Cancer Screening Program Research Articles

Colorectal Cancer Screening Participation and Health Belief Levels of Public Hospital Patients in Türkiye.

Colorectal cancer can be diagnosed early with screening tests; therefore, patients' beliefs regarding colorectal cancer screening are closely related to clinical and pathological disease stages at the time of diagnosis. This study aimed to determine participation in colorectal cancer screening programs and health beliefs related to protection from colorectal cancer among patients aged 40-70years and evaluate factors affecting their participation in such screening programs. This descriptive study was conducted in a state hospital in Türkiye between May 2021 and December 2021 with the participation of 1,016 patients. Study data were collected through face-to-face interviews using a questionnaire consisting of an "Introductory Information Form" and the "Health Belief Model Scale for Prevention of Colorectal Cancer." Signed voluntary consent was obtained from all participants, as well as ethics committee approval and institutional permission from the hospital. The mean age of the participants was 50.12±9.29years, 54% were 40-50years old, 55.5% were female, 87.3% were married, 6.8% had a primary education or below, and 39.3% were employed. The internal consistency was low for the health motivation subscale and relatively high for other subscales of the Health Belief Model Scale for Prevention of Colorectal Cancer.

Multi-center evaluation of the Alinity m HR HPV assay with liquid-based cytology cervical specimens in the United States.

Incorporating molecular testing for human papillomavirus (HPV) into the screening of cervical specimens can improve risk stratification and, in turn, patient management. Infection with a high-risk (HR) HPV genotype is associated with greater risk for persistent infection, viral integration, and progression of cervical neoplasia. Current guidelines consider HPV 16 or HPV 18 clinically actionable with referral to colposcopy; however, 12 Other HR HPV genotypes have been associated with cervical cancer risk, suggesting a benefit of extended genotyping. In this multi-center study, we evaluated the performance of the Alinity m HR HPV assay, which reports HPV 16, 18, and 45 individually and aggregates of HPV 31/33/52/58 and HPV 35/39/51/56/59/66, compared with cobas HPV and Aptima HPV assays, across a variety of cytology result categories. A total of 746 de-identified residual cervical specimens, collected as part of routine cervical cancer screening programs, were tested using Alinity m HR HPV and at least one comparator assay. The overall percent agreement was ≥90.7% for results from the Alinity m HR HPV assay and cobas HPV assays and 90.5% for results from the Alinity m HR HPV and Aptima HPV assay. In patients with any abnormal cytology result, Alinity m identified 78 specimens with non-HPV 16/18 results, underscoring the benefit of detecting additional HR HPV genotypes to guide patient management more accurately. Among specimens with normal cytology, Alinity m detected 14 additional specimens with non-HPV 16/18 genotypes. Extended HR HPV testing can provide additional information to triage patients for appropriate testing and follow-up.IMPORTANCEExtended genotyping for high-risk human papillomavirus (HPV) types enhances diagnostic precision by identifying additional oncogenic HPV types beyond 16 and 18 therefore offering a more nuanced risk profile. This more comprehensive detection may aid in identifying persistent infections that are more likely to progress, thereby supporting future risk-based patient management strategies.

Impact of Deep Learning 3D CT Super-Resolution on AI-Based Pulmonary Nodule Characterization

Background/Objectives: Correct pulmonary nodule volumetry and categorization is paramount for accurate diagnosis in lung cancer screening programs. CT scanners with slice thicknesses of multiple millimetres are still common worldwide, and slice thickness has an adverse effect on the accuracy of the pulmonary nodule volumetry. Methods: We propose a deep learning based super-resolution technique to generate thin-slice CT images from thick-slice CT images. Analysis of the lung nodule volumetry and categorization accuracy was performed using commercially available AI-based lung cancer screening software. Results: The accuracy of pulmonary nodule categorization increased from 72.7 percent to 94.5 percent when thick-slice CT images were converted to generated-thin-slice CT images. Conclusions: Applying the super-resolution-based slice generation on thick-slice CT images prior to automatic nodule evaluation significantly increases the accuracy of pulmonary nodule volumetry and corresponding pulmonary nodule category.

Prioritizing performance and outcome indicators for quality assessment of cancer screening programs in the EU.

