Benefits Of Screening Programs Research Articles

Identifying the main barriers for participation in a population-based colorectal cancer screening programme in East Azerbaijan, Iran.

BackgroundColorectal cancer (CRC) is the third most common cancer and the second leading cause of death worldwide. However, CRC is considered as one of the most preventable cancers by which the mortality rates reduce about 60% through implementing the screening programmes. The present study aimed to evaluate the main barriers of CRC screening in a defined population.MethodHealthy individuals from all regions of the state were invited to participate in different healthcare centres. They were assessed by a provided online risk assessment tool, which was completed for all recruited subjects, and has been developed to assess the CRC risk based on personal and family history of adenoma, CRC, and other high-risk diseases. Research team staff assessed all individuals by this tool and then eligible people according to their lifetime risk of CRC were included in the study. There was not any age restriction in this study. Colonoscopy and three stool-based tests including faecal occult blood test, faecal immunochemical test and stool DNA tests were performed.ResultsOverall, 725 cases including 425 (58.6%) males and 300 (41.4%) females participated in the study. Lack of knowledge and attitude about screening programmes was the most common barrier, especially among women (68% for women versus 58% for men) and those from rural areas (88% in rural versus 55% in urban areas). Fear of colonoscopy and procedure complications and pain (48%), discomfort and anxiety from inserting a tube into the bowel (65% among females versus 43% among males) were reported commonly. Embarrassment and dignity were other complaints, especially in women (62% in females versus 35% in males).ConclusionIncreasing knowledge and attitude about the aims and benefits of screening programmes, acceptable and convenient communication of health systems with the general population are considered to be the key elements in the success and implementation of any screening programme.

Who Detects Skin Cancer? Factors Associated With the Suspicion of Malignancy in Patients With Skin Tumors.

Early diagnosis of skin cancer is associated with a reduction in morbidity/mortality and in treatment costs [1]. The benefits of screening programs (especially for melanoma), however, have not been conclusively demonstrated.

Association of Thyroid Function Test Abnormalities and Thyroid Autoimmunity With Preterm Birth

Maternal hypothyroidism and hyperthyroidism are risk factors for preterm birth. Milder thyroid function test abnormalities and thyroid autoimmunity are more prevalent, but it remains controversial if these are associated with preterm birth. To study if maternal thyroid function test abnormalities and thyroid autoimmunity are risk factors for preterm birth. Studies were identified through a search of the Ovid MEDLINE, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, and Google Scholar databases from inception to March 18, 2018, and by publishing open invitations in relevant journals. Data sets from published and unpublished prospective cohort studies with data on thyroid function tests (thyrotropin [often referred to as thyroid-stimulating hormone or TSH] and free thyroxine [FT4] concentrations) or thyroid peroxidase (TPO) antibody measurements and gestational age at birth were screened for eligibility by 2 independent reviewers. Studies in which participants received treatment based on abnormal thyroid function tests were excluded. The primary authors provided individual participant data that were analyzed using mixed-effects models. The primary outcome was preterm birth (<37 weeks' gestational age). From 2526 published reports, 35 cohorts were invited to participate. After the addition of 5 unpublished data sets, a total of 19 cohorts were included. The study population included 47 045 pregnant women (mean age, 29 years; median gestational age at blood sampling, 12.9 weeks), of whom 1234 (3.1%) had subclinical hypothyroidism (increased thyrotropin concentration with normal FT4 concentration), 904 (2.2%) had isolated hypothyroxinemia (decreased FT4 concentration with normal thyrotropin concentration), and 3043 (7.5%) were TPO antibody positive; 2357 (5.0%) had a preterm birth. The risk of preterm birth was higher for women with subclinical hypothyroidism than euthyroid women (6.1% vs 5.0%, respectively; absolute risk difference, 1.4% [95% CI, 0%-3.2%]; odds ratio [OR], 1.29 [95% CI, 1.01-1.64]). Among women with isolated hypothyroxinemia, the risk of preterm birth was 7.1% vs 5.0% in euthyroid women (absolute risk difference, 2.3% [95% CI, 0.6%-4.5%]; OR, 1.46 [95% CI, 1.12-1.90]). In continuous analyses, each 1-SD higher maternal thyrotropin concentration was associated with a higher risk of preterm birth (absolute risk difference, 0.2% [95% CI, 0%-0.4%] per 1 SD; OR, 1.04 [95% CI, 1.00-1.09] per 1 SD). Thyroid peroxidase antibody-positive women had a higher risk of preterm birth vs TPO antibody-negative women (6.6% vs 4.9%, respectively; absolute risk difference, 1.6% [95% CI, 0.7%-2.8%]; OR, 1.33 [95% CI, 1.15-1.56]). Among pregnant women without overt thyroid disease, subclinical hypothyroidism, isolated hypothyroxinemia, and TPO antibody positivity were significantly associated with higher risk of preterm birth. These results provide insights toward optimizing clinical decision-making strategies that should consider the potential harms and benefits of screening programs and levothyroxine treatment during pregnancy.

