Annual Screening Program Research Articles

Prevalence and causes of visual impairment and blindness among school children in Muzaffarabad, Pakistan

<p class="abstract"><strong>Background:</strong> Vision loss<strong> </strong>in childhood has serious implications in all stages of child’s growth and development. It poses social, educational and occupational challenges, with affected children being at greater risk of developing behavioral, psychological and emotional problems, lower self-esteem and poorer social integration. The aim of this study was to assess the prevalence and identify the causes of visual impairment and blindness in school children of UC Gojra, Muzaffarabad, Pakistan so that prevention strategies could be implemented.</p><p class="abstract"><strong>Methods:</strong> This was a<strong> </strong>school-based descriptive cross-sectional study conducted among public and private schools. A multi-stage stratified random sampling technique was used for selecting study participants aged 5-20 years from 24 schools in Muzaffarabad. The vision of school children was examined for visual acuity using standard Snellen chart. Those participants who had visual acuity of <6/18 in either eye underwent a more detailed ophthalmic examination to diagnose the causes of VI. An exploration of demographic variables was conducted using Chi-square test. </p><p class="abstract"><strong>Results:</strong> The mean age of participants was 10±2.83.<strong> </strong>The prevalence of visual impairment was 19.6% and 2.3% for severe visual impairment. The age group most affected by VI was 11-15 years (74.2%). There were increased chances of developing VI with advancing age of the participants. Males contributed 88.7% of the cases of VI while females contributed only 11.3%. The class category 5-6 had higher percentage of VI cases (32.7%). Public schools contributed 52.8% of the cases of VI while for private schools the corresponding percentage was 47.2%. The leading cause of VI was refractive error (89.3%) followed by amblyopia (5.0%). Other causes of VI included cataract (1.2%), corneal disease (1.8%), strabismus (1.8%) and nystagmus (0.6%).</p><p class="abstract"><strong>Conclusions:</strong> There is a need to implement school health policy on visual screening prior to admissions in schools and annual eye screening program for early detection and prompt treatment of eye problems among school children in Muzaffarabad.</p>

Renal glucosuria in schoolchildren: Clinical characteristics.

We conducted an annual urine glucose screening program at schools, and diagnosed schoolchildren with diabetes at an early stage of the disease. We also identified some cases of renal glucosuria (RG), based on positive urine glucose with normal glucose tolerance. During 2000-2015, 3309631 schoolchildren participated in the screening program. The positive rate for glucosuria in the first test was approximately 0.1%, whereas on repeat urine test it was approximately 0.05%. In total 350 schoolchildren were positive for glucosuria on detailed examination. Oral glucose tolerance test (OGTT) was also used to evaluate glucose intolerance. One hundred and two schoolchildren (29.7%) were diagnosed with diabetes, whereas RG was identified in 246 (70.3%) with normal glucose metabolism. In regard to the characteristics of RG, the percentage of boys was 50.3%, and the mean age at diagnosis was 11.2 ± 2.4years. Twenty-eight children (11.4%) were overweight (body mass index standard deviation score [BMI-SDS] > +2.0 SD), whereas five (2.0%) were underweight (BMI-SDS < -2.0 SD). First-degree family history was suspected in 176 cases (71.5%). All RG subjects had normal glucose tolerance in the absence of insulin resistance and decreased insulin secretion (homeostasis model assessment for β-cell function, 78.8 ± 59.5%) on OGTT. RG is not rare in Japanese schoolchildren with glucosuria. This disorder seems to have a strong genetic background, and to involve less growth retardation and weight loss than expected despite continuous excretion of glucose in urine.

Oral Cancer Awareness And Practice Of Risk Habits And Mouth Self-Examination In High Risk Indigenous Community In Sarawak, Malaysia

Introduction: This study was to obtain baseline information and its associated factors on oral cancer awareness, practice of risk habits and mouth self-examination (MSE) among selected highrisk indigenous community in Sarawak. Materials and Methods: Cross-sectional survey using faceto-face interview was conducted on consented Malaysian, aged ≥15 years old who attended a one day Ministry of Health annual oral cancer screening programme at Bisaya villages in Limbang, Sarawak. Data were analysed using chi-square and multiple logistic regression. Significance level was set at p&lt;0.05. Results: 75.1% of respondents were aware of oral cancer. Smoking was the most recognised risk habits (85.1%). About three-quarter of respondents recognised non-healing ulcer (74.7%) and red/white spot (72.1%) in the mouth as possible early cancer signs. Men had higher prevalence of smoking (85.7%) and drinking (70.8%)(p&lt;0.01), whereas, women had higher percentage of betel quid chewing (62.5%). Low income was significantly associated with smoking and alcohol habits, whereas older age group and lower education level were significantly associated with betel quid chewing. Although 94.8% of respondents agreed that early detection may improve treatment outcome, only 33.8% had heard about MSE. Respondents who ever heard of MSE were 57 times more likely to practice MSE. Conclusion(s): Majority of selected high-risk indigenous community were aware of oral cancer, however awareness of MSE are still lacking. Gender, age, education level and income were significantly associated with health-risk behaviours. Future health promotion agenda should focus in addressing socio-environment gaps, and develop health education intervention based on specific health behaviour theory.