A key element in ensuring appropriate balance of harms and benefits in cancer screening is to develop a priority set of performance and outcome indicators to be used in screening data evaluation systems. These indicators need to be equity-focused, aligned to new screening approaches and broad-based to cover possible opportunistic screening, but at the same time as limited as possible. Indicators for breast, colorectal and cervical cancer screening programs were chosen through a consensus building Delphi methodology involving a panel of cancer screening experts. The list of indicators was developed using a multistage process. First, a systematic search was performed along with an extensive grey literature search to identify all potential existing indicators. Next, these indicators were refined by two expert groups, definitions and calculations were agreed upon, redundant indicators removed. A final list of 38 indicators was put forward into a Delphi study. 33 cancer screening experts were invited to take part. The Delphi study consisted of two rounds of an online survey and an online facilitated discussion between the cancer screening experts. 23 indicators were chosen covering 10 predefined indicator categories with detection rate, examination coverage and interval cancer rate deemed most important. Outcome indicators such as crude incidence rate and time from screen to result notification, while ultimately reaching consensus were deemed of less importance. 23 priority indicators cover the entire screening pathway including harms, barriers and inequalities. These indicators have been piloted by the CanScreen-ECIS project.

Behavior Changes for Smokers and Betel Quid Chewers Participating in the Organized Oral Mucosal Screening Between 2010 and 2021 in Taiwan

Objective: To investigate the likelihood of smoking and betel quid chewing behavior changes, as well as the associated factors, among subjects in a nationwide oral cancer screening program in Taiwan, where oral cancer is the fourth leading malignancy in men. Methods: The Taiwanese Oral Cancer Screening Program targets smokers and betel quid chewers over the age of 30. Between 2010 and 2021, 2,578,245 individuals participated in the program at least twice. During each visit, the central data monitoring center collected information on gender, age, education level, smoking and betel quid chewing habits, the quantities consumed, and diagnoses of oral potentially malignant disorders (OPMDs) and oral cancer. A three-state Markov chain exponential regression model was employed to assess the probabilities of behavior change—deterioration, maintenance, or improvement—and the factors influencing these changes. Results: The largest proportion of both smokers and betel quid chewers remained unchanged in the repeated attendees. The smoking cessation transition result was less than 10%, whereas the reduction in dosage exceeded 20%. However, the discontinuation of betel quid chewing was observed in more than 20% of individuals in the low-dose group, and there was also a reduction in dosage of more than 20%. The positive OPMDs caused the progression of the Net Force Progression (NFP) from an initial stage of none, as well as the NFP between low and high doses of both smoking and betel quid chewing. Higher levels of education, residing in urban areas, and receiving screenings in large hospitals help to avoid the progressive NFP between low and high doses of smoking. Additionally, these factors also help to prevent the development of the NFP from an initial stage of none, as well as the progressive NFP between low and high doses of betel quid chewing. Conclusion: Participation in an oral cancer screening program can effectively enhance hazardous oral behaviors, including smoking and betel quid chewing. Although it may not have a substantial effect on smoking cessation, it can decrease the daily consumption of cigarettes. This approach demonstrates encouraging outcomes in encouraging individuals to quit betel quid chewing and decrease their daily consumption. Higher levels of education, urban residency, and receiving screenings at large hospitals all have a good impact on reducing dangerous oral cancer behaviors.

Human Papillomavirus Infection and Cytological Atypia in Female Allogeneic Hematopoietic Stem Cell Transplantation Recipients.

Female recipients of allogeneic hematopoietic stem cell transplantation are at high risk of developing human papillomavirus (HPV)-associated lesions and (pre)cancer. We describe the results of a cervical cancer screening program in these women. From 2010 to 2022, 70 female recipients of allogeneic hematopoietic stem cell transplantation in our institution entered a standardized protocol of gynecological evaluation. HPV testing, Papanicolaou smear, and thorough gynecological examinations were conducted in all the women. The cumulative prevalence of HPV infection was 21.4% (15/70). Ten of 70 women (14.3%) had a positive HPV test result in the first gynecological evaluation and 5 additional women (7.1%) became positive during follow-up. Thirteen women (18.5%) presented cytohistological lesions (3 high-grade lesions and 10 low-grade lesions). Twenty-nine women (41.4%) showed HPV-negative reactive atypical abnormalities related to the conditioning treatment, which closely mimicked HPV-associated lesions, which spontaneously disappeared during follow-up. Gynecological evaluation should be maintained over time, as a significant proportion of these women may become HPV positive during follow-up. Reactive benign, atypical changes related to the treatment, which closely mimic HPV-associated lesions, are a frequent finding in these women. HPV testing is a key tool for the evaluation of these patients, as it allows for identifying women at risk and excluding cytological mimickers.

