National Screening Research Articles

Biopsychosocial Late Effects After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastases from Colorectal and Appendiceal Cancer: A National Prospective Cohort Study.

Colorectal cancer with peritoneal metastases can be treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Treatment may result in biopsychosocial late effects (LEs). We explored the frequency and severity of the following biopsychosocial LEs: anxiety, depression, fear of cancer recurrence (FCR), insomnia, fatigue, cognitive impairment, and pain, and evaluated their impact on quality of life (QoL). This was a national prospective cohort study screening for LEs during the period January 2021-May 2023. Patients completed the following questionnaires: General Anxiety Disorder-7, Patient Health Questionnaire-9, FCR Inventory-Short Form, Insomnia Severity Index, Functional Assessment of Chronic Illness Therapy-Fatigue, cognitive impairment (six items from the European Organisation for Research and Treatment of Cancer Item Library), and the Rectal Cancer Pain Score. Preregistration was completed at ClinicalTrials.gov (NCT04956107). In total, 99 patients were included. The mean age was 61 years and 57% were women. At 3 months after surgery, the frequent LEs were fatigue (72%), FCR (58%), and pain (48%), and at 12 months after surgery, the frequent LEs were FCR (65%), fatigue (40%), and insomnia (33%). More than half of the patients (54%) reported at least two LEs after 12 months. Patients with moderate-to-severe LEs reported a lower QoL than patients with no/mild LEs. Patients with no/mild LEs had a similar QoL as the Danishnorm population. Biopsychosocial LEs were prevalent. The QoL of patients reporting LEs in the worst severity categories was negatively impacted. Screening and treatment for these LEs should be a focus in cancer survivor follow-up.

Incidence, distribution, disease spectrum, and genetic deficits of congenital heart defects in China: implementation of prenatal ultrasound screening identified 18,171 affected fetuses from 2,452,249 pregnancies

BackgroundCongenital heart defects (CHDs) are the most common birth defects. Assessment of the incidence, distribution, disease spectrum, and genetic deficits of fetal CHDs in China is urgently needed.MethodsA national echocardiography screening program for fetal CHDs was implemented in 92 prenatal screening–diagnostic centers in China.FindingsA total of 18,171 fetal CHD cases were identified from 2,452,249 pregnancies, resulting in 7·4/1,000 as the national incidence rate of fetal CHD. The incidences of fetal CHD in the six geographical regions, the southern, central, eastern, southwestern, northern, and northwestern, were 7·647 (CI: 7·383–7·915), 7·839 (CI: 7·680–8·000), 7·647 (CI: 7·383–7·915), 7·562 (CI: 7·225–7·907), 5·618 (CI: 5·337–5·906), and 4·716 (CI: 4·341–5·108), respectively, per 1,000 pregnancies. Overall, ventricular septal defect was the most common fetal CHD, accounting for 17.04% of screened pregnancies nationwide, and tetralogy of Fallot, the most common anomaly in the major defect of fetal CHD, was the second most common, accounting for 9.72%. A total of 76.24% cases of fetal CHD were found to be an isolated intracardiac single defect. The remaining 23.76% of cases of fetal CHD had multiple heart defects. Among all extracardiac malformations, the central nervous system (CNS) was the most common tissue with extracardiac anomalies associated with CHD, accounting for 22.89% of fetal CHD cases. Chromosomal karyotyping identified trisomy 18 as the most common chromosomal abnormality in fetal CHD. We also documented that CHD-containing syndromes could be identified with a comprehensive approach integrating prenatal ultrasound, MRI, pathological autopsy, and cytogenetics and molecular genetics.ConclusionImplementation of prenatal echocardiography as a practically feasible platform to screen fetal CHD will reduce the financial and emotional burden of CHD, which may facilitate intrauterine and neonatal intervention of CHD.

The association between migraine and Parkinson's disease: a nationwide cohort study.

