Organized Screening Program Research Articles

Coverage of mammography imaging in and outside an organized breast cancer screening program - variation by age and sociodemographic groups.

In recent decades, attendance to organized breast cancer screening has been decreasing in European countries. This could be partly due to an increase in the use of opportunistic screening. The aim of this study was to assess the coverage of imaging in and outside the screening program in Finland during the period of 1999-2018. We also compared the usage of imaging services across sociodemographic groups in the more recent years (2017-2018). Our initial data consisted of 1,159,000 screening-target-aged women (50-69 years) in 1999-2018 and 1,849,000 women aged 30-89 years in 2017-2018. Data on organized breast cancer screening program was drawn from the Finnish Cancer Registry and supplemented with comprehensive individual data on mammograms and ultrasounds performed outside the program. Among the screening-aged women (50-69), a clear decline in the overall imaging coverage was observed during the study period (from 89 to 85%). The use of outside imaging increased slightly but not enough to compensate for the overall decrease. There were large differences in coverages between sociodemographic groups. Compared to manual workers and the unemployed, upper-level employees were around two times more active in using outside imaging (8.2% vs. 3.6% and 4.3%, respectively). Overall breast imaging coverage has slowly decreased during the 2000s, while outside imaging has increased slightly. The coverage of imaging in and outside the program largely followed the same trends, with the highest usage concentrating on higher socioeconomical groups, native speakers and highly educated women.

A scoping review on sociodemographic inequalities in breast cancer screening attendance in Germany

Abstract Background Organized breast cancer screening (BCS) programs are effective measures among women aged 50-69 for preventing the fifth cause of death in Germany. However, still participation rates have not yet reached EU standards. It is unclear which and how sociodemographic factors are related to BCS attendance. This scoping review aims to identify sociodemographic inequalities in BCS attendance among 50-69-year-old women following implementing the Organized Screening Program in Germany. Methods Following PRISMA guidelines, we searched the Web of Science, Scopus, MEDLINE, PsycINFO, and CINAHL. We included primary studies with a quantitative study design and reviews examining BCS attendance among women aged 50-69 with data from 2005 onwards in Germany. Harvest plots depicting effect size direction for the different identified sociodemographic inequalities were developed. Results We screened 476 titles and abstracts and 33 full texts. In total, 27 records were analysed, 14 were national reports, and 13 peer-reviewed articles. Eight sociodemographic variables were identified and summarised in the harvest plots: age, education, income, migration status, type of district, employment status, partnership cohabitation and health insurance. Older women, women with lower incomes and migration backgrounds who live in rural areas and lack private insurance, respond more favourably to BCS invitations. However, from a lifetime perspective, these associations only hold for migration background, are reversed for income and urban residency, and are complemented by partner cohabitation. Finally, women living in the federal states of Lower Saxony, Saxony, Mecklenburg-Western Pomerania, Saxony-Anhalt, and Thuringia showed higher attendance rates in the last two years. Conclusions High-quality research is needed to identify women at higher risk of not attending BCS in Germany, particularly as the overall attendance rate still falls below European standards. Key messages • High-quality research is needed to identify women at higher risk of not attending BCS in Germany, particularly as the overall attendance rate still falls below European standards. • Women without migration background, high income, living in rural areas, and not cohabitating with their partners are at higher risk of never attending BCS in Germany.

Detecting Unrecognized Dementia Using Deep Learning Methods with Korean National Claims Data