P0449 qFIT as a predictor of relapse in quiescent Crohn’s disease – initial results from the Stratifying Crohn’s Using Biomarker Assessment (SCUBA) study

Abstract Background The Stratifying Crohn’s Using Biomarker Assessment (SCUBA) study assessed a number of biomarkers (Faecal Calprotectin (FCP), quantitative faecal immunochemical testing (qFIT), C reactive protein (CRP), plasma and faecal zinc) in their ability to predict relapse in quiescent Crohn’s disease (CD). FCP is widely utilised as a surrogate marker in the monitoring of CD but is labour intensive and expensive. Population qFIT testing is established in colorectal cancer screening and is relatively cheap and simple to analyse. qFIT has been shown to predict relapse in ulcerative colitis1. Here we present a comparison of qFIT and FCP at predicting relapse in quiescent luminal CD. Methods A single centre prospective cohort study was performed. Patients with clinically quiescent CD (Harvey Bradshaw Index ≤3) were identified and provided paired, baseline FCP, qFIT and routine biochemical workup. Patients over 50 years were excluded due to overlay with bowel cancer screening programmes as were those with isolated upper GI or perianal disease. Patients were followed up over 1 year or until relapse defined by need for escalation of CD related treatment, steroids, surgery or hospitalisation for CD. Results 274 patients were recruited with 211 returning paired baseline faecal samples. Median age was 34 years (range 18-49) and 108/211 (51.1%) were female. Median HBI at submission was 1 and median FCP, qFIT and CRP was 61µg/g stool, 9 µg Hb/g and 2 mg/l respectively. 42/211 (19.9%) experienced a relapse during follow up. Both FCP and qFIT showed good ability to predict relapse at 1 year, performing comparably, with the area under the receiver operating characteristic curves (AUROC) 0.80 (95% CI 0.74- 0.85) vs 0.75 (95% CI 0.68-0.80)(p=0.28). Combination biomarker use did not significantly improve performance, AUROC 0.82 (95%CI 0.76- 0.87) p=0.34 and p=0.07 respectively. Optimal threshold for prediction of relapse was >180 µg/g stool for FCP (sensitivity 0.69 and specificity 0.85) and >9 µg Hb/g for qFIT (sensitivity 0.65 and specificity 0.82). Utilising these thresholds (figure 1) patients with both FCP and qFIT above threshold had a probability of relapse free survival of 16.7% (95% CI 0.20%-31.6%) at 1 year vs 95.4% (95% CI 91.7%-99.0%, p<.0001) in patients under threshold. In combination, FCP and qFIT had a positive predictive value of 50.1% and negative predictive value (NPV) of 97.6%. Conclusion qFIT performs well and comparably to FCP in predicting relapse in clinically quiescent luminal CD and may be used in preference to FCP being an easier and cheaper test to undertake. When combined at optimal thresholds, qFIT & FCP show significant discriminatory ability in prediction of CD relapse-free survival with an excellent NPV.

P0440 Faecal and plasma zinc as predictors of relapse in quiescent Crohn’s Disease in the Stratifying Crohn’s Using Biomarker Assessment (SCUBA) study

