29 participating and 28 responding clinics. Among the 28 responding clinics, 21 were able to report their Medicaid population (75%), 19 reported the number of patients aged 50 to 75 (68%) and the number screened for CRC in the last year (68%). Only 8 (29%) were able to report screening details such as number screened by FIT and 9 were able to report on patients with an abnormal FIT or colonoscopy completed after FIT (32%). Health plans had challenges properly identifying where enrollees received care and had missing data for race and ethnicity (range 22 to 34% unknown race, <1% to 24% unknown ethnicity). DISCUSSION Most participating rural primary care clinics and Medicaid health plans experienced challenges identifying the population due for a CRC screening outreach program. Better EHR functionality and data reporting capabilities could help rural clinics apply population-based strategies and ultimately attenuate disparities in cancer screening and follow-up.
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Yeoh A, Mannalithara A, Ladabaum U. Cost-Effectiveness of Earlier or More Intensive Colorectal Cancer Screening in Overweight and Obese Patients. Clin Gastroenterol Hepatol 2023; 21:507-519. [PMID: 35940514 DOI: 10.1016/j.cgh.2022.07.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND & AIMS Overweight and obese persons have not only elevated rates of colorectal cancer (CRC), but also higher competing mortality and healthcare spending. We examined the cost-effectiveness of intensified CRC screening in overweight and obese persons. METHODS We adapted our validated decision analytic model of CRC screening to compare screening starting at 45 or 40 years of age instead of at 50 years of age, or shortening screening intervals, in women and men with body mass index (BMI) ranging from normal to grade III obesity. Strategies included colonoscopy every 10 years (Colo10) or every 5 years (Colo5), or annual fecal immunochemical test. RESULTS Without screening, sex-specific total CRC deaths were similar for persons with overweight or obesity I-III, reflecting the counterbalancing of higher CRC risk by lower life expectancy as BMI rises. For all BMI and sex groups, Colo10 starting at 45 years of age or FIT starting at 40 years of age were cost-effective at a threshold of $100,000 per quality-adjusted life year gained. Colo10 starting at 40 years of age was cost-effective only for men with obesity II-III, at $93,300 and $80,400 per quality-adjusted life year gained, respectively. Shifting Colo10 to earlier starting ages was always preferred over Colo5 starting at later ages. Results were robust in sensitivity analysis, including varying all-cause mortality, complication, and BMI-specific CRC risks. CONCLUSIONS CRC screening starting at 45 years of age with colonoscopy, or at 40 years of age with FIT, appears cost-effective for women and men across the range of BMI. In men with obesity II-III, who have the highest CRC but also all-cause mortality risks, colonoscopy starting at 40 years of age appears cost-effective. It remains to be decided whether BMI should be used as a single predictor or incorporated into a multivariable tool to tailor CRC screening.
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Affiliation(s)
- Aaron Yeoh
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Ajitha Mannalithara
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Uri Ladabaum
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California.
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Levine JW, Hawa F, Bloom PP. Incidental Hepatocellular Carcinoma Bony Metastasis in a Patient Listed for Liver Transplant. ACG Case Rep J 2023; 10:e00967. [PMID: 38445217 PMCID: PMC10914223 DOI: 10.14309/crj.0000000000000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/15/2022] [Indexed: 03/07/2024] Open
Abstract
A 67-year-old man with a history of alcohol and hepatitis C-associated cirrhosis is diagnosed with incidental metastatic liver cancer during hospitalization for hepatic encephalopathy. He had 2 LI-RADS-3 (indeterminant) lesions on liver magnetic resonance imaging 3 months prior but had no history of hepatocellular carcinoma and was listed for liver transplant. During inpatient paracentesis, the ascites fluid was bloody, so the abdominal and pelvic computed tomography was performed showing a lytic lesion in the left posterior inferior pubic rami. Alpha fetoprotein was within normal limits. His liver was imaged on several occasions without definite evidence of malignancy. Bone biopsy revealed metastatic hepatocellular carcinoma. On return to baseline mental status, patient endorsed no bony pain.
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Affiliation(s)
- Jake W. Levine
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Fadi Hawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Patricia P. Bloom
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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Ewing AP, Alalwan MA, Brown JA, Adekunle TE, Korley ND, Nafiu TC, Coughlin EC, Parvanta CP, Meade CD, Gwede CK, Best AL. Physically fit with a higher cancer risk? Influences of cervical cancer screening among a sample of physically active women ages 21-49 living in the United States. Prev Med Rep 2022; 30:101978. [PMID: 36157713 PMCID: PMC9494240 DOI: 10.1016/j.pmedr.2022.101978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022] Open
Abstract
To achieve the lowest risk level for various cancers, individuals would engage in several healthy lifestyle behaviors and age-eligible cancer screenings as recommended. Nonetheless, research has largely omitted exploration of concurrent primary and secondary prevention behaviors. This study was designed to explore influences of cervical cancer screening among physically active women who reported participation in recreational sports. U.S. based women between the ages of 21–49, who had never been diagnosed with cancer, were eligible to complete a web-based survey. Logistic regression analyses were conducted using SAS 9.4. On average, women were 31 years of age (N = 394) and self-identified as Black (51.3 %). Although low overall (30.7 %), higher odds of cervical cancer screening were associated with age (OR = 1.06, 95 % CI = 1.03–1.10), employment (OR = 2.43, 95 % CI = 1.14–5.18), knowledge of cancer-related risk behaviors (OR = 4.04, 95 % CI = 1.33–12.28), routine doctor’s visit (OR = 4.25, 95 % CI = 1.56–11.54), and team-based vs individual-based sport participation (OR = 1.95, 95 % CI = 1.13–3.34). Our study provides insight into the health profile of physically active women, ages 21–49, as it relates to risks for cervical cancer. Screening uptake among this diverse sample was much lower than the general population and national goals set by Healthy People 2030. Interventions should be tailored to increase knowledge of cancer-related risk behaviors, access to healthcare, and recommended cervical cancer screenings among even assumed-to-be healthy populations.
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Affiliation(s)
- A P Ewing
- The Ohio State University College of Public Health, Division of Epidemiology (APE, MAA, NDK, TCN), 1841 Neil Ave Building 293, Columbus OH 43210, USA
| | - M A Alalwan
- The Ohio State University College of Public Health, Division of Epidemiology (APE, MAA, NDK, TCN), 1841 Neil Ave Building 293, Columbus OH 43210, USA
| | - J A Brown
- University of North Carolina Chapel Hill, Department of Epidemiology, Gillings School of Global Public Health (JAB) CB # 7400 135 Dauer Drive, Chapel Hill NC 27599, USA
| | - T E Adekunle
- School of Public Health and Information Sciences (SPHIS), University of Louisville (TEA) 485 E Gray St, Louisville KY 40202, USA
| | - N D Korley
- The Ohio State University College of Public Health, Division of Epidemiology (APE, MAA, NDK, TCN), 1841 Neil Ave Building 293, Columbus OH 43210, USA
| | - T C Nafiu
- The Ohio State University College of Public Health, Division of Epidemiology (APE, MAA, NDK, TCN), 1841 Neil Ave Building 293, Columbus OH 43210, USA
| | - E C Coughlin
- College of Public Health, University of South Florida (ECC, CPP, ALB) 13201 Bruce B Downs Blvd, Tampa, FL 33612, USA
| | - C P Parvanta
- College of Public Health, University of South Florida (ECC, CPP, ALB) 13201 Bruce B Downs Blvd, Tampa, FL 33612, USA
| | - C D Meade
- Moffitt Cancer Center, Population Science, Health Outcomes and Behavior (CDM, CKG) 4117 E Fowler Ave, Tampa, FL 33612, USA
| | - C K Gwede
- Moffitt Cancer Center, Population Science, Health Outcomes and Behavior (CDM, CKG) 4117 E Fowler Ave, Tampa, FL 33612, USA
| | - A L Best
- College of Public Health, University of South Florida (ECC, CPP, ALB) 13201 Bruce B Downs Blvd, Tampa, FL 33612, USA
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Milovac T. Parachutes, randomized controlled trials, and all-cause mortality. Hist Philos Life Sci 2022; 44:68. [PMID: 36434291 DOI: 10.1007/s40656-022-00551-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/10/2022] [Indexed: 06/16/2023]
Abstract
In 2003 and 2018 researchers discussed the perils of blind reliance on randomized controlled trials that have been substituted for medical experience and clinical acumen. Although these past articles do well to shed light on this issue, they neglect to discuss the topic of all-cause mortality in controlled trials. The current essay seeks to fill this void and expand the thought put into the appropriateness of all-cause mortality, especially when trials extend excessively far into the future. To do this effectively the current essay leans on trial data from statin research and evidence from cancer screening-where researchers have explicitly called for all-cause mortality to be used in lieu of cancer or cardiovascular specific mortality. The issue with such an endpoint is that it obfuscates the issue at hand, namely that a specific intervention is intended to have a specific effect, not that a specific intervention is supposed to have any kind of effect. The effect(s) of medical interventions ought to be relevant to their intended mechanism of action and not simply any positive effect that can be pulled from trial data.
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Affiliation(s)
- Thomas Milovac
- Department of Philosophy, University of Waterloo, 200 University Ave W, Waterloo, Canada.
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Adams EC, Varkey TC, Aijaz A, Taboada J, Nguyen AM. Increased Surveillance or Increased Scrutiny: Curbing Inappropriate Screening of Endometrial Cancer in Transgender Men. J Family Reprod Health 2022; 16:170-176. [PMID: 36569259 PMCID: PMC9759439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective: The transgender male body is often considered a "black box" by even the most senior of attending physicians. Because of the stigma and fear associated with the utilization of Hormone Replacement Therapy (HRT) and the lack of clinical knowledge surrounding the subject, many transgender men will experience unnecessary testing for endometrial cancers. Materials and methods: This narrative review looked through publicly available PubMed and GoogleScholar articles on the topic of the use of pelvic ultrasounds in gynecological screening in transgendered males. 18,000 articles were filtered by relevance, date, clarity of the topic, and clinical recommendations. Of these articles 37 were included for discussion. Results: Of these 18,000 articles, only 37 were included for discussion. The resulting table, diagnostic tree, and discussion section are included within. Conclusion: Herein, the authors discuss the current understanding of the role of imaging in the diagnosis and treatment of gynecological cancers in transgendered men and how unnecessary imaging studies can be curbed for the benefit of the patient and the medical system at large.