Declining prevalence of cytological squamous intraepithelial lesions of the cervix among women living with well-controlled HIV - Most women living with HIV do not need annual PAP smear screening.

Cervical screening by means of annual Papanicolaou (PAP) smears has been recommended for all women living with HIV. We analysed the results of our annual PAP smear screening program to identify low-risk subgroups for less rigorous screening. The study comprised 369 women followed at the Helsinki University Hospital 2002-2013, with a total of 2033 PAP smear results. We analyzed the temporal changes in PAP smear findings. Logistic regression analysis for binominal dependent variables was used for assessing risk factors for ever having cytological squamous intraepithelial lesions (hereafter referred as SIL) using generalized estimating equations taking into account multiple observations of each patient. Most women had well-controlled HIV, especially towards the end of the study. PAP smear results improved substantially. At the time of each individual's last PAP smear, 90.0% of the findings displayed normal results. Conversely, the rate of SIL decreased from 16.8% to 4.6% from 2002 to 2013. In multivariate analysis the risk of SIL was significantly lower in women with consecutive normal PAP smear findings during the first two years of follow up [odds ratio (OR) 0.21, 95% confidence interval (CI) 0.10-0.45, p<0.001] and with CD4 counts >500cells/μL (OR 0.11, 95% CI 0.05-0.26, p<0.001). Widespread use of combination antiretroviral therapy (cART) and systematic cervical screening has reduced the rate of abnormal PAP smears. It seems feasible to identify low-risk women by combining HIV-related information and PAP smear results. Screening low-risk women living with HIV at three-year intervals similar to HIV-negative women appears justified.

Development and Validation of an Individualized Immune Prognostic Signature in Early-Stage Nonsquamous Non–Small Cell Lung Cancer

The prevalence of early-stage non-small cell lung cancer (NSCLC) is expected to increase with recent implementation of annual screening programs. Reliable prognostic biomarkers are needed to identify patients at a high risk for recurrence to guide adjuvant therapy. To develop a robust, individualized immune signature that can estimate prognosis in patients with early-stage nonsquamous NSCLC. This retrospective study analyzed the gene expression profiles of frozen tumor tissue samples from 19 public NSCLC cohorts, including 18 microarray data sets and 1 RNA-Seq data set for The Cancer Genome Atlas (TCGA) lung adenocarcinoma cohort. Only patients with nonsquamous NSCLC with clinical annotation were included. Samples were from 2414 patients with nonsquamous NSCLC, divided into a meta-training cohort (729 patients), meta-testing cohort (716 patients), and 3 independent validation cohorts (439, 323, and 207 patients). All patients underwent surgery with a negative surgical margin, received no adjuvant or neoadjuvant therapy, and had publicly available gene expression data and survival information. Data were collected from July 22 through September 8, 2016. Overall survival. Of 2414 patients (1205 men [50%], 1111 women [46%], and 98 of unknown sex [4%]; median age [range], 64 [15-90] years), a prognostic immune signature of 25 gene pairs consisting of 40 unique genes was constructed using the meta-training data set. In the meta-testing and validation cohorts, the immune signature significantly stratified patients into high- vs low-risk groups in terms of overall survival across and within subpopulations with stage I, IA, IB, or II disease and remained as an independent prognostic factor in multivariate analyses (hazard ratio range, 1.72 [95% CI, 1.26-2.33; P < .001] to 2.36 [95% CI, 1.47-3.79; P < .001]) after adjusting for clinical and pathologic factors. Several biological processes, including chemotaxis, were enriched among genes in the immune signature. The percentage of neutrophil infiltration (5.6% vs 1.8%) and necrosis (4.6% vs 1.5%) was significantly higher in the high-risk immune group compared with the low-risk groups in TCGA data set (P < .003). The immune signature achieved a higher accuracy (mean concordance index [C-index], 0.64) than 2 commercialized multigene signatures (mean C-index, 0.53 and 0.61) for estimation of survival in comparable validation cohorts. When integrated with clinical characteristics such as age and stage, the composite clinical and immune signature showed improved prognostic accuracy in all validation data sets relative to molecular signatures alone (mean C-index, 0.70 vs 0.63) and another commercialized clinical-molecular signature (mean C-index, 0.68 vs 0.65). The proposed clinical-immune signature is a promising biomarker for estimating overall survival in nonsquamous NSCLC, including early-stage disease. Prospective studies are needed to test the clinical utility of the biomarker in individualized management of nonsquamous NSCLC.

