Non-screened Group Research Articles

Effectiveness of school-based dental screening in increasing dental care utilization: A systematic review and meta-analysis.

School based dental screening has been a popular public health intervention. However, literature provides contrasting evidence regarding effectiveness of such programs on the utilization of dental services. We designed this review to understand the differences in dental attendance rates of children below 15 years of age, receiving a school based dental screening versus those not receiving it. The standard methodological procedures prescribed by The Cochrane Collaboration for Systematic review and meta-analysis was employed. An electronic (MEDLINE via PUBMED, Cochrane trial registry, and Google scholar) and a manual search (2016) were made to identify studies. Five studies met the inclusion criteria, covering a population of 28208 school children of which 21447 were included in the meta-analysis. The review concludes that school based dental screening marginally increases the dental attendance by 16 percent as opposed to a non-screening group (RR 1.16 (95% CI 1.11, 1.21). The quality of evidence was found to be low. There is evidence of marginally increased dental attendance rate of 16 % following screening. As the quality of evidence was found to be low, the results of this review may be used with caution.

Finding an oral potentially malignant disorder in screening program is related to early diagnosis of oral cavity cancer – Experience from real world evidence

ObjectivesOur study evaluates the effectiveness of the Taiwan Oral Mucosal Screening (TOMS) program in stage-shift among oral cavity cancer patients, and identifies the related factors with early cancer diagnosis. Materials and methodsThis retrospective cohort study used the Taiwan Cancer Registry (TCR), TOMS and Taiwan Death Registry (TDR) databases. We identified oral cavity cancer patients (ICD-C-O: C00-C06) from the TCR during 2012–2015. Patients’ screening history, first screening status and subsequent screenings were analyzed with cancer stages and survival outcomes. ResultsThe 5-year survival rates for stages 0–4 were 83.9%, 82.1%, 72.7%, 60.1% and 38.0%. Among 18,625 patients identified from the TCR, 37% did not have any prior screenings. Patients with prior positive or negative screenings all had better survival rates (3-year: 71.4% and 68.7% vs. 63.5%, Log-rank p-value < 0.0001). The best chance for early-stage diagnosis occurs in oral potentially malignant disorder (OPMD, OR = 1.99, 95% CI = 1.78–2.22, p < 0.0001) patients at their first screenings. The hazard ratios (HR) for patients with prior screenings indicated a significant survival benefit. The group of incomplete diagnosis confirmation also has better survival (HR = 0.78, 95% CI = 0.81–0.93, p < 0.0001), and a greater chance of early diagnosis at subsequent screenings. ConclusionWhile TOMS improved stage-shift for early cancer diagnosis, we found no obvious differences in participants with cancers at screening (stages 0–1: 26.3% vs. 27.8% in non-screening group). Survival benefit and early diagnosis are found in most of screening groups, and identifying an OPMD is particularly essential to early diagnosis of oral cavity cancer patients.

Mortality From Postscreening (Interval) Colorectal Cancers Is Comparable to That From Cancer in Unscreened Patients—A Randomized Sigmoidoscopy Trial

Endoscopic screening for colorectal cancer (CRC) is performed at longer time intervals than the fecal occult blood test or screenings for breast or prostate cancer. This causes concerns about interval cancers, which have been proposed to progress more rapidly. We compared outcomes of patients with interval CRCs after sigmoidoscopy screening vs outcomes of patients with CRC who had not been screened. We performed a secondary analysis of a randomized sigmoidoscopy screening trial in Norway with 98,684 participants (age range, 50-64 years) who were randomly assigned to groups that were (n= 20,552) or were not (n= 78,126) invited for sigmoidoscopy screening from 1999 through 2001; participants were followed up for a median 14.8 years. We compared CRC mortality and all-cause mortality between individuals who underwent screening and were diagnosed with CRC 30 days or longer after screening (interval cancer group, n= 163) and individuals diagnosed with CRC in the nonscreened group (controls, n= 1740). All CRCs in the control group were identified when they developed symptoms (clinically detected CRCs). Analyses were stratified by cancer site. We used Cox regression to estimate hazard ratio (HRs), adjusted for age and sex. Over the follow-up period, 43 individuals in the interval cancer group died from CRC; among controls, 525 died from CRC. CRC mortality (adjusted HR, 0.98; 95% confidence interval, 0.72-1.35; P= .92), rectosigmoid cancer mortality (adjusted HR, 1.10; 95% confidence interval, 0.63-1.92; P= .74), and all-cause mortality (adjusted HR, 0.99; 95% confidence interval, 0.76-1.27; P= .91) did not differ significantly between the interval cancer group and controls. In this randomized sigmoidoscopy screening trial, mortality did not differ significantly between individuals with interval CRCs and unscreened patients with clinically detected CRCs. ClinicalTrials.gov identifier: NCT00119912.

