Organized Screening Research Articles

Cervical, vaginal and vulvar cancer incidence and survival trends in Denmark, Finland, Norway and Sweden with implications to treatment

BackgroundIncidence of cervical cancer has been reduced by organized screening while for vaginal and vulvar cancers no systematic screening has been implemented. All these cancers are associated with human papilloma virus (HPV) infection. We wanted to analyze incidence trends and relative survival in these cancers with specific questions about the possible covariation of incidence, survival changes coinciding with incidence changes and the role of treatment in survival. We used nationwide cancer registry data for Denmark (DK), Finland (FI), Norway (NO) and Sweden (SE) to address these questions.MethodsWe use the NORDCAN database for the analyses: incidence data were available from 1943 in DK, 1953 in FI and NO and 1960 in SE, through 2016. Survival data were available from 1967 through 2016. World standard population was used in age standardization.ResultsIn each country the incidence of cervical cancer declined subsequent to rolling out of screening activities. The attained plateau incidence was lowest at 4/100,000 in FI and highest at 10/100,000 in DK and NO. The incidence of vaginal and vulvar cancer remained relatively constant at about 2/100,000. Relative 1-year survival in cervical cancer improved in all countries from low 80%s to high 80%s in the 50-year period, and 5-year survival improved also but at 20% units lower level. Survival gains were found only in patients diagnosed before age 60 years. Survival in vaginal and vulvar cancer followed the same patterns but at a few % units lower level.ConclusionCervical cancer screening appeared to have reached its limits in the Nordic countries by year 2000. Novel treatments, such as immunotherapy, would be needed to improve survival until HPV vaccination will reach population coverage and boost the global fight against these cancers.

Declining Colectomy Rates for Nonmalignant Colorectal Polyps in a Large, Ethnically Diverse, Community-Based Population.

INTRODUCTION:Despite studies showing improved safety, efficacy, and cost-effectiveness of endoscopic resection for nonmalignant colorectal polyps, colectomy rates for nonmalignant colorectal polyps have been increasing in the United States and Europe. Given this alarming trend, we aimed to investigate whether colectomy rates for nonmalignant colorectal polyps are increasing or declining in a large, integrated, community-based healthcare system with access to advanced endoscopic resection procedures.METHODS:We identified all individuals aged 50–85 years who underwent a colonoscopy between 2008 and 2018 and were diagnosed with a nonmalignant colorectal polyp(s) at the Kaiser Permanente Northern California integrated healthcare system. Among these individuals, we identified those who underwent a colectomy for nonmalignant colorectal polyps within 12 months after the colonoscopy. We calculated annual colectomy rates for nonmalignant colorectal polyps and stratified rates by age, sex, and race and ethnicity. Changes in rates over time were tested by the Cochran-Armitage test for a linear trend.RESULTS:Among 229,730 patients who were diagnosed with nonmalignant colorectal polyps between 2008 and 2018, 1,611 patients underwent a colectomy. Colectomy rates for nonmalignant colorectal polyps decreased significantly from 125 per 10,000 patients with nonmalignant polyps in 2008 to 12 per 10,000 patients with nonmalignant polyps in 2018 (P < 0.001 for trend). When stratified by age, sex, and race and ethnicity, colectomy rates for nonmalignant colorectal polyps also significantly declined from 2008 to 2018.DISCUSSION:In a large, ethnically diverse, community-based population in the United States, we found that colectomy rates for nonmalignant colorectal polyps declined significantly over the past decade likely because of the establishment of advanced endoscopy centers, improved care coordination, and an organized colorectal cancer screening program.

An international consensus on the essential and desirable criteria for an \u2018organized\u2019 cancer screening programme

BackgroundHigh variability in the definition and interpretation of organized cancer screening needs to be addressed systematically. Moreover, the relevance of the current practice of categorizing screening programmes dichotomously into organized or non-organized needs to be revisited in the context of considerable heterogeneity that exists in the delivery of cancer screening in the real world. We aimed to identify the essential and desirable criteria for organized cancer screening that serve as a charter of best practices in cancer screening.MethodsWe first did a systematic review of literature to arrive at an exhaustive list of criteria used by various publications to describe or define organized cancer screening, based on which, a consolidated list of criteria was generated. Next, we used a Delphi process comprising of two rounds of online surveys to seek agreement of experts to categorize each criterion into essential, desirable, or neither. Consensus was considered to have been achieved based on a predetermined criterion of agreement from at least 80% of the experts. The outcomes were presented before the experts in a virtual meeting for feedbacks and clarifications.ResultsA total of 32 consolidated criteria for an organized screening programme were identified and presented to 24 experts from 20 countries to select the essential criteria in the Delphi first round. Total 16 criteria were selected as essential with the topmost criteria (based on the agreement of 96% of experts) being the availability of a protocol/guideline describing at least the target population, screening intervals, screening tests, referral pathway, management of positive cases and a system being in place to identify the eligible populations. In the second round of Delphi, the experts selected eight desirable criteria out of the rest 16. The most agreed upon desirable criterion was existence of a specified organization or a team responsible for programme implementation and/or coordination.ConclusionsWe established an international consensus on essential and desirable criteria, which screening programmes would aspire to fulfil to be better-organized. The harmonized criteria are a ready-to-use guide for programme managers and policymakers to prioritize interventions and resources rather than supporting the dichotomous and simplistic approach of categorizing programmes as organized or non-organized.