Abstract Background Zinc is an essential trace element playing an important role in immune function, inflammation regulation and intestinal barrier integrity. Deficiency is common in Inflammatory Bowel Disease (IBD). Recent data has shown zinc deficiency is associated with adverse disease specific outcomes in IBD1 and work from our unit has also suggested it a potential predictor of disease course in Crohn’s disease (CD)2. The Stratifying Crohn’s Using Biomarker Assessment (SCUBA) study assessed a number of biomarkers ability to predict relapse in quiescent CD including plasma and faecal zinc. Here we report the performance of these two potential biomarkers. Methods Patients with clinically quiescent CD (Harvey Bradshaw Index ≤3) were recruited prospectively from a single centre over a 2-year period. Faecal calprotectin, quantitative faecal immunochemical test, plasma and faecal zinc were obtained at baseline in addition to routine biochemical work up. Patients over 50 years old were excluded due to overlay with bowel cancer screening programmes as were those with isolated upper gastrointestinal or perianal CD. Patients were followed up for 1 year or until relapse defined by need for escalation of CD related treatment, steroid, surgery or hospitalisation for CD. Results 274 patients were recruited with 216 plasma zinc and 184 faecal zinc samples returned (of which 171 were paired). Median age was 34 years (range 18-49) and123/229 53.7% were female. Median HBI at submission was 1 with median FCP 55µg/g stool and C reactive protein 3mg/l. Median plasma zinc was 11.6 (IQR 10.5-12.6) µmol/L with 54/216 (25.0%) patients deficient at baseline (gender adjusted). Median faecal zinc was 832 (IQR 419-1481) µmol/kg wet weight. 44/229 (19.2%) experienced a relapse during follow up. No association between plasma zinc and faecal zinc was observed (r=0.068, p=0.38). Plasma zinc did not show ability to predict relapse at one year, area under the receiver operating characteristic curve 0.53. Following adjustment for gender, below reference range plasma zinc did not show discriminative value in predicting time to relapse, relative risk (RR) 1.37 (95% CI 0.73-2.56), p=0.33. After adjustment for confounders a RR 0.49 (95% CI 0.21-1.20), p= 0.12 was observed for (log transformed) faecal zinc. Conclusion Previous retrospective studies have reported an association between plasma zinc and time to relapse however this was not observed in our prospective study. Given these finding plasma zinc is unlikely to be of clinical utility with more accurate established biomarkers available. Levels of faecal zinc were noted to be markedly elevated compared to the literature however given the potential for methodological differences further work is required to validate this finding.

Comparing the cost-benefit of breast cancer screening programs in rural and urban areas across four economic zones in China: a Markov modeling analysis

BackgroundThis study assessed the effectiveness and cost-effectiveness of breast cancer screening across rural and urban regions in China’s four economic zones.MethodsUsing a decision-analytic Markov model, we evaluated 5,280 scenarios involving different ages and screening technologies. The model followed individuals from birth through 100 yearly cycles in eight settings. Model parameters, such as incidence, transition rate, attendance and compliance rate, screening accuracy, utility, and mortality, were based on Chinese research and international data. Screening costs were calculated using median medical costs in the respective zones. The main outcome measured was incremental net benefit (INB) and incremental cost-effectiveness ratio (ICER), with sensitivity analyses to assess uncertainty.ResultsUsing a willingness-to-pay threshold of three times the local per capita Gross domestic product (GDP), the recommended strategies varied across regions. However, annual screening of individuals aged 30–70 years with a combination of mammography (MAM) and computed tomography laser mammography (CTL) was the most cost-effective strategy for most regions. The incremental cost-effectiveness ratios (ICERs) of the most cost-effective strategies, compared to no intervention and status quo in China, ranged from US$5,173.31/QALY to US$18,551.27/QALY, and from US$-3,872.28 to US$17,804.59, respectively. Except for the rural central region, where the cost-effective strategy had suboptimal outcomes compared to status quo, the recommended strategies in the other seven regions could prevent 41.12–58.80% and 8.08–35.39% of advanced breast cancer cases, and 18.83–29.27% and 2.71–14.06% of breast cancer deaths, when compared to no screening and status quo, respectively. Sensitivity analysis indicated that the results were robust.ConclusionOur study identified cost-effective breast cancer screening strategies suitable for the rural and urban areas in China’s four major economic zones. These findings highlight the necessity of universal screening and the importance of optimizing strategies based on regional economic development and epidemiological characteristics. These insights are crucial for improving national breast cancer screening policies.

Age at first full-term pregnancy and other reproductive factors are associated with mammographic breast density in postmenopausal women: a study in Flanders, Belgium.