Prevalence of anogenital HPV infection, related disease and risk factors among HIV-infected men in inner-city Johannesburg, South Africa: baseline findings from a cohort study

BackgroundPersistent high-risk human papillomavirus (HR-HPV) infection is associated with the development of anogenital cancers, particularly in men living with HIV (MLWH). We describe the prevalence of anogenital HPV infection, abnormal anal cytology and anogenital warts (AGWs) in MLWH in Johannesburg, and explore whether HPV infection and receipt of antiretroviral treatment is associated with detection of abnormal anal cytology and AGWs.MethodsWe enrolled a cohort of 304 sexually-active MLWH ≥18 years, who completed a questionnaire and physical examination. Genital swabs were collected from all men and intra-anal swabs from 250 (82%). Swabs were tested for HPV DNA and genotypes, and anal smears graded using the Bethesda classification. Factors associated with anogenital disease were assessed by logistic regression models.ResultsTwo thirds were receiving antiretroviral treatment, for a median 33 months (IQR = 15–58) and 54% were HIV-virologically suppressed. Only 5% reported ever having sex with men. Among 283 genital swabs with valid results, 79% had any HPV, 52% had HR-HPV and 27% had >1 HR-HPV infection. By comparison, 39% of the 227 valid intra-anal swabs had detectable HPV, 25% had any HR-HPV and 7% >1 HR infection. While most anal smears were normal (51%), 20% had ASCUS and 29% were LSIL. No cases had HSIL or cancer. Infection with >1 HR type (adjusted OR [aOR] = 2.39; 95%CI = 1.02–5.58) and alpha-9 types (aOR = 3.98; 95%CI = 1.42–11.16) were associated with having abnormal cytology. Prevalence of AGWs was 12%. Infection with any LR type (aOR = 41.28; 95%CI = 13.57–125.62), >1 LR type (aOR = 4.14; 95%CI = 1.60–10.69), being <6 months on antiretroviral treatment (aOR = 6.90; 95%CI = 1.63–29.20) and having a CD4+ count <200 cells/μL (aOR = 5.48; 95%CI: 1.60–18.78) were associated with having AGWs.ConclusionsIn this population, anogenital HR-HPV infection and associated low-grade disease is common, but severe anal dysplasia was not detected. Findings reinforce the need for HPV vaccination in men for preventing both AGWs and HR-HPV infection. Given the absence of anal HSILs, however, the findings do not support the use of anal screening programmes in this population.

Individual external doses below the lowest reference level of 1 mSv per year five years after the 2011 Fukushima nuclear accident among all children in Soma City, Fukushima: A retrospective observational study.

After the 2011 Fukushima Daiichi nuclear power plant accident, little information has been available on individual doses from external exposure among residents living in radioactively contaminated areas near the nuclear plant; in the present study we evaluated yearly changes in the doses from external exposure after the accident and the effects of decontamination on external exposure. This study considered all children less than 16 years of age in Soma City, Fukushima who participated in annual voluntary external exposure screening programs during the five years after the accident (n = 5,363). In total, 14,405 screening results were collected. The median participant age was eight years. The geometric mean levels of annual additional doses from external exposure attributable to the Fukushima accident, decreased each year: 0.60 mSv (range: not detectable (ND)–4.29 mSv), 0.37 mSv (range: ND–3.61 mSv), 0.22 mSv (range: ND–1.44 mSv), 0.20 mSv (range: ND–1.87 mSv), and 0.17 mSv (range: ND–0.85 mSv) in 2011, 2012, 2013, 2014, and 2015, respectively. The proportion of residents with annual additional doses from external exposure of more than 1 mSv dropped from 15.6% in 2011 to zero in 2015. Doses from external exposure decreased more rapidly than those estimated from only physical decay, even in areas without decontamination (which were halved in 395 days from November 15, 2011), presumably due to the weathering effects. While the ratios of geometric mean doses immediately after decontamination to before were slightly lower than those during the same time in areas without decontamination, annual additional doses reduced by decontamination were small (0.04–0.24 mSv in the year of immediately after decontamination was completed). The results of this study showed that the levels of external exposure among Soma residents less than 16 years of age decreased during the five years after the Fukushima Daiichi nuclear power plant accident. Decontamination had only limited and temporal effects on reducing individual external doses.