A Modified Implementation Mapping Methodology for Evaluating and Learning From Existing Implementation.

When empirically supported interventions are implemented in real-world practice settings, the process of how these interventions are implemented is highly relevant for their potential success. Implementation Mapping is a method that provides step-by-step guidance for systematically designing implementation processes that fit the respective intervention and context. It includes needs assessments among relevant stakeholders, the identification of implementation outcomes and determinants, the selection and design of appropriate implementation strategies, the production of implementation protocols and an implementation outcome evaluation. Implementation Mapping is generally conceptualized as a tool to prospectively guide implementation. However, many implementation efforts build on previous or ongoing implementation efforts, i.e., “existing implementation.” Learnings from existing implementation may offer insights critical to the success of further implementation activities. In this article, we present a modified Implementation Mapping methodology to be applied when evaluating existing implementation. We illustrate the methodology using the example of evaluating ongoing organized colorectal cancer screening programs in Switzerland. Through this example, we describe how we identify relevant stakeholders, implementation determinants and outcomes as well as currently employed implementation strategies. Moreover, we describe how we compare the types of strategies that are part of existing implementation efforts with those that implementation science would suggest as being suited to address identified implementation determinants. The results can be used for assessing the current state of implementation outcomes, refining ongoing implementation strategies, and informing future implementation efforts.

Trends in cervical cancer incidence and mortality of young and middle adults in Japan.

In most high‐resource countries with organized screening programs, the incidence and mortality of cervical cancer is decreasing. Recent statistics have also revealed a reduction in invasive cervical cancer incidence as a result of national vaccination programs. Paradoxically, cervical cancer incidence has increased in Japan, particularly amongst women of reproductive age. This study aimed to examine the trends in cervical cancer incidence and mortality for young and middle adult women in Japan, by analyzing trends in 10‐year interval age‐groups. Cervical cancer incidence for young and middle adult women (ages 20‐59 years) was obtained from high‐quality population‐based cancer registries in three prefectures from 1985 to 2015. National cancer mortality data were obtained from published vital statistics from 1985 to 2019. Trends in crude and age‐standardized rates (ASR) were analyzed using Joinpoint regression. The cervical cancer incidence trend in 20‐59‐year‐old women combined significantly increased over the observation period. Both crude and ASR increased from 1985 to 2015 with an annual percent change (APC) of +1.6% (95% confidence interval, 1.1, 2.1) and +1.7% (1.2, 2.3), respectively. Similar increases were seen in ages 20‐29, 30‐39, and 40‐49 years with higher APCs especially in 20s and 30s. Both crude and ASR mortality significantly increased after the early 1990s in ages 20‐59 years combined. Based on the recognition that current cervical cancer control strategies in Japan have not been effective in reducing the cervical cancer burden in young and middle adults, promotion of screening and vaccination should be urgently strengthened.

Impact of a Human Papillomavirus Vaccination Program within Organized Cervical Cancer Screening: Cohort Study.

We assessed the effectiveness of an HPV (human papillomavirus) vaccination program in lowering cervical abnormality risk, and conferring herd protection. Retrospective cohort study using linked screening and vaccination administrative health data of the general population of Ancona Province, Italy. We included all female residents born in 1990-1993, eligible for catch-up HPV vaccination up to age 25 years, and adhering to organized screening in 2015-2020 (n = 4,665). Cervical abnormalities rates were compared between: Vaccinated and unvaccinated women, and cohorts with high and low vaccination uptake. Analyses were adjusted for age, country of birth, screening tests number, laboratory, and municipality average income. Main outcomes were ASC-US+ or LSIL+ Pap smears, and CIN1+ or CIN2+ histology. Mean screening age was 26.6±1.5 years, and 1,118 screened women (24.0%) were vaccinated (mean vaccination age 19.2±1.5 years). The diagnosed cervical abnormalities were: 107 LSIL+ (2.3%), 70 CIN1+ (1.5%), and 35 CIN2+ (0.8%). The adjusted odds ratios of LSIL+, CIN1+, and CIN2+ among vaccinated versus unvaccinated women were, respectively: 0.55 [(95% confidence interval (CI), 0.33-0.91)], 0.43 (95% CI, 0.22-0.86), and 0.31 (95% CI, 0.11-0.91). Among the unvaccinated, those in the highest-uptake (45.3%) 1993 cohort, versus the last pre-vaccination 1990 cohort, showed AORs of LSIL+ and CIN1+ of 0.23 (95% CI, 0.10-0.50), and 0.22 (95% CI, 0.07-0.69), respectively. In the first evaluation from Central Italy, catch-up HPV vaccination considerably reduced the risk of all cervical abnormalities diagnosed within organized screening, and conferred an elevated degree of herd protection among unvaccinated women. The high protection conferred by HPV vaccination suggests the need to update cervical screening.