Whom to screen? A view on lung cancer screening from the pneumologist’s perspective

The benefits of screening programs are highly dependent on risk group definition. This is especially true for lung cancer screening. Results from the National Lung Cancer Screening Trial (NLST) and the NELSON trial (Dutch/Belgian randomised lung cancer screening trial) demonstrated that lung cancer screening using low-dose CT scans results in reduction of cancer-related mortality. This article gives a short overview on participant selection in the NLST and NELSON trials, and on current evidence for implementation of multivariable risk prediction models.

Cancer screening: inequalities ... in the data

Palencia et al were rightly concerned by inequalities in the use of cancer screening in 2002.(1) The discussion rightly began by an analysis of the strengths and weakness of the study but I am concerned by two points. The validity of the data could have been discussed, at least for France. For France, the prevalence of breast cancer screening can hardly be found in peer-reviewed journals but data exists.(http://www.invs.sante.fr/presse/2010/communiques/depistage_cancer_sein_060410/index.html) The French organized breast cancer screening programme achieved national coverage in 2004. Acceptance rate for this organized program increased from 40.2 % in 2004 49.3 % in 2006 and 52.5 % in 2008 which are far lower than the 79.4 cited by Palencia et al. Even in 2008 and 2009 only one territory, out a hundred, reached the 70% level (Haute-Vienne), whereas at the opposite Paris has the lowest rate (28.2 %). The second point is the relevance of the definition of screening prevalence (ie. mammography use in the previous 3years.). The benefit of screening programs is evidenced from randomized trials with durations reaching a decade. Evaluating the prevalence of screening by a cross-sectional analysis is misleading: it overestimates the quality of the programs and therefore the potential benefits. Last but not least, the publication in 2010 of raw data from 2002 underlines the urgent need for an European Cancer Observatory with adequate funding.(http://eu-cancer.iarc.fr/7-about-eco.html) This observatory muts allow to benchmark for reducing inequalities in cancer care among European countries.

Counseling and care: A Breast Cancer Awareness Training to improve participation and adherence to screening recommendations in women with a family history of breast cancer

1530 Background: BRCA1 or BRCA2 mutation carriers are at an increased lifetime risk to develop breast and ovarian cancer. In a substantial number of families with affected members the known susceptibility genes cannot be identified. According to the recommendations of the German Consortium for Hereditary Breast and Ovarian Cancer, women with a hereditary predisposition for breast cancer should participate at an intensified surveillance program (ISP) including genetic counseling, risk estimation, BSE, CBE, BreastUS, MX, and MRI. Nonadherence might be influenced by cancer worryness, anxiety, health beliefs, and a lack of information about screening benefits.The aim of this investigation was to evaluate the impact of an indivualized Breast Cancer Awareness Training to improve the participation and adherence towards an ISP. Methods: Since 2005, an at-risk sample of 46 non-participating women (mean age 29 y; range 19–43 y) got an intensive breast cancer awareness training, including structured BSE, specific information about regular follow-up, screening advice, and radiological diagnostic procedures. To establish invidualized counseling and training particular needs (e.g., reasons for non-adherence, health beliefs and behaviours), risk perception, anxiety, and sociodemographic factors were evaluated by interviews and self-report questionnaires. The control group consisted of 38 participants of the ISP. Results: Breast cancer worry, anxiety, and lack of information about the benefits of screening programs were the main reasons for non-adherence. Within 3 months after the base counseling participation rates in MX (&gt;30J), BUS, MRI, and CBE reached 98%. The numbers remain consistent in a 2-year follow up. 80% of participants practice BSE monthly, and 46% reported changes in lifestyle regarding nutrition, obesity, and health beliefs. Conclusions: Our approach emphasizes importance of self confidence and awareness for participation at the ISP for women at high breast cancer risk. Individualized counseling, BSE, re-evaluation, and reinforcement sessions are correlated with changes in health beliefs and behaviours for enhancing participation and adherence in women with a family history of breast cancer. No significant financial relationships to disclose.

