Optimal Screening Strategies Research Articles

Translating Scientific Knowledge to Government Decision Makers Has Crucial Importance in the Management of the COVID-19 Pandemic.

In times of epidemics and humanitarian crises, it is essential to translate scientific findings into digestible information for government policy makers who have a short time to make critical decisions. To predict how far and fast the disease would spread across Hungary and to support the epidemiological decision-making process, a multidisciplinary research team performed a large amount of scientific data analysis and mathematical and socioeconomic modeling of the COVID-19 epidemic in Hungary, including modeling the medical resources and capacities, the regional differences, gross domestic product loss, the impact of closing and reopening elementary schools, and the optimal nationwide screening strategy for various virus-spreading scenarios and R metrics. KETLAK prepared 2 extensive reports on the problems identified and suggested solutions, and presented these directly to the National Epidemiological Policy-Making Body. The findings provided crucial data for the government to address critical measures regarding health care capacity, decide on restriction maintenance, change the actual testing strategy, and take regional economic, social, and health differences into account. Hungary managed the first part of the COVID-19 pandemic with low mortality rate. In times of epidemics, the formation of multidisciplinary research groups is essential for policy makers. The establishment, research activity, and participation in decision-making of these groups, such as KETLAK, can serve as a model for other countries, researchers, and policy makers not only in managing the challenges of COVID-19, but in future pandemics as well.

Performance characteristics of screening strategies to identify Lynch syndrome in women with ovarian cancer.

BackgroundFor women with ovarian cancer (OC), the optimal screening strategy to identify Lynch syndrome (LS) has not been determined. In the current study, the authors compared the performance characteristics of various strategies combining mismatch repair (MMR) immunohistochemistry (IHC), microsatellite instability testing (MSI), and family history for the detection of LS.MethodsWomen with nonserous and/or nonmucinous ovarian cancer were recruited prospectively from 3 cancer centers in Ontario, Canada. All underwent germline testing for LS and completed a family history assessment. Tumors were assessed using MMR IHC and MSI. The sensitivity, specificity, and positive and negative predictive values of screening strategies were compared with the gold standard of a germline result.ResultsOf 215 women, germline data were available for 189 (88%); 13 women (7%) had pathogenic germline variants with 7 women with mutS homolog 6 (MSH6); 3 women with mutL homolog 1 (MLH1); 2 women with PMS1 homolog 2, mismatch repair system component (PMS2); and 1 woman with mutS homolog 2 (MSH2). A total of 28 women had MMR‐deficient tumors (13%); of these, 11 had pathogenic variants (39%). Sequential IHC (with MLH1 promoter methylation analysis on MLH1‐deficient tumors) followed by MSI for nonmethylated and/or MMR‐intact patients was the most sensitive (92.3%; 95% confidence interval, 64%‐99.8%) and specific (97.7%; 95% confidence interval, 94.2%‐99.4%) approach, missing 1 case of LS. IHC with MLH1 promoter methylation analysis missed 2 patients of LS. Family history was found to have the lowest sensitivity at 55%.ConclusionsSequential IHC (with MLH1 promoter methylation analysis) followed by MSI was found to be most sensitive. However, IHC with MLH1 promoter methylation analysis also performed well and is likely more cost‐effective and efficient in the clinical setting. The pretest probability of LS is high in patients with MMR deficiency and warrants universal screening for LS.

Performance and costs of multiple screening strategies for type 2 diabetes: two population-based studies in Shanghai, China

IntroductionTo compare the performance and the costs of various assumed screening strategies for type 2 diabetes mellitus (T2DM) among Chinese adults, and identify an optimal one for the population.Research design...

FRI077 - Optimal non-invasive screening strategy for non-alcoholic fatty liver disease in a prospective cohort of patients with type 2 diabetes

FRI077 - Optimal non-invasive screening strategy for non-alcoholic fatty liver disease in a prospective cohort of patients with type 2 diabetes

A comparison of screening tests for detection of high-grade cervical abnormalities in women living with HIV from Cameroon