Abstract Background Dementia is one of the leading causes of death in elderly people. In Korea, the government supports dementia screening for people aged 60 and older, but it is not a population-based organized screening program. It is difficult to achieve early diagnosis and early treatment. The objective of this study is to detect unrecognized dementia using Korean National Claims Data for early diagnosis. Methods This study used the National Health Insurance Claims data in Korea. The case group is the new dementia visit as an unrecognized group, while the control group was randomly selected from the general population without dementia. The predictors included health utilization, socioeconomic and demographic, procedure codes, diagnostic codes and health screenings data. The health utilization variables included length of stay, the number of outpatient visits, health expenditures and other encounter information. All medical utilization data was aggregated monthly. In the case group, 12 months of data from 6-month or 2-years before the onset of dementia were used. In the control group, 12 months of data from randomly selected time point were included. Transformer, embedding methods, and Time2Vec were used as the deep learning methods. This study included 453,306 incidents of dementia, representing almost all cases reported from 2010 to 2019 in Korea. The control group consisted of 669,873. Results After training the deep learning prediction model, the AUC for 6-month dementia prediction on the test dataset was 0.87, and for 2-year dementia prediction, it was 0.76. The most important variables were health utilization variables, especially health expenditures. The health utilization trajectories of the case group were significantly different from those of the control group. Conclusions Based on the claims data, we could detect unrecognized dementia case. We can extend the model to other chronic disease such as cancer and stroke, which are significant burden of disease. Key messages • Screening in healthcare facilities or using lab test results would be more accurate, but it would be difficult to apply to a large population due to the cost-effectiveness and timeliness constraints. • On the other hand, the detection model using the existing claims data would be helpful to to develop cost-effective mass screening program. It can cover the weakness of current screening program.

B-335 Analytical Performance of the Novel EQA Material for Fecal Immunochemical Test for Hemoglobin

Abstract Background EQA (external quality assurance) program for FIT (fecal immunochemical test for hemoglobin) is performed in many countries, and its demand increases as FIT is widely used in organized colorectal cancer screening programs. The materials used in FIT EQA vary from buffer-based liquid control, and lyophilized stool, to material that mimics stool, artificial stool. We could not find ideal EQA material with hemoglobin uniformly contained, good stability of hemoglobin, and ease in use such as ready-to-use form. The merit to use material that simulates actual sample, stool, is not only to be compliant with ISO15189 but also to suit various methods and sampling devices in FIT. The development of artificial stool material has been awaited by laboratories using FIT to evaluate errors and precisions in specimen collection.We assessed the analytical performance of the new artificial stool developed in HECTEF (Health Care Technology Foundation) to evaluate this artificial stool material was suitable as an EQA material. We examined the following three points: 1) Sample collection, 2) Uniformity, and 3) Stability of hemoglobin. Methods 1) Sample collection: The material was collected with the sampling probes of OC-Auto Sampling Bottle 3 (Eiken Chemical) and the collection amount was calculated by comparing the weight before and after sampling the artificial stool. 2) Uniformity: The uniformity of hemoglobin was evaluated during production before and after bottling based on “Uniformity of dosage units” section of The Japanese Pharmacopoeia 18th edition, 2021. The material was sampled from 10 different points and hemoglobin concentrations were measured using OC-Sensor DIANA. The uniformity of hemoglobin between the vials was evaluated by calculating the CV from the average of hemoglobin concentrations from samples of three points from three vials. 3) Stability of hemoglobin: The materials stored under different temperature conditions were compared with the material stored frozen at -20 °C. Storage conditions were at refrigeration for 20 months, at 30 °C for 1 month, and freeze-thawing for five times. Evaporation from the material was evaluated by weighing the samples before and after storage at 30 °C for 1 month. Results 1) Sample collection: The material was collected with sampling probes and the collection amounts were 106% (compared to theoretical amount).2) Uniformity: Uniformity of hemoglobin during production was within the specification of “Uniformity of dosage units” section of the pharmacopoeias, acceptance value<15.0. Uniformity of hemoglobin among three vials was within ±10% CV.3) Stability of hemoglobin: Stabilities of the material were all within ±10% from the control material (frozen) after storage at all temperature conditions. Evaporation from the material in a vial was below 1% at 30 °C storage for 1 month. Conclusions This artificial stool is suitable for EQA material because it is confirmed that it shows favorable analytical results in sample collection, uniformity, and stability of hemoglobin. The evaluation of this material in the EQA program to show its suitability was performed by Labquality. The result is reported in a poster at ADLM 2024.