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Affiliation(s)
- Edy C. Adams
- Department of Radiology, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Thomas C. Varkey
- Department of Radiology, Dell Medical School, The University of Texas at Austin, Austin, Texas,The Colangelo College of Business, Grand Canyon University, Phoenix, Arizona
| | - Afaf Aijaz
- Dow International Medical University, Karachi, Pakistan
| | - Jorge Taboada
- Department of Radiology, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Anne M. Nguyen
- Department of Radiology, Dell Medical School, The University of Texas at Austin, Austin, Texas
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Kennedy K, Hulbert A, Pasquinelli M, Feldman LE. Impact of CT screening in lung cancer: Scientific evidence and literature review. Semin Oncol 2022; 49:S0093-7754(22)00053-7. [PMID: 36114033 DOI: 10.1053/j.seminoncol.2022.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 11/11/2022]
Abstract
The treatment of lung cancer has improved significantly in recent years however, lung cancer remains as a leading cause of cancer-related mortality worldwide. Lung cancer screening has been explored, over the past several decades, as a means of reducing lung cancer mortality, to identify asymptomatic disease when it is potentially curable. The National Lung Screening Trial (NLST) established that low-dose computed tomography (LDCT) scans of the chest can be instrumental in reducing lung cancer mortality but the criteria for screening implemented in this trial may not be equitably sensitive across racial and sex subpopulations. Furthermore, the high false detection rate reported in this trial has raised concerns regarding overdiagnosis with LDCT alone. The aim of this review is to summarize the history of lung cancer screening trials, limitations of lung cancer screening, the impact of alternative risk prediction models in reducing disparities, and the use of biomarkers in conjunction with imaging to improve diagnostic authenticity.
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Affiliation(s)
- Kathleen Kennedy
- Division of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Alicia Hulbert
- Department of Surgery, University of Illinois at Chicago, College of Medicine, Chicago, Illinois; Section of Hematology/Oncology, Medical Service, Jesse Brown VA Medical Center, Chicago, Illinois
| | - Mary Pasquinelli
- Division of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; Division of Pulmonary, Critical Care, Sleep, and Allergy Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Lawrence E Feldman
- Division of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; Section of Hematology/Oncology, Medical Service, Jesse Brown VA Medical Center, Chicago, Illinois.
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20
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Wood LD, Canto MI, Jaffee EM, Simeone DM. Pancreatic Cancer: Pathogenesis, Screening, Diagnosis, and Treatment. Gastroenterology 2022; 163:386-402.e1. [PMID: 35398344 PMCID: PMC9516440 DOI: 10.1053/j.gastro.2022.03.056] [Citation(s) in RCA: 176] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/13/2022] [Accepted: 03/25/2022] [Indexed: 12/13/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a clinically challenging cancer, due to both its late stage at diagnosis and its resistance to chemotherapy. However, recent advances in our understanding of the biology of PDAC have revealed new opportunities for early detection and targeted therapy of PDAC. In this review, we discuss the pathogenesis of PDAC, including molecular alterations in tumor cells, cellular alterations in the tumor microenvironment, and population-level risk factors. We review the current status of surveillance and early detection of PDAC, including populations at high risk and screening approaches. We outline the diagnostic approach to PDAC and highlight key treatment considerations, including how therapeutic approaches change with disease stage and targetable subtypes of PDAC. Recent years have seen significant improvements in our approaches to detect and treat PDAC, but large-scale, coordinated efforts will be needed to maximize the clinical impact for patients and improve overall survival.
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Affiliation(s)
- Laura D Wood
- Departments of Pathology and Oncology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Marcia Irene Canto
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth M Jaffee
- Sidney Kimmel Cancer Center, Skip Viragh Center for Pancreatic Cancer Research and Clinical Care, Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Diane M Simeone
- Departments of Surgery and Pathology, Perlmutter Cancer Center, NYU Langone Health, New York, New York
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21
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Vallone F, Lemmo D, Martino ML, Donizzetti AR, Freda MF, Palumbo F, Lorenzo E, D'Argenzio A, Caso D. Factors Promoting Breast, Cervical and Colorectal Cancer Screenings participation: A Systematic Review. Psychooncology 2022; 31:1435-1447. [PMID: 35793430 PMCID: PMC9541457 DOI: 10.1002/pon.5997] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 12/05/2022]
Abstract
Objective The present study aims at systematically reviewing research conducted on factors promoting breast, cervical and colorectal cancer screenings participation. Methods A literature search in MEDLINE/PubMed and PsycInfo from January 2017 to October 2021 was performed. Data extraction, researchers' full agreement and the inclusion criteria produced 102 eligible studies. Data were narratively synthesized and critically interpreted. Results Multiple factors favoring or hindering breast, cervical and colorectal cancer screenings were identified and summarized as factors operating at the individual level (background information, individual characteristics, emotions related to screening procedure and to cancer, knowledge and awareness), at the relational level (relationships with healthcare staff, significant others, community members), and at the healthcare system level (systems barriers/policy, lack of staff). A critical appraisal of studies revealed a fragmentation in the literature, with a compartmentalization of studies by type of cancer screening, country and specific populations of destination. Conclusions Overall findings indicated that greater integration of research results obtained independently for each cancer diagnosis and within the different countries/populations could foster a more comprehensive understanding of factors potentially enhancing the participation in breast, cervical and colorectal cancer screenings worldwide. This review, which is grounded in the current context of globalization and superdiversification in population, can help to enhance a better integration between research and practices, by supporting the development of more effective and inclusive evidence‐based interventions and health‐promotion campaigns worldwide. Research and practical implications are highlighted and discussed.
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Affiliation(s)
- Federica Vallone
- University of Naples Federico II, Department of Humanities, Napoli, Italy.,Dynamic Psychology Laboratory, Department of Political Sciences, University of Naples Federico II, Napoli, Italy
| | - Daniela Lemmo
- University of Naples Federico II, Department of Humanities, Napoli, Italy
| | | | | | | | - Francesco Palumbo
- Department of Political Sciences, University of Naples Federico II, Napoli, Italy
| | - Elvira Lorenzo
- Regione Campania, Direzione Generale per la Tutela della Salute ed il Coordinamento del Sistema Sanitario Regionale, Napoli, Italy
| | - Angelo D'Argenzio
- Regione Campania, Direzione Generale per la Tutela della Salute ed il Coordinamento del Sistema Sanitario Regionale, Napoli, Italy
| | - Daniela Caso
- University of Naples Federico II, Department of Humanities, Napoli, Italy
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22
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Li P, Pang J, Xu S, He H, Ma Y, Liu Z. A Glycoform-Resolved Dual-Modal Ratiometric Immunoassay Improves the Diagnostic Precision for Hepatocellular Carcinoma. Angew Chem Int Ed Engl 2022; 61:e202113528. [PMID: 35194906 DOI: 10.1002/anie.202113528] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Indexed: 02/06/2023]
Abstract
The glycosylation pattern of alpha fetoprotein (AFP) paves the basis for precise early diagnosis of hepatocellular carcinoma (HCC). However, existing analytical methods ignore the contribution of terminal sialic acid, which has been reported to be highly connected with HCC. Besides, the development of diagnostic assays is severely hindered by the preparation of anti-glycans antibodies. Molecularly imprinted polymers (MIPs), as synthetic antibody mimics, provide unique strengths to address these issues. Herein, we report a MIPs-based dual-modal ratiometric immunoassay for precise HCC diagnosis. Using a "pit one against ten" MIP to recognize a subset of glycans containing sialic acid and/or core fucose, we demonstrated our assay exhibited improved precision as compared with ELISA. This assay provided not only a glycoform-resolved method for precise HCC diagnosis, but also a new paradigm for developing antibody mimics via molecular imprinting towards challenging biomedical applications.
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Affiliation(s)
- Pengfei Li
- State Key Laboratory of Analytical Chemistry for Life Science, School of Chemistry and Chemical Engineering, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China
| | - Jilei Pang
- State Key Laboratory of Analytical Chemistry for Life Science, School of Chemistry and Chemical Engineering, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China
| | - Shuxin Xu
- State Key Laboratory of Analytical Chemistry for Life Science, School of Chemistry and Chemical Engineering, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China
| | - Hui He
- State Key Laboratory of Analytical Chemistry for Life Science, School of Chemistry and Chemical Engineering, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China
| | - Yanyan Ma
- State Key Laboratory of Analytical Chemistry for Life Science, School of Chemistry and Chemical Engineering, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China
| | - Zhen Liu
- State Key Laboratory of Analytical Chemistry for Life Science, School of Chemistry and Chemical Engineering, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China
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23
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Plotzker RE, Barnell GM, Wiley DJ, Stier EA, Jay N. Provider Preferences for Anal Cancer Prevention Screening: Results of the International Anal Neoplasia Society Survey. Tumour Virus Res 2022; 13:200235. [PMID: 35183808 PMCID: PMC9006639 DOI: 10.1016/j.tvr.2022.200235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 02/02/2023] Open
Abstract
Objective This study explores provider preferences regarding anal cancer screening indications, initiation age, tools, and referral threshold to high resolution anoscopy (HRA). Methods International Anal Neoplasia Society affiliates were invited to complete an online survey. Options for initiation age and tools were delineated by sub-groups. HRA referral thresholds separately queried recommendations by patient immune status. Results One hundred forty respondents participated. Although consensus was lacking with regard to specific screening initiation age, more respondents recommended younger initiation ages for men who have sex with men (MSM) living with HIV (LWH) compared with MSM not LWH (p < 0.01). “No age threshold” ranged 44-55% among sub-groups with lower genital tract disease. Cytology and digital anorectal exam (DARE) were the most frequently selected tools for all sub-groups (ranges 77-90% and 74-86%, respectively). HRA was recommended significantly more frequently for MSM LWH (58%) and patients with vulvar cancer (52%) compared to others (p < 0.01). “Any [test] abnormality” was more often selected as indication for HRA for immunocompromised (56%) and immunocompetent (46%) patients than a specific cytology test result (29%, 36% respectively). Conclusion Cytology and DARE were preferred screening tools; screening initiation age and HRA referral threshold showed less consensus. Evidence-based guidelines are needed and may lead to more consistent screening practices.
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Affiliation(s)
- Rosalyn E Plotzker
- UCSF ANCRE Center, Mount Zion Hospital, 1600 Divisadero Street, 3rd Floor, San Francisco, CA 94115 USA.
| | - Gregory M Barnell
- Kaiser Permanente, Oakland Medical Center, Department of Surgery, 3600 Broadway, Suite 38, Oakland, CA 94611, USA.
| | - Dorothy J Wiley
- UCLA School of Nursing, 700 Tiverton Avenue, Factor Building Room #4242, Los Angeles, CA 90095-6918 USA.
| | - Elizabeth A Stier
- Boston University School of Medicine, Boston Medical Center, 771 Albany Street, Dowling 4, Boston, MA 02118 USA.
| | - Naomi Jay
- UCSF ANCRE Center, Mount Zion Hospital, 1600 Divisadero Street, 3rd Floor, San Francisco, CA 94115 USA.