Screening for chronic kidney disease: where does Europe go?

This review discusses various screening approaches for chronic kidney disease that are used in Europe. The criterion for defining chronic kidney disease in the various programs differs but is frequently limited to estimated glomerular filtration rate, thus offering only data on chronic kidney disease stages 3 and higher; however, screening should not be limited to measuring only estimated glomerular filtration rate but should also include a measure of microalbuminuria, because this will offer identification of chronic kidney disease stages 1 and 2. Defining these earlier stages is of importance because the risk for developing end-stage renal disease that is associated with stages 1 and 2 is nearly equal to the risk that is associated with stage 3. Moreover, the risk for cardiovascular events in stages 1 and 2 is equal to that in stage 3. Various reports argue that costs of screening programs in general practitioner or outpatient offices are high and that they are cost-effective only for preventing end-stage renal disease when they are limited to target groups, such as patients with diabetes or hypertension and elderly. The benefits of screening programs, however, should not be evaluated only with respect to the prevention of renal events but should also include the benefits of preventing cardiovascular events. The use of preselection based on either an impaired estimated glomerular filtration rate or on protein-dipstick positivity or elevated albuminuria in a morning urine void has been found effective in various European countries as an alternative for targeted screening.

Tuberculin Skin Testing in Children

In 1996, the American Academy of Pediatrics (AAP) recommended targeted tuberculin skin testing (TST) of children while discouraging routine TST of children without risk factors for tuberculosis (TB). Recent studies have provided evidence in support of the targeted TST and recommendations that favor risk assessment over universal screening with TST. While evidence for targeted TB testing exists and benefits of screening programs are clear, administrative logistics could be a greater issue. The challenge for public health and school officials is to develop a screening program that avoids stigmatization of the at-risk group. Until then, pediatric healthcare providers will continue to have a key role in identifying children at risk for latent TB infection by using the AAP-endorsed risk-assessment questionnaire and should screen children with TST only when >1 risk factor is present.

The effect of medical experience on the economic evaluation of health policies. A discrete choice experiment

In this paper we present results on the effect of medical experience on the economic evaluation of health policies utilizing the method of discrete choice experiments. Subjects in two split samples were asked about choice situations involving alternative profiles defined by the attributes of an innovative program for cervical cancer screening. The first sample was formed by expert medical practitioners who were familiar with the illness and its potential treatments. A second sample was formed by young undergraduate students in social sciences who were not familiar with the illness or with the potential benefits of screening programmes. The statistical comparison between both subsamples utilizes a robust method for discrete choice models which shows that there are no significant differences in the structural models and the parameter estimates. The main implication is that background medical information and familiarity with the process of illness might not have a relevant impact on the valuation of health policies with discrete choice experiments.

Computational methods in medical decision making: to screen or not to screen?