Prevalence of abnormal thyroid function test in adults attending primary care setting in the year 2022 in the Kingdom of Bahrain

ABSTRACT Background: Thyroid disease is known to be one of the most common endocrine diseases globally and has serious health implications if left untreated. Objective: This study aimed to gain a better understanding of common thyroid diseases and to explore the associated risk factors in the Kingdom of Bahrain. Methods: A case-control study was carried out after obtaining all thyroid stimulating hormone (TSH) results done in a primary healthcare setting from January 1, 2022 to December 31, 2022 from the Health Information Department. In total, 500 participants were randomly selected from each group: the abnormal thyroid test group (cases) and the normal thyroid test group (controls). Participants were interviewed using a structured list of associated risk factors with the following sections: sociodemographic characteristics, comorbidities, family history of thyroid disease, BMI, previous radiation therapy, and certain medications. Results: The prevalence of abnormal thyroid tests was found to be 11%. Cases were categorized into four groups: hyperthyroidism (26.4%), hypothyroidism (64.6%), hyperthyroidism (4.5%), and subclinical hypothyroidism 13 (4.5%). The results showed significant differences between case and control in the following risk factors: female sex, increasing age, BMI, dyslipidemia, family history of thyroid disease, and previous radiation therapy (P = <0.05). Conclusion: In summary, the high prevalence of abnormal thyroid results highlights the need for an organized national screening program for individuals at average risk for developing thyroid disease.

Cervical cancer screening outcomes among First Nations and non‐First Nations women in Alberta, Canada

BackgroundCervical cancer disproportionately affects First Nations women in Canada but there is limited information on their participation in organized cervical cancer screening programs. MethodsThis co-led retrospective cohort study linked population-based Alberta Cervical Cancer Screening Program point of care data with First Nations identifiers. This Screening Program database includes cervical cancer screening history, screen test results, colposcopy procedure findings, and pathology results for all women in Alberta. First Nations identifiers were obtained from Alberta Health who steward these data on their behalf. Data were available from 2012 to 2018 for women 25 – 69 years of age who were age eligible to participate in cervical cancer screening. Screening participation and retention rates, and screening outcomes were compared between First Nations and non- First Nations women using descriptive statistics with trends estimated using joinpoint models. ResultsAge standardized screening participation and retention rates of First Nations women were lower than those for the non-First Nations women, with an average difference of 13.9 % lower for participation rates (95 % confidence interval = 12.9–14.8 %; P <.0001) and 7.2 % for retention rates (95 % confidence interval = 2.2 % to 12.72; P = 0.013). First Nations women consistently had higher percentages of high risk (high-grade squamous intraepithelial lesion, atypical glandular cells, atypical squamous cells where HSIL cannot be excluded, Carcinoma in situ) abnormal cytology tests than non-First Nations women. ConclusionIdentifying where inequities were found in cervical cancer screening participation and retention in this study is the first step to reduce the disproportionate burden of cervical cancer for First Nations women in Canada.

Transition from opportunistic cytological to organized screening program with DNA-HPV testing detected prevalent cervical cancers 10 years in advance

Cervical cancer screening in Brazil is opportunistic, based on cytology and offered for women aged 25–64 years, with low coverage (30%) and 70% of cancer diagnoses done in advanced stages, without impact on mortality. The current study reports 5-year first-round results of a population-based DNA-HPV testing screening program in a Brazilian city, which intended to be a model for transition to a more efficient program. Program flowchart is simple and current, indicating repetition of a negative test after five years. The first-round (October 2017-September 2022) screened 20,551 women by DNA-HPV testing with 58.7% coverage and 99.4% compliance with the program's targeted age range. Coverage increases to 77.8% when excluding the ‘pandemic period’. The DNA-HPV testing was 87.2% negative with 6.2% colposcopy referrals and 84.8% colposcopies performed. A total of 258 high-grade precursor lesions and 29 cervical cancers (mean age = 41.4 years, 83% Stage I) were detected. As a reference, 41,387 cytology tests from the previous program (2012–2016) detected 36 cervical cancers (mean age = 52.0 years, p = 0.0005), with 67% in advanced stages (p < 0.0001). Organizing cervical cancer screening using DNA-HPV testing demonstrated good coverage, high age and colposcopy compliance, and detection of more precancerous lesions and cervical cancers 10 years in advance.