Clinical studies have suggested an association between migraine and the occurrence of Parkinson's disease (PD). However, it is unknown whether migraine affects PD risk. We aimed to investigate the incidence of PD in patients with migraine and to determine the risk factors affecting the association between migraine and PD incidence. Using the Korean National Health Insurance System database (2002-2019), we enrolled all Koreans aged ≥40 years who participated in the national health screening program in 2009. International Classification of Diseases (10th revision) diagnostic codes and Rare Incurable Diseases System diagnostic codes were used to define patients with migraine (within 12 months of enrollment) and newly diagnosed PD. We included 214,193 patients with migraine and 5,879,711 individuals without migraine. During 9.1 years of follow-up (55,435,626 person-years), 1,973 (0.92%) and 30,664 (0.52%) individuals with and without migraine, respectively, were newly diagnosed with PD. Following covariate adjustment, patients with migraine showed a 1.35-fold higher PD risk than individuals without migraine. The incidence of PD was not significantly different between patients with migraine with aura and those without aura. In males with migraine, underlying dyslipidemia increased the risk of PD (p=0.012). In contrast, among females with migraine, younger age (<65 years) increased the risk of PD (p=0.038). Patients with migraine were more likely to develop PD than individuals without migraine. Preventive management of underlying comorbidities and chronic migraine may affect the incidence of PD in these patients. Future prospective randomized clinical trials are warranted to clarify this association.

Resilience of the Dutch HPV-based cervical screening programme during the COVID-19 pandemic

ObjectivesOrganisation of a screening programme influences programme resilience to a disruption as COVID-19. Due to COVID-19, the Dutch human papillomavirus–based cervical screening programme was temporarily suspended. Afterwards, multiple measures have been taken to catch-up participation. This study aimed to investigate programme resilience by examining the effect of COVID-19 and programme measures taken on participation in cervical screening. Study designObservational cohort study. MethodsData from the national screening registry and Dutch nationwide pathology databank (Palga) were used on invitations and follow-up in 2018/2019 (pre-COVID) and 2020 (COVID). Sending invitations, reminders and self-sampling kits were suspended from March to July 2020. Main outcome measures include distribution of participant characteristics (age, region and screening history), participation rates by age and region, time between invitation and participation (i.e. response time) and self-sampling use per month. ResultsParticipation rate was significantly lower in 2020 (49.8%) compared to 2018/19 (56.8%, P < 0.001), in all ages and regions. Compared to 2018/19, participation rates decreased most in women invited from January to March 2020 (−6.7%, −9.1% and −10.4%, respectively). From August, participation rates started to recover (difference between −0.8% and −2.7%). Median response time was longer in February and March (2020: 143 and 173 days; 2018/19: 53 and 55 days) and comparable from July onwards (median difference 0–6 days). Self-sampling use was higher in 2020 (16.3%) compared to 2018/19 (7.6%). ConclusionsThe pandemic impacted participation rates in the Dutch cervical screening programme, especially of women invited before the programme pause. Implementation of self-sampling in national cervical screening programmes could increase participation rates and could serve as an alternative screening method in times of exceptional health care circumstances, such as a pandemic. Due to the well-organised programme and measures taken to catch-up participation, the impact of COVID-19 on the screening programme remained small.

Performance measures of 8,169,869 examinations in the National Breast Cancer Screening Program in Taiwan, 2004–2020

BackgroundThe benefits of mammographic screening have been shown to include a decrease in mortality due to breast cancer. Taiwan’s Breast Cancer Screening Program is a national screening program that has offered biennial mammographic breast cancer screening for women aged 50–69 years since 2004 and for those aged 45–69 years since 2009, with the implementation of mobile units in 2010. The purpose of this study was to compare the performance results of the program with changes in the previous (2004–2009) and latter (2010–2020) periods.MethodsA cohort of 3,665,078 women who underwent biennial breast cancer mammography screenings from 2004 to 2020 was conducted, and data were obtained from the Health Promotion Administration, Ministry of Health and Welfare of Taiwan. We compared the participation of screened women and survival rates from breast cancer in the earlier and latter periods across national breast cancer screening programs.ResultsAmong 3,665,078 women who underwent 8,169,869 examinations in the study population, the screened population increased from 3.9% in 2004 to 40% in 2019. The mean cancer detection rate was 4.76 and 4.08 cancers per 1000 screening mammograms in the earlier (2004–2009) and latter (2010–2020) periods, respectively. The 10-year survival rate increased from 89.68% in the early period to 97.33% in the latter period. The mean recall rate was 9.90% (95% CI: 9.83–9.97%) in the early period and decreased to 8.15% (95%CI, 8.13–8.17%) in the latter period.ConclusionsThe evolution of breast cancer screening in Taiwan has yielded favorable outcomes by increasing the screening population, increasing the 10-year survival rate, and reducing the recall rate through the participation of young women, the implementation of a mobile unit service and quality assurance program, thereby providing historical evidence to policy makers to plan future needs.