Does School Screening Affect Scoliosis Curve Magnitude at Presentation to a Pediatric Orthopedic Clinic?

BackgroundWith new data supporting the efficacy of bracing, the role of school screening for early detection of moderate scoliosis curves has been revisited. Because of a high rate of false-positive screening and cost concerns, a comprehensive county-wide school screening program was discontinued in 2004. We aim to determine the impact of a comprehensive school screening program on curve magnitude at presentation and initial scoliosis treatment for all local county patients presenting to a pediatric orthopedic clinic from all referral sources. MethodsBetween 1994 and 2014, a total of 761 county patients presented to a pediatric orthopedic clinic for new scoliosis evaluation. Curve magnitude and recommended treatment were recorded. Treatment indications for bracing, surgery, and observation were consistent over the study period. ResultsFrom January 1994 to July 2004 (school screening period), 514 children were seen by a pediatric orthopedic specialist for scoliosis evaluation compared to 247 patients from August 2004 to December 2014 (no school screening). There was a 48% decrease in the number of county children who were evaluated for idiopathic scoliosis by pediatric orthopedics once school screening was discontinued. Mean maximal Cobb angle at presentation increased from 20° (range, 4°–65°) to 23° (range, 7°–57°). At presentation, 5 of 514 (0.97%) patients in the screened group required surgery and 68 of 514 (13.2%) required bracing, compared to 3 of 247 (1.2%) patients in the nonscreened group requiring surgery and 47 of 247 (19%) requiring bracing (p>.05, p=.04, respectively). ConclusionAfter school screening was discontinued, mean curve magnitude and rates of bracing at presentation statistically increased in county patients evaluated for new scoliosis, although the clinical significance is unclear. After school screening was discontinued, there were fewer patient referrals, braces prescribed, and unnecessary evaluations (patients discharged at first visit). This study provides data to evaluate the role of school screening for children with regular access to health care. Level of EvidenceLevel 3.

Is the incidence of advanced-stage breast cancer affected by whether women attend a steady-state screening program?

In this cross-sectional population-based study, we assessed the incidence of advanced breast cancer based on screening attendance. Women from the Netherlands Cancer Registry were included if aged ≥49 years and diagnosed with breast cancer between 2006 and 2011, and data were linked with the screening program. Cancers were defined as screen-related (diagnosed <24 months after screening) or nonscreened (all other breast cancers). Two cut-offs were used to define advanced breast cancer: TNM-stage (III-IV vs 0-I-II) and T-stage alone (≥15 mm vs <15 mm or DCIS). The incidence rates were adjusted for age and logistic regression was used to compare groups. Of the 72,612 included women diagnosed with breast cancer, 44,246 (61%) had screen-related breast cancer. By TNM stage, advanced cancer was almost three times as likely to be at an advanced TNM stage in the nonscreened group compared with the screen-related group (38 and 94 per 100,000, respectively; OR: 2.86, 95%CI: 2.72-3.00). By T-stage, the incidence of advanced cancer was higher overall, and in nonscreened women was significantly higher than in screened women (210 and 169 per 100,000; OR: 1.85, 95%CI: 1.78-1.93). Data on actual screening attendance showed that the incidence of advanced breast cancer was significantly higher in nonscreened women than in screened women, supporting the expectation that screening would cause a stage shift to early detection. Despite critical evaluations of breast cancer screening programs, our data show that breast cancer screening is a valuable tool that can reduce the disease burden in women.