Diseases, drugs and dust

From 1 January to 20 June 2024, there were 186,900 reported flu cases resulting in 14 deaths in various regions of Thailand and on 21 August 2024 Thailand confirmed the first case of a new lethal variant of mpox. Thailand's Ministry of Public Health has announced plans to reclassify cannabis and hemp as illegal narcotics starting 1 January 2025. Vaping bans were emphasized on 31 May, the World No Tobacco Day. The organized Lung Cancer Screening program was started in the Northern Thailand where the prevalence of lung cancer and the level of PM 2.5 were high.

Organized prostate cancer screening program: a proposal from the Italian Society of Urology (SIU).

To contrast opportunistic PCa screening, the European Union Council suggested extending screening programs to PCa by recommending the implementation of a stepwise approach in the EU Countries to evaluate the feasibility and effectiveness of an organized program based on PSA testing in combination with additional MRI as a follow-up test. The objective of this expert-based document is to propose an organized PCa screening program according to the EU Council recommendations. The Italian Society of Urology (SIU) developed a team of experts with the aim to report 1) the most recent epidemiologic data about incidence, prevalence, and mortality of PCa; 2) the most important risk factors to identify categories of men with an increased risk to eventually develop the disease; 3) the most relevant studies presenting data on population-based screening; and 4) the current recommendations of the leading International Guidelines. According to previous evidence, the Panel proposed some indications to develop a new organized PCa screening program for asymptomatic men with a life-expectancy of at least fifteen years. The SIU Panel strongly supports the implementation of a pilot, organized PCa screening program inviting asymptomatic men in the age range of 50-55 years. Invited men who are already performing opportunistic screening will be randomized to continue opportunistic screening or to cross into the organized protocol. Men with PSA level ≤3 ng/mL and familiarity for PCa received a DRE as well as all those with PSA levels >3 ng/mL. All other men with PSA levels greater than 3 ng/mL proceed to secondary testing represented by mpMRI. Men with Prostate Imaging-Reporting and Data System (PI-RADS) lesions 3 and PSAD 0.15 ng/mL/cc or higher as well as those with PI-RADS 4-5 lesions proceed to targeted plus systematic prostate biopsy. The primary outcome of the proposed pilot PCa screening program will be the detection rate of clinically significant PCa defined as a tumor with a ISUP Grade Group ≥2. Main secondary outcomes will be the detection rate of aggressive PCa (ISUP Grade Group ≥4); the detection rate of insignificant PCa (ISUP Grade Group 1); the number of unnecessary prostate biopsy avoided, the metastasis-free survival, and the overall survival. Men will be invited over a one-year period. Preliminary analyses will be planned 2 and 5 years after the baseline enrollment. According to the recent EU Council recommendations on cancer screening, pilot studies evaluating the feasibility and effectiveness of PCa screening programs using PSA as the primary and mpMRI as the secondary screening test in selected cohorts of patients must be strongly promoted by scientific societies and supported by national governments.

Modalités préférées des femmes à la Réunion pour le dépistage du cancer du col de l’utérus par prélèvement vaginal