Breast cancer quality of care in Syria: screening, diagnosis, and staging

BackgroundThe Syrian decade-long war has severely affected the healthcare system, including almost vanishing cancer screening practices, war-destroyed medical facilities, and lack of continuous medical education. This study aims to present data on the affected breast cancer screening practices, methods of diagnosis, and stages distribution in Syria.MethodsMedical charts of breast cancer patients treated at Albairouni University Hospital between January 2019 and May 2022 were retrospectively reviewed. Eligible patients were women diagnosed with primary breast cancer. Exclusion criteria included females receiving neoadjuvant chemotherapy and incomplete charts. Data regarding the patient’s age, city of residence, marital status, number of children, smoking habits, method of diagnosis, tumor size (T), lymph nodes (N), and distal metastasis (M) were collected. We used Microsoft Excel and Statistical Package for the Social Sciences (SPSS) to analyze data. Descriptive methodology (frequency [n], percentage) was used.ResultsThe number of charts reviewed was 4,500. The number of remaining charts after applying the exclusion criteria was 2,367. The mean age was 51.8 (SD = 11.3). More than half of the patients (58.3%) came from outside Damascus -where the hospital is located- and its suburbs. Less than 5% of the population detected cancer by screening mammography. Only 32.4% of patients were diagnosed by a biopsy, while surgical procedures (lumpectomy and mastectomy) were used to diagnose 64.8% of the population. At the time of diagnosis, only 8% of patients presented with local-stage disease (stages 0 & I), 73% had a regional disease (stages II & III), and 19% had metastatic breast cancer (stage IV).ConclusionOur retrospective chart review analysis is the first comprehensive review in Syria for female breast cancer patients. We found a significant low percentage of patients diagnosed based on a screening mammogram, much higher surgical biopsies rather than a simple imaging-guided biopsy, and much lower than the national average of early-stage disease. Our alarming findings can serve as the base for future strategies to raise the population’s health awareness, create more serious national screening campaigns, and adopt a multidisciplinary approach to the disease in Syria.

A comprehensive strategy of diabetic retinopathy screening in a public health system: Identifying and overcoming obstacles for implementation

AimsThis study reports the implementation of a diabetic retinopathy (DR) screening program in Aracaju, Brazil, emphasizing the challenges and premature termination. MethodsThe program, a collaboration between local health authorities, national DR screening experts, private clinics, trained retinal imaging technicians, a portable retinal camera with artificial intelligence (AI), telemedicine, and AI-assisted image analysis, was established. Screening occurred at primary care centers, with free specialized treatment for high-risk DR cases. ResultsAfter a public tender, two clinics were selected for screening, and four for secondary management. Initially, diabetic patient attendance at primary care clinics varied considerably, posing a challenge. Nonetheless, the screening continued, with 3,561 patients screened within six months. However, due to complaints and disputes between providers and authorities, the program was prematurely terminated, achieving less than a quarter of the initial screening target. ConclusionsThe DR screening program faced significant challenges, including low adherence and organizational issues at primary care centers. This experience highlights the need to standardize clinical workflows, enhance organization and integration among primary care units, and address cultural factors to improve adherence rates. These insights are valuable for implementing screening programs, particularly in low- and middle-income countries.

Physical activity has a more beneficial effect on the risk of all-cause mortality in patients with metabolic syndrome than in those without