OA17.02 Potential Health and Economic Consequences of Organized vs Opportunistic Lung Cancer Screening in Canada

Annual LDCT screening for individuals 55-74 yrs with >30 pack-year smoking history is supported by evidence from the NLST but has led to questions of implementation. Compared to organized screening (ORG), opportunistic screening (OPP) may utilize broader entry criteria and not include smoking cessation. Health and economic impacts of ORG using NLST entry criteria were modelled using population microsimulation (OncSim – formerly Canadian Risk Management Model v 2.3) and compared to OPP scenarios. We modeled ORG at a participation rate of 30 and 60%, with and without smoking cessation, compared to various plausible OPP scenarios: younger individuals (40-74 yrs); lesser smoking histories (10 or 20 pack-yrs). Outcomes projected to 20 years included incidence, mortality, number of scans, invasive diagnostics for false positives, and screening and treatment costs. A lifetime horizon and 3% discounting were used to estimate the incremental cost-effectiveness ratio (ICER) from a health system perspective. All costs are in 2016 CAD. A large number of outputs can be presented. At a participation rate of 30%, average annual incremental incident cases of lung cancer with OPP for 40-74 yr-olds with 10 pack-yr histories are higher by 254 over ORG without cessation, and there would be an average 135 fewer deaths annually. However, the annual number of CT scans would increase by 433,000 on average and diagnostic tests for false positive results would increase by 1540. Average annual costs would increase by $141 M compared with ORG without cessation, resulting in an ICER of $133,000/QALY. OPP with 40-74 yr-olds having 20 and 30 pk-yr histories result in $92,147 and 74,978/QALY respectively. In all cases of OPP compared to ORG with cessation there are net losses of QALY. Notably, ORG with smoking cessation compared to ORG without yields an ICER of $2800/QALY. OPP screening results in more incident cases and fewer deaths but more cost from over-diagnosis and false positives. In Canada, an annual screening program with strict adherence to NLST entry criteria could be highly cost-effective. Jurisdictions will have to weigh the benefits and risks of LDCT scanning beyond the currently available evidence.

Cost of diabetic retinopathy and macular oedema in a population, an eight year follow up.

BackgroundProspective, population-based study of an 8-year follow up.To determine the direct cost of diabetic retinopathy [DR], evaluating our screening programme and the cost of treating DR, focusing on diabetic macular oedema [DMO] after anti-vascular endothelial growth factor [anti-VEGF] treatment.MethodsA total of 15,396 diabetes mellitus [DM] patients were studied. We determined the cost-effectiveness of our screening programme against an annual programme by applying the Markov simulation model. We also compared the cost-effectiveness of anti-VEGF treatment to laser treatment for screened patients with DMO.ResultsThe cost of our 2.5-year screening programme was as follows: per patient with any-DR, €482.85 ± 35.14; per sight-threatening diabetic retinopathy [STDR] patient, €1528.26 ± 114.94; and €1826.98 ± 108.26 per DMO patient. Comparatively, an annual screening programme would result in increases as follows: 0.77 in QALY per patient with any-DR and 0.6 and 0.44 per patient with STDR or DMO, respectively, with an incremental cost-effective ratio [ICER] of €1096.88 for any-DR, €4571.2 for STDR and €7443.28 per DMO patient. Regarding diagnosis and treatment, the mean annual total cost per patient with DMO was €777.09 ± 49.45 for the laser treated group and €7153.62 ± 212.15 for the anti-VEGF group, with a QALY gain of 0.21, the yearly mean cost was €7153.62 ± 212.15 per patient, and the ICER was €30,361.ConclusionsScreening for diabetic retinopathy every 2.5 years is cost-effective, but should be adjusted to a patient's personal risk factors. Treatment with anti-VEGF for DMO has increased costs, but the cost-utility increases to 0.21 QALY per patient.

Implementing low-dose computed tomography screening for lung cancer in Canada: implications of alternative at-risk populations, screening frequency, and duration.