BackgroundSince the introduction of HPV testing as a first-line screening method for women aged 30 and over, vaginal sampling (VS) by a healthcare professional or self-sampling (SS) is now possible for women who have not responded to the organized screening program using cervical uterine sampling. The aim of this study was to understand the choices made by a sample of women from La Reunion would like to perform their VS, and the content of the instructions they would like to receive. MethodsWe conducted a cross-sectional descriptive study using a single-answer questionnaire. Patients were either interviewed in doctors’ office or offered the possibility to answer an online questionnaire. We included women aged 30 to 65 in La Reunion who were concerned by CC screening. We compared the answers of women who were up to date with their screening with those of women who were not. ResultsWe included 202 women. The study showed that 64.9% of patients wished to collect the VS kit from a healthcare professional, 80.8% wished to perform SS and 52.5% wished to return it to the laboratory. The preferred language of the instruction was French, with pictures and drawings for 48.5% of patients. There was no significant difference between the answers of women who were up to date with their screening and those who were not. ConclusionIn a sample of women eligible for CC screening in La Reunion, the preferred methods for CC screening were to collect the PV kit from a healthcare professional, perform the SS at home and then return it to the laboratory. These responses differed from other studies. A feasibility study on a part of La Reunion's eligible population for CC screening would enable us to assess the feasibility and generalizability of a screening modality based on SS.

Education and Information to Improve Adherence to Screening for Breast, Colorectal, and Cervical Cancer-Lessons Learned during the COVID-19 Pandemic.

The objective of this study was to determine the correlation between adherence to cancer screening programs and earlier diagnosis of the 14 most common types of cancers in the adult population, before and during the COVID-19 pandemic. National data concerning number of admissions and operations in Italy for adult patients admitted with oncologic problems during the COVID-19 pandemic (2020 to 2022) and in the pre-pandemic period (2015 to 2019) were analyzed. We selected 14 types of cancer that present the most common indications for surgery in Italy. This study included 1,365,000 adult patients who had surgery for the 14 most common types of cancer in the period 2015-2022, and interviews concerning adherence rates to screening for breast, colorectal, and cervical cancer were conducted for 133,455 individuals. A higher decrease in the number of operations for the 14 types of cancer (-45%) was registered during the first three acute phases of the pandemic, and it was more evident for screenable cancers like breast, colorectal, and cervical cancer (p < 0.001). During the first year of the COVID-19 pandemic, the number of screened individuals for breast, colorectal, and cervical cancer decreased by 33.8% (from 7,507,893 to 4,969,000) and the number of diagnoses and operations for these three types of cancer decreased by 10.5% (from 107,656 to 96,405). The increase and return to normality of the number of screened individuals in the last year of the pandemic (2022) and in the first post-pandemic year (2023) was associated with a return to the pre-pandemic levels of diagnoses and operations. The adherence rates were lower for individuals living in rural areas, with low socio-economic status, and unmarried persons; however, the most statistically significant factor for reduced adherence was a lower level of educational attainment. Free screening through nationally organized programs reduced social disparities. There were no significant differences between the pre-pandemic and pandemic periods for several types of cancers (stomach, esophagus, pancreas, liver) that are diagnosed for the occurrence of symptoms and for which nationally organized programs might increase the possibility of earlier diagnosis and improved clinical outcomes. Education, information, and appropriate expenditure for preventive care have the potential to reduce cancer mortality. Nationally organized screening programs for several types of cancers, which are often detected for the occurrence of symptoms, may increase the possibility of diagnosis at earlier stages.

Linguistic difference in the effect of organized programs on socioeconomic inequalities in breast cancer screening: ecological study in Switzerland.

The objective of this study is to examine how the effect of organized mammography screening programs on breast cancer screening participation differ between socioeconomic strata and how this relationship may be modified by the context of linguistic differences. Switzerland, marked by its diverse linguistic landscape, reflects cultural variations alongside differences in public health strategies. The goal of this study was to assess potential socioeconomic differences in regional mammography screening programs effectiveness to improve breast cancer screening participation. Data on 14 173 women in the regionally adapted breast cancer screening age range was drawn from five cross-sectional waves of the nationally representative Swiss Health Interview Survey (1997-2017). Socioeconomic indicators included education, household income, and employment status. Poisson regression was used to estimate the adjusted prevalence ratios of up-to-date (last 2 years) mammography uptake. Inequality was assessed using relative index of inequality and the slope index of inequality. Organized screening programs were generally effective and increased up-to-date mammography uptake by close to 20 percentage points in both regions. While in the Latin cantons, screening programs had no impact on socioeconomic inequalities in screening, it reduced inequalities for women with lower education in the German cantons. This modification effect of screening programs was not seen for income and employment-related inequalities and did not differ across linguistic regions. Public health agencies should consider the different cultural reception of programs as addressing these differences could help ensure that breast cancer screening initiatives are not only effective, but also culturally equitable across different socioeconomic groups.