Analysis survival of screening and non-screening patients of esophageal cancer in Linzhou city

Objective: To evaluate effect of screening of esophageal cancer though comparing difference of survival level between screening and non-screening patients in Linzhou city. Methods: The records pathologically diagnosed as serious hyperplasia/carcinoma and esophageal cancer were drawn from database of first round screening in Linzhou city from 2005-2013 and were assigned to the screening group. The records of new esophageal cancer cases which diagnosed within 2 years before, screening from the same village aged from 40 to 69, were drawn from database of cancer registry in Linzhou city and were assigned to the non-screening group. Five or 10 year survival rate with 95%CI of patients with different malignant degree diseases in the screening group and the patients with esophageal cancer in the non-screening group was calculated respectively. The survival curves between the screening and non-screening group were compared by Log rank method. Results: All 26 908 persons were examined in first round screening in Linzhou city from 2005 to 2013. There were 374 persons with serious hyperplasia/carcinoma in situ, 157 persons with esophageal cancer (141 intramucosal carcinomas/submucosal cancers, 16 invasive cancers). The 5 year survival rate of serious hyperplasia/carcinoma, intramucosal carcinoma/submucosal cancer and invasive cancer were 95.0% (95%CI: 91.7%-97.0%) , 72.0% (95%CI: 62.7%-79.3%) and 41.7% (95%CI: 17.4%-64.6%) separately. The 5 year survival rate of esophageal cancer in screening and non-screening group were 68.7% (95%CI:59.9%-75.9%) and 40.8% (95%CI: 36.4%-45.2%). The 10 year survival rate of esophageal cancer in screening and non-screening group were 58.0% (95% CI: 44.6%-69.3%) and 34.3% (95% CI:29.1%-39.5%). The 5 or 10 year survival rate of esophageal cancer in the screening group were higher than that in the non-screening group in whatever sex or age. The survival distribution of the screening group was better than non-screening group (χ(2)=38.88, P<0.001). Conclusion: More precancerous lesions and early esophageal cancer can be detected and patients' survival level was improved through organized esophageal cancer screening, which provided support to evaluate value of organized screening.

Population Screening and Intervention for Vascular Disease in Danish Men (VIVA): A Randomised Controlled Trial

Summary Background Abdominal aortic aneurysm is the only cardiovascular disease targeted by population screening. In this study, we test the effect of screening and subsequent intervention for abdominal aortic aneurysm, peripheral arterial disease, and hypertension combined. Methods In this randomised controlled trial, we randomly allocated (1:1) all men aged 65–74 years living in the Central Denmark Region to screening for abdominal aortic aneurysm, peripheral arterial disease, and hypertension, or to no screening. We based allocation on computer-generated random numbers from 1 to 100 in blocks of 1067 to 4392, stratified by 19 municipalities. Only the non-screening group and the investigator assessing outcomes were masked. We invited participants who were found to have abdominal aortic aneurysm or peripheral arterial disease back for confirmation and eventual initiation of relevant pharmacological therapy. We further offered participants with abdominal aortic aneurysm annual control or surgical repair. We referred participants with suspected hypertension to their general practitioner. The primary outcome was all-cause mortality, assessed 5 years after randomisation, analysed in all randomly allocated participants except for those who had incorrect person identification numbers. This trial is registered at ClinicalTrials.gov, number NCT00662480. Findings Between Oct 8, 2008, and Jan 11, 2011, we randomly allocated 50 156 participants, with 25 078 (50%) each in the screening and non-screening groups. Four ( vs 4129 per 100 000 person-years in the non-screening group), intracerebral haemorrhage (146 vs 140), renal failure (612 vs 649), cancer (3578 vs 3719), or 30 day mortality after cardiovascular surgery (44·57 vs 39·33) did not differ between groups. Interpretation The observed reduction of mortality risk from abdominal aortic aneurysm, peripheral arterial disease, and hypertension has never been seen before in the population screening literature and can be linked primarily to initiation of pharmacological therapy. Health policy makers should consider implementing combined screening whether no screening or isolated abdominal aortic aneurysm screening is currently offered. Funding The 7th European Framework Programme, Central Denmark Region, Viborg Hospital, and the Danish Council for Independent Research.