Screening for a disease such as cancer is often regarded as a beneficial and successful strategy for reducing mortality. However, as with any clinical treatment or intervention, benefit cannot be assumed, and screening can entail both costs and harms, so the screening as a 'treatment' must undergo evaluation. An evaluation requires a definition of the treatment 'benefit', design of studies to measure that benefit with as little bias and variance as possible, and the development of methods for estimating the potential benefit. In screening studies, the factors most central to the evaluation are unobservable (e.g. earliest point in time at which disease becomes detectable, or 'preclinical'; time at which disease might have been detected in the absence of screening; test sensitivity). Thus, screening programs should be evaluated on scenarios in which these factors are varied, to ensure the robustness of the estimated benefit under a variety of circumstances. This article describes the importance of computational methods and simulations to assess the benefit of screening programs, particularly for cancer, based on randomized screening trials, with special attention to benefit time, lead time, and bias due to length-biased sampling.

The impact of mammographic screening on breast cancer mortality: overview of the evidence so far

Controversy remains over the scale of benefit women can expect from attending mammographic screening programs. We review the evidence, presenting (1) an updated meta-analysis of the latest results from the randomised trials and (2) an overview of the non-randomised evidence. After eight randomised trials with 12–20 years follow-up, the pooled results show a significant 20% (95% confidence interval [CI]: 14%, 27%) reduction in breast cancer mortality associated with invitation to screening. When stratified by age, the reductions were 15% (95% CI: 2%, 27%) for women aged under 50 and 22% (95% CI: 14%, 30%) for women aged 50–74. The search strategy for nonrandomised evidence relating to mortality yielded 12 descriptive studies, seven case-series, six case–control, eight cohort and three nonrandomised comparative studies. All indicated some benefit associated with screening. Overall, the case–control studies indicated a 35% (95% CI: 20%, 48%) reduction in breast cancer mortality associated with screening. The corresponding reduction for cohort studies was 44% (95% CI: 39%, 48%) for screening and 31% (95% CI: 21%, 40%) for invitation. The majority of evidence from randomised and nonrandomised sources demonstrates a reduction in breast cancer mortality with screening. Studies should continue to monitor the benefit of screening programmes, taking care to address potential forms of bias.

Celiac disease and insulin-dependent diabetes mellitus. Screening in an adult population.

We screened for celiac disease, by means of IgA class anti-endomysium antibodies (EmA), 383 consecutive adults with insulin-dependent diabetes mellitus (IDDM). Two control populations entered the study as well: 151 adults with biopsy proven celiac disease, as true positives; and 520 controls (healthy and diseased) as true negatives. IgA-EmA positivity was found in 145 of 151 (96%) celiac disease patients but in none of the controls (100% specificity). EmA were positive in 12 of 383 (3.13%) IDDM patients: 10 of these positives underwent intestinal biopsy, which showed either partial or total villous atrophy. Only one patient presented with gastrointestinal complaints, but severe iron deficiency was found in all. The IDDM celiac patients were started on a gluten-free diet: four refused both the diet and the follow-up protocol. Approximately one year after gluten withdrawal no significant change in the degree of diabetes control was observed, while an increased requirement for insulin was observed in three of four patients who strictly complied with the diet. The prevalence of biopsy-proven celiac disease among adult IDDM patients (1:38), eight times higher than that recently estimated for the general Italian population and the absence, except in one case, of gastrointestinal symptoms emphasizes the benefit of screening programs on populations at risk.

Public policy implications of human genetic technology: genetic screening.

As rapid advances in human genetic research are transferred into new areas of genetic technology, questions relating to the use of these techniques will escalate. This paper examines some of the policy concerns surrounding recent developments in genetic screening. It discusses the impetus and implications of genetic screening in general, examines various applications, and analyzes the costs and benefits of screening programs currently in existence. Special emphasis is placed on whether or not screening should be considered a matter of public health and mandated on those grounds. This paper argues against any compulsory screening programs except where the disease is easily identified, applicable across social groups, and treatable. While screening services for carriers of genetic disease and prenatal diagnosis should be made available and education programs should be expanded substantially, the burden of proof for involuntary programs is placed on the proponents. There is little public health justification at this time for mandatory screening though this does not preclude future public health demands. It is argued that the goals and justification of various human genetic technologies must be examined at this time due to the rapid advancement of the research as well as the ultimate benefits promised for humankind.