BackgroundWomen living with human immunodeficiency virus (WLWH), especially those living in low- and middle-income countries (LMIC), are at increased risk of cervical cancer. The optimal cervical-cancer screening strategy for WLWH has not been determined. We therefore conducted a pilot study of screening methods in WLWH living in Limbe, Cameroon.MethodsFive-hundred sixty-six WLWH, aged 25–59 years, were enrolled. After self-collecting a cervicovaginal specimen, they underwent a pelvic exam, during which a provider also collected a cervical specimen and visual inspection after acetic acid (VIA) was performed. Both self- and provider-collected specimens were tested for high-risk HPV by the Xpert HPV Test (Cepheid, Sunnyvale, CA, USA), with the residual of the latter used for liquid-based cytology. Women testing HPV positive on either specimen and/or VIA positive were referred to colposcopy and biopsies. However, because of poor attendence for follow-up colposcopy for the screen positives due to civil strife and technical issues with biopsies, high-grade cytology and/or clinical diagnosis of cancer was used as the primary high-grade cervical abnormality endpoint. Clinical performances for high-grade cervical abnormality of HPV testing and VIA for screening WLWH, and the most carcinogenic HPV genotypes and/or VIA to triage high-risk HPV-positive WLWH, were evaluated.ResultsFour-hundred eighty-seven (86.0%) WLWH had results for HPV testing on both specimen, VIA, and cytology and were included in the analysis. Forty-nine (10.1%) had a high-grade cervical abnormality. HPV testing on provider- and self-collected specimens was more sensitive than VIA (95.9 and 91.8% vs. 43.8%, respectively, p < 0.01 for both comparisons) for identifying women with high-grade cervical abnormalities. HPV testing on provider- and self-collected specimens was less specific than VIA (57.5 and 51.6% vs. 89.7%, respectively, p < 0.01 for both comparisons) for identifying women with high-grade cervical abnormalities; HPV testing on provider-collected specimens was more specific than on self-collected specimens (p < 0.01). Among HPV-positive women, HPV16/18/45 detection or VIA positivity had a sensitivity and positive predictive value of 73.5 and 29.0%, respectively, for provider-collected specimens and 68.8 and 22.9%, respectively, for self-collected specimens for high-grade cervical abnormalities.ConclusionsHPV testing was more sensitive but less specific than VIA for detection of high-grade cervical abnormality in WLWH. Improved triage methods for HPV-positive WLWH are needed.Trial registrationNCT04401670 (clinicaltrials.gov); retrospectively registered on May 26, 2020

Long-Term Follow Up of an Occupational Cohort in Yunnan, People’s Republic of China: 20-Year Postscreening Follow Up and 8-Year Lung Cancer Screening

PURPOSE There is no long-term, population-based cohort screening evidence for lung cancer in China. This study aimed to evaluate whether increased screening rounds could reduce mortality as a result of lung cancer. METHODS We conducted a one-armed, prospective lung cancer screening cohort study with chest radiography and sputum cytology in Yunnan, People’s Republic of China, from 1992 to 1999. A total of 9,295 tin miners age 40 years or older were enrolled in this study and follow up ended on December 31, 2018. We stratified patients into 4 subgroups on the basis of screening rounds—1-2, 3-4, 5-6, or 7-8 rounds within 8 years—and selected 1-2 screening rounds within 8 years as the control group. Hazard ratios (HRs) and 95% CIs for the effect of screening rounds on mortality were estimated using Cox proportional hazards regression models. RESULTS Of participants, 831 (8.9%) were lost to follow up, and 4,517 patients died, 1,600 from cancer (1,135 from lung cancer), 1,519 from circulatory system diseases, and 619 from respiratory diseases. Participants who received 7-8 screening rounds within 8 years had reduced lung cancer mortality by 46% (HR, 0.54; 95% CI, 0.46 to 0.63 in all age groups. For those who received 5-6 screening rounds within 8 years, the benefit of reduction was mostly observed in patients older than age 52 years (HR, 0.63; 95% CI, 0.52 to 0.77), and there was no effect among those age 52 years or younger (HR, 0.72; 95% CI, 0.48 to 1.07). In contrast, only for those patients age 52 years or younger did 3-4 screening rounds within 8 years decrease mortality from lung cancer (HR, 0.56; 95% CI, 0.36 to 0.87). CONCLUSION We showed that increased screening rounds could reduce lung cancer mortality in a high-risk population, but the effect is influenced by age group. The optimal screening strategy for different age groups needs additional investigation.

Risk stratification in breast cancer screening: Cost-effectiveness and harm-benefit ratios for low-risk and high-risk women.