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24
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Shin HS, Chi E, Han HR. [Validity and Reliability of the Korean Version of Assessment of Health Literacy in Breast and Cervical Cancer Screening]. J Korean Acad Nurs 2022; 51:769-781. [PMID: 35023864 DOI: 10.4040/jkan.21108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE Health literacy is a significant determinant of health and health behaviors such as cancer screening. Despite its significance, there are limited instruments available to assess health literacy targeting Koreans. The purpose of this study was to test the psychometric properties of Korean translation of a validated health literacy instrument in cancer screening-Korean version of assessment of health literacy in breast and cervical cancer screening (K-AHL-C). METHODS A total of 555 women aged 20~65 participated in the online survey study. Of 52 items addressing five domains included in the original version, we focused on 36 items addressing three key domains closely associated with cancer screening: familiarity, health navigation, and comprehension. RESULTS During content validation, two items from the health navigation domain were removed, yielding 34 items. Using Rasch analysis and confirmatory factor analysis, we found the evidence of construct validity of K-AHL-C. The Korean version was also significantly correlated with measures of Functional Health Literacy scale, cancer prevention behaviors, and subjective health status, suggesting convergent validities respectively. Finally, K-AHL-C had acceptable reliability coefficients (α) ranging from 0.71 to 0.92 for each domain and the total scale. CONCLUSION These psychometric properties support the K-AHL-C is a valid and reliable instrument for measuring Koreans' health literacy in cancer screening. Also it is expected to use the instrument to detect breast and cervical cancer early and improve the screening rate, and ultimately to contribute to the promotion of women's health and women's health nursing practice.
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Affiliation(s)
- Hye Sook Shin
- College of Nursing Science, Kyung Hee University, Seoul, Korea
| | - Eunlim Chi
- Graduate School of Education, Kyung Hee University, Seoul, Korea
| | - Hae-Ra Han
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
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25
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Kumar AD, Durham DD, Lane L, Perera P, Rivera MP, Henderson LM. Randomized control trial of unconditional versus conditional incentives to increase study enrollment rates in participants at increased risk of lung cancer. J Clin Epidemiol 2022; 141:11-17. [PMID: 34469801 PMCID: PMC8903037 DOI: 10.1016/j.jclinepi.2021.08.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/05/2021] [Accepted: 08/21/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Understanding how incentives and their timing influence study enrollment rates is important to efficient study design and increasing the generalizability of findings. This 2-arm, parallel randomized trial evaluated how conditional vs. unconditional mailed incentives of a $20 gift card affected study enrollment in a sample of participants screened for lung cancer screening. METHODS Eligible participants included Black and White adults who underwent lung cancer screening with low-dose CT and had negative screening results at two North Carolina imaging facilities in 2018. We used a stratified randomization scheme, by sex and race, to assign incentive type (conditional vs. unconditional). We used the Tailored Design Method with six points of mailed contact to engage participants. We compared study enrollment rates using chi-square tests and logistic regression analyses. RESULTS After adjusting for sex, race, age, smoking status, participant residence, and screening site, participants who received unconditional incentives were 74% more likely to enroll than those who received conditional incentives (adjusted OR = 1.74 (95% CI: 1.01, 3.00). CONCLUSIONS Type of incentive can play a role in increasing study enrollment, especially mailed surveys that target individuals who currently or previously smoked. Unconditional incentives may be worth the initial cost to engage study participants.
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Affiliation(s)
- Anjali D. Kumar
- Department of Epidemiology, University of North Carolina, Chapel Hill,Corresponding author.
| | | | - Lindsay Lane
- Department of Radiology, University of North Carolina, Chapel Hill
| | - Pasangi Perera
- Department of Radiology, University of North Carolina, Chapel Hill
| | - M. Patricia Rivera
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of North Carolina, Chapel Hill,Lineberger Comprehensive Cancer Center, University of North Carolina Chapel Hill
| | - Louise M. Henderson
- Department of Epidemiology, University of North Carolina, Chapel Hill,Department of Radiology, University of North Carolina, Chapel Hill,Lineberger Comprehensive Cancer Center, University of North Carolina Chapel Hill
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26
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Hanley SJB, Fujita H, Aoyama-Kikawa S, Kasamo M, Torigoe T, Matsuno Y, Noriaki S. Evaluation of partial genotyping with HPV16/18 for triage of HPV positive, cytology negative women in the COMPACT study. J Gynecol Oncol 2021; 32:e86. [PMID: 34708593 PMCID: PMC8550923 DOI: 10.3802/jgo.2021.32.e86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/15/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022] Open
Abstract
Objective While cytology-based screening programs have significantly reduced mortality and morbidity from cervical cancer, the global consensus is that primary human papillomavirus (HPV) testing increases detection of high-grade cervical intraepithelial neoplasia (CIN) and invasive cancer. However, the optimal triage strategy for HPV+ women to avoid over-referral to colposcopy may be setting specific. We compared absolute and relative risk (RR) of >CIN2/3 within 12 months of a negative cytologic result in women HPV16/18+ compared to those with a 12-other high-risk HPV (hrHPV) genotype to identify women at greatest risk of high-grade disease and permit less aggressive management of women with other hrHPV infections. Methods Participants were 14,160 women aged 25–69 years with negative cytology participating in the COMparison of HPV genotyping And Cytology Triage (COMPACT) study. Women who were HPV16/18+ were referred to colposcopy. Those with a 12-other hrHPV type underwent repeat cytology after 6 months and those with >abnormal squamous cells of undetermined significance went to colposcopy. Results Absolute risk of >CIN2 in HPV16/18+ women was 19.5% (95% CI=12.4%–29.4%). In women 25–29 years and HPV16+ it was 40.0% (95% CI=11.8%–76.9%). Absolute risk of >CIN3 in women HPV16/18+ was 11.0% (95% CI=5.9%–19.6%). For women 30–39 years and HPV16+ it was 23.1% (95% CI=5.0%–53.8%). Overall risk of >CIN2, >CIN3 in women with a 12-other hrHPV HPV type was 5.6% (95% CI=3.1%–10.0%) and 3.4% (95% CI=1.6%–7.2%) respectively. RR of >CIN2, >CIN3 in HPV16/18+ vs. 12-other hrHPV was 3.5 (95% CI=1.7–7.3) and 3.3 (95% CI=1.2–8.8), respectively. Conclusion Primary HPV screening with HPV16/18 partial genotyping is a promising strategy to identify women at current/future risk of >CIN2 in Japan without over-referral to colposcopy. Trial Registration UMIN Clinical Trials Registry Identifier: UMIN000013203
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Affiliation(s)
- Sharon J B Hanley
- Department of Obstetrics and Gynecology, Hokkaido University Faculty of Medicine, Sapporo, Japan.,Hokkaido Center for Environmental and Health Sciences, Sapporo, Japan.
| | | | | | | | | | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Sakuragi Noriaki
- Department of Obstetrics and Gynecology, Hokkaido University Faculty of Medicine, Sapporo, Japan.,Women's Healthcare Center, Otaru General Hospital, Otaru, Japan
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27
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Shungu N, Sterba KR. Barriers and Facilitators to Informed Decision-Making About Prostate Cancer Screening Among Black Men. J Am Board Fam Med 2021; 34:925-36. [PMID: 34535518 DOI: 10.3122/jabfm.2021.05.210149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Black men are disproportionately impacted by prostate cancer (PrCa). Current guidelines recommend that all men make informed decisions about whether to be screened for PrCa. Little is known about the barriers and facilitators of informed decision-making (IDM) about PrCa screening in Black men. METHODS We conducted focus groups with a convenience sample of Black men aged 55 to 69 years from a primary care practice (n = 21). Template analysis was used to evaluate themes related to barriers and facilitators of IDM about PrCa screening. RESULTS IDM was impacted by external factors, intrinsic factors, and personal beliefs about PrCa screening. Family, friends, and clinicians played a paramount role in shaping attitudes about PrCa screening. Distrust of the medical community impaired IDM, and lack of clinician communication about PrCa screening further engendered mistrust. Participants felt they lacked adequate knowledge to make an informed decision about PrCa screening. Identified areas to promote IDM included education on racial disparities, education that screening is a personal choice, and differentiating PrCa screening from colon cancer screening. CONCLUSIONS Our results indicate that Black men may lack the prerequisite information to make informed decisions about PrCa screening, which is notable in light of known PrCa racial disparities. Clinicians can play an important role in facilitating IDM through fostering discussions about the benefits and risks of PrCa screening and educating Black men about racial disparities.
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28
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Steinkasserer L, Irmgard D, Weiss T, Dirschlmayer W, Mossig M, Zeimet AG, Marth C. Efficacy of an optimal ovarian cancer screening: a best-case scenario study based on real-world data. Arch Gynecol Obstet 2021; 305:159-167. [PMID: 34125280 PMCID: PMC8782802 DOI: 10.1007/s00404-021-06117-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 06/02/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To date, ovarian cancer screening in asymptomatic women has not shown a mortality benefit. The aim of this simulation study was to outline the impact of different histological subtypes on a potential stage-shift, achieved by screening. METHODS Real-world data were derived in the period of 2000-2017 from the Klinischen Tumorregister Austria. We estimated five-year overall survival (OS) of patients with ovarian cancer regarding different histological subtypes and FIGO stages. A theoretical model was generated predicting the trend of OS mediated by an eventual down-shifting of ovarian cancer from FIGO stage III/IV to FIGO stage I/II by screening, considering the influence of different histological subtypes. RESULTS 3458 ovarian cancer patients were subdivided according to histological subtypes and FIGO classification. Major difference in distribution of histological types was found between FIGO stage I/II and III/IV. A theoretical down-shift of tumors from high to low FIGO stages based on our registry calculations showed that the five-year OS would increase from 50% to nearly 80% by perfect screening. CONCLUSION In our simulation study, we showed that down-shifting ovarian cancers by successful screening might increase OS by 30 percentage point. Our results underscore the importance to recognize ovarian cancer as a heterogenous disease with distinct epidemiologic, molecular and clinical features. The individual characteristic of each histotype is of utmost impact on the definition of screening aims and may influence early detection and stage-shift. Efficacy of screening is mainly dependent on detection of high-risk cancer types and not the slow growing low-grade types.