Population screening and intervention for vascular disease in Danish men (VIVA): a randomised controlled trial

Abdominal aortic aneurysm is the only cardiovascular disease targeted by population screening. In this study, we test the effect of screening and subsequent intervention for abdominal aortic aneurysm, peripheral arterial disease, and hypertension combined. In this randomised controlled trial, we randomly allocated (1:1) all men aged 65-74 years living in the Central Denmark Region to screening for abdominal aortic aneurysm, peripheral arterial disease, and hypertension, or to no screening. We based allocation on computer-generated random numbers from 1 to 100 in blocks of 1067 to 4392, stratified by 19 municipalities. Only the non-screening group and the investigator assessing outcomes were masked. We invited participants who were found to have abdominal aortic aneurysm or peripheral arterial disease back for confirmation and eventual initiation of relevant pharmacological therapy. We further offered participants with abdominal aortic aneurysm annual control or surgical repair. We referred participants with suspected hypertension to their general practitioner. The primary outcome was all-cause mortality, assessed 5 years after randomisation, analysed in all randomly allocated participants except for those who had incorrect person identification numbers. This trial is registered at ClinicalTrials.gov, number NCT00662480. Between Oct 8, 2008, and Jan 11, 2011, we randomly allocated 50 156 participants, with 25 078 (50%) each in the screening and non-screening groups. Four (<1%) participants in the screening group were lost to follow-up. After a median follow-up of 4·4 years (IQR 3·9-4·8), 2566 (10·2%) of 25 074 participants in the screening group and 2715 (10·8%) of 25 078 in the non-screening group had died. This finding resulted in a significant hazard ratio of 0·93 (95% CI 0·88-0·98; p=0·01), an absolute risk reduction of 0·006 (0·001-0·011), and a number needed to invite of 169 (89-1811). Incidences of diabetes (3995 per 100 000 person-years in the screening group vs 4129 per 100 000 person-years in the non-screening group), intracerebral haemorrhage (146 vs 140), renal failure (612 vs 649), cancer (3578 vs 3719), or 30 day mortality after cardiovascular surgery (44·57 vs 39·33) did not differ between groups. The observed reduction of mortality risk from abdominal aortic aneurysm, peripheral arterial disease, and hypertension has never been seen before in the population screening literature and can be linked primarily to initiation of pharmacological therapy. Health policy makers should consider implementing combined screening whether no screening or isolated abdominal aortic aneurysm screening is currently offered. The 7th European Framework Programme, Central Denmark Region, Viborg Hospital, and the Danish Council for Independent Research.

Biosecurity risk factors presented by international vessels: a statistical analysis

Invasive non-indigenous species are among the greatest threats to global biodiversity. Shipping is the principal vector for international dispersal of nonindigenous species, and shipping rates are increasing globally. The Australian government performs a range of regulatory actions to mitigate biosecurity risks associated with marine vessels, and in so doing has amassed a large volume of operational inspection data. This data can be used to quantitatively examine risk factors of vessels failing biosecurity procedures after arriving from international ports, the nature of biosecurity failures, and the types and seizure rates of biosecurity risk material (BRM). Classification trees with gradient boosting were used to assess characteristics that predict high risk vessels (n = 93,006) for carrying BRM, across 7 years of inspection data. Undeclared vessels and suspected irregular entry vessels posed the highest risk, but both were rare. Vessels that visit infrequently (<20 visits in 7 years) were common and had almost three times greater odds of failing inspection than vessels visiting frequently. On statistical analysis, yachts appeared to pose less risk than commercial vessels. In operational terms, a tentative profiled 20% fraction would contain 57% of genuine failures, and the concomitant non-screened group would contain 82% of passes. The most common reason for inspection failures was ballast water non-compliance (2.53%) and plant or insect detections (1.77%); biofouling was less common (0.13%) but testing for biofouling is not exhaustive. Invertebrate species comprised almost 90% of invasive organisms detected and seized from vessels failing biosecurity inspections. This study targets an entire transportation vector, which includes many pathways. Understanding the characteristics of transport vectors is pivotal to characterising the risk of biological invasions and applying adequate controls and prevention strategies. Our results show that biosecurity risk is not uniform on maritime pathways, so there is considerable scope for biosecurity regulators to impose risk-based intervention.

Clinical implications of the 2012 US Preventive Services Task Force (USPSTF) PSA screening recommendation in prostate cancer diagnoses and 5-year survival at a Minnesota safety net health care system.