This study evaluated the association between age at first full-term pregnancy (FFTP) and mammographic breast density (MBD) in postmenopausal women. 1,034 women, age 50-69y, were recruited from the Flemish (Belgium) population-based breast cancer screening program. Participants completed a questionnaire on lifestyle and reproductive factors. From mammography we assessed the percentage glandular tissue of the total breast volume (GLAND), the Volumetric Breast Density (VBD), and the BI-RADS density classification. For statistical analysis we used the piecewise linear regression (PLR) model. Average age at FFTP was 26.1 years. Among women with a FFTP >25.7 years, each year increase in FFTP was associated with 1.17% increase in GLAND (95%CI: 0.20% to 2.46%, p = 0.041) and 1.45% increase in VBD (95%CI: 0.18% to 2.75%, p = 0.026). Similarly, the odds of a higher BI-RADS classification increased by 5.0% (95%CI: 0.0% to 11.0%, p = 0.059) for each year increase in FFTP age after 25.7 years. For every year delay in age at menarche, there was a 2.48% higher GLAND (95%CI: 0.43 % to 4.57%, p = 0.017) and 2.45% higher VBD (95%CI: 0.38 % to 4.56%, p = <0.020). Ever use of oral contraceptive resulted in 12.24% lower in GLAND (95%CI: -20.90% to -2.63%, p = 0.014) and 13.48% lower in VBD (95%CI:-22.1% to -3.91%, p = 0.007). MBD is significantly higher when FFTP takes place after 25.7 years. Later age at menarche is associated with higher MBD, while ever use of oral contraceptive was associated with lower MBD at postmenopause.

Interhospital variation in surgical treatment of screen-detected breast cancer in the South of the Netherlands.

The effectiveness of the Dutch breast cancer screening programme depends on the quality of the full trajectory, from the first screening to the final treatment of a screen-detected breast cancer. Interhospital variation in breast cancer treatment has been explored by several studies, however, not specifically in a screen-detected breast cancer population. The current study compares the treatment strategies of women with screen-detected breast cancer between hospitals in the South of the Netherlands. A total of 1450 women with screen-detected breast cancer, who participated in the Dutch screening programme between January 2009 and July 2019, were included in this retrospective analysis of a prospectively obtained database. Breast cancer treatment (i.e. preoperative MRI, neoadjuvant systemic therapy and type and outcomes of surgery) was compared between hospitals using multivariate analysis. Statistically significant interhospital variation was observed in the use of preoperative MRI (range 20.8-35.8%, p<0.001), neoadjuvant systemic therapy (range 4.0-13.3%, p<0.001) and breast conserving surgery (range 70.0-87.1%, p<0.001). These differences persisted after adjustment for case-mix. In patients with invasive breast cancer treated by breast conserving surgery, the mean volume of the resection specimen ranged from 381 to 541ml between hospitals (p<0.001). However, this was not accompanied by significant differences in the percentage of patients with positive resection margins (range 2.9-5.7%, p=0.34). We observed significant interhospital variation in the management of women with screen-detected breast cancer. Quality assurance in screen-detected breast cancer may reduce these differences, but evolving breast cancer care and more personalised approaches should be accounted for.

Strategies for strengthening cervical cancer screening programmes in Gwanda district, Zimbabwe: a qualitative study

BackgroundNumerous studies have been conducted on barriers to cervical cancer screening in low resourced settings. Few have however explored the factors that motivate women to make the decision for screening. This study therefore aimed at identifying strategies that could strengthen the utilisation of screening services, with the goal of informing the development of context for enhancing cervical cancer programmes in Gwanda district, Zimbabwe. The socio-ecological model that implies individual, inter-personal, community, and health system factors as influencers of screening behaviours guided the study.MethodsA cross sectional qualitative design using five focus group discussions with 36 screening-eligible women aged 25–50 years, and 25 in-depth interviews of health providers with varied responsibilities in the screening programme were conducted. Data were analysed thematically with the aid of the Web Atlas.ti software.ResultsKey findings suggest that women’s willingness to be screened, on-going awareness campaigns and an increasing number of screening sites and nurses trained in screening procedures promote the uptake of screening. Concomitantly, awareness and knowledge about cervical cancer screening, male support, and community involvement in planning and implementation of programmes were seen as facilitators to screening, with accessibility of cervical cancer screening services being recognised as the most important.ConclusionsTo exploit on women’s willingness to be screened, delivery of screening services need to be re-engineered through development of strategies for increased and sustained educational programmes and increase of screening facilities. This could effectively address the prevalent barriers and enhance the facilitators for screening uptake.