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Affiliation(s)
- Lena Steinkasserer
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Delmarko Irmgard
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Tatjana Weiss
- Department of Obstetrics and Gynecology, Hospital Barmherzige Schwestern, Linz, Austria
| | - Walter Dirschlmayer
- Department of Obstetrics and Gynecology, Hospital Barmherzige Schwestern Ried, Vienna, Austria
| | - Michael Mossig
- Department of Obstetrics and Gynecology, Hospital Hietzing, Vienna, Austria
| | - Alain G Zeimet
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Christian Marth
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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29
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Bradley SH, Thompson MJ, Nicholson BD. Ensuring Informed Decision-Making for Cancer Screening. J Am Board Fam Med 2021; 34:435-8. [PMID: 33833015 DOI: 10.3122/jabfm.2021.02.200353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/26/2020] [Accepted: 09/02/2020] [Indexed: 11/08/2022] Open
Abstract
The history of cancer screening has demonstrated that the case for cancer screening is not straightforward. In contemporary practice, sharing decision-making with patients has become expected of family physicians. At the same time, increasing emphasis has been placed on encouraging patients to participate in screening programs to improve cancer outcomes. The success of cancer screening is often judged by the number of those who participate. Improving cancer outcomes should be a priority for family medicine, but the importance of this goal should not undermine doctors' commitment to helping patients make informed decisions that are consistent with their values and priorities. If we are serious about empowering patients, we need to be more open about the limitations of cancer screening, to help patients make up their minds.
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30
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Kono K, Morisada T, Saika K, Aoki ES, Miyagi E, Ito K, Takahashi H, Nakayama T, Saito H, Aoki D. The first-round results of a population-based cohort study of HPV testing in Japanese cervical cancer screening: baseline characteristics, screening results, and referral rate. J Gynecol Oncol 2021; 32:e29. [PMID: 33559411 PMCID: PMC8039178 DOI: 10.3802/jgo.2021.32.e29] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/08/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022] Open
Abstract
Objective In 2013, a cohort study aimed to clarify the positive and negative effects of introducing the human papillomavirus (HPV) testing for population-based cervical cancer screening has been launched in Japan. This study included four screenings during the subsequent 7-year follow-up period. We aim to describe the results of the first round of this study on cervical cancer screening here. Methods This study began in September 2013 with recruitment completed in March 2016. Women aged 30–49 years were divided into 2 groups: those who received uterine cervical cytology alone in the first year (control group), or those who received a combination of cytology and HPV testing (intervention group), based on their age. After first screening, women with positive result of cytology or positive HPV test required referral. We summarized the results of the first round of cervical cancer screening. Results Of the 25,074 women who were eligible for the study, 13,845 women (55.2%) were screened with cytology alone; 11,229 women (44.8%) received a combination of cytology and HPV testing. After screening, 407 women (2.9%) in the control group and 1,003 women (8.9%) in the intervention group required referral, respectively. Adding HPV testing increased referral rate significantly (p<0.001). Conclusion After first screening, introduction of HPV testing appears to contribute to significantly higher referral rates, suggesting that the number of colposcopies as a detailed examination may increase. These preliminary findings suggest that if HPV testing is introduced into screening, medical institutions need to be prepared for an increasing number of follow-up examinations.
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Affiliation(s)
- Kanako Kono
- Medical Science Specialty, Keio University Graduate School of Medicine, Tokyo, Japan.,Division of Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Tohru Morisada
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Kumiko Saika
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan.,Division of International Collaborative Research, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Eiko Saitoh Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan.,Preventive Medicine Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kiyoshi Ito
- Department of Disaster Obstetrics and Gynecology, Tohoku University School of Medicine, Miyagi, Japan
| | - Hirokazu Takahashi
- Division of Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Tomio Nakayama
- Division of Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Hiroshi Saito
- Aomori Prefectural Central Hospital, Aomori, Japan.,Division of Medical Support and Partnership, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan.
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Cooper GS, Grimes A, Werner J, Cao S, Fu P, Stange KC. Barriers to Follow-Up Colonoscopy After Positive FIT or Multitarget Stool DNA Testing. J Am Board Fam Med 2021; 34:61-9. [PMID: 33452083 DOI: 10.3122/jabfm.2021.01.200345] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Fecal immunochemical testing (FIT) and multi-target stool DNA testing (mt-sDNA) are recommended colorectal cancer screening options but require follow-up with colonoscopy to determine the source of a positive result. We performed a retrospective analysis in an academic health system to determine adherence to colonoscopy in these patients. METHODS We identified all patients aged 40 years and older with at least 1 primary care visit who had a positive FIT or mt-sDNA between January 2016 and June 2018. We identified receipt of colonoscopy within 6 months of the positive test and reviewed medical records to determine reasons for lack of colonoscopy. RESULTS We identified 308 eligible patients with positive FIT and 323 with positive mt-sDNA. Some patients with positive FIT (46.7%) and patients with positive mt-sDNA (71.5%) underwent colonoscopy within 6 months, and time to colonoscopy was also shorter with mt-sDNA (hazard ratio, 1.83; 95% CI, 1.48-2.25). These differences remained in a multivariable model adjusting for patient characteristics. Among patients without colonoscopy after positive FIT, 1 or more system, provider, and patient-related barriers were identified in 32.1%, 57.6%, and 36.3%, respectively. Among patients without colonoscopy after positive mt-sDNA, corresponding frequencies were 30.4%, 43.5%, and 57.6%, respectively. CONCLUSIONS Follow-up colonoscopy was higher for mt-sDNA than FIT, which could be due in part to preselection by clinicians and/or patients. Among patients who did not follow-up, provider and system factors were as frequently encountered as patient factors. These findings reinforce the need for multi-level interventions to improve follow-up.
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Melson JE, Imperiale TF, Itzkowitz SH, Llor X, Kochman ML, Grady WM, Schoen RE, Burke CA, Shaukat A, Rabeneck L, Ladabaum U, Bresalier R, Spiegel B, Yee J, Wang T, Lieberman D, Komanduri S, Muthusamy VR, Dey N. AGA White Paper: Roadmap for the Future of Colorectal Cancer Screening in the United States. Clin Gastroenterol Hepatol 2020; 18:2667-2678.e2. [PMID: 32634626 DOI: 10.1016/j.cgh.2020.06.053] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/26/2020] [Accepted: 06/15/2020] [Indexed: 02/07/2023]
Abstract
The American Gastroenterological Association's Center for Gastrointestinal Innovation and Technology convened a consensus conference in December 2018, entitled, "Colorectal Cancer Screening and Surveillance: Role of Emerging Technology and Innovation to Improve Outcomes." The goal of the conference, which attracted more than 60 experts in screening and related disciplines, including the authors, was to envision a future in which colorectal cancer (CRC) screening and surveillance are optimized, and to identify barriers to achieving that future. This White Paper originates from that meeting and delineates the priorities and steps needed to improve CRC outcomes, with the goal of minimizing CRC morbidity and mortality. A one-size-fits-all approach to CRC screening has not and is unlikely to result in increased screening uptake or desired outcomes owing to barriers stemming from behavioral, cultural, and socioeconomic causes, especially when combined with inefficiencies in deployment of screening technologies. Overcoming these barriers will require the following: efficient utilization of multiple screening modalities to achieve increased uptake; continued development of noninvasive screening tests, with iterative reassessments of how best to integrate new technologies; and improved personal risk assessment to better risk-stratify patients for appropriate screening testing paradigms.
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Aslanian HR, Lee JH, Canto MI. AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review. Gastroenterology 2020; 159:358-362. [PMID: 32416142 DOI: 10.1053/j.gastro.2020.03.088] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/16/2020] [Accepted: 03/23/2020] [Indexed: 12/12/2022]
Abstract
DESCRIPTION The purpose of this American Gastroenterological Association Institute Clinical Practice Update is to describe the indications for screening for pancreas cancer in high-risk individuals. METHODS The evidence reviewed in this work is based on reports of pancreas cancer screening studies in high-risk individuals and expert opinion. BEST PRACTICE ADVICE 1: Pancreas cancer screening should be considered in patients determined to be at high risk, including first-degree relatives of patients with pancreas cancer with at least 2 affected genetically related relatives. BEST PRACTICE ADVICE 2: Pancreas cancer screening should be considered in patients with genetic syndromes associated with an increased risk of pancreas cancer, including all patients with Peutz-Jeghers syndrome, hereditary pancreatitis, patients with CDKN2A gene mutation, and patients with 1 or more first-degree relatives with pancreas cancer with Lynch syndrome, and mutations in BRCA1, BRCA2, PALB2, and ATM genes. BEST PRACTICE ADVICE 3: Genetic testing and counseling should be considered for familial pancreas cancer relatives who are eligible for surveillance. A positive germline mutation is associated with an increased risk of neoplastic progression and may also lead to screening for other relevant associated cancers. BEST PRACTICE ADVICE 4: Participation in a registry or referral to a pancreas Center of Excellence should be pursued when possible for high-risk patients undergoing pancreas cancer screening. BEST PRACTICE ADVICE 5: Clinicians should not screen average-risk individuals for pancreas cancer. BEST PRACTICE ADVICE 6: Pancreas cancer screening in high-risk individuals should begin at age 50 years, or 10 years younger than the initial age of familial onset. Screening should be initiated at age 40 years in CKDN2A and PRSS1 mutation carriers with hereditary pancreatitis and at age 35 years in the setting of Peutz-Jeghers syndrome. BEST PRACTICE ADVICE 7: Magnetic resonance imaging and endoscopic ultrasonography (EUS) should be used in combination as the preferred screening modalities in individuals undergoing pancreas cancer screening. BEST PRACTICE ADVICE 8: The target detectable pancreatic neoplasms are resectable stage I pancreatic ductal adenocarcinoma and high-risk precursor neoplasms, such as intraductal papillary mucinous neoplasms with high-grade dysplasia and some enlarged pancreatic intraepithelial neoplasias. BEST PRACTICE ADVICE 9: Screening intervals of 12 months should be considered when there are no concerning pancreas lesions, with shortened intervals and/or the performance of EUS in 6-12 months directed towards lesions determined to be low risk (by a multidisciplinary team). EUS evaluation should be performed within 3-6 months for indeterminate lesions and within 3 months for high-risk lesions, if surgical resection is not planned. New-onset diabetes in a high-risk individual should lead to additional diagnostic studies or change in surveillance interval. BEST PRACTICE ADVICE 10: Decisions regarding therapy directed towards abnormal findings detected during screening should be made by a dedicated multidisciplinary team together with the high-risk individual and their family. BEST PRACTICE ADVICE 11: Surgical resection should be performed at high-volume centers. BEST PRACTICE ADVICE 12: Clinicians should consider discontinuing pancreas cancer screening in high-risk individuals when they are more likely to die of non-pancreas cancer-related causes due to comorbidity and/or are not candidates for pancreas resection. BEST PRACTICE ADVICE 13: The limitations and potential risks of pancreas cancer screening should be discussed with patients before initiating a screening program.