5051 Background: Prostate specific antigen (PSA) screening for prostate cancer has declined following the USPSTF 2012 recommendation. How screening rates and prostate cancer diagnoses have subsequently changed in a racially diverse patient population is not well defined. In this study, we aim to determine the impact of the USPSTF screening recommendation in the Hennepin Healthcare System (HHS) in the state of Minnesota. Methods: A single-institution retrospective analysis of data from our electronic health record, to identify the characteristics of PSA screening and new prostate cancer diagnoses for men ≥50 years between 2008 and 2015. Data before and after May 2012 were compared. P-values were calculated using binominal and generalized linear models. Results: Nearly 22,000 patients underwent PSA screening from 2008 to 2015. PSA screening rates decreased after May 2012 for the four largest demographics represented (p &lt; 0.001). Hispanics and Blacks were more likely to be screened when compared to Whites and Asians (p &lt; 0.05). 319 cases of prostate cancer were diagnosed from 2008 to 2015 with 87 cases (27.3%) diagnosed by PSA-screening. The number needed to screen to diagnose one patient with prostate cancer at HHS was 137.5, and 9.5% of patients (1146 patients) had a false positive PSA that led to further testing or a biopsy. $56,090 was spent in screening costs per diagnosis of early stage prostate cancer via screening. Patients diagnosed from screening were less likely to present with high Gleason scores (8-10) compared to non-screening diagnosis (8% vs 23.3%, p &lt; 0.01). The 5-year survival percentage (prostate cancer mortality) was improved for those patients diagnosed by PSA screening vs the non-screened group (100% vs 89.3%, p &lt; 0.05). Conclusions: PSA screening has declined at HHS since the USPSTF recommendation against prostate cancer screening. Implementation of PSA screening in our healthcare system is expensive and leads to a high number of false positives. Despite this, the 5-year survival from prostate cancer is significantly higher when patients are diagnosed by PSA screening.

Screening for coeliac disease in type 1 diabetes

In this issue of Acta Paediatrica, Laitinen et al. 1 explore symptoms and mucosal damage in 22 patients with type 1 diabetes who were screened for coeliac disease and compared them to 498 individuals diagnosed with coeliac disease on a clinical basis. The authors concluded that screening for coeliac disease should be considered among children with type 1 diabetes, which is in line with current recommendations 2-4. A meta-analysis found that coeliac disease occurred in more than one in 20 patients with type 1 diabetes 5, and long-term coeliac disease may influence the risk of both retinopathy and chronic renal disease in type 1 diabetes 6, 7, potentially due to an increased prevalence of microvascular complications in patients with both type 1 diabetes and coeliac disease 8. The paper by Laitinen et al. 1 is interesting for several reasons. First of all, the authors found that patients with type 1 diabetes and coeliac disease did differ from patients diagnosed with coeliac disease due to clinical symptoms. For instance, patients with type 1 diabetes and coeliac disease did not experience such poor growth as those with clinically diagnosed coeliac disease. That is reassuring, as poor growth in childhood can have long-term consequences. Although catch-up growth is commonly seen in children with coeliac disease just after diagnosis, restricting food intake to make a diet suitable for both type 1 diabetes and coeliac disease could theoretically make catch-up growth more difficult to achieve. The authors also found that while children with type 1 diabetes and coeliac disease often had unrecognised gluten-dependent symptoms, these were less severe than in children who were clinically diagnosed with coeliac disease. That was to be expected, because otherwise the children with type 1 diabetes and coeliac disease should have been diagnosed before, due to gastrointestinal symptoms, rather than just after their diagnosis of type 1 diabetes. We believe that the lower prevalence of symptoms reflects the fact that patients with type 1 diabetes and coeliac disease may have less severe small-bowel mucosal atrophy than patients who just have coeliac disease. We disagree with Laitinen et al. on their interpretation in this regard, as we believe that the lack of difference with regard to mucosal atrophy in their study was due to lack of power. Laitinen et al. based their findings on only 22 patients with type 1 diabetes and coeliac disease and the statistical lack of difference was probably due to the equal proportions of patients with subtotal villous atrophy. Estimating total villous atrophy from their Figure 1B seems to indicate that it was more common in patients with clinical suspicion of coeliac disease (roughly 23% versus 9%), while partial villous atrophy was more common in patients with type 1 diabetes (52% versus roughly 32%). The same objection could be raised about the conclusion that dietary adherence was similar in patients with both type 1 diabetes and coeliac disease and those with just coeliac disease. The power for dietary adherence was limited in type 1 diabetes and coeliac disease patients as there was only dietary data for 16 of the 22 patients, and the p value of 0.086 may have reached statistical significance if the type 1 diabetes and coeliac disease group had been larger. This said, it should be emphasised that a very high proportion of patients with type 1 diabetes and coeliac disease did comply with the diet. Nevertheless, the long-term implications of prescribing a life-long diet for a child based on screening are unknown, as adherence to a gluten-free diet may decline in adolescence among children with screen-detected coeliac disease. While the strongest evidence for the value of screening for coeliac disease would be derived from a randomised trial, in which a nonscreened group would be compared to a screened group with regard to morbidity, the length and expense of such a trial would probably be prohibitive. As such, we rely on observational studies, such as those by Laitinen et al., to inform us of the potential outcomes of screening. In conclusion, this article makes a valuable contribution to the literature and once again underlines the potential value of examining children with type 1 diabetes for other autoimmunity problems, including coeliac disease. None. None.