BackgroundIt has not been clarified whether physical activity (PA) has more benefit in terms of health outcomes, including mortality risk, among those with metabolic syndrome (MS) compared to those without. Therefore, the aim of this study is to elucidate whether regular PA has interaction with MS on health outcomes.MethodsParticipants with no underlying cardiovascular diseases who underwent national health screening in 2009 were included. According to the metabolic equivalent (MET)-minutes/week, the amount of PA among the participants was grouped as follows: Group 1 (0 MET-minutes/week), Group 2 (1–499), Group 3 (500–999), Group 4 (1000–1499), and Group 5 (≥ 1500). Multivariable Cox proportional hazard models were applied to evaluate the impacts of the amount of PA on health outcomes among those with and without MS. Health outcomes included all-cause mortality and incident cardiovascular diseases (CVDs).ResultsOf 9,628,109 total participants, 335,970 deaths occurred during a median 8.3-year follow-up. After adjustment for age, sex, smoking status, alcohol consumption, and body mass index, the higher the PA amount was, the lower the risk of all-cause mortality in both those with MS [adjusted hazard ratio (aHR) compared with Group 1, 0.86 (95% CI 0.85, 0.87) in Group 2; 0.82 (95% CI 0.81, 0.83) in Group 3; 0.75 (95% CI 0.74, 0.77) in Group 4; and 0.78 (95% CI 0.76, 0.80) in Group 5; P for trend < 0.001] and those without MS [aHR compared with Group 1, 0.87 (95% CI 0.86, 0.88) in Group 2; 0.84 (95% CI 0.83, 0.85) in Group 3, 0.79 (95% CI 0.78, 0.80) in Group 4, and 0.82 (95% CI 0.81, 0.84) in Group 5; P for trend < 0.001]. The beneficial effects of the amount of PA on all-cause mortality were larger among those with MS than among those without MS in a multiplicative interaction (P for interaction < 0.001). The results were similar in the analysis of the relationship between the PA amount and incident CVD.ConclusionsMore PA was associated with a lower risk of all-cause mortality, which was more prominent in those with MS than in those without MS. Physicians should emphasize more the importance of PA in patients with MS.

ASCEND-Eye: Effects of Omega-3 Fatty Acids on Diabetic Retinopathy

PurposePreclinical studies support a protective role for omega-3 fatty acids (FAs) on diabetic retinopathy (DR), but these observations have not been confirmed in randomized trials. We present randomized evidence for the effects of omega-3 FAs on DR outcomes. Design and ParticipantsA sub-study of the ASCEND (A Study of Cardiovascular Events iN Diabetes) double-blind, randomized, placebo-controlled trial of 1g omega-3 fatty acids (containing 460mg eicosapentaenoic acid and 380mg docosahexaenoic acid) daily for the primary prevention of serious cardiovascular events, in 15,480 UK adults at least 40 years of age, with diabetes. MethodsLinkage to electronic NHS Diabetic Eye Screening Programme records in England and Wales, and confirmation of participant-reported eye events via medical record review. Logrank and stratified logrank methods were used for intention-to-treat analyses of time until the main outcomes of interest. Main Outcome MeasuresThe primary efficacy endpoint was time to the first post-randomization recording of referable disease, a composite of referable retinopathy (R2 or R3a/s) or referable maculopathy (M1) based on the grading criteria defined by the UK National Screening Committee. Secondary and tertiary outcomes included the referable disease outcome stratified by the severity of DR at baseline, any progression in retinopathy grade, and incident diabetic maculopathy. ResultsLinkage data were obtained for 7360 participants (48% of those who were randomized in ASCEND). During their mean follow-up of 6.5 years, 548 [14.8%] had a referable disease event in the omega-3 FAs group, compared to 513 [13.9%] in the placebo group (rate ratio 1.07; 95% confidence interval: 0.95-1.20; P = 0.29). There were no statistically significant between-group differences in the proportion of events for either of the secondary or tertiary outcomes. DiscussionRepresenting the first large-scale, prospective test of its kind, these data exclude any clinically meaningful benefits of 1g daily omega-3 FAs on DR.

Underestimated Cervical Cancer among Women over 65 Years Old: Is It Time to Revise the Screening Target Age Group?

To compare cytological and histological results from women > 64 years old who followed the Brazilian national cervical cancer screening guidelines with those who did not. The present observational retrospective study analyzed 207 abnormal cervical smear results from women > 64 years old in a mid-sized city in Brazil over 14 years. All results were reported according to the Bethesda System. The women were divided into those who followed the screening guidelines and those who did not. Atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion cytology results were found in 128 (62.2%) cases. Of these, 112 (87.5%) had repeated cytology with positive results. The other 79 (38.1%) with abnormal results should have been referred to colposcopy and biopsy. Out of 41 (51.9%) biopsied women, 23 (29.1%) had a confirmed diagnosis of neoplasia or precursor lesion. In contrast, among the 78 (37.7%) biopsied patients, 40 (51.3%) followed the guideline recommendations, with 9 (22.5%) positive biopsies. Of the 38 (48.7%) women who did not follow the guidelines, there were 24 (63.1%) positive results. Women who did not follow the guidelines demonstrated higher chances of cancer and precursor lesions (odds ratio [OR]: 5.904; 95% confidence interval [CI]: 2.188-15.932; p = 0.0002). Women > 64 years old who did not follow the national screening protocol showed significant differences in the frequency of abnormal results and severity of diagnosis compared with those who followed the protocol.