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Affiliation(s)
| | - Jeffrey H Lee
- University of Texas, MD Anderson Cancer Center, Houston, Texas
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Lake M, Shusted CS, Juon HS, McIntire RK, Zeigler-Johnson C, Evans NR, Kane GC, Barta JA. Black patients referred to a lung cancer screening program experience lower rates of screening and longer time to follow-up. BMC Cancer 2020; 20:561. [PMID: 32546140 PMCID: PMC7298866 DOI: 10.1186/s12885-020-06923-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Racial disparities are well-documented in preventive cancer care, but they have not been fully explored in the context of lung cancer screening. We sought to explore racial differences in lung cancer screening outcomes within a lung cancer screening program (LCSP) at our urban academic medical center including differences in baseline low-dose computed tomography (LDCT) results, time to follow-up, adherence, as well as return to annual screening after additional imaging, loss to follow-up, and cancer diagnoses in patients with positive baseline scans. METHODS A historical cohort study of patients referred to our LCSP was conducted to extract demographic and clinical characteristics, smoking history, and lung cancer screening outcomes. RESULTS After referral to the LCSP, blacks had significantly lower odds of receiving LDCT compared to whites, even while controlling for individual lung cancer risk factors and neighborhood-level factors. Blacks also demonstrated a trend toward delayed follow-up, decreased adherence, and loss to follow-up across all Lung-RADS categories. CONCLUSIONS Overall, lung cancer screening annual adherence rates were low, regardless of race, highlighting the need for increased patient education and outreach. Furthermore, the disparities in race we identified encourage further research with the purpose of creating culturally competent and inclusive LCSPs.
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Affiliation(s)
- Michael Lake
- The Jane and Leonard Korman Respiratory Institute, Division of Pulmonary and Critical Care Medicine, 834 Walnut Street, Suite 650, Philadelphia, PA, 19107, USA
| | - Christine S Shusted
- The Jane and Leonard Korman Respiratory Institute, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut Street; Suite 826, Philadelphia, PA, 19107, USA
| | - Hee-Soon Juon
- Department of Medical Oncology, Division of Population Science, Thomas Jefferson University, 834 Chestnut Street; Suite 311, Philadelphia, PA, 19107, USA
| | - Russell K McIntire
- Jefferson College of Population Health, Thomas Jefferson University, 901 Walnut Street; 10th Floor, Philadelphia, PA, 19107, USA
| | - Charnita Zeigler-Johnson
- Department of Medical Oncology, Division of Population Science, Thomas Jefferson University, 834 Chestnut Street; Suite 311, Philadelphia, PA, 19107, USA
| | - Nathaniel R Evans
- The Jane and Leonard Korman Respiratory Institute, Department of Surgery, Division of Thoracic Surgery, 1025 Walnut Street; Suite 607, Philadelphia, PA, 19107, USA
| | - Gregory C Kane
- The Jane and Leonard Korman Respiratory Institute, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut Street; Suite 826, Philadelphia, PA, 19107, USA
| | - Julie A Barta
- The Jane and Leonard Korman Respiratory Institute, Division of Pulmonary and Critical Care Medicine, 834 Walnut Street, Suite 650, Philadelphia, PA, 19107, USA.
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Jin EH, Lee D, Bae JH, Kang HY, Kwak MS, Seo JY, Yang JI, Yang SY, Lim SH, Yim JY, Lim JH, Chung GE, Chung SJ, Choi JM, Han YM, Kang SJ, Lee J, Chan Kim H, Kim JS. Improved Accuracy in Optical Diagnosis of Colorectal Polyps Using Convolutional Neural Networks with Visual Explanations. Gastroenterology 2020; 158:2169-2179.e8. [PMID: 32119927 DOI: 10.1053/j.gastro.2020.02.036] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/10/2020] [Accepted: 02/20/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Narrow-band imaging (NBI) can be used to determine whether colorectal polyps are adenomatous or hyperplastic. We investigated whether an artificial intelligence (AI) system can increase the accuracy of characterizations of polyps by endoscopists of different skill levels. METHODS We developed convolutional neural networks (CNNs) for evaluation of diminutive colorectal polyps, based on efficient neural architecture searches via parameter sharing with augmentation using NBIs of diminutive (≤5 mm) polyps, collected from October 2015 through October 2017 at the Seoul National University Hospital, Healthcare System Gangnam Center (training set). We trained the CNN using images from 1100 adenomatous polyps and 1050 hyperplastic polyps from 1379 patients. We then tested the system using 300 images of 180 adenomatous polyps and 120 hyperplastic polyps, obtained from January 2018 to May 2019. We compared the accuracy of 22 endoscopists of different skill levels (7 novices, 4 experts, and 11 NBI-trained experts) vs the CNN in evaluation of images (adenomatous vs hyperplastic) from 180 adenomatous and 120 hyperplastic polyps. The endoscopists then evaluated the polyp images with knowledge of the CNN-processed results. We conducted mixed-effect logistic and linear regression analyses to determine the effects of AI assistance on the accuracy of analysis of diminutive colorectal polyps by endoscopists (primary outcome). RESULTS The CNN distinguished adenomatous vs hyperplastic diminutive polyps with 86.7% accuracy, based on histologic analysis as the reference standard. Endoscopists distinguished adenomatous vs hyperplastic diminutive polyps with 82.5% overall accuracy (novices, 73.8% accuracy; experts, 83.8% accuracy; and NBI-trained experts, 87.6% accuracy). With knowledge of the CNN-processed results, the overall accuracy of the endoscopists increased to 88.5% (P < .05). With knowledge of the CNN-processed results, the accuracy of novice endoscopists increased to 85.6% (P < .05). The CNN-processed results significantly reduced endoscopist time of diagnosis (from 3.92 to 3.37 seconds per polyp, P = .042). CONCLUSIONS We developed a CNN that significantly increases the accuracy of evaluation of diminutive colorectal polyps (as adenomatous vs hyperplastic) and reduces the time of diagnosis by endoscopists. This AI assistance system significantly increased the accuracy of analysis by novice endoscopists, who achieved near-expert levels of accuracy without extra training. The CNN assistance system can reduce the skill-level dependence of endoscopists and costs.
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Affiliation(s)
- Eun Hyo Jin
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Dongheon Lee
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, Korea
| | - Jung Ho Bae
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Hae Yeon Kang
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Min-Sun Kwak
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Ji Yeon Seo
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Jong In Yang
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Sun Young Yang
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Seon Hee Lim
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Jeong Yoon Yim
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Joo Hyun Lim
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Goh Eun Chung
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Su Jin Chung
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Ji Min Choi
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Yoo Min Han
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Seung Joo Kang
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Jooyoung Lee
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Chan Kim
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, Korea; Department of Biomedical Engineering College of Medicine, Seoul National University, Seoul, Korea; Institute of Medical & Biological Engineering, Medical Research Center, Seoul National University, Seoul, Korea.
| | - Joo Sung Kim
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea; Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
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Zheng Y, Corley DA, Doubeni C, Halm E, Shortreed SM, Barlow WE, Zauber A, Tosteson TD, Chubak J. ANALYSES OF PREVENTIVE CARE MEASURES WITH INCOMPLETE HISTORICAL DATA IN ELECTRONIC MEDICAL RECORDS: AN EXAMPLE FROM COLORECTAL CANCER SCREENING. Ann Appl Stat 2020; 14:1030-1044. [PMID: 34531936 PMCID: PMC8442666 DOI: 10.1214/20-aoas1342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The calculation of quality of care measures based on electronic medical records (EMRs) may be inaccurate because of incomplete capture of past services. We evaluate the influence of different statistical approaches for calculating the proportion of patients who are up-to-date for a preventive service, using the example of colorectal cancer (CRC) screening. We propose an extension of traditional mixture models to account for the uncertainty in compliance, which is further complicated by the choice of various screening modalities with different recommended screening intervals. We conducted simulation studies to compare various statistical approaches and demonstrated that the proposed method can alleviate bias when individuals with complete prior medical history information were not representative of the targeted population. The method is motivated by and applied to data from the National Cancer Institute-funded consortium Population-Based Research Optimizing Screening through Personalized Regiments (PROSPR). Findings from the application are important for the evaluation of appropriate use of preventive care and provide a novel tool for dealing with similar analytical challenges with EMR data in broad settings.
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Affiliation(s)
- Yingye Zheng
- Department of Biostatistics, Fred Hutchinson Cancer Research Center, Seattle WA
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Chyke Doubeni
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ethan Halm
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical School, Dallas TX
| | | | | | - Ann Zauber
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Jessica Chubak
- Health Research Institute, Kaiser Permanente Washington, Seattle WA
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Shin HY, Lee B, Hwang SH, Lee DO, Sung NY, Park JY, Jun JK. Evaluation of satisfaction with three different cervical cancer screening modalities: clinician-collected Pap test vs. HPV test by self-sampling vs. HPV test by urine sampling. J Gynecol Oncol 2020; 30:e76. [PMID: 31328458 PMCID: PMC6658592 DOI: 10.3802/jgo.2019.30.e76] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 02/23/2019] [Accepted: 03/05/2019] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Human papillomavirus testing by self-sampling and urine sampling might be alternatives to Papanicolaou test (Pap test) for cervical cancer screening (CCS), and may increase compliance and adherence thereto. The present study aimed to explore satisfaction and preferences for cervical screening modalities among Korean women. METHODS In total, 732 women aged between 20 and 69 years responded to a questionnaire designed to survey the women's perceived satisfaction for the 3 CCS modalities: clinician-collected Pap test, self-collected vaginal sampling (self-sampling) and urine sampling. RESULTS Overall satisfaction was significantly higher with both the self-sampling and urine sampling than the clinician-collected Pap test (odds ratio [OR]=2.01; 95% confidence interval [CI]=1.48-3.00 and OR=2.47; 95% CI=1.75-3.48, respectively). Psychological distress, including embarrassment, pain, anxiety, discomfort, and stress, with self-sampling and urine sampling were significantly lower than that with the Pap test. 52% of participants reported preferences for self-sampling in the next screening round. CONCLUSIONS Korean women were more likely to report satisfaction with alternative modalities (self-sampling and urine sampling) for CCS in comparison to the Pap test. This suggests that self-collected modalities may help with improving CCS uptake rates by eliminating burden related with the Pap test. However, further studies for test accuracy and cost-effective analysis of the alternative modalities should be conducted in order to apply CCS.