Population-based screening program for reducing oral cancer mortality in 2,334,299 Taiwanese cigarette smokers and/or betel quid chewers.

To reduce oral cancer mortality, an organized, population-based screening program for the early detection of oral premalignancy and oral cancer was designed for high-risk individuals with habits of betel quid chewing, cigarette smoking, or both. The objective of this report was to evaluate the long-term effectiveness of this program in reducing the incidence of advanced disease and deaths from oral cancer. A nationwide, population-based screening program for oral cancer has been conducted in Taiwan since 2004. Residents aged ≥ 18 years with oral habits of cigarette smoking and/or betel quid chewing were invited. The standardized mortality ratio method was used to compare the observed numbers of advanced oral cancers and deaths from oral cancer among screening attendees with the expected numbers derived from mortality among nonattendees. An intention-to-treat analysis of the relative rate of reductions in advanced-stage oral cancers and oral cancer mortality also was conducted. The overall screening rate was 55.1%. The relative risk of death from oral cancer was 0.53 (95% confidence interval [CI], 0.51-0.56) as a result of screening compared with the expected risk of oral cancer deaths in the absence of screening. The corresponding relative risk was 0.74 (95% CI, 0.72-0.77) after adjusting for self-selection bias. The relative risk of advanced oral cancer for the screened group versus the nonscreened group was 0.62 (95% CI, 0.59-0.64), which increased to 0.79 (95% CI, 0.76-0.82) after adjustment for self-selection bias. An organized, population-based oral cancer screening program targeting more than 2 million Taiwanese cigarette smokers and/or betel quid chewers demonstrated the effectiveness of reducing stage III or IV oral cancers and oral cancer mortality. These evidence-based findings corroborate and support the screening strategy of oral visual inspection for the prevention of oral cancer among high-risk individuals in areas with a high incidence of oral cancer. Cancer 2017;123:1597-1609. © 2017 American Cancer Society.

Impacts of Colorectal Cancer Knowledge and Health Literacy on Self-management Behaviors among Elderly Women in Rural Areas

Purpose: Korean elderly women residing in rural areas still appear to be marginalized from health services for cancer prevention. The purposes of this study were to measure the degrees of colorectal cancer (CRC) knowledge, health literacy, and self-management behaviors among the elderly women in rural areas and to identify the influences of their CRC knowledge and health literacy on self-management behaviors. Methods: Total 121 elderly women aged 65 or older living in rural areas were recruited for this descriptive study and answered survey questionnaires. Results: The participants’ mean age was 78.2±7.51 years old. Of participants, 49.6% completed CRC screening and age of non-screening group was significantly older than that of screening group (x2=35.31, p<.001). The screening group showed higher levels of CRC knowledge (t=3.76, p<.001) and cancer preventive behaviors (t=2.68, p=.008) than non-screening group. Age (B=0.15) and CRC knowledge (B=-0.36) were identified as influencing factors on the CRC screening. Health literacy (β=.37) and CRC knowledge (β=.30) were found as the most influencing factors on the cancer preventive behaviors. Conclusion: The results of this study could be used as a basis for developing educational interventions and effective strategies specifically for the elderly women residing rural areas in Korea.

44. Does breast screening offer a survival benefit? A retrospective comparative study of oncological outcomes of screen detected and symptomatic early stage breast cancer cases

Background: It is based on high evidence randomized controlled trials that mammography screening is able to reduce breast cancer mortality up to 32%. Some recent studies doubt the impact of the non-palpable early stage breast cancer detection on mortality reduction. The aim of this study was to analyze the clinicopathological and long term follow up data of breast cancer patients diagnosed via population based mammographic screening in comparison to a non-screened symptomatic group of early staged breast cancer patients.