In mammography screening programmes, women are screened according to a one-size-fits-all principle. Tailored screening, based on risk levels, may lead to a better balance of benefits and harms. With microsimulation modelling, we determined optimal mammography screening strategies for women at lower (relative risk [RR] 0.75) and higher (RR 1.8) than average risk of breast cancer, eligible for screening, using the incremental cost-effectiveness ratio (ICER) of current uniform screening in the Netherlands (biennial [B] 50-74) as a threshold ICER. Strategies varied by interval (annual [A], biennial, triennial [T]) and age range. The number of life-years gained (LYG), breast cancer deaths averted, overdiagnosed cases, false-positive mammograms, ICERs and harm-benefit ratios were calculated. Optimal risk-based screening scenarios, below the threshold ICER of €8883/LYG, were T50-71 (€7840/LYG) for low-risk and B40-74 (€6062/LYG) for high-risk women. T50-71 screening in low-risk women resulted in a 33% reduction in false-positive findings, a similar reduction in costs and improved harm-benefit ratios compared to the current screening schedule. B40-74 in high-risk women led to an increase in screening benefit, compared to current B50-74 screening, but a relatively higher increase in false-positive findings. In conclusion, optimal screening consisted of a longer interval and lower stopping age than current uniform screening for low-risk women, and a lower starting age for high-risk women. Extending the interval for women at lower risk from biennial to triennial screening reduced harms and costs while maintaining most of the screening benefit.

Smoking and hypertension: what is behind the mask?

Smoking and hypertension: what is behind the mask?

Clinicopathologic analysis of MMR gene mutations and uterine adenocarcinomas: An updated population-based study.

e18100 Background: Endometrial carcinoma frequently harbors genetic alterations in genes encoding mismatch repair (MMR) enzymes, a finding which has important implications for adjuvant therapy. The aim of this study is to determine an optimal screening strategy to detect MMR mutations for each histologic subtype of endometrial carcinoma (EC). Methods: We performed a comparative analysis of the demographic, clinical, pathologic, and molecular data, including MLH1, MLH3, PMS1, PMS2, MSH2, MSH3, MSH6, and EPCAM, for 562 patients from The Cancer Genome Atlas database (TCGA), stratified by tumor histologic subtype. Results: Molecular data was available for 562 patients, of which 162 (28.8%) had tumors that were positive for MMR mutations. We did not separate somatic and germline mutation. Of these tumors, the penetrate rate of FIGO grade 3 endometrioid endometrial carcinoma (EEC G3) (84/184, 45.7%) was significantly higher than the one of uterine serous carcinoma (USC) (35/156, 22.4%) ( p &lt; 0.001), grade 2 (EEC G2) (26/129, 20.2%) ( p &lt; 0.001), and grade 1 (EEC G1) (17/93, 18.3%) ( p &lt; 0.001). Of EEC G3 tumors, patients with MMR gene mutations were significantly older ( p = 0.024) or had lower BMI's than MMR mutation noncarriers ( p = 0.028). Of 562 endometrial carcinomas, alterations in MSH2 (n = 55), MSH6 (n = 54), MSH3 (n = 50) were the most frequent mutations. There were no differences in overall survival and progression-free interval between MMR mutation carriers and nonmutation carriers (p &gt; 0.05) except that PFI with MMR gene mutation was higher than with MMR proficiency in EEC G3 ( p = 0.014). Conclusions: EEC G3 harbored the most MMR mutations among EC. EEC G3 and USC could be more considered to screen MMR mutation due to more MMR mutations occurred in EEC G3 and USC than did among EEC G2 and EEC G1. Besides MLH1, MSH2, MSH6, PMS2 and EPCAM mutation , MLH3, MSH3, PMS1 mutation could be screened in patients with newly diagnosed endometrial carcinoma. [Table: see text]

Effect of mammography screening frequency on false-positive biopsy rates and detection of local recurrence among breast cancer survivors.

