Evaluation Of Cancer Screening Program Research Articles

Manual on the creation of quality indicators for population based cancer screening programs in Italy

Abstract Issue In many countries the organized screening programs have been in the frontline in developing and implementing the evaluation of the quality of screening and of the entire process of care following a positive test. Over the years, the three Italian Screening Groups (GIS) have separately published indicators and standards concerning the programs for breast, cervical and colorectal cancers they were responsible for, thus hampering coherence, homogeneity. In addition, at local level, an increasing number of indicators have been observed with difficult to monitor all of them. Description of the Problem The Screening Indicators Manual, prepared by a multidisciplinary working group, represents the guidance agreed upon by the Italian Screening Network (ONS) and the three GIS on how to develop, implement, communicate and maintain a set of quality indicators for the evaluation of cancer screening programs. Results The Manual indicates that the three GIS must first constitute, with ONS, the common steering committee made of six-nine experts. The involvement of the public and the management of the conflicts of interests are foreseen. The conceptual framework distinguishes indicators of context, coverage and process. It is based on six dimensions: efficacy, efficiency, security, appropriateness, person centeredness, equity. There are four macro-processes: invitation; test, further assessment and diagnosis; treatment and follow-up; evaluation. The methods include: a survey of the existent indicators, their selection with the Delphi method, the evaluation of the completeness of the resulting indicators set, its integration, when needed, by means of a public call, and finally a new Delphi round. Appropriate standards, empirical or evidence based, are then identified. Last, indicators are assigned to core or library list based on priority. Lessons Select, define and measure an indicator is a way to understand what we are aiming at even more than provide the measure of how we do it. Key messages The creation of the Manual allows to build a coherent evaluation framework for the three screening programs. The Manual promotes the adoption of rigorous methods and make feasible the monitoring activity according to its purpose, level of observation and detail of information needed.

Evaluation of organized cancer screening programs: general aspects and current status in Germany

In the past decades, it has been increasingly recognized that cancer screening is not always or not exclusively beneficial and, in the case of some measures, the negative effects may even outweigh the benefits. This has fundamentally changed the significance and emphasis placed on the evaluation of cancer screening programs. Generally, there is adistinction between an endpoint evaluation, which assesses the effectiveness or risk/benefit ratio, and aprocess evaluation, which aims to ensure optimum implementation of the program.Prior to the nationwide introduction of ascreening measure, proof of effectiveness should ideally be provided by arandomized controlled trial (RCT), in which persons without ascreening offer form the control group. From ascientific point of view, this study design is by far the best method to evaluate the endpoint, as it avoids biases that may distort the results in observational studies. RCT evidence on cancer screening measures currently offered by statutory health insurance providers in Germany - if available at all - originates exclusively from other countries.When mammography screening was introduced as the first organized screening program in Germany, comprehensive measures for process evaluation were taken. In April 2013, the legal basis for the transfer of colorectal and cervical cancer screening into organized programs was created. According to the legal provisions, both aprocess and an endpoint evaluation are planned for the new programs. It remains to be seen how the necessary data flows will be conceptualized and later implemented in practice.

Sociodemographic correlates of cervical cancer screening rates in Calgary, AB: Matched Trend analysis of 2006, 2011 and 2016

IntroductionCervical Cancer Screening (CCS) has reduced the incidence and mortality rates of cervical cancer (CC). However, the benefits are distributed unevenly since 30% of eligible women have not been screened within three years in Alberta. Women who have never been screened or are screened irregularly are most at risk for CC.
 Objectives and ApproachThe aim of this study was to understand who gets CCS and who does not, in Calgary, Alberta and analyze the CC policy implications since 2006-2016. CCS information of women aged 25-69 were obtained from Calgary Laboratory Services for the years 2006, 2011 and 2016 and matched with Canadian Census data. Negative binomial regression and Generalized Estimating Equations were used to test associations of CCS rates with socio-demographic variables for eligible women. CCS spatial trends over the years was studied using the GIS Hotspot analysis.
 ResultsMajor age and geographical variations were observed in CCS rates in Calgary. CCS rates in the recommended age groups varied from 40.6 % to 23.6 %. For age groups between 25 and 54, CCS rates were above 33\%, which implies that many women are having tests more than once every three years. Use was positively associated with median household income, education, Chinese ethnicity and negatively associated with ‘Black’ visible minority status. Women living in lower socio-economic areas of Calgary are screened at lower rates. Hotspot analysis maps revealed heterogeneous testing patterns in the city with relatively higher testing in the downtown, Southeast and Northwest quadrants of the city and relatively decreased CCS in the Northeast quadrant of Calgary
 Conclusion/ImplicationsScreening programs need to be strengthened with greater focus on including specific demographic groups and reducing overuse. Understanding current testing patterns are important in assessing the benefit to harm ratio of CCS and for monitoring and evaluation of CCS program.

Assessing the efficacy of cancer screening

Population-based cancer screening has been established for several types of cancer in Australia and internationally. Screening may perform differently in practice from randomised controlled trials, which makes evaluating programs complex. We discuss how to assess the evidence of benefits and harms of cancer screening, including the main biases that can mislead clinicians and policy makers (such as volunteer, lead-time, length-time and overdiagnosis bias). We also discuss ways in which communication of risks can inform or mislead the community. The evaluation of cancer screening programs should involve balancing the benefits and harms. When considering the overall worth of an intervention and allocation of scarce health resources, decisions should focus on the net benefits and be informed by systematic reviews. Communication of screening outcomes can be misleading. Many messages highlight the benefits while downplaying the harms, and often use relative risks and 5-year survival to persuade people to screen rather than support informed choice. An evidence based approach is essential when evaluating and communicating the benefits and harms of cancer screening, to minimise misleading biases and the reliance on intuition.

Misclassification of microinvasive cervical cancer and carcinoma-in-situ of the cervix

Kavanagh AM, Brown R, Fortune D, Mulvany N, Scurry J, Giles GG. Misclassification of microinvasive cervical cancer and cardnoma- in-situ of the cervix. Int J Gynecol Cancer 1998; 8: 46-50. We estimated the extent of misclassification of microinvasive cervical cancer and carcinoma-in-situ by reviewing the histology of all cases of squamous cell micro invasive disease (N = 61) and a random sample of cases of squamous cell carcinoma-in-situ (N = 35) reported to the Victorian Cancer Registry in 1992. Five cases (3 microinvasive and 2 cardnoma- in-situ) were excluded for technical reasons or because we were unable to obtain the slides for review. Four pathologists reviewed the slides and came to a consensus diagnosis. Eleven cases (19.0%, 95% CI 8.9-29.1) of squamous cell microinvasive cancer had squamous cell carcinoma- in-situ on review and three cases (5.2%, 95% CI 0.0-10.9) were invasive cancer. Two cases (6.1%, 95% CI 0.0-14.1) of carcinoma-in-situ had microinvasive disease on review. Adjusting squamous cell cervical cancer incidence rates for overcalling of squamous cell carcinoma-in-situ as squamous cell microinvasive cancer results in a 5.7% reduction in the age-standardized incidence rate of squamous cell cervical cancer; however, adjusting for both the overcalling of squamous cell carcinoma-insitu and the undercalling of squamous cell microinvasive cancer as squamous cell carcinoma-in-situ results in a 49% increase in the agestandardized incidence rates of squamous cell cervical cancer. Errors in cervical cancer incidence rates hinder the evaluation of cervical cancer screening programs.

Evaluation of the AAD Skin Cancer Screening Program

From 1985 to 1994, dermatologists performed 750,000 free skin cancer screening examinations under the auspices of the American Academy of Dermatology.