Sunitinib treatment in patients with advanced renal cell cancer: the Brazilian National Cancer Institute (INCA) experience

ABSTRACTPurpose:The aim of this study was to assess the impact of sunitinib treatment in a non-screened group of patients with metastatic renal cell cancer (mRCC) treated by the Brazilian Unified Health System (SUS) at a single reference institution.Material and Methods:Retrospective cohort study, which evaluated patients with mRCC who received sunitinib between May 2010 and December 2013.Results:Fifty-eight patients were eligible. Most patients were male 41 (71%), with a median age of 58 years. Nephrectomy was performed in 41 (71%) patients with a median interval of 16 months between the surgery and initiation of sunitinib. The most prevalent histological subtype was clear cell carcinoma, present in 52 (91.2%) patients. In 50 patients (86%), sunitinib was the first line of systemic treatment. The main adverse effects were fatigue (57%), hypothyroidism (43%), mucositis (33%) and diarrhea (29%). Grade 3 and 4 adverse effects were infrequent: fatigue (12%), hypertension (12%), thrombocytopenia (7%), neutropenia (5%) and hand-foot syndrome (5%). Forty percent of patients achieved a partial response and 35% stable disease, with a disease control rate of 75%. Median progression free survival was 7.6 months and median overall survival was 14.1 months.Conclusion:Sunitinib treatment was active in the majority of patients, especially those with low and intermediate risk by MSKCC score, with manageable toxicity. Survival rates were inferior in this non-screened population with mRCC treated in the SUS.

Screening vs. non-screening detected colorectal cancer: Differences in pre-therapeutic work up and treatment.

Objectives To compare preoperative staging, multidisciplinary team-assessment, and treatment in patients with screening detected and non-screening detected colorectal cancer. Methods Data on patient and tumour characteristics, staging, multidisciplinary team-assessment and treatment in patients with screening and non-screening detected colorectal cancer from 2008 to 2012 were collected from the Stockholm-Gotland screening register and the Swedish Colorectal Cancer Registry. Results The screening group had a higher proportion of stage I disease (41 vs. 15%; p < 0.001), a more complete staging of primary tumour and metastases and were more frequently multidisciplinary team-assessed than the non-screening group ( p < 0.001). In both groups, patients with endoscopically resected cancers were less completely staged and multidisciplinary team-assessed than patients with surgically resected cancers ( p < 0.001). No statistically significant differences were observed between the screening and non-screening groups in the use of neoadjuvant treatment in rectal cancer (68 vs.76%), surgical treatment with local excision techniques in stage I rectal cancer (6 vs. 9%) or adjuvant chemotherapy in stages II and III disease (46 vs. 52%). Emergency interventions for colorectal cancer occurred in 4% of screening participants vs. 11% of non-compliers. Conclusions Screening detected cancer patients were staged and multidisciplinary team assessed more extensively than patients with non-screening detected cancers. Staging and multidisciplinary team assessment prior to endoscopic resection was less complete compared with surgical resection. Extensive surgical and (neo)adjuvant treatment was given in stage I disease. Participation in screening reduced the risk of emergency surgery for colorectal cancer.

Screening for hepatitis C in average and high-risk populations of Qatar using rapid point-of-care testing.

Screening for hepatitis C has been found to be beneficial in high-risk individuals and 'baby boomers'. Our aim was to screen for hepatitis C in average and high-risk individuals and compare the disease characteristics and response to treatment among the screened group (SG) and non-screened group (NSG). Community-based screening for hepatitis C was done in the average and high-risk populations of Qatar. Screening was done using rapid point-of-care testing. All patients with stage 1 fibrosis on liver biopsy were treated with pegylated interferon and ribavirin. In total, 13,704 people were screened and 272 (2%, 95% CI (1.8-2.2%) had positive antibodies to hepatitis C. During the same period, 237 non-screened patients (NSG) with hepatitis C were referred for treatment. Alanine and aspartate aminotransferases (ALT, AST) and overall fibrosis were significantly lower in the SG as compared with the NSG (p = 0.04, 0.04 and 0.01, respectively). The response to treatment was similar in the SG as compared with the NSG (sustained viral response 61.7 % versus 69.1%, p = 0.55). Average-risk patients had significantly lower ALT levels (p = 0.04) but had similar response to treatment as the high-risk individuals (sustained viral response 63.2 % versus 61%, p = 0.87). Screening detects hepatitis C with lesser fibrosis but does not result in better response to pegylated interferon and ribavirin as compared with non-screened patients.