7016 Background: Current guidelines recommend that women with a history of early-stage breast cancer treated with breast-conserving therapy (BCT) continue screening mammography after treatment. One strategy is semi-annual ipsilateral mammography for the first 3 years after diagnosis, when risk of local recurrence is highest. However, a potential harm of more frequent screening is false-positive breast biopsy. We examined the association between screening frequency and rates of false-positive biopsy and local recurrence among breast cancer survivors. Methods: We conducted a retrospective cohort study at Columbia University Irving Medical Center (CUIMC) in New York, NY, of women diagnosed with stage 0-III breast cancer from 2007 to 2017, who were treated with BCT and had at least 2 screening mammograms at CUIMC within the first 3 years after diagnosis. Demographic and clinical information were collected from the electronic health record. Frequency of mammography screening was defined as the median interval between two consecutive mammograms (every 6 months vs. yearly). False-positive biopsy and local recurrence were identified by review of breast pathology reports. A false-positive biopsy was defined as a breast biopsy without evidence of invasive or non-invasive cancer. Descriptive statistics and logistic regression models were conducted to examine relationships between covariates and either false-positive biopsy or local recurrence. Results: In our study cohort (n = 1404), the median age at breast cancer diagnosis was 61 years (range, 24-94), including 45% white, 14% black, 32% Hispanic, and 8% Asian. Eighty percent of women had screening mammography of the ipsilateral breast every 6 months during the first 3 years after diagnosis. Comparing women who screened every 6 months vs. yearly, there was no difference in local recurrence rates (4.0% vs. 4.1%), including screen-detected and invasive recurrences, but a higher rate of false-positive biopsy (13.5% vs. 7.5%). In multivariable analysis, women who screened every 6 months had about a 2-fold increased risk of having a false-positive biopsy (OR 1.93; 95% CI 1.17-3.19); no other factors were significantly associated with false-positive biopsy. Conclusions: We observed that women with early-stage breast cancer treated with BCT who underwent more frequent screening mammography had more false-positive breast biopsies, but no difference in local recurrence rates. Future studies are needed to determine optimal screening strategies for breast cancer survivors.

Optimizing screening strategies for coronavirus disease 2019: A study from Middle China

BackgroundCoronavirus disease 2019 (COVID-19) has been highly epidemic in China since January 2020. Rapid detection of the causative agent, severe acute respiratory coronavirus-2 (SARS-CoV-2), is very important due to its high rate of infectivity. This study aimed to clarify the epidemiology and clinical characteristics of COVID-19 outside of Hubei province, China, and to optimize screening strategies for COVID-19 in attempts to contain spread of the virus. MethodsThis retrospective study included all confirmed cases of COVID-19 in Hunan Provincial People's Hospital (Changsha, China) between January 22 and February 15, 2020. All cases were detected using a real-time reverse transcription polymerase chain reaction assay. The epidemiology and clinical characteristic of these cases were investigated according to outcome in attempts to optimize screening strategies for COVID-19. ResultsThere were 24 confirmed cases of COVID-19 in the fever outpatient department of Hunan Provincial People's Hospital. Three patients were asymptomatic, and 3 exhibited mild and 3 moderate disease. There was a family cluster phenomenon. ConclusionIndividuals with COVID-19 can be asymptomatic or exhibit mild manifestations of disease. Close monitoring and an optimized screening strategy for COVID-19 could help deter spread of the virus.

MON-644 Prevalence of Non-Alcoholic Fatty Liver Disease and Liver Fibrosis in Patients with Type 2 Diabetes Mellitus

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. The more severe form is non-alcoholic steatohepatitis (NASH) which can progress to liver fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). NASH is more common in patients with type 2 diabetes mellitus (T2DM). However, its true prevalence in unselected patients with T2DM in the United States remains unknown. In 2019, the American Diabetes Association recommended screening for NASH and liver fibrosis in all patients with T2DM with steatosis and/or elevated ALT. Screening focuses on liver fibrosis as associated with increased risk of cirrhosis and HCC. Still, a liver biopsy remains the gold standard to accurately assess the severity of liver disease. The aim of this study was to determine the prevalence of liver fibrosis in unselected patients with T2DM presenting to primary care or endocrinology clinics at a university hospital in the US. Secondary outcomes were to assess the prevalence of steatosis controlled attenuation parameter (CAP) and performance of vibration-controlled transient elastography (VCTE) as a non-invasive tool to identify patients with significant liver fibrosis. Patients with T2DM between ages of 21-79 and without a history of alcohol intake or other causes secondary causes of NAFLD were recruited for the study. Participants underwent screening for NAFLD at the time of their clinic visit by means of point-of-care CAP and VCTE. Initial evaluation also included obtaining patient demographics, routine chemistries, and fasting samples (on visit #2 if not fasting initially) for metabolic measurements and fibrosis biomarkers. Liver biopsies were offered to patients with a liver stiffness measurement (LSM) ≥8.0 kPa (i.e., highly likely to have moderate-to-severe fibrosis or ≥F2), or those with ≥7 kPa if AST ≥20 and had an APRI and/or FIB-4 score suggestive of being at high-risk of liver fibrosis (i.e., at least mild-to-moderate fibrosis or ≥F1). A total of 469 patients were recruited (age 59±12; 56% females; 60% non-Hispanic whites, 30% African Americans, 4% Asian; BMI 33±6 Kg/m2; A1c 7.5±1.7%; FPG 143±60 mg/dL; AST 22±11 U/L; ALT 24±17 U/L; triglycerides 156±151 mg/dL; LDL-C 88±37 mg/dL; HDL-C 47±13 mg/dL). The prevalence of NAFLD by CAP (≥280) was 67% with a mean CAP of 305±3. The prevalence of any fibrosis was 24% patients. Among those with fibrosis, 15% had moderate-to-severe fibrosis or ≥F2. In those that underwent a liver biopsy, 61% had moderate-to-severe fibrosis (F2-3). Our ongoing study demonstrates the high prevalence of liver steatosis and fibrosis in patients with T2DM. NASH is a common but under-recognized complication of T2DM that requires greater awareness among clinicians taking care of patients with diabetes. While the optimal screening strategy remains unclear, an approach based on plasma biomarkers and CAP/VCTE deserves further exploration moving forward.