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Affiliation(s)
- Hye Young Shin
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Bomyee Lee
- Department of Medical Education and Medical Humanities, Graduate School, Kyung Hee University, Seoul, Korea
| | - Sang Hyun Hwang
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Ock Lee
- Center for Uterine Cancer, National Cancer Center Hospital, National Cancer Center, Goyang, Korea
| | - Na Young Sung
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jae Young Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
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Burgos-Teruel A, Bernet L, Gil-Tomás JJ, Jover-García J, López A, Osca A. Human Papillomavirus in the region of La Ribera-Valencia: Present and future. Rev Esp Quimioter 2020; 33:103-109. [PMID: 32080997 PMCID: PMC7111244 DOI: 10.37201/req/090.2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/04/2019] [Accepted: 12/16/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Human Papillomavirus (HPV) is the main cause of cervical cancer. The etiology and effects derived from this infection are set by molecular techniques and cytological diagnosis, respectively. In the present study, data obtained by an opportunist screening of cervical cancer in La Ribera region are revised and related statistically. METHODS Data considering different variables such as age, degree of lesion, HPV type detected and number of virus in coinfection were collected from 1,372 HPV positive cytology samples. HPV detection was carried out by means of three molecular techniques and the degree of lesion was analyzed by cytological diagnosis (Bethesda). In order to determine the relationship between different selected variables, several statistical analyses were performed. RESULTS Only degree of lesion variable showed a direct relationship with the rest of variables, increasing with aging process, viral oncogenicity, presence of at least one high-risk virus and with the fact of being mono-infected. The probability of presenting a higher-level degree of lesion multiplied by 28.4 when high-risk HPV was detected in mono-infection. CONCLUSIONS HPV molecular detection is the most suitable technique to perform a cervix cancer primary screening for the management of women with negative cytological diagnose. The number of detected types is statistically related to the degree of lesion. The establishment of a properly regulated screening to identify HPV infection, and therefore, of cervical cancer risk, is essential.
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Affiliation(s)
| | | | - J J Gil-Tomás
- Jesús J. Gil-Tomás, Hospital Universitario Casa de Salud. C/ Dr. Manuel Candela, 41, 46021, Valencia, Spain.
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Aoki ES, Yin R, Li K, Bhatla N, Singhal S, Ocviyanti D, Saika K, Suh M, Kim M, Termrungruanglert W. National screening programs for cervical cancer in Asian countries. J Gynecol Oncol 2020; 31:e55. [PMID: 32266804 PMCID: PMC7189071 DOI: 10.3802/jgo.2020.31.e55] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 02/16/2020] [Indexed: 12/24/2022] Open
Abstract
Cervical cancer is still one of the most common female cancers in Asia and the leading cause of cancer-related deaths in low- and middle-income countries. Nowadays, national screening programs for cervical cancer are widely provided in Asian countries. We reviewed the National Cancer Screening Program (NCSP) in China, India, Indonesia, Japan, Korea, and Thailand. The NCSP were established at varying times, from 1962 in Japan to 2014 in Indonesia. The primary screening method is based on cytology in all countries except for India and Indonesia. In India and Indonesia, visual inspection of the cervix with acetic acid (VIA) is mainly used as a primary screening method, and a “see and treat” strategy is applied to women with a positive VIA result. The starting age of NCSP ranges from 18 years in China to 30 years in Thailand. The screening interval is 2 years in all countries except for China and Indonesia, in which it is 3 years. Uptake rates of NCSP vary from 5.0%‒59.7%. Many women in low- and middle-income countries still do not participate in NCSP. To improve uptake rates and thereby prevent more cases of cervical cancer, Asian countries should continue to promote NCSP to the public using various approaches.
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Affiliation(s)
- Eiko Saitoh Aoki
- Department of Preventive Medicine Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Rutie Yin
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Kemin Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Beijing, China
| | - Neerja Bhatla
- Department of Gynecology, All India Institute of medical Sciences, New Delhi, India
| | - Seema Singhal
- Department of Gynecology, All India Institute of medical Sciences, New Delhi, India
| | - Dwiana Ocviyanti
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Kumiko Saika
- Division of Medical Support and Partnership, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Miseon Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea.
| | - Wichai Termrungruanglert
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Kang Y, Sun P, Mao X, Dong B, Ruan G, Chen L. PCR-reverse dot blot human papillomavirus genotyping as a primary screening test for cervical cancer in a hospital-based cohort. J Gynecol Oncol 2019; 30:e29. [PMID: 30887754 PMCID: PMC6424850 DOI: 10.3802/jgo.2019.30.e29] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/24/2018] [Accepted: 11/13/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To evaluate the polymerase chain reaction (PCR)-reverse-dot-blot (RDB) human papillomavirus (HPV) genotyping test as a feasible assay for the cervical cancer primary screening. METHODS In a hospital-based cohort, a total of 21,568 women were voluntarily enrolled from March 2009 to November 2016 for evaluating the 3 current cervical cancer screening strategies: co-test, cytology primary and high-risk HPV (HR-HPV) primary by using PCR-RDB HPV genotyping and liquid-based cytology (thinprep cytologic test [TCT]). Women with HR-HPV infection and/or abnormal cytology were referred for colposcopy, and the biopsy or conization was performed according to the American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines. RESULTS Overall, 18.20% (3,935/21,568) of the women were detected as HR-HPV-positive, 5.04% (1,088/21,568) were diagnosed with cervical intraepithelial neoplasia 2 or higher (CIN2+), and 3.43% (739/21,568) with CIN3+. The cumulative incidence rates for CIN2+/CIN3+ in patients with HPV-16/18-positive were 48.28%/37.20%, while they were 0.86%/0.38%, 0.30%/0.15% and 0.18%/0.09% in cytology-negative, HR-HPV-negative and co-test-negative population, respectively. Using CIN2+ and CIN3+ as the observed endpoints, the sensitivity and negative predictive value (NPV) of HR-HPV genotyping as a primary screening tool were 90.99%/99.49% and 91.57%/99.80%. Moreover, using HR-HPV genotyping primary screening could detect the same more CIN2+/CIN3+ cases in baseline-detection as co-testing (990/700 vs. 991/701) and far more than cytology primary screening (903/656, p<0.05). It also achieved the lowest misdiagnosis rate (8.01%/5.02%). Although HPV genotyping primary screening required an increased number of colposcopies (2.75/3.89 per CIN2+/CIN3+ case), it yielded an acceptable rate. CONCLUSIONS The PCR-RDB HPV genotyping test is a cost-effective and beneficial cervical cancer primary screening for hospital-based opportunistic screening.
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Affiliation(s)
- Yafang Kang
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Pengming Sun
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.
| | - Xiaodan Mao
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Binhua Dong
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guanyu Ruan
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Lihua Chen
- Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Adunlin G, Cyrus JW, Asare M, Sabik LM. Barriers and Facilitators to Breast and Cervical Cancer Screening Among Immigrants in the United States. J Immigr Minor Health 2019; 21:606-658. [PMID: 30117005 DOI: 10.1007/s10903-018-0794-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
To summarize the literature on barriers and facilitators to breast and cervical cancer screening among immigrants to the US. A literature review was conducted for studies on breast and cervical cancer screening among immigrant populations. A thematic analysis of 180 studies identified a variety of barriers and facilitators to screening at the personal and system levels. Personal barriers included lack of knowledge and insurance coverage, high cost of care, and immigration status. System barriers included poor access to services, lack of interpreter services, and insensitivity to patient needs. Facilitators to screening included knowledge of disease, access to information sources, physician recommendation, and social networks. Cultural norms and resource availability at the individual and system levels influence screening among immigrants. Health insurance coverage was found to be an important predictor of preventative screening use. Future research should seek to identify the best way to address this and other barriers to cancer screening among immigrants groups.
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Affiliation(s)
- Georges Adunlin
- McWhorter School of Pharmacy, Samford University, 2100 Lakeshore Dr, Homewood, AL, 35229, USA.
| | - John W Cyrus
- Tompkins-McCaw Library, Virginia Commonwealth University, 509 N 12th St, Richmond, VA, 23298-0430, USA
| | - Matthew Asare
- Department of Public Health, Baylor University, One Bear Place #97313, Waco, TX, 76798-7313, USA
| | - Lindsay M Sabik
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, 130 De Soto St., Pittsburgh, PA, 15261, USA
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Abstract
African-born immigrants are among the fastest growing immigrant groups in the US, yet they are underrepresented in healthcare research, particularly, cancer research and tend to be categorized as African American or Black, obscuring any cultural nuances that exist. A survey designed to provide insight on the barriers to healthcare, knowledge of common cancers, and cancer risks was utilized during a health fair. Data analyses included descriptive statistics to examine participant demographics and other study variables of interest. Most of the participants reported African origin (approximately 97%), were males (59%), were aged 18-40 years (49%), had a minimum of some college education (78%), a household income of >$50,000 (35%) and were mostly uninsured (45%). The cost of medical treatment 19 (45.2%) was reported as a major barrier to healthcare access. The Health Fair presented the opportunity to provide free health screenings, education/awareness, and referral to follow-up resources. The findings are evidence of the importance and impact of health fairs in communities of greatest need.
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Pan JY, Haile RW, Templeton A, Macrae F, Qin F, Sundaram V, Ladabaum U. Worldwide Practice Patterns in Lynch Syndrome Diagnosis and Management, Based on Data From the International Mismatch Repair Consortium. Clin Gastroenterol Hepatol 2018; 16:1901-1910.e11. [PMID: 29702294 PMCID: PMC6440473 DOI: 10.1016/j.cgh.2018.04.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/22/2018] [Accepted: 04/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Families with a history of Lynch syndrome often do not adhere to guidelines for genetic testing and screening. We investigated practice patterns related to Lynch syndrome worldwide, to ascertain potential targets for research and public policy efforts. METHODS We collected data from the International Mismatch Repair Consortium (IMRC), which comprises major research and clinical groups engaged in the care of families with Lynch syndrome worldwide. IMRC institutions were invited to complete a questionnaire to characterize diagnoses of Lynch syndrome and management practice patterns. RESULTS Fifty-five providers, representing 63 of 128 member institutions (49%) in 21 countries, completed the questionnaire. For case finding, 55% of respondents reported participating in routine widespread population tumor testing among persons with newly diagnosed Lynch syndrome-associated cancers, whereas 27% reported relying on clinical criteria with selective tumor and/or germline analyses. Most respondents (64%) reported using multigene panels for germline analysis, and only 28% reported testing tumors for biallelic mutations for cases in which suspected pathogenic mutations were not confirmed by germline analysis. Respondents reported relying on passive dissemination of information to at-risk family members, and there was variation in follow through of genetic testing recommendations. Reported risk management practices varied-nearly all programs (98%) recommended colonoscopy every 1 to 2 years, but only 35% recommended chemoprevention with aspirin. CONCLUSIONS There is widespread heterogeneity in management practices for Lynch syndrome worldwide among IMRC member institutions. This may reflect the rapid pace of emerging technology, regional differences in resources, and the lack of definitive data for many clinical questions. Future efforts should focus on the large numbers of high-risk patients without access to state-of-the-art Lynch syndrome management.