Low-dose computed tomography (ldct) screening has been shown to reduce mortality from lung cancer; however, the optimal screening duration and "at risk" population are not known. The Cancer Risk Management Model developed by Statistics Canada for the Canadian Partnership Against Cancer includes a lung screening module based on data from the U.S. National Lung Screening Trial (nlst). The base-case scenario reproduces nlst outcomes with high fidelity. The impact in Canada of annual screening on the number of incident cases and life-years gained, with a wider range of age and smoking history eligibility criteria and varied participation rates, was modelled to show the magnitude of clinical benefit nationally and by province. Life-years gained, costs (discounted and undiscounted), and resource requirements were also estimated. In 2014, 1.4 million Canadians were eligible for screening according to nlst criteria. Over 10 years, screening would detect 12,500 more lung cancers than the expected 268,300 and would gain 9200 life-years. The computed tomography imaging requirement of 24,000-30,000 at program initiation would rise to between 87,000 and 113,000 by the 5th year of an annual nlst-like screening program. Costs would increase from approximately $75 million to $128 million at 10 years, and the cumulative cost nationally over 10 years would approach $1 billion, partially offset by a reduction in the costs of managing advanced lung cancer. Modelling various ways in which ldct might be implemented provides decision-makers with estimates of the effect on clinical benefit and on resource needs that clinical trial results are unable to provide.

An epidemiological study to assess the true incidence and prevalence of rheumatic heart disease and acute rheumatic fever in New Caledonian school children.

To provide in New Caledonian school children (i) the prevalence of rheumatic heart disease (RHD) detected by annual screening program using new World Heart Federation diagnostic criteria; (ii) the point prevalence of acute rheumatic fever (ARF); and (iii) to investigate socio-demographic risk factors associated with RHD. This study linked data from national ARF/RHD programs by combining ARF incidence data from the register with RHD prevalence data from echocardiographic screening data for a single age year of the population for overall point prevalence ARF/RHD rates. For the analysis, cases of echocardiographic detection of RHD are presumed to be synonymous with undiagnosed ARF. All results were weighted to minimise the bias introduced from absent pupils of each annual screening program. Incidence and prevalence were age-standardised to the WHO World Standard Population. Each 2013 cumulative prevalence of definite and borderline RHD was studied using a multivariate logistic regression adjusted for socio-demographic factors. The overall age-standardised incidence of clinical and undiagnosed ARF (i.e. echocardiographic-detected RHD) was combined as point prevalence and estimated to be 99/10 000 cases in 2012 and 114/10 000 cases in 2013. This included 40/10 000 prevalent cases of asymptomatic RHD detected by screening each year. Being Melanesian, OR 23.2 (95% CI: 3.4-157.3), or Polynesian, OR 21.5 (95% CI: 2.9-157.7), was associated with a higher prevalence of having definite RHD compared with being Caucasian. Being a girl was associated with a higher risk of having borderline RHD, OR 1.9 (95% CI: 1.03-3.3). Without echocardiographic screening, ARF/RHD burden is substantially underestimated.

Skin cancer screening in the medically underserved population: A unique opportunity for APNs to make a difference.

To implement and evaluate the feasibility of an annual skin cancer screening program for the medically underserved at a free clinic in Marion, Indiana. Clinical initiative with descriptive analysis of results. IRB approval was obtained and the project was found to be exempted. The participation rate of 65% supported the feasibility of the skin screening program in a free clinic. The skin screening program allowed for detection of 17 worrisome lesions and all of these patients were referred to either the small procedure clinic, general surgeon, or dermatologist for definitive treatment. The project affirmed that clients in this setting are interested in total body skin exams and will participate in the screening program. Furthermore, there were a significant number of worrisome lesions discovered, which underscores the importance of this screening exam and the need for healthcare providers to either perform or refer patients for skin cancer screening on a regular basis. This area of screening is a unique opportunity for advanced practice nurses to make a difference in the medically underserved population who often lack skin cancer screening.