Newborn screening program and advanced therapies as a chance for the youngest patients – based on spinal muscular atrophy (SMA)

Abstract Introduction. Newborn screening programs, commonly conducted, are prophylactic procedures with the aim to detect serious, often lethal diseases in their presymptomatic stage. It should be emphasized that the costs of the program are lower than medical care and treatment costs for sick citizens without diagnosis of these disorders. Every step, starting from receiving the parental consent, taking a dried blood spot sample by the nurses and finally testing was fully prepared and is under the supervision of the Institute of Mother and Child in Warsaw. In March 2022 screening for spinal muscular atrophy (SMA) among all newborns was introduced. This disorder leads to progressive deterioration of motor skills and sometimes even to death. The breakthrough of the SMA therapy was Zolgensma, called the most expensive drug in the world. Currently, this treatment is fully funded for some patients under the national drug program. Aim. The aim is to present issues related to the newborn screening program and advanced SMA therapies. Material and methods. Analysis of scientific studies in the PubMed database and national newborn screening programs. Conclusions. Early implementation of the appropriate treatment gives the chance to improve the quality of life, especially if the earliest detection is provided by newborn screening program.

Association between Anemia and Dementia in Korea older adults: A national cohort study

AbstractBackgroundAs the global elderly population increases, the prevalence of dementia is also increasing. Korea is one of the rapidly aging countries in the world, and 10.33% of elderly people aged 65 and older are receiving treatment for dementia as reported in 2021. Since disease modifying drugs have not yet been developed for dementia, the importance of modifiable risk factors that can lower the risk of dementia is being emphasized, and one of them is anemia in the elderly. We analyze national cohort data of approximately 20 years to disclose the relationship between anemia and dementia in Korean elderly, and suggest that anemia is a modifiable risk factor for dementia needed active intervention.MethodWe analyzed a large population‐based cohort study of aged ³65 years who participated in the national health screening program including blood tests and cognitive function tests from 2007 to 2008 in Korean National Health Insurance Service database 2006‐2020. The risk of AD according to the presence and severity of anemia was evaluated using a multivariable Cox regression model, after adjustments for sex, BMI, HTN, DM, LDL, TG, SCr, GFR and past medical history (depression, HTN, DM, cardiovascular disease, cerebrovascular disease).ResultAs a result of the analysis, dementia occurred in 27.9% of the total subjects (316,881 persons) during the follow‐up period until 2020. Also, dementia occurred in 27.5% of the normal group, but 30.1% of the anemia group. As a result of survival analysis, even after adjusting for sex, there was a statistically significant difference between the presence of anemia and the prevalence of dementia (HR 1.07, 95% CI 1.05‐1.09). In addition, even after adjusting for sex, BMI, HTN, DM, LDL, SCr, GFR, and past medical history, there was a statistically significant association between anemia and dementia (HR 1.05, 95% CI 1.03‐1.07).ConclusionWe reported that the presence of anemia statue and the severity of anemia in the elderly were related to the occurrence of dementia through a national date of Korea. We suggest that anemia is a modifiable risk factor for dementia and requires intensive intervention in the elderly.

Temporal trends in age- and stage-specific incidence of colorectal adenocarcinomas in Germany