Impact of Screening for Hepatic Hemangiomas in Patients with Multiple Cutaneous Infantile Hemangiomas.

Hepatic hemangiomas are often found in association with multiple cutaneous infantile hemangiomas. Screening abdominal ultrasonography has been recommended for patients with five or more cutaneous lesions. We sought to determine whether hemangiomas found through screening had improved clinical outcomes. Patients entered into our hepatic hemangioma registry between 1995 and 2012 were reviewed. Seventy-two patients with multiple cutaneous and hepatic hemangiomas were identified; 43 (60%) were detected through screening. The median age at diagnosis was 41 days for screened patients and 53 days for those not screened. Screening detected 40 (93%) multifocal and 3 (7%) diffuse hemangiomas, compared to 18 (62%) and 11 (38%), respectively, in the nonscreened group. Patients identified by screening had lower incidences of congestive heart failure and hypothyroidism and were less likely to receive treatment for their hemangiomas. The mortality rate in the children not screened was 28% (n = 8). None of the patients found by screening died (p < 0.001). Multivariate analysis of treated patients demonstrated that screening was a significant predictor of reduced mortality (p = 0.04). Hepatic hemangiomas found through screening ultrasonography are less likely to develop serious clinical sequelae. Although the reasons for this may include detection of hemangiomas that are less likely to progress to symptomatic disease, it appears that it also allows for earlier intervention for more concerning (e.g. diffuse) subtypes. Screening may allow for closer surveillance and earlier treatment before life-threatening progression in a subset of infants with liver hemangiomas, preventing complications and reducing mortality.

Comparison of Screened and Nonscreened Breast Cancer Patients in Relation to Age: A 2-Institution Study

IntroductionScreening programs for breast cancer aim to allow early diagnosis, and thus reduce mortality. The aim of this study was to assess the effect of a population screening program in a sample of women aged between 50 and 69 years in terms of recurrence, metastasis, biological profiles, and survival, and to compare their results with those of women of a wider age range who did not participate on the screening program. Patients and MethodsA prospective multicenter study in which 1821 patients with 1873 breast tumors who received surgery between 1999 and 2014 at MútuaTerrassa University Hospital and the Hospital of Terrassa in Barcelona were analyzed. A comparison was performed in the 50- to 69-year-old age group between those who participated on the screening program and those who did not. ResultsThe mean age of patients was 58 years. The mean follow-up was 72 months, and median follow-up 59 months. The screened group showed significantly better results in all prognostic factors and in specific mortality than all nonscreened groups. The specific mortality rate in the screened patients was 2.4% (12/496), local recurrence 2.8% (14/496), and metastasis at 10 years 3.6% (18/496). In the nonscreened group, younger women presented a higher rate of metastasis (16.4% [81/493]) and a shorter disease-free period (77.1% [380/493]). The age group older than 70 years had the highest number of T4 tumors (7.5% [30/403]) and the highest proportion of radical surgery (50.4% [203/403]). ConclusionPatients in the screening program presented improved survival. We speculate that extending breast cancer screening programs to women younger than 50 and older than 70 years could bring about mortality benefits.

Screening for carcinoma in situ (CIS) testis and occurrence of metachronous germ cell cancer (mGCC).

4554 Background: CIS is present in the contralateral testicle in 5-6% of untreated patients with unilateral germ cell cancer (GCC). A Danish screening program for contralateral CIS was initiated in order to prevent mGCC. Methods: In total, 4,180 GCC patients diagnosed from 1984 through 2007 were offered a contralateral single-site biopsy in relation to orchiectomy (intention to screen, ITS). A non-screened group included 450 patients. Recommended treatment for CIS was radiotherapy (RT) in doses of 14 to 20 Gy, also in chemotherapy treated (CT) patients. CIS-negative (CISneg) patients who developed mGCC had the biopsy revised according to today’s standard including immunohistochemical staining. Data was merged with national administrative registries, and information on second GCC and vital status was obtained for all patients up to December 2012. Results: Median observation time was 14.1 years (range 0.1-28.9). Contralateral CIS was found in 193 patients (4.6%). Seven CIS-positive (CISpos) patients develop...