Screening for Social Determinants of Health Among Children: Patients' Preferences for Receiving Information to Meet Social Needs and a Comparison of Screening Instruments.

To characterize optimal strategies for screening for social determinants of health (SDOH) among children, the authors performed a cross-sectional study of parents and adolescents ages ≥13 years in a community health center. Participants were queried about how they prefer to receive information about social needs resources and 2 screening instruments were compared: Well Child Care, Evaluation, Community Resources, Advocacy, Referral, Education (WE CARE) and Accountable Health Communities (AHC). In July 2019, 154 parents and 21 adolescents were surveyed. Surveys were administered via tablet and required 5.6 minutes (standard deviation [SD] 3.9 minutes) for parents and 3.9 minutes (SD 1.4 minutes) for adolescents to complete. Parents identified technology (text message, email) and informational printouts as preferred mechanisms for information receipt (58% and 32% of participants, respectively); adolescents preferred text message (57%) and printouts (19%). Few (<10% overall) preferred in-person consultation with a care coordinator. Adolescent/parent pairs (n = 19 pairs) agreed, on average across SDOH, 82% of the time for WE CARE and 85% for AHC. AHC elicited more positive screens than WE CARE for housing insecurity (12% of parents versus 7%) and food insecurity (47% versus 16%) but fewer positive screens than WE CARE for difficulties paying for utilities (27% versus 39%). Routine screening for SDOH in children requires 2-3 minutes per screening instrument. Screening can target parents of young children and either adolescents themselves or their parents. Families prefer to receive information about meeting social needs via technologically-based methods as opposed to in-person consultation with enabling services providers.

Abstract P2-02-03: Impact of genetic testing for hereditary breast cancer on supplemental breast imaging and false positive biopsy rates among young breast cancer patients