Migrant women’s perception toward cervical and breast cancer screening in Türkiye: a qualitative analysis

IntroductionThis study aims to investigate the knowledge, attitudes, and behaviors of Syrian migrant women regarding breast and cervical cancer screenings in the Sultanbeyli district of Istanbul.MethodsThe women were recruited from Extended Migrant Health Centre, which is a primary health care institution in Istanbul. In August 2024, face-to-face interviews were conducted using an open-ended, semi-structured question form administered by a nurse experienced in qualitative research. Sociodemographic information, their thoughts on cancer, information on the types of cancers screened and sources of information, their participation in cancer screenings, and their perspectives on cancer screenings were asked.ResultsIn depth interviews were conducted with 40 migrant women. Four main themes and thirteen sub-themes were identified. These themes include “Opinions about the cancers and information about the cancer screenings” “Attitudes about the cancer screening program” “Perspectives on preventive measures against cancers” and “Problems in access to health services”. Women mostly described cancer as a serious, incurable, and fatal disease. Despite this perception, almost half of the participants had not attended cancer screening programs. The majority said they did not undergo screening because they had no symptoms. The other main barriers for participation included lack of knowledge, fear of receiving a negative result, or fear of the procedures involved.ConclusionsBased on this study, migrant women have low level of attendance to breast and cervical cancer screening programs. Besides, they lack adequate information about breast cancer and cervical cancer, the screening protocols and preventive measuremets.

Practices and perspectives of genetic counselors about high-risk pancreatic cancer screening: A cross-sectional survey study.

Surveillance of individuals at high-risk of pancreatic cancer using CAPS criteria and other expert consensus guidelines may result in earlier pancreatic cancer detection in some cases; therefore, clinicians are responsible for appropriately identifying and referring these individuals to appropriate high-risk pancreas cancer screening programs. This study aimed at assessing the perspective, knowledge, and clinical practices of cancer genetic counselors surveyed nationwide towards identification of individuals at high-risk of pancreatic cancer and utilization of high-risk pancreatic cancer screening programs. One hundred and eighty-nine genetic counselors who listed "Cancer" as their specialty on the NSGC website responded to the survey, which consisted of multiple practice-based, knowledge-based, and clinical vignette-based questions. Almost 70% of the genetic counselors surveyed accurately identified when an individual would be considered for high-risk pancreatic cancer screening, when using 2019 CAPS consensus guidelines as a benchmark. Access to high-risk pancreatic cancer screening programs and increased provider comfort in counseling individuals at high-risk of pancreatic cancer were found to be statistically associated in accurate identification of high-risk individuals in three of the clinical vignettes. Additionally, 60% of genetic counselors reported the majority of high-risk individuals accept a referral for pancreatic cancer screening, which shows a high uptake of patients accepting referrals from genetic counselors. Genetic counselors have high accuracy in determining who is eligible for high-risk pancreas screening; thus, they are the ideal providers for initiating referrals to high-risk pancreatic cancer screening programs. Genetic counseling programs and high-risk pancreatic cancer screening programs should establish a close working relationship to optimize the identification and subsequent referrals of high-risk individuals eligible for pancreas cancer screening.

Gender Disparities and Lung Cancer Screening Outcomes Among Individuals Who Have Never Smoked