Low ALT blood levels predict long-term all-cause mortality among adults. A historical prospective cohort study

BackgroundIncreased blood levels of alanine amino transferase (ALT, also known as SGPT; serum glutamic pyruvic transaminase) serve as a marker of liver injury by various mechanisms. Less is known about the clinical implications associated with low-normal ALT levels. Previous studies showed low ALT levels to be associated with poor long-term outcomes among elderlies, serving as a biomarker for increased incidence of frailty and subsequent risk of mortality. However, it has not been determined yet whether low-normal ALT values might be predictive of frailty and mortality in younger, middle-aged adults. MethodsWe conducted a historical prospective cohort analysis. ResultsA total of 23,506 adults with ALT levels within the normal range, at the mean age of 48±11years, participating in an annual screening program for preventive medicine, were followed-up for a median period of 8.5years during which 638 died. Low-normal ALT values (serum ALT activity <17IU/L) were found to be predictive for increased risk of all-cause mortality (HR=1.6; 95% CI 1.34–1.92; p<0.001). Statistically significant correlation was demonstrated even after applying a multifactorial model correction for age, gender, eGFR, low albumin, arterial hypertension, diabetes mellitus and ischemic heart disease. ConclusionsWe suggest that low-normal ALT values may serve as an independent predictive marker for increased long-term mortality in middle-aged adults.

Optimal colorectal cancer screening in states' low-income, uninsured populations—the case of South Carolina.

To determine whether, given a limited budget, a state's low-income uninsured population would have greater benefit from a colorectal cancer (CRC) screening program using colonoscopy or fecal immunochemical testing (FIT). South Carolina's low-income, uninsured population. Comparative effectiveness analysis using microsimulation modeling to estimate the number of individuals screened, CRC cases prevented, CRC deaths prevented, and life-years gained from a screening program using colonoscopy versus a program using annual FIT in South Carolina's low-income, uninsured population. This analysis assumed an annual budget of $1 million and a budget availability of 2 years as a base case. The annual FIT screening program resulted in nearly eight times more individuals being screened, and more important, approximately four times as many CRC deaths prevented and life-years gained than the colonoscopy screening program. Our results were robust for assumptions concerning economic perspective and the target population, and they may therefore be generalized to other states and populations. A FIT screening program will prevent more CRC deaths than a colonoscopy-based program when a state's budget for CRC screening supports screening of only a fraction of the target population.

English

INTRODUCTION: For a child, hearing and speech are essential tools of learning, playing and developing social skills. External sound and speech is used by infants and children to learn their communicating skills by imitation. In absence of perception of this external stimulus, they cannot develop speech and language. This results in delayed speech/language development, social problems and academic difficulty. Hearing loss, in varying degrees, affects two in every 100 children under the age of 18. The most effective treatment is achieved through diagnosis, early intervention by fitting suitable hearing aids. An early start on special education programs helps maximize a child's hearing which will give the child best of chances for successful speech and language development. MATERIALS AND METHODS: The study carried out to determine the hearing level, prevalence of loss of hearing and to identify its causes in schools of slums of Kurnool, Andhra Pradesh, India where the population is homogeneous in terms of occupation, socio-economic status, literacy, food habits and health related beliefs and practices. The children were of 5yrs to 15yrs in age. Totally 1041 children constituted the sample frame and underwent clinical examination and audiometry. OBSERVATIONS: Out of 440 students examined for HL 102 were had different causes for HL. 22.5% of children belonged to the age group of 5 to 8 ears. Presence of wax10.2%, ASOM 5.68%, Glue ear 3.4%, CSOM 3.4% were among the common causes. 39.09% children showed a loss of more than 25dB. 66.74% of the causes were preventable and curable at a district level Hospital. CONCLUSION: Analysis showed that 16.3% of these children have low-frequency or high-frequency hearing loss of at least 20dB hearing level in 1 or both ears. Among children in elementary, middle, and high school, audiometric screening should include low-frequency and high-frequency testing to detect hearing loss. As more than 50% of the causes of HL in this group is curable, its difficulties on speech and language might be controlled and treated via appropriate hearing screening protocol and program in every educational setting. The results obtained emphasize annual hearing screening programs for school-age children in order to promote health care and to prevent social and educational problems.

10 Year Experience of a National Breast Screening Programme Following Radiotherapy for Hodgkin Lymphoma in South East Wales