Abstract Introduction Annual mammography screening is recommended for women diagnosed with breast cancer for the early detection of local recurrence and new breast primaries. Younger women have higher breast density, which lowers the sensitivity of mammography for early detection. The American Cancer Society recommends breast MRI as an adjunct to mammography for women with known hereditary breast cancer syndromes. However, there is insufficient evidence on the use of breast MRI or ultrasound as an adjunct to screening mammography among young women with a personal history of breast cancer. Our objective was to investigate factors associated with use of supplemental screening among young breast cancer patients and the impact of supplemental screening on detection of breast cancer recurrence and false positive biopsy rates. Methods We conducted a retrospective analysis of women diagnosed with stage 0-III breast cancer at age 50 years or younger at Columbia University Irving Medical Center in New York, NY between 2007 and 2017. Patients were excluded if they had stage IV disease at diagnosis, bilateral mastectomy, or no breast imaging available in the CUIMC electronic health record (EHR). All clinical data was extracted from the EHR and tumor registry, including receipt and results of genetic testing. Supplemental screening was defined as use of breast ultrasound or MRI in the absence of breast symptoms and in the setting of a normal mammogram. Breast cancer recurrence and false positive biopsy were defined as any breast biopsy which did or did not show ductal carcinoma in situ (DCIS) or invasive carcinoma, respectively. Univariate and multivariate analyses were performed to assess the association between demographic and clinical factors and our main outcomes of supplemental screening and false positive biopsy. Results Among 681 evaluable women, mean age at diagnosis was 44 years (SD, 4.9) with 41.6% white, 28.2% Hispanic, 12.6% black, 11.7% Asian, and 5.9% other race/ethnicity. About 62.7% had private insurance and 23.1% Medicaid, and 47% had undergone genetic testing, including 20 (2.9%) with pathogenic variants. Over half (51%) had supplemental screening with either breast MRI or ultrasound, 130 (19.1%) had a false positive biopsy, and 52 (7.6%) had a breast cancer recurrence, with about half (51.9%) screen-detected. In multivariate analysis, supplemental screening was less likely among black and Hispanic women compared to whites (odds [OR]=0.56, 95% confidence interval [CI]=0.33-0.97 and OR=0.46, 95% CI=0.30-0.72, respectively), those with Medicaid compared to private insurance (OR=0.46, 95% CI=0.30-0.71), and women with lower breast density (OR=0.63, 95% CI=0.43-0.92). False positive biopsies were more frequent among women who underwent supplemental screening compared to those who did not (26.4% vs. 11.4%, p&amp;lt;0.001), however, screen-detected breast cancer recurrences were comparable (4.0% vs. 3.9%, p=0.209). Supplemental screening was associated with a greater than 2-fold increased risk of false positive biopsy (OR=2.77, 95% CI=1.78-4.32). Compared to young breast cancer patients who did not undergo genetic testing, women with pathogenic variants had a trend toward more supplemental screening (OR=2.28, 95% CI=0.82-6.36) and more false positive biopsies (OR=2.75, 95% CI=0.96-7.85). Conclusions Our findings suggest that decisions to engage in supplemental screening are influenced by insurance coverage and breast density. Furthermore, patients who receive supplemental screening were significantly more likely to have false positive biopsies, but had no difference in screen-detected breast cancer recurrences. Prospective studies are needed to better define optimal screening strategies for young breast cancer survivors. Citation Format: Vicky Ro, Ziyi Zhao, Samuel Pan, Katherine D. Crew. Impact of genetic testing for hereditary breast cancer on supplemental breast imaging and false positive biopsy rates among young breast cancer patients [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-02-03.

Association of Baseline Prostate-Specific Antigen Level With Long-term Diagnosis of Clinically Significant Prostate Cancer Among Patients Aged 55 to 60 Years

The use of prostate-specific antigen (PSA) screening for prostate cancer is controversial because of the risk of overdiagnosis and overtreatment of indolent cancers. Optimal screening strategies are highly sought. To estimate the long-term risk of any prostate cancer and clinically significant prostate cancer based on baseline PSA levels among men aged 55 to 60 years. This secondary analysis of a cohort in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial uses actuarial analysis to analyze the association of baseline PSA levels with long-term risk of any prostate cancer and of clinically significant prostate cancer among men aged 55 to 60 years enrolled in the screening group of the trial between 1993 and 2001. Single PSA measurement at study entry. Long-term risk of any prostate cancer and clinically significant prostate cancer diagnoses. There were 10 968 men aged 55 to 60 years (median [interquartile range] age, 57 [55-58] years) at study enrollment in the screening group of the PLCO Cancer Screening Trial who had long-term follow-up. Actuarial 13-year incidences of clinically significant prostate cancer diagnosis among participants with a baseline PSA of 0.49 ng/mL or less was 0.4% (95% CI, 0%-0.8%); 0.50-0.99 ng/mL, 1.5% (95% CI, 1.1%-1.9%); 1.00-1.99 ng/mL, 5.4% (95% CI, 4.4%-6.4%); 2.00-2.99 ng/mL, 10.6% (95% CI, 8.3%-12.9%); 3.00-3.99 ng/mL, 15.3% (95% CI, 11.4%-19.2%); and 4.00 ng/mL and greater, 29.5% (95% CI, 24.2%-34.8%) (all pairwise log-rank P ≤ .004). Only 15 prostate cancer-specific deaths occurred during 13 years of follow-up, and 9 (60.0%) were among men with a baseline PSA level of 2.00 ng/mL or higher. In this secondary analysis of a cohort from the PLCO Cancer Screening Trial, baseline PSA levels among men aged 55 to 60 years were associated with long-term risk of clinically significant prostate cancer. These findings suggest that repeated screening can be less frequent among men aged 55 to 60 years with a low baseline PSA level (ie, <2.00 ng/mL) and possibly discontinued among those with baseline PSA levels of less than 1.00 ng/mL.