BackgroundA national colorectal cancer (CRC) screening programme was launched in 2002 in Germany. A comprehensive evaluation of the programme effectiveness using real-world data is still lacking. In addition, there are regional reports on increasing colorectal cancer incidence in younger populations. Therefore, we aimed to describe and compare the overall, age- and stage-specific incidence trends for colorectal, colon and rectal cancer.MethodsWe used data from seven population-based cancer registries in Germany. We report absolute and relative changes in incidence rates between the early screening phase (2003–2005) and the most recent time period available (2015–2017), as well as annual percent changes. We analysed incidences according to tumour site (colorectum, colon, and rectum) and to six age groups (young adults: 15–34, 35–39, 40–49, screening-entitled/older adults: 50–54, 55–69 and 70 + years old).ResultsIn our sample of 271,011 colorectal adenocarcinomas, about two-thirds were located in the colon and 95% of them occurred in the age group 50+ (50–54: 5%, 55–69: 32.8%, 70+: 57.2%). For the time period 2003–2005 the age-specific incidence rates of individuals in the age group 55–69 were about 76/100,00 for colon and 54/100,000 for rectal cancer (age group 70 + colon: 179/100,000; rectum: 84/100,000). The incidence rates in young adults were less than 13% of that of individuals in the age group 55–69 (< 5% of individuals aged 70+; <33% of individuals aged 50–54).Over time, incidence decreased in individuals at the age of 55+, for all subsites considered as well as for early and late stage cancers (with few exceptions), while incidence of young adult CRC (both early and late stage) increased steepest in the youngest age groups. For late stage rectal cancer, a shift was observed in all age groups from UICC stage IV to stage III being the most frequent stage.ConclusionsSix years after the introduction of the national colonoscopy screening program, late stage CRC incidence began to decline substantially in the screening-eligible age groups (55-69, 70+). It is likely that this decline and the increase in early stage CRC observed in younger age groups can be attributed to the program. Long lasting public awareness campaigns for CRC screening might have led to opportunistic screening in younger adults. Whether these benefits outweigh the possible harm of screening in younger age groups remains unclear.

Improving Diabetes Screening in the Primary Care Clinic.

In our suburban primary care clinic, the average rate of screening for diabetes among eligible patients was only 51%, similar to national screening data. We conducted a quality improvement project to increase this rate. During the 6-month preintervention phase, we collected baseline data on the percentage of eligible patients screened per week (percentage of patients with hemoglobin A1c checked in the prior 3 years out of patients eligible for screening who completed a visit during the week). We then implemented a two-phase intervention. In phase 1 (approximately 8 months), we generated an electronic health record (EHR) report to identify eligible patients and pended laboratory orders for physicians to sign. In phase 2 (approximately 3 months), we replaced the phase 1 intervention with an EHR clinical decision support tool that automatically identifies eligible patients. We compared screening rates in the preintervention vs. intervention period. For phase 1, we also assessed laboratory completion rates and the laboratory results. We surveyed physicians regarding intervention acceptability and satisfaction at 3, 6, 9, and 12 months during the intervention period. The weekly percentage of patients screened increased from an average of 51% in the preintervention phase to 65% in the intervention phase (p < 0.001). During phase 1, most patients underwent laboratory blood testing as recommended (83% within 3 months), and results were consistent with prediabetes in 23% and with diabetes in 4%. Overall, most physicians believed that the intervention appropriately identified patients due for screening and was helpful (100% of respondents agreed at 9 months vs. 71% at 3 months). We successfully implemented a systematic screening intervention involving a manual workflow and EHR tool and improved diabetes screening rates in our clinic.

Colorectal Cancer and Precursor Lesion Prevalence in Adults Younger Than 50 Years Without Symptoms