In 2003, the UK Department of Health initiated a recall and breast screening programme for women who received radiotherapy as treatment for HL. Velindre Cancer Centre in SE Wales (population 1.5 million) identified 300 female HL patients treated with RT through a case record search. Of these 100 had received RT to the mediastinum and/or axilla at age < 36 years. 7 patients had already died (3 lymphoma, 1 breast cancer, 1 treatment toxicity, 2 unknown). 83 patients treated with RT between 1968 – 2003 were traced and contacted. 3 patients were alive with breast cancer, and 1 with breast and thyroid cancer. Since 2003, a further 8 have died (5 lymphoma, 3 breast cancer, 2 brain metastases unknown primary, 1 lung cancer, 1 AML and 3 other/unknown). 2 breast cancers have been detected, 1 at the initial recall and 1 on the annual screening programme. The national programme for HL breast screening in Wales is provided by 3 regional centres and at-risk patients are registered on a database at time of RT. Screening starts 8 years after RT or at the age of 25yrs following a consultation with an oncologist for informed consent. Annual MRI is used for patients < 30yrs, and mammography ± MRI between 30 – 50yrs. HL patients are screened in 2 dedicated sessions at the Breast Test Wales (BTW) National Screening Centre in Cardiff, while MRI scans are performed at local hospitals. Standard 3-yearly screening is performed after the age of 50. Results are reviewed at an annual meeting, and a user survey has been very positive, with women finding screening reassuring. 40 patients currently have annual screening, 17 of these with MRI. 1 patient chose to have bilateral mastectomies. 18 patients are in standard 3 yearly screening, and 12 patients have not yet commenced screening. Numbers of patients at risk will fall with evolving treatment strategies, and the risk of breast cancer for treated patients may fall with smaller fields and lower doses. A treatment-risk adapted approach to screening combined with newer low dose mammographic techniques may improve outcomes and cost effectiveness of the programme.

Translation of research results to simple estimates of the likely effect of a lung cancer screening programme in the United Kingdom

Background:There is considerable interest in the possibility of provision of lung cancer screening services in many developed countries. There is, however, no consensus on the target population or optimal screening regimen.Methods:In this paper, we demonstrate the use of published results on lung cancer screening and natural history parameters to estimate the likely effects of annual and biennial screening programmes in different risk populations, in terms of deaths prevented and of human costs, including screening episodes, further investigation rates and overdiagnosis.Results:Annual screening with the UK Lung Screening Study eligibility criteria was estimated to result in 956 lung cancer deaths prevented and 457 overdiagnosed cancers from 330 000 screening episodes. Biennial screening would result in 802 lung cancer deaths prevented and 383 overdiagnosed cancers for 180 000 screening episodes.Interpretation/conclusion:The predictions suggest that the intervention effect could justify the human costs. The evidence base for low-dose CT screening for lung cancer pertains almost entirely to annual screening. The benefit of biennial screening is subject to additional uncertainty but the issue merits further empirical research.

The Place of Skin Cancer Screening in Heart Transplant Recipient Follow-Up Protocols: A Case Series

Objectives For solid organ transplant recipients the risk of skin cancer is markedly increased due to immunosuppression. Many studies propose an annual, or more frequent, skin screening program by a dermatologist. As the number of transplant recipients increases and survival times improve, the need for screening and rapid response (as required) access is increasing. Design In a quality control study we retrospectively examined the medical records of patients participating in an annual screening program between 1997 and 2012. A total of 69 medical records were studied and we here describe the program and present the findings. Results We found malignant melanoma in 3 cases. Cutaneous squamous cell carcinoma occurred in 16 patients and basal cell carcinoma in 12 patients. The most frequent skin lesions were actinic keratoses, reported in 20 patients. Conclusions Incidence rates for all diagnoses were elevated compared to the general population. Awareness of the increased risk for skin malignancies is of importance to those involved in the care of solid organ transplant recipients. Routines for early discovery of skin tumors are needed both in the form of screening, which can also establish risk group status and give preventive education, and as rapid response access for skin lesion diagnosis and treatment.

Abstract C49: A randomized phase II trial of low-dose aspirin versus placebo in high-risk individuals with CT screen-detected subsolid lung nodules