A Retrospective Analysis of Gender-Based Difference in Adherence to Initial Colon Cancer Screening Recommendations.

Background: Colorectal cancer (CRC) is the fourth leading cause of cancer-related death in the United States, despite being largely preventable and treatable. Improving overall screening rates among both men and women is considered an important and effective strategy toward reducing morbidity and mortality from CRC. In order to optimize screening strategies, factors associated with decreased compliance need to be understood. This study aimed to compare initial CRC screening rates between males and females in a population of patients who presented for an annual physical examination. Methods: A retrospective chart review study of 380 patients designed to compare rates of initial CRC screening between males and females was conducted. Patients who were seen at our institution for an annual physical examination and were between 51 and 60 years of age were included. Results: There was no evidence of a difference in the rate of initial colon cancer screening between females (83.0%) and males (80.9%) in either unadjusted analysis (odds ratio = 1.16, P = .59) or in multivariable analysis adjusting for potential confounding variables (odds ratio = 1.16, P = .61). Conclusions: There was no significant difference in the rate of initial CRC screening between males and females who presented for an annual physical examination. This suggests that designing interventions to improve screening specific to gender may not be needed in a population of patients who attend routine preventive health examinations. Further study is needed in the general population to examine for gender-based differences in initial CRC screening among patients who do not regularly follow up for preventive examinations.

A Bias of Screening

This paper deals with the issue of screening. It focuses on a decision maker who, based on noisy unbiased assessments, screens elements from a general set. Our analysis shows that stricter screening not only reduces the number of accepted elements, but possibly reduces their average expected value. We provide a characterization for optimal threshold strategies for screening and also derive implications to cases where such screening strategies are suboptimal. We further provide various applications of our results to credit ratings, auctions, general trade, the Peter Principle, and affirmative action. (JEL C38, D44, F10, G24, J15)

Cost-Effectiveness Analysis of Hepatitis B Virus Screening and Management in Patients With Hematologic or Solid Malignancies Anticipating Immunosuppressive Cancer Therapy.

National hepatitis B virus (HBV) screening recommendations for patients with cancer anticipating systemic anticancer therapy range from universal screening to screening based on risk of HBV infection, cancer therapy-specific risk of HBV reactivation, or both. We conducted cost-effectiveness analyses to identify optimal HBV screening strategies. We constructed decision-analytic models to analyze three strategies (no screening, universal screening, and selective screening based on use of an HBV infection risk tool) for hypothetic cohorts of patients anticipating anticancer therapy at high or lower risk for HBV reactivation. Model parameters were drawn from previously published studies, the SEER-Medicare database, and other online resources. Outcomes included lifetime expected cost, quality-adjusted life expectancy, and incremental cost-effectiveness ratio, measured in US dollars required to gain an additional quality-adjusted life-year (QALY). For patients at high reactivation risk, universal screening dominated (ie, was cheaper and more effective than) the other two strategies. Universal screening was associated with a gain in life expectancy of 0.01 QALY compared with no screening and cost $76.06 less than no screening and $4.34 less than selective screening. For those at lower reactivation risk, universal screening still dominated selective screening; however, the incremental cost-effectiveness ratio of the universal screening strategy compared with no screening was $186,917 per QALY gained. Universal HBV screening is cost effective and cheaper for patients receiving anticancer therapy associated with a high reactivation risk. For patients receiving anticancer therapy associated with a lower reactivation risk, universal screening is not cost effective.

Therapeutic Challenges And Advances In The Management Of Systemic Sclerosis-Related Pulmonary Arterial Hypertension (SSc-PAH).