Prostate cancer screening? Only evidence-based, risk-adjusted, and organized!

In view of arecent recommendation of the European Commission to conceptualize novel screening approaches for lung, gastric, and prostate cancer, Germany is also invoked to revise its prostate early detection program. This discussion article provides an overview of new findings on prostate cancer screening, which suggest an organized and risk-adapted screening approach. Based on the German risk-adapted screening trial PROBASE, together with recently published data on organized screening programs in Europe, model projects should be established to determine the specific modalities for anew organized and risk-adapted prostate cancer screening program.

Factors associated with deferral or non-performance of an organized breast cancer screening program during the COVID-19 pandemic in France.

Delays in detection and treatment of breast cancer can lead to increased mortality. To date, participation in organized breast cancer screenings (OBCS) has been suboptimal worldwide. The objective of this study was to investigate the factors associated with deferral or non-performance of mammography during the COVID-19 pandemic for women who had previously participated in OBCS. A retrospective observational study was conducted on a cohort of 6282 women from the Aube Department of France, who were invited to an OBCS in 2020. Participants were divided into women who promptly underwent screening after receiving an invitation (between 22 and 25 months elapsed since the last mammogram), women who underwent late screening (≥26 months since the last mammogram), and those who were never screened. Data were collected from a self-reported questionnaire. Comparative and multivariable analyses modeling the probability of each type of attendance were performed using these data. In total, 2301 women (aged 50-74 years) returned a valid questionnaire. Compared to women who promptly underwent mammography, non- and late-screening participants were younger, had less frequent gynecological follow-up and a less frequent history of colorectal cancer screening. Women with higher education status and those residing in socially disadvantaged areas were more likely to attend late. The absence of regular gynecological follow-up and the absence of colorectal cancer screening were significant factors associated with deferral of or non-attendance at OBCS.

HPV self-sampling in organized cervical cancer screening program: A randomized pilot study in Estonia in 2021.

Cervical cancer incidence in Estonia ranks among the highest in Europe, but screening attendance has remained low. This randomized study aimed to evaluate the impact of opt-in and opt-out human papillomavirus (HPV) self-sampling options on participation in organized screening. A random sample of 25,591 women were drawn from the cervical cancer screening target population who were due to receive a reminder in autumn 2021 and thereafter randomly allocated to two equally sized intervention arms (opt-out and opt-in) receiving a choice between HPV self-sampling or clinician sampling. In the opt-out arm, a self-sampler was sent to home address by regular mail; the opt-in arm received an e-mail containing a link to order a self-sampler online. The remaining 30,102 women in the control group received a standard reminder for conventional screening. Participation by intervention arm, age and region of residence was calculated; a questionnaire was used to assess self-sampling user experience. A significant difference in participation was seen between opt-out (41.7%) (19.8% chose self-sampling and 21.9% clinician sampling), opt-in (34.1%) (7.9% self-sampling, 26.2% clinician sampling) and control group (29.0%, clinician sampling only). All age groups and regions in the intervention arms showed higher participation compared to the control group, but the size of the effect varied. Among self-sampling users, 99% agreed that the device was easy to use and only 3.5% preferred future testing at the clinic. Providing women with a choice between self-sampling and clinician sampling significantly increased participation in cervical cancer screening. Opt-in and opt-out options had a different effect across age groups, suggesting the need to adapt strategies.