Abstract Lung cancer screening by spiral low-dose CT scan (ld-CT) is a noninvasive test with low radiation exposure and no contrast medium and offers the opportunity to serially examine the peripheral lung for the first time, albeit with the limitation that small lesions cannot be biopsied, leaving their identity unknown. However, the incidence of undetermined nodules detected with ld-CT is more than 50% in high-risk individuals. The nature of these nodules remains uncertain but some of them could represent precancerous lesions. Particularly, ground glass opacities (GGO), compared with solid nodules, can represent localized bronchioloalveolar carcinoma without foci of active fibroblastic proliferation or atypical adenomatous hyperplasia, a putative adenocarcinoma precursor lesion. Two screening programs with annual ld-CT in current and former smokers are run at the EIO and they may represent suitable cohorts of at-risk subjects to be enrolled in a chemopreventive study. Aspirin, the first nonsteroidal anti-inflammatory drug (NSAID) identified, may have anti-cancer properties, especially for diseases whose etiology implicates chronic inflammation including lung cancer. The anti-inflammatory effect of NSAIDs operates through inhibition of prostaglandins via suppression of cyclooxygenase-1 (COX-1) and COX-2. Evidence of this effect is derived from several recently published meta-analyses of aspirin in the prevention of cardiovascular events showing that daily aspirin reduced the incidence of several cancers and reduced metastases. In 2011, Rothwell et al. pooled data from 8 double-blind randomized controlled trials of daily aspirin and analyzed the effect of aspirin on cancer mortality as secondary endpoints. The 20-year risk of death due to all cancers was lower in the aspirin than in the control group and the benefit increased with treatment duration. Lung cancer-specific mortality rates were reduced by 29% (95% CI, 11-42) in the aspirin group in the 20-year period after the trial commenced. No trend with dose (above 75 mg/day) was observed, but the effect on all cancers was more evident in adenocarcinomas and was present in both smokers and nonsmokers. Several further observational studies have been published confirming a lower lung cancer risk in aspirin users. Based on the growing evidence on the potential preventive effect of Aspirin on lung cancer, we will conduct a monoinstitutional, double-blind, placebo-controlled phase IIb study in which 128 participants enrolled in a ld-CT annual screening program will be randomized to receive either low dose Aspirin (100 mg/day) or placebo for 12 month. The primary endpoint will be the shrinkage of GGO and partially solid nodules after one-year treatment in a per-lesion and per-subject analysis. Secondary endpoints will be the modulation of biological markers and their potential correlation with modification of lung nodules shrinkage. In particular, we will evaluate the effect of Aspirin on a signature of serum miRNA correlated to subsolid nodules. Other secondary endpoints will be the evaluation of lung nodule density before and after treatment and the number and size of non-target lesions. Additional circulating biomarkers will include the modulation of hs-CRP as a marker of inflammation, the evaluation of urinary cotinine as marker of tobacco exposure and investigation of the potential effect of aspirin according to its concentration, the measurement of urinary prostaglandin metabolites (PGEM) and urine LTE4. Tolerability of low dose Aspirin will be also evaluated. The study is expected to start by December 2013. Supported by NCI, DCP Contract HHSN261201200034I to the UT MD Anderson Cancer Prevention Agent Development Program: Early Phase Clinical Research Citation Format: Aliana Guerrieri-Gonzaga, Giulia Veronesi, Pier Paolo Di Fiore, Matteo Lazzeroni, Massimo Bellomi, Eva Szabo, Lana A. Vornik, Powel H. Brown, Bernardo Bonanni. A randomized phase II trial of low-dose aspirin versus placebo in high-risk individuals with CT screen-detected subsolid lung nodules. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr C49.

A cost-utility analysis of lung cancer screening and the additional benefits of incorporating smoking cessation interventions.

BackgroundA 2011 report from the National Lung Screening Trial indicates that three annual low-dose computed tomography (LDCT) screenings for lung cancer reduced lung cancer mortality by 20% compared to chest X-ray among older individuals at high risk for lung cancer. Discussion has shifted from clinical proof to financial feasibility. The goal of this study was to determine whether LDCT screening for lung cancer in a commercially-insured population (aged 50–64) at high risk for lung cancer is cost-effective and to quantify the additional benefits of incorporating smoking cessation interventions in a lung cancer screening program.Methods and FindingsThe current study builds upon a previous simulation model to estimate the cost-utility of annual, repeated LDCT screenings over 15 years in a high risk hypothetical cohort of 18 million adults between age 50 and 64 with 30+ pack-years of smoking history. In the base case, the lung cancer screening intervention cost $27.8 billion over 15 years and yielded 985,284 quality-adjusted life years (QALYs) gained for a cost-utility ratio of $28,240 per QALY gained. Adding smoking cessation to these annual screenings resulted in increases in both the costs and QALYs saved, reflected in cost-utility ratios ranging from $16,198 per QALY gained to $23,185 per QALY gained. Annual LDCT lung cancer screening in this high risk population remained cost-effective across all sensitivity analyses.ConclusionsThe findings of this study indicate that repeat annual lung cancer screening in a high risk cohort of adults aged 50–64 is highly cost-effective. Offering smoking cessation interventions with the annual screening program improved the cost-effectiveness of lung cancer screening between 20% and 45%. The cost-utility ratios estimated in this study were in line with other accepted cancer screening interventions and support inclusion of annual LDCT screening for lung cancer in a high risk population in clinical recommendations.