Systemic sclerosis (SSc) is a rare autoimmune disorder with multi-organ involvement. SSc-associated pulmonary arterial hypertension (SSc-PAH) is one of the leading causes of morbidity and mortality in the SSc population. With advances in our understanding of pulmonary arterial hypertension (PAH) diagnosis and treatment, outcomes for all PAH patients have significantly improved. While SSc-PAH patients have also benefited from these advances, significant challenges remain. Diagnosis of PAH is a challenging endeavor in SSc patients who often have many co-existing pulmonary and cardiac comorbidities. Given the significantly elevated prevalence and lifetime risk of PAH in the SSc population, screening for SSc-PAH is a critically useful strategy. Treatment with pulmonary arterial (PA) vasodilators has resulted in a dramatic improvement in the survival and quality of life of PAH patients. While therapy with PA vasodilators is beneficial in SSc-PAH patients, therapy effects appear to be attenuated when compared to responses in patients with idiopathic PAH (IPAH). This review attempts to chronicle and summarize the advances in our understanding of the optimal screening strategies to identify PAH in patients with SSc. The article also reviews the advances in the therapeutic and risk stratification strategies for SSc-PAH patients.

Identification of Optimal Thalassemia Screening Strategies for Migrant Populations in Thailand: A Mixed-Methods Approach

BACKGROUND: Severe thalassemia is common in Southeast Asia (SEA) and can lead to transfusion dependent anemia, growth retardation, and perinatal death. Prevention and control of thalassemia can be approached either preconceptionally (through carrier screening, reproductive planning, or preimplantation diagnosis) or antenatally (through prenatal screening and diagnosis and termination of pregnancy). Thailand's national thalassemia program focuses on antenatal interventions, provided free to citizens. However, there is a growing population of migrant workers from neighboring countries who face barriers to healthcare and likely have varied beliefs towards pregnancy termination. We conducted a mixed-methods study using survey, interview, and focus group data to identify key barriers to and optimal strategies for thalassemia screening in migrant communities in Thailand. METHODS: Myanmar and Cambodian migrant workers and agents, Thai healthcare providers, and Thai adults (aged 18-49 years) at Laem Chabang Hospital (Chonburi, Thailand) participated in a knowledge, attitudes, and practices (KAP) survey, interviews, and focus groups. All sessions were conducted in Thai or English, audio recorded, transcribed and translated into English, and analyzed thematically using MAXQDA. Codes were developed iteratively and used to answer key explanatory questions arising from the KAP survey. Ethical approval for the study was obtained from Mahidol and Duke Universities. RESULTS: Both quantitative and qualitative data showed dramatically lower thalassemia awareness in migrants vs Thai (Table 1). Furthermore, providers perceived migrants to be disinterested in thalassemia screening, though migrant narratives illustrated significant language barriers, economic barriers, lack of health literacy, and competing social stressors - all of which may contribute to perceived indifference towards thalassemia screening. Both Thai and migrants had misconceptions about thalassemia, believing it to be contagious and sexually transmitted, or equating thalassemia carrier status with disease and vice versa (Table 1). These misconceptions may contribute to the stigmatization and isolation of individuals with thalassemia and disincentivize carrier screening for fear of discrimination. Participants supported thalassemia prevention and identified antenatal care (ANC) as the main access point for thalassemia education, screening, and prevention. However, they described key limitations of this antenatal approach, including the inability to offer termination in pregnancies presenting late to ANC; couples' hesitation to terminate; cost of prenatal testing (for migrants); and reliance on male partners to present for prenatal testing. In addition, migrants expressed more negative attitudes towards termination of pregnancy on the survey (Table 1). Participants associated this attitude with the perception that migrants were more religious, less educated, less knowledgeable about genetic disease risk, and more eager to have children. Participants proposed a number of solutions, including targeted education, delivered in migrants' native languages through ANC or public media, and universal carrier screening as a more acceptable approach to thalassemia prevention and control in migrant communities. Recommended settings for screening include schools or universities, hospitals, and workplaces. Migrants also reported relying heavily on employers for access to healthcare. Therefore, employer engagement in thalassemia education and screening efforts is critical, though employment discrimination remains a concern. CONCLUSION: This study provides insight from a variety of stakeholders into potential barriers and strategies for thalassemia screening in SEA migrant populations. Findings highlight a profound lack of thalassemia awareness among migrants leading to apparent disinterest in thalassemia screening, misconceptions and stigma surrounding thalassemia, and negative attitudes towards termination of pregnancy. Promotion of public education and carrier screening is an optimal strategy for migrant populations in Thailand. Furthermore, this approach can be adopted regionally and cooperatively by member states of the Association of SEA Nations (ASEAN) to better address the shared public health problem of thalassemia. Disclosures Telen: Pfizer: Other: Member of a clinical trial steering committee; Novartis: Other: Member of a safety monitoring committee; Forma Therapeutics: Research Funding.