Non-participation in breast screening in Denmark: Sociodemographic determinants

BackgroundInternationally, non-participation in breast screening increased with decreasing level of education indicating importance of information campaigns to enhance awareness of screening. However, in Denmark in the 1990s the association between education and non-participation was U-shaped. We therefore analyzed recent Danish data.MethodsData derived from the Capital Region of Denmark, biennial, organized breast screening program 2008–2020, where women aged 50–69 were personally invited to screening. Non-participation was measured as number of women with no participation out of women eligible for at least three invitations. Sociodemographic determinants were identified by linkage to public registers. Results were reported as age adjusted odds ratios (OR) of non-participation including 95% confidence intervals (CI).ResultsAmong 196,085 women, 86% participated. Using women with low education as baseline, the OR for professional bachelors was 0.64; and for academics 0.75. The strongest determinants of non-participation were being non-married OR 2.03; born outside Denmark OR 2.04; being self-employed OR 1.67; retired OR 3.12; on public support OR 3.66; or having co-morbidity OR 1.56.ConclusionThe U-shaped association between education and non-participation in breast screening prevailed. The data further indicated that screening participation was low in women with pertinent health and social problems.

Evaluation of Host Gene Methylation as a Triage Test for HPV-Positive Women-A Cohort Study.

This study was designed to evaluate the performance of a host gene methylation marker panel (ASTN1, DLX1, ITGA4, RXFP3, SOX17, and ZNF671) in the triage of human papillomavirus (HPV)-positive women, its possible impact in a cervical cancer screening program, and the possible influence of the variation of the rate of HPV16/18 in its performance. Cohort study in which consecutive women referred for colposcopy in an organized cervical cancer screening program had repeated HPV testing, colposcopy, and biopsies. The women that remained HPV positive at the time of colposcopy were tested with the panel of DNA methylation markers. The performance of the test was evaluated and compared to standard practice. The study test had a sensitivity and specificity for cervical intraepithelial neoplasia (CIN) 2+ of 60.8% (49.1-71.6%) and 88.4% (83.2-92.5%), respectively. For CIN3+, it was of 78.0% (64.0-88.5%) and 86.0% (80.8-90.2%), respectively.The rate and level of methylation positively correlated with the severity of disease. The use of methylation reduces the referral for colposcopy to 25.5%, while detecting 78.0% of the CIN3+ cases. Referral of all HPV16/18-positive cases and triage of the other high-risk HPV-positive cases with methylation, detects 90.0% of the cases of CIN3+, while reducing the number of referrals to 43.2%.The variation in the rate of HPV16/18 does not relevantly affect the performance of the methylation panel. The studied methylation panel has a high sensitivity and specificity for CIN3+ and reduces the rate of referrals for colposcopy, without relevant variation according to the rate of HPV16/18.

The possible benefit of artificial intelligence in an organized population-related screening program : Initial results and perspective

Mammography screening programs (MSP) have shown that breast cancer can be detected at an earlier stage enabling less invasive treatment and leading to abetter survival rate. The considerable numbers of interval breast cancer (IBC) and the additional examinations required, the majority of which turn out not to be cancer, are critically assessed. In recent years companies and universities have used machine learning (ML) to develop powerful algorithms that demonstrate astonishing abilities to read mammograms. Can such algorithms be used to improve the quality of MSP? The original screening mammographies of 251 cases with IBC were retrospectively analyzed using the software ProFound AI® (iCAD) and the results were compared (case score, risk score) with acontrol group. The relevant current literature was also studied. The distributions of the case scores and the risk scores were markedly shifted to higher risks compared to the control group, comparable to the results of other studies. Retrospective studies as well as our own data show that artificial intelligence (AI) could change our approach to MSP in the future in the direction of personalized screening and could enable asignificant reduction in the workload of radiologists, fewer additional examinations and areduced number of IBCs; however, the results of prospective studies are needed before implementation.