Incidence of colorectal cancer (CRC) is increasing among younger adults. However, data on precursor lesions in patients who are asymptomatic, especially those aged younger than 50 years, are lacking. To analyze the prevalence and number needed to screen (NNS) for adenomas, advanced adenomas, and serrated lesions, as well as the incidence of CRC in patients older than age 20 years. This cohort study was conducted among 296 170 patients who received a screening colonoscopy within a national screening colonoscopy registry from 2012 to 2018 in Austria, including 11 103 patients aged younger than 50 years. CRC incidence was analyzed using data from Statistic Austria from 1988 to 2018. Data were analyzed in September 2021. The prevalence of adenomas and other lesions and the incidence of CRC in individuals aged 20 years or older were assessed. Among 296 170 patients included in the study (median [IQR] age, 60 [54-68] years; 150 813 females [50.9%]), 11 103 patients (3.7%) were aged younger than 50 years and 285 067 patients (96.3%) were aged 50 years or older. Among patients younger than age 50 years, 1166 individuals (10.5%; NNS = 9) had adenomas and 389 individuals (3.9%; NNS = 26) had at least 1 advanced adenoma, while among those aged 50 years or older, 62 384 individuals (21.9%; NNS = 5) had adenomas and 19 680 individuals (6.9%; NNS = 15) had at least 1 advanced adenoma. Among 1128 males aged 40 to 44 years, 160 individuals (14.2%; NNS = 7) had at least 1 adenoma, and among 1398 females aged 40 to 44 years, 114 individuals (8.1%; NNS = 12) had at least 1 adenoma. The prevalence of adenomas for individuals aged 45 to 49 years vs 50 to 54 years was 490 of 2879 males (17.1%; NNS = 6) vs 8269 of 40 935 males (20.2%; NNS = 5) and 284 of 2792 females (10.2%; NNS = 10) vs 4997 of 40 303 females (12.4%; NNS = 8), respectively. Prevalence of adenomas changed from 61 of 498 individuals (12.4%) in 2008 to 150 of 1064 individuals (14.1%) in 2018 among those younger than 50 years and from 2646 of 12 166 individuals (21.8%) to 10 673 of 37 922 individuals (28.2%) among those aged 50 years and older. The prevalence of advanced adenomas changed from 20 individuals (4.0%) in 2008 to 55 individuals (5.2%) in 2018 in individuals younger than 50 years and from 888 individuals (7.3%) in 2008 to 2578 individuals (6.8%) in 2018 among those aged 50 years and older. Among individuals younger than age 50 years, CRC incidence per 100 000 individuals changed from 9.1 incidents in 1988 to 10.2 incidents in 2018 among males (average annual percentage change [AAPC], 0.5%; 95% CI, 0.1% to 1.0%) and from 9.7 incidents in 1988 to 7.7 incidents in 2018 among females, with a nonsignificant AAPC (-0.2%; 95% CI, -0.7% to 0.3%). Among individuals aged 50 years or older, CRC incidence per 100 000 individuals changed from 168 incidents in 1988 to 97 incidents in 2018 among females (AAPC, -1.8%; 95% CI, -1.9% to -1.6%), and 217 incidents in 1988 to 143 incidents in 2018 among males (AAPC, -1.2%; 95% CI, -1.3% to -1.1%). In this study, CRC incidence decreased after 1988 in Austria among individuals older than 50 years, while among patients younger than 50 years, incidence increased among males but decreased among females. Prevalence of adenomas increased in all age groups, while advanced adenoma prevalence increased among patients younger than 50 years but decreased in patients aged 50 years and older.

The landscape of cancer research and cancer care in China.

The rising cancer incidence rate in China poses a substantial public health concern, although there have been remarkable improvements in the country's cancer mortality and survival rates. In this Review, we outline the current landscape and future directions of cancer care and research in China. We discuss national screening programs and strategies for cancer detection and delve into the evolving landscape of cancer care, emphasizing the adoption of multidisciplinary, comprehensive treatment and precision oncology. Additionally, we examine changes in drug research and development policies that have enabled approval of new drugs. Finally, we look to the future, highlighting key priorities and identifying gaps. Effectively addressing challenges and seizing opportunities associated with cancer research in China will enable the development of targeted approaches to alleviate the global burden of cancer.

Abstract C115: Framework for a community-based multiple myeloma screening program

Abstract Purpose: We develop a framework for a community-based screening program for multiple myeloma (MM). MM is known to be twice as common in Black/African American (B/AA) persons compared to white persons and B/AA patients have a higher risk of delay in initial treatment compared to white patients. Therefore, we developed a community-wide screening program for B/AA persons 50 years and older. As the first of these programs, we reveal an organizational framework that prioritizes engagement with key community partners who address barriers to cancer screening. Experimental Procedures: We expand organizational development knowledge about how to implement community-based MM screening and address barriers. The study uses an iterative and qualitative continuous improvement process. The study draws on literature review and multi-disciplinary team collaboration among clinicians, researchers, administrators, and the Cleveland Clinic Community Outreach Program (Cleveland Outreach). Data Summary: Our framework includes three interrelated partners and each address barriers to MM screening: 1) Cleveland Clinic Cancer Center. The multi-disciplinary team designs an educational brochure, secures pilot grant funding, plans for insurance/financial assistance as needed, develops care algorithms, and evaluates the impact of the program. Cleveland Outreach, a department within the Cancer Center, uses the Harold Freeman model as its foundational approach, which includes patient navigators and community outreach managers who are culturally/linguistically matched to medically underserved communities. The Cancer Center addresses barriers including program implementation despite a lack of national screening guidelines, insurance/financial barriers, and patient navigation to address fears and health literacy. 2) Faith-based organizations. Church leaders committed to cancer prevention participate in Cleveland Outreach’s faith-based outreach model. Faith-based partners address barriers of trust and fear. Also, by providing space at churches for on-site screening blood draws, they address transportation barriers. 3) Clinicians at Federally Qualified Health Centers (FQHC’s). Providers and nurses at FQHC’s receive a Continuing Medical Education program about MM screening designed/funded by the Cancer Center. From within the community, providers notify medically underserved patients about the screening. With their primary care patient population, FQHC partners address barriers such as trust, health literacy, and fear of blood draws. They facilitate on-site screening at FQHC’s and health fairs, which addresses transportation barriers. Conclusions: Given that there are no universal guidelines for MM screening, we develop a novel approach to early disease detection in B/AA patients. Our framework is a partnership between the Cancer Center, faith-based organizations, and FQHC’s. Collaboratively, we address barriers to screening including fear, trust, insurance/financial, health literacy, transportation, and patient navigation if abnormal results suggest the need for further testing. Citation Format: Heather McKee Hurwitz, Kimberly Bell, Diana Basali, Raymond D. Jackson II, Jason Valent. Framework for a community-based multiple myeloma screening program [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C115.