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Affiliation(s)
- Jennifer Y Pan
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California; Division of Gastroenterology, Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
| | - Robert W Haile
- Department of Medicine, Division of Hematology/Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Allyson Templeton
- International Mismatch Repair Consortium, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Finlay Macrae
- Department of Medicine, University of Melbourne, Melbourne, Australia; Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Melbourne, Australia
| | - FeiFei Qin
- Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, California
| | - Vandana Sundaram
- Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, California
| | - Uri Ladabaum
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California
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Termrungruanglert W, Khemapech N, Tantitamit T, Havanond P. Cost effectiveness analysis of HPV primary screening and dual stain cytology triage compared with cervical cytology. J Gynecol Oncol 2018; 30:e17. [PMID: 30740950 PMCID: PMC6393632 DOI: 10.3802/jgo.2019.30.e17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 12/19/2022] Open
Abstract
Objectives To assess the clinical and cost-effectiveness of human papillomavirus (HPV) primary screening triage with p16/Ki-67 dual stain cytology compared to cytology. Methods We conducted an Excel®-based budget impact model to estimate the preinvasive and invasive cervical cancer cases identified, mortality rate, direct medical costs, quality-adjusted life years (QALYs) and the incremental cost-effectiveness analysis of two strategies from the healthcare payer perspective. The study population is a cohort of women 30–65 years of age presenting for cervical screening. Results HPV primary screening triage with p16/Ki-67 dual stain showed higher sensitivity without losing specificity compared to conventional Pap smear. The improving the screening performance leads to decrease the prevalence of precancerous lesion, annual incidence and mortality of cervical cancer. The incidence of cervical cancer case detected by new algorithm compared with conventional method were 31,607 and 38,927, respectively. In addition, the new algorithm was more effective and more costly (average QALY 24.03, annual cost $13,262,693) than conventional cytology (average QALY 23.98, annual cost $7,713,251). The incremental cost-effective ratio (ICER) per QALY gained was $1,395. The sensitivity analysis showed if the cost of cytology and HPV test increased three times, the ICER would fall to $303/QALY gained and increased to $4,970/QALY gained, respectively. Conclusion Our model results suggest that screening by use of HPV genotyping test as a primary screening test combined with dual stain cytology as the triage of HPV positive women in Thai population 30–65 years old is expected to be more cost-effective than conventional Pap cytology.
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Affiliation(s)
- Wichai Termrungruanglert
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Nipon Khemapech
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tanitra Tantitamit
- Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University, Nakhonnayok, Thailand
| | - Piyalamporn Havanond
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Liaw W, Krist AH, Tong ST, Sabo R, Hochheimer C, Rankin J, Grolling D, Grandmont J, Bazemore AW. Living in "Cold Spot" Communities Is Associated with Poor Health and Health Quality. J Am Board Fam Med 2018; 31:342-350. [PMID: 29743218 PMCID: PMC7085304 DOI: 10.3122/jabfm.2018.03.170421] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/09/2018] [Accepted: 01/12/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Little is known about incorporating community data into clinical care. This study sought to understand the clinical associations of cold spots (census tracts with worse income, education, and composite deprivation). METHODS Across 12 practices, we assessed the relationship between cold spots and clinical outcomes (obesity, uncontrolled diabetes, pneumonia vaccination, cancer screening-colon, cervical, and prostate-and aspirin chemoprophylaxis) for 152,962 patients. We geocoded and linked addresses to census tracts and assessed, at the census tract level, the percentage earning less than 200% of the Federal Poverty Level, without high school diplomas, and the social deprivation index (SDI). We labeled those census tracts in the worst quartiles as cold spots and conducted bivariate and logistic regression. RESULTS There was a 10-fold difference in the proportion of patients in cold spots between the highest (29.1%) and lowest practices (2.6%). Except for aspirin, all outcomes were influenced by cold spots. Fifteen percent of low-education cold-spot patients had uncontrolled diabetes compared with 13% of noncold-spot patients (P < .05). In regression, those in poverty, low education, and SDI cold spots were less likely to receive colon cancer screening (odds ratio [CI], 0.88 [0.83-0.93], 0.87 [0.82-0.92], and 0.89 [0.83-0.95], respectively) although cold-spot patients were more likely to receive cervical cancer screening. CONCLUSION Living in cold spots is associated with worse chronic conditions and quality for some screening tests. Practices can use neighborhood data to allocate resources and identify those at risk for poor outcomes.
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Affiliation(s)
- Winston Liaw
- From the Robert Graham Center, Washington, DC (WL, AWB); Virginia Commonwealth University, Richmond, VA (AHK, STT, RS, CH); HealthLandscape, Cincinnati, OH (JR, DG, JG); McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX (WL).
| | - Alex H Krist
- From the Robert Graham Center, Washington, DC (WL, AWB); Virginia Commonwealth University, Richmond, VA (AHK, STT, RS, CH); HealthLandscape, Cincinnati, OH (JR, DG, JG); McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX (WL)
| | - Sebastian T Tong
- From the Robert Graham Center, Washington, DC (WL, AWB); Virginia Commonwealth University, Richmond, VA (AHK, STT, RS, CH); HealthLandscape, Cincinnati, OH (JR, DG, JG); McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX (WL)
| | - Roy Sabo
- From the Robert Graham Center, Washington, DC (WL, AWB); Virginia Commonwealth University, Richmond, VA (AHK, STT, RS, CH); HealthLandscape, Cincinnati, OH (JR, DG, JG); McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX (WL)
| | - Camille Hochheimer
- From the Robert Graham Center, Washington, DC (WL, AWB); Virginia Commonwealth University, Richmond, VA (AHK, STT, RS, CH); HealthLandscape, Cincinnati, OH (JR, DG, JG); McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX (WL)
| | - Jennifer Rankin
- From the Robert Graham Center, Washington, DC (WL, AWB); Virginia Commonwealth University, Richmond, VA (AHK, STT, RS, CH); HealthLandscape, Cincinnati, OH (JR, DG, JG); McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX (WL)
| | - David Grolling
- From the Robert Graham Center, Washington, DC (WL, AWB); Virginia Commonwealth University, Richmond, VA (AHK, STT, RS, CH); HealthLandscape, Cincinnati, OH (JR, DG, JG); McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX (WL)
| | - Jene Grandmont
- From the Robert Graham Center, Washington, DC (WL, AWB); Virginia Commonwealth University, Richmond, VA (AHK, STT, RS, CH); HealthLandscape, Cincinnati, OH (JR, DG, JG); McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX (WL)
| | - Andrew W Bazemore
- From the Robert Graham Center, Washington, DC (WL, AWB); Virginia Commonwealth University, Richmond, VA (AHK, STT, RS, CH); HealthLandscape, Cincinnati, OH (JR, DG, JG); McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX (WL)
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Liu M, Liu Z, Cai H, Guo C, Li X, Zhang C, Wang H, Hang D, Liu F, Deng Q, Yang X, Yuan W, Pan Y, Li J, Zhang C, Shen N, He Z, Ke Y. A Model To Identify Individuals at High Risk for Esophageal Squamous Cell Carcinoma and Precancerous Lesions in Regions of High Prevalence in China. Clin Gastroenterol Hepatol 2017; 15:1538-1546.e7. [PMID: 28342951 DOI: 10.1016/j.cgh.2017.03.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/16/2017] [Accepted: 03/16/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We aimed to develop a population-based model to identify individuals at high risk for esophageal squamous cell carcinoma (ESCC) in regions of China with a high prevalence of this cancer. METHODS We collected findings from 15,073 permanent residents (45-69 years old) of 334 randomly selected villages in Hua County, Henan Province, China who underwent endoscopic screening (with iodine staining) for ESCC from January 2012 through September 2015. The entire esophagus and stomach were examined; biopsies were collected from all focal lesions (or from standard sites in the esophagus if no abnormalities were found) and analyzed histologically. Squamous dysplasia, carcinoma in situ, and ESCC were independently confirmed by 2 pathologists. Before endoscopy, subjects completed a questionnaire on ESCC risk factors. Variables were evaluated with unconditional univariate logistic regression analysis; variables found to be significantly associated with ESCC were then analyzed by multivariate logistic regression modeling. We used the Akaike information criterion to develop our final model structure and the coding form of variables with multiple measures. We developed 2 groups of models, separately defining severe dysplasia and above (SDA) (lesions including severe dysplasia and higher-grade lesions) and moderate dysplasia and above (lesions including moderate dysplasia and higher-grade lesions) as outcome events. Age-stratified and whole-age models were developed; their discriminative ability in the full multivariate model and the simple age model was compared. We performed area under the receiver operating characteristic curve (AUC) and the DeLong test to evaluate model performance. RESULTS Our age-stratified prediction models identified individuals 60 years of age or younger with SDA with an AUC value of 0.795 (95% confidence interval, 0.736-0.854) and individuals older than 60 years with SDA with an AUC value of 0.681 (95% confidence interval, 0.618-0.743). Factors associated with SDA in individuals 60 years or younger included age closer to 60 years, use of coal or wood as a main source of cooking fuel, body mass index of 22 kg/m2 or less, unexplained epigastric pain, and rapid ingestion of meals. In subjects older than 60 years, SDA associated with age, family history of ESCC, cigarette smoking, body mass index of 22 kg/m2 or less, pesticide exposure, irregular eating habits, intake of high temperature foods, rapid ingestion of meals, and ingestion of leftover food in summer months. Use of our model in screening could have allowed 27% of subjects 60 years or younger and 9% of subjects older than 60 years to avoid endoscopy without missing SDAs. This means that approximately 2500 of endoscopies in total (16.6%) could have been avoided. CONCLUSIONS We developed a low-cost, easy-to-use model to identify individuals at risk for severe dysplasia or cancer of the esophagus living in a region of China with a high risk of ESCC. This model might be used to select individuals and groups of persons who should undergo endoscopy analysis for esophageal cancer.