327 Impact of Adjuvant Chemotherapy/Radiotherapy on the 5 Year Overall Survival of Patients with Non-Metastatic Rectal Cancer in Bulgaria - a Retrospective Population-Wide Observational Study

Abstract Introduction Survival rates of patients with non-metastatic rectal cancer (RC) have increased, due the use of adjuvant chemotherapy/radiotherapy post-surgery, recommended by the National Comprehensive Cancer Network (NCCN) [1–3]. The aim of the study was to analyse the impact of adjuvant chemotherapy/radiotherapy on the 5-year overall survival (OS) of patients diagnosed with non-metastatic RC patients in Bulgaria. Method This is a retrospective population wide observational study of 8968 cases registered with Colorectal cancer in the Bulgarian National Cancer Registry (BNCR) between 2015 and 2016. The mean and median age of patients with left colon (LCC) and right colon (RCC) along with rectal cancer (RC) was analysed. The impact of adjuvant chemotherapy and radiotherapy on the 5-Year OS for non-metastatic RC was analysed. Kaplan-Meier curve with log rank, ANOVA and chi-squared tests were used to estimate the statistical significance. Results The mean age at diagnosis for RCC, LCC and RC was 68.9, 67.41 and 66.4 respectively (p-Value=&amp;lt;0.001). The median age at diagnosis was 69, 68 and 67 for RCC, LCC and RC respectively. Our study showed that patients with non-metastatic RC that received both adjuvant chemotherapy and radiotherapy had a higher 5-year OS compared to patients who received either chemotherapy, radiotherapy or neither therapy (61.4%, 59.5%, 56.2%, 51.8%), p-Value=0.007. Less than 40% of patients received either adjuvant chemotherapy or radiotherapy. Conclusions Adjuvant chemotherapy/radiotherapy improves the 5-Year OS for patients with non-metastatic RC. NCCN guidelines should be implemented in Bulgaria [1–3]. Bulgaria will benefit by implementing an organised screening programme [4].

Adenoma detection rate and tolerability of 2 ultra-low-volume bowel preparations in screening: a noninferiority randomized controlled trial

The adenoma detection rate (ADR), recognized as a surrogate marker for colorectal cancer incidence and mortality reduction, is closely linked to the efficacy of bowel cleansing. However, there is a dearth of evidence examining the impact on ADR when employing two distinct very low-dose bowel cleansing products. This study sought to compare ADR in a fecal immunochemical occult blood testing (iFOBT) based organized screening program by utilizing 1L polyethylene glycol plus ascorbate (1L-PEGA) versus magnesium citrate plus picosulphate (SPMC), both administered in a split-dose regimen. We conducted a comparative, parallel, randomized, noninferiority, and low-intervention clinical trial, the study targeted individuals from a population colorectal cancer screening program aged 50-69 with a positive iFOBT result scheduled for a work-up colonoscopy in the morning. Participants were randomized to either 1L-PEGA or SPMC for bowel cleansing. Main outcome was ADR. Secondary outcomes were bowel preparation quality, individuals' safety, tolerability and satisfaction. A total of 1,002 subjects were included, 501 in each group. There were no differences between groups with respect to pooled ADR (SPMC, 56.5% [52.1-60.8]; 1L-PEGA, 53.7% [49.3-58.0]; RR 0.95 [0.85-1.06]); therefore, SPMC demonstrated noninferiority in ADR compared to 1L-PEGA (difference, 2.8%; 2-sided 95% lower confidence limit (LCL), -3.4). In addition, there were no significant differences in mean lesions regardless of size and location between arms. Bowel preparation favored 1L-PEGA (96.2% vs. 89.2%; p<0.001) whereas SPMC exhibited significantly higher safety and tolerability, as evidenced by fewer non-serious treatment-emergent adverse events CONCLUSIONS: SPMC emerged as a noninferior laxative compared to 1L-PEGA concerning ADR. Despite the superior bowel preparation quality associated with 1L-PEGA, the safety, tolerability and overall satisfaction of participants were higher with SPMC. This trial was registered at ClinicalTrials.gov (EudraCT: 2019-003186-18) on March 18, 2019.