Lung cancer in individuals who have never smoked (INS) is a growing global concern, with a rapidly increasing incidence and proportion among all lung cancer cases. Particularly in East Asia, opportunistic lung cancer screening (LCS) programs targeting INS have gained popularity. However, the sex-specific outcomes and drawbacks of screening INS remain unexplored, with data predominantly focused on women. To compare LCS outcomes between Asian women and men with no smoking history. This multicenter cohort study was conducted at health checkup centers in South Korea from 2009 to 2021. Participants included individuals aged 50 to 80 years with no smoking history who underwent low-dose computed tomography (LDCT) screening. Data were retrospectively analyzed from November 2023 to June 2024. Opportunistic LDCT screening for lung cancer. Participants were followed up until December 2022 for the outcome of death. Lung cancer diagnosis, diagnostic characteristics, clinical course, and lung cancer-specific deaths (LCSD) were compared between women and men. A total of 21 062 participants (16 133 [76.6%] women and 4929 [23.4%] men) with a mean (SD) age of 59.8 (7.2) years were included. From baseline screening, 176 participants (139 women [0.9%] and 37 men [0.8%]) were diagnosed with lung cancer (screen-detected); 131 of 139 women (94.3%) and 33 of 37 men (89.2%) were diagnosed with stage 0 to I disease, with 133 of 139 women (95.7%) and 36 of 37 men (97.3%) having adenocarcinoma. There were no significant sex-based differences in stage or histologic type distribution. Among the 21 062 screened individuals, LCSD was reported in 8 women and 3 men during a mean (SD) follow-up of 83.8 (41.7) months. Multivariable analyses found no significant association between sex and cumulative hazards of lung cancer diagnosis (adjusted hazard ratio [aHR], 0.90 [95% CI, 0.64-1.26] for men vs women) or LCSD (aHR, 1.06 [95% CI, 0.28-4.00] for men vs women). The estimated 5-year lung cancer-specific survival rate was 97.7% for women and 100% for men with screen-detected lung cancer, showing no significant sex differences. In this cohort study of Asian individuals with no smoking history who underwent LDCT screening, no significant sex-based differences were detected in lung cancer diagnosis, stage distribution, or LCSD. These findings suggest that men and women who have never smoked would experience similar risks of overdiagnosis with little to no benefit when exposed to indiscriminate screening.

Lung cancer screening in India: Preparing for the future using smart tools &amp; biomarkers to identify highest risk individuals

There is a growing burden of lung cancer cases in India, incidence projected to increase from 63,708 cases (2015) to 81,219 cases (2025). The increasing numbers are attributed to smoking (India currently has nearly 100 million adult smokers) and environmental pollution. Most patients present with advanced disease (80-85% are incurable), causing nearly 60,000 annual deaths from lung cancer. Early detection through lung cancer screening (LCS) can result in curative therapies for earlier stages of lung cancer and improved survival. Annual low-dose computerized tomography (LDCT) is the standard method for LCS. Usually, high-risk populations (age&gt;50 yr and &gt;20 pack-years of smoking) are considered for LCS, but even such focused screening may be challenging in resource-limited countries like India. However, developing a smart LCS programme with high yield may be possible by leveraging demographic and genomic data, use of smart tools, and judicious use of blood-based biomarkers. Developing this model over the next several years will facilitate a structured cancer screening programme for populations at the highest risk of lung cancer. In this paper, we discuss the demographics of lung cancer in India and its relation to smoking patterns. Further, we elaborate on the potential applications and challenges of bringing a smart approach to LCS in high-risk populations in India.

The impact of the BreastScreen NSW transition from film to digital mammography, 2002-2016: a linked population health data analysis.

To assess the impact of the transition from film to digital mammography in the Australian national breast cancer screening program. Retrospective linked population health data analysis (New South Wales Central Cancer Registry, BreastScreen NSW); interrupted time series analysis. New South Wales, 2002-2016. Women aged 40 years or older with breast cancer diagnosed during 2002-2017 who had been screened by BreastScreen NSW and for whom complete follow-up information until the end of the recommended re-screening interval was available. Transition from film to digital mammography; 2009 defined as transition year (digital mammography becomes dominant screening modality). Population rates of screen-detected cancer, interval cancer, recalls, and false positive findings. The study cohort comprised 967 573 women; of the 2 741 555 screens, 1 535 184 used film mammography (2002-2010) and 1 206 371 used digital mammography (2006-2016). The screen-detected cancer rate was 4.86 (95% confidence interval [CI], 4.75-4.97) cases per 1000 screens with film mammography and 6.11 (95% CI, 5.97-6.24) cases per 1000 screens with digital mammography (unadjusted difference, 1.24 [95% CI, 1.06-1.41] cases per 1000 screens). The interval cancer rate was 2.56 (95% CI, 2.48-2.64) cases per 1000 screens with film mammography and 2.84 (95% CI, 2.75-2.94) cases per 1000 screens with digital mammography (unadjusted difference, 0.27 [95% CI, 0.15-0.40] cases per 1000 screens). With the transition to digital mammography, the screen-detected cancer rate increased by 0.07 per 1000 screens, the sum of the decline in the invasive cancer rate (-0.21 cases per 1000 screens) and the rise in the ductal carcinoma insitu detection rate (0.28 cases per 1000 screens); during 2009-2015, it increased by 0.18 cases per 1000 screens per year. With the transition to digital mammography, the interval cancer rate increased by 0.75 cases per 1000 screens (invasive cancer: by 0.69 cases per 1000 screens); during 2009-2015, it declined by 0.13 cases per 1000 screens per year. The recall rate increased by 8.02 per 1000 screens and the false positive rate by 7.16 per 1000 screens following the transition; both rates subsequently declined to pre-transition levels. The increased screen-detected cancer rate following the transition to digital mammography was not accompanied by a reduction in interval cancer detection rates.