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Affiliation(s)
- Mengfei Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Zhen Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Hong Cai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Chuanhai Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Xiang Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Chaoting Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Hui Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Dong Hang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Fangfang Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Qiuju Deng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Xin Yang
- North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei Province, P.R. China
| | - Wenqing Yuan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Yaqi Pan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Jingjing Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Chanyuan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Na Shen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Zhonghu He
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China.
| | - Yang Ke
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China.
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Bergl PA, Feagles J. Individualizing Cancer Screening Recommendations: A Team-Based Learning Activity for Fourth-Year Medical Students. MedEdPORTAL 2017; 13:10574. [PMID: 30800776 PMCID: PMC6338177 DOI: 10.15766/mep_2374-8265.10574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 04/11/2017] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Cancer screenings are key preventive services that patients receive in primary care. Health care professional students are generally taught about major society guidelines and U.S. Preventive Services Task Force recommendations for cancer screenings. Unfortunately, students and novice providers may view these influential recommendations as a rule book by which to provide care. Experienced providers recognize that not every patient fits neatly into clinical guidelines. Appropriate use of cancer screening entails an understanding of patient preferences, patient-specific health factors, and screening risks and associated pitfalls. METHODS This 2-hour team-based learning (TBL) session immerses learners in three challenging patient scenarios that are designed to stimulate nuanced discussion of cancer screening using controversial cases. The scenarios encompass the following cases: (1) a 68-year-old man actively seeking prostate cancer screening, (2) a heavy smoker with psychiatric illness and alcoholism being considered for lung cancer screening, and (3) a 42-year-old woman seeking to become pregnant who inquires about breast cancer screening. RESULTS The materials were originally designed for fourth-year students on an ambulatory medicine rotation. Our students universally viewed this activity as a high-quality presentation applicable to their careers. They strongly agreed that the cases facilitated a deeper understanding of the nuances of cancer screening. DISCUSSION This TBL encourages learners to critically appraise cancer screening guidelines and apply them to real-life examples. It is applicable for learners who understand the complexities of patient care but still suffer from a guidelines-are-rules mentality.
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Affiliation(s)
- Paul A. Bergl
- Fellow, Division of Pulmonary, Critical Care, and Sleep Medicine, Medical College of Wisconsin
| | - Jennifer Feagles
- Program Coordinator in Undergraduate Medical Education, Department of Medicine, Medical College of Wisconsin
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Sun P, Song Y, Ruan G, Mao X, Kang Y, Dong B, Lin F. Clinical validation of the PCR-reverse dot blot human papillomavirus genotyping test in cervical lesions from Chinese women in the Fujian province: a hospital-based population study. J Gynecol Oncol 2017; 28:e50. [PMID: 28657218 PMCID: PMC5540716 DOI: 10.3802/jgo.2017.28.e50] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/11/2017] [Accepted: 04/09/2017] [Indexed: 11/30/2022] Open
Abstract
Objective To determine the clinical significance of the polymerase chain reaction (PCR)-reverse dot blot (RDB) human papillomavirus (HPV) genotyping assay in cervical cancer screening. Methods A total of 10,442 women attending the Fujian Provincial Maternity and Children's Health Hospital were evaluated using the liquid-based cytology (thinprep cytologic test [TCT]) and the PCR-RDB HPV test. Women with HPV infection and/or abnormal cytology were referred for colposcopy and biopsy. For HPV DNA sequencing, 120 specimens were randomly selected. Pathological diagnosis was used as the gold standard. Results Using the PCR-RDB HPV test, overall HPV prevalence was 20.57% (2,148/10,442) and that of high-risk (HR)-HPV infection was 18.68% (1,951/10,442). There was 99.2% concordance between HPV PCR-RDB testing and sequencing. In this studied population, the most common HR-HPV types were HPV-16, -52, -58, -18, -53, -33, and -51, rank from high to low. HPV-16, -18, -58, -59, and -33 were the top 5 prevalent genotypes in cervical cancer but HPV-16, -18, -59, -45, and -33 were the top 5 highest risk factors for cancer (odds ratio [OR]=34.964, 7.278, 6.728, 6.101, and 3.658; all p<0.05, respectively). Among 10,442 cases, 1,278 had abnormal cytology results, of which, the HR-HPV positivity rate was 83.02% (1,061/1,278). To screen for cervical cancer by PCR-RDB HPV testing, when using CIN2+, CIN3+, and cancer as observed endpoints, the sensitivity was 90.43%, 92.61%, and 94.78% and the negative predictive value (NPV) was 99.06%, 99.42%, and 99.78%, respectively. PCR-RDB HPV and TCT co-testing achieved the highest sensitivity and NPV. Conclusion For cervical cancer screening, the PCR-RDB HPV test can provide a reliable and sensitive clinical reference.
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Affiliation(s)
- Pengming Sun
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity & Children's Health Hospital of Fujian Medical University, Fuzhou, China.,Department of Gynecology, Fujian Provincial Maternity & Children's Health Hospital of Fujian Medical University, Fuzhou, China.
| | - Yiyi Song
- Department of Gynecology, Fujian Provincial Maternity & Children's Health Hospital of Fujian Medical University, Fuzhou, China
| | - Guanyu Ruan
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity & Children's Health Hospital of Fujian Medical University, Fuzhou, China
| | - Xiaodan Mao
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity & Children's Health Hospital of Fujian Medical University, Fuzhou, China
| | - Yafang Kang
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity & Children's Health Hospital of Fujian Medical University, Fuzhou, China
| | - Binhua Dong
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity & Children's Health Hospital of Fujian Medical University, Fuzhou, China
| | - Fen Lin
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity & Children's Health Hospital of Fujian Medical University, Fuzhou, China
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49
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Nieto T, Tomlinson CL, Dretzke J, Bayliss S, Dilworth M, Beggs AD, Tucker O. Epigenetic biomarkers in progression from non-dysplastic Barrett's oesophagus to oesophageal adenocarcinoma: a systematic review protocol. BMJ Open 2016; 6:e013361. [PMID: 27927666 PMCID: PMC5168625 DOI: 10.1136/bmjopen-2016-013361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Barrett's oesophagus (BO), a metaplastic condition affecting the lower oesophagus due to long-standing gastro-oesophageal reflux and chronic inflammation, is a precursor lesion for oesophageal adenocarcinoma (OADC). There is no clinical test to predict which patients with BO will progress to OADC. The British Society of Gastroenterology recommends endoscopic surveillance of patients with BO. Epigenetic changes have been well characterised in the neoplastic progression of ulcerative colitis to colonic carcinoma, another gastrointestinal cancer associated with chronic inflammation. This systematic review protocol aims to identify and evaluate studies which examine epigenetic biomarkers in BO and their association with progression to OADC. METHODS AND ANALYSIS All prospective and retrospective primary studies, and existing systematic reviews investigating epigenetic markers including DNA methylation, histone modification, chromatin remodelling, micro and non-coding RNAs of all types will be eligible for inclusion. Eligible patients are those over the age of 18 with BO, BO with dysplasia, OADC or unspecified oesophageal cancer. A comprehensive search of bibliographic databases using combinations of text and index words relating to the population, prognostic markers and outcome will be undertaken with no language restrictions. Results will be screened by 2 independent reviewers and data extracted using a standardised proforma. The quality and risk of bias of individual studies will be assessed using the Quality in Prognostic Studies (QUIPS) tool. A narrative synthesis of all evidence will be performed with key findings tabulated. Meta-analysis will be considered where studies and reported outcomes are considered sufficiently homogeneous, both clinically and methodologically. Findings will be interpreted in the context of the quality of included studies. The systematic review will be reported according to PRISMA guidelines. ETHICS AND DISSEMINATION This is a systematic review of completed studies and no ethical approval is required. Findings from the full systematic review will be submitted for publication and presentation at national and international conferences which will inform future research on risk stratification in patients with BO. REVIEW REGISTRATION NUMBER CRD42016038654.
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Affiliation(s)
- T Nieto
- Department of Surgery, University of Birmingham, Birmingham, UK
| | - C L Tomlinson
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - J Dretzke
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - S Bayliss
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - M Dilworth
- Department of Surgery, Heart of England Foundation Trust and Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - A D Beggs
- Department of Surgery, University of Birmingham, Birmingham, UK
| | - O Tucker
- Department of Surgery, University of Birmingham, Birmingham, UK
- Department of Surgery, Heart of England Foundation Trust and Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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50
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Yang HJ, Lim SH, Lee C, Choi JM, Yang JI, Chung SJ, Choi SH, Im JP, Kim SG, Kim JS. Management of Suspicious Mucosa-Associated Lymphoid Tissue Lymphoma in Gastric Biopsy Specimens Obtained during Screening Endoscopy. J Korean Med Sci 2016; 31:1075-81. [PMID: 27366005 PMCID: PMC4900999 DOI: 10.3346/jkms.2016.31.7.1075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 04/05/2016] [Indexed: 12/19/2022] Open
Abstract
It is often difficult to differentiate gastric mucosa-associated lymphoid tissue (MALT) lymphoma from Helicobacter pylori-associated follicular gastritis, and thus, it becomes unclear how to manage these diseases. This study aimed to explore the management strategy for and the long-term outcomes of suspicious gastric MALT lymphoma detected by forceps biopsy during screening upper endoscopy. Between October 2003 and May 2013, consecutive subjects who were diagnosed with suspicious gastric MALT lymphomas by screening endoscopy in a health checkup program in Korea were retrospectively enrolled. Suspicious MALT lymphoma was defined as a Wotherspoon score of 3 or 4 upon pathological evaluation of the biopsy specimen. Of 105,164 subjects who underwent screening endoscopies, 49 patients with suspicious MALT lymphomas who underwent subsequent endoscopy were enrolled. Eight patients received a subsequent endoscopy without H. pylori eradication (subsequent endoscopy only group), and 41 patients received H. pylori eradication first followed by endoscopy (eradication first group). MALT lymphoma development was significantly lower in the eradication first group (2/41, 4.9%) than in the subsequent endoscopy only group (3/8, 37.5%, P = 0.026). Notably, among 35 patients with successful H. pylori eradication, there was only one MALT lymphoma patient (2.9%) in whom complete remission was achieved, and there was no recurrence during a median 45 months of endoscopic follow-up. H. pylori eradication with subsequent endoscopy would be a practical management option for suspicious MALT lymphoma detected in a forceps biopsy specimen obtained during screening upper endoscopy.
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Affiliation(s)
- Hyo-Joon Yang
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seon Hee Lim
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Changhyun Lee
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Ji Min Choi
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jong In Yang
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Su Jin Chung
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Seung Ho Choi
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Jong Pil Im
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Gyun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Sung Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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