Analysis of the Screening Rates and Examination Results of the National Dental Screening for Infants and Children

The purpose of this study was to analyze the screening rates and examination results of the national dental screening program for infants and children since its initiation. Data for this study were obtained from the annual health screening statistical yearbook of the National Health Insurance Service. The investigation focused on the screening rate according to year, age, and region, as well as examination results from 2008 to 2021. The study revealed a general increase in screening rates over the years, with a simultaneous decrease observed as the age of the subjects increased. Regional variations in screening rates were observed, with the highest and lowest rates in Sejong and Jeonbuk, respectively. Analysis of examination results revealed an increasing proportion of subjects requiring treatment as they aged. From 2008 to 2013, less than 15% of subjects aged 18 - 24 and 18 - 29 months required treatment, whereas over 30% required treatment in the remaining age groups. Between 2014 and 2021, the proportion of subjects in the 18 - 29 month age group requiring treatment remained under 15%, but it exceeded 40% in the other age groups. In conclusion, active participation in national dental screening for infants and children is crucial to improving oral health outcomes.

65세 이상 노인의 국가건강검진 수검 여부에 미치는 요인 : 제8기 국민건강영양조사(2019~2021년) 자료를 이용하여

65세 이상 노인의 국가건강검진 수검 여부에 미치는 요인 : 제8기 국민건강영양조사(2019~2021년) 자료를 이용하여

Cervical cancer screening in Doukoula- the far north region of Cameroon

With a morbidity of 600,000 cases and 375,000 lethal cases per year, cervical cancer (CC) is the second most prevalent gynecological cancer all over the world. Because of the absence of a widespread preventative campaign, CC has a significant impact in developing countries. An acceptable, efficient, and cost-effective screening technique in low-income nations is the visual inspection of the cervix with acetic acid and Lugol's iodine. By conducting a CC screening exercise in Doukoula, we hope to ignite the culture of CC screening campaigns in the Kar-Hay health district in the extreme north of Cameroon. Methods: Doukoula District Hospital hosted a one-week CC screening and treatment exercise from the 3rd of November 2021 to the 9th of November 2021. Treatments for dysplastic lesions included thermal coagulation and LEEP. To improve cervix visibility, a MobileODT colposcopic gadget was used. Results: 306 women in all agreed to take part in the study. A screening uptake of 82% was achieved, with 251 of them completing the process. 7 (2.8%) declared being HIV positive. The mean age of this study was 37.33. We had 31 cases of dysplasia (12.75%) and 1 case of cervical cancer (0.4%). Out of 251 participants, only 3 (1.2%) had undergone CC screening, and just one had received an HPV vaccination in the past. Five CIN-1 cases, aged 25 years and below, did not receive any treatment. The 11 cases of CIN 1 aged over 25 years and the 13 CIN 2 cases were eligible for thermotherapy. The two CIN-3 cases had a LEEP, and a sample was taken for pathology analysis. 20 presented themselves for treatment. The total uptake for treatment was 76.72%. Conclusion: Despite growing recognition that cervical cancer is a disease that can be prevented, relatively little is being done to increase vaccine, screening, and treatment rates. While waiting for the development of efficient national screening systems, the use of a “see and treat” screening strategy is a reasonable method of approach for the prevention of CC in low-income countries.