A new approach for detecting HPV DNA in cervical swabs: comparison of nucleic acid extraction with direct PCR

BackgroundAlmost all cases of cervical cancer are associated with persistent high-risk HPV infection. WHO prioritizes primary HPV testing for cervical cancer screening. Cervical cancer screening programs require the ability to process a large number of samples in a simple and standardized manner and obtain reliable results. The workload, time, and cost associated with the number of samples to be processed encourage the development of alternative methods to the traditional nucleic acid extraction method for population-based screening. In this study, we aimed to compare the performance of a commercial pre-denaturation solution with nucleic acid extraction in HPV DNA detection by PCR in cervical swab samples.MethodsThe study was designed in two phases: an experimental phase and a clinical phase. A total of 1200 cervical swabs were included in the clinical phase of the study. Positive results were obtained in 143 (11.9%) samples by nucleic acid extraction and 137 (11.4%) samples by PharmaDirect. Discordant results were detected in 28 (2.3%) samples.ResultsPharmaDirect provided 88.1% sensitivity compared to nucleic acid extraction. PharmaDirect provided high sensitivity for HPV genotype 16 (92.3%) and relatively limited sensitivity for mixed genotype infections (73.7%).ConclusionThis study demonstrates the potential of an alternative commercial pre-denaturation product that does not require nucleic acid extraction for HPV DNA detection in cervical swab samples. Such approaches may represent a useful alternative for population-based screening studies.Trial registrationNot applicable.

A Scoping Review of 20 Years Breast Cancer Screening Programs in Iran

A Scoping Review of 20 Years Breast Cancer Screening Programs in Iran

Factors Associated with Smoking Cessation of Participants in the National Lung Cancer Screening Program in Korea.

Smoking cessation interventions for participants in lung cancer screening are essential for increasing the effectiveness of screening to reduce lung cancer mortality. This study aimed to investigate the factors that lead to smoking cessation after lung cancer screening. The Korean National Lung Cancer Screening (KNLCS) Satisfaction Survey was conducted from 2021 to 2022 with 1,000 samples per year among participants in KNLCS targets 30 or more pack-year smokers. Factors associated with smoking cessation were analyzed based on the survey. Among 1,525 current smokers in the survey participants, 728 (47.7%) received screening result counseling from physician after screening and showed significantly higher smoking cessation rate than non-counselling participants [OR 2.17, 95% CI 1.27-3.70]. The participants who considered the counseling helpful were more likely to quit smoking [OR 3.53, 95% CI 2.00-6.22] and to reduce smoking amount [OR 2.05, 95% CI 1.54-2.71]. Similarly, those who received physicians' active recommendations to quit smoking were likely to quit smoking [OR 2.20, 95% CI 1.25-3.87] and to decrease smoking amount [OR 1.30, 95% CI 1.00-1.68]. In contrast, participants who had no abnormal findings from screening tended to have no significant change in smoking status despite the physicians' active recommendations to quit smoking. Physicians' active recommendations and effective counseling to quit smoking could be a key factor in increasing smoking cessation among lung cancer screening participants. Further research should be conducted to develop more effective strategies for smoking cessation to participants without abnormal findings in lung cancer screening.