Could a Behavioral Model Explain Adherence to Second-Level Colonoscopy for Colon Cancer Screening? Results of a Cross-Sectional Study of the Palermo Province Population.

According to Italian Essential Levels of Assistance (ELA), a colonoscopy is strongly recommended after a positive fecal occult blood test (FOBT) due to its effectiveness in early colorectal cancer detection. Despite the evidence, the Palermo province population (Italy), after a positive FOBT, have a lower colonoscopy adherence compared to Italian standards. This cross-sectional study analyzed patients’ perceptions of colonoscopy procedures to understand the reasons for non-adherence. Patients with a positive FOBT who did not undergo a colonoscopy within the national organized screening program were administered a telephone interview based on the Health Belief Model (HBM) questionnaire. The number of non-compliant patients with a colonoscopy after a positive FOBT were 182, of which 45 (25.7%) patients had undergone a colonoscopy in another healthcare setting. Among the HBM items, in a multivariate analysis only perceived benefits were significantly associated with colonoscopy adherence (aOR = 6.7, p = 0.03). Health promotion interventions should focus on the importance of the benefits of colorectal screening adherence to prevent colorectal cancer, implementing health communication by healthcare workers that have closer contacts with people, as general practitioners.

Trends in lung cancer incidence by gender, histological type and stage at diagnosis in Japan, 1993 to 2015: A multiple imputation approach.

Continued decrease in smoking prevalence and increasing use of sensitive diagnostic procedures necessitate updated monitoring of trends in lung cancer incidence in Japan. We analyzed histology‐ and stage‐specific trends in 1993 to 2015 using data from 62 870 diagnosed cases from the Monitoring of Cancer Incidence in Japan project. After applying a multiple imputation approach to impute missing/unknown values of stage and histology, we estimated age‐standardized incidence rates and applied joinpoint regression analyses. We observed long‐term growth trends in adenocarcinoma (ADC) and localized cancer among both genders, long‐term declining trends among men and leveling‐off trends among women in small‐cell carcinoma (SMC) and squamous cell carcinoma (SQC). Stratifying by gender, we observed an increase in localized ADC with average annual percentage changes (AAPC) of 4.5 (95% confidence interval: 3.9 to 5.0) and 5.7 (5.0 to 6.4), a decrease in regional ADC with AAPC of −1.5 (−2.5 to −0.6) and −2.3 (−4.6 to 0.0), but an increase in distant ADC with AAPC of 1.5 (1.1 to 1.9) and 1.6 (0.9 to 2.3) among males and females, respectively. Additionally, increasing trends in female‐to‐male incidence rate ratios were observed in localized ADC with significantly above one in the most recent diagnosis period. Our results revealed evidence for a partial shift from advanced to early cancer stage, which may suggest the modest effectiveness of nationwide organized screening programs. The observed increasing localized and distant ADC may be linked to improved diagnostic procedures, especially for metastasis detection. Further investigation is needed for more accurate quantification of these factors.

Improvement of participation rate in colorectal cancer (CRC) screening by training general practitioners in motivational interviewing (AmDepCCR)

BackgroundColorectal cancer (CRC) is the second leading cause of cancer death in France (17,712 annual deaths). However, this cancer is preventable in the majority of cases by the early detection of adenomas. In France, the organized screening for CRC relies on general practitioners (GPs). The tests delivered by the GPs are carried out in 89% of cases. However, GPs do not systematically offer the test, because of time management and communication.MethodsAmDepCCR is a cluster randomized trial. Patients are prospectively included by their GPs. The study is designed in 2 phases for the GPs: first, GPs who have never participated in motivational interviewing (MI) training will be recruited then randomly split in 2 groups. Secondly, a 6-day motivational interviewing training will be carried out for the intervention group. Then, patients will be included in both groups during a period of 1 year. The primary outcome will be the number of CRC screenings achieved in each group and its difference. The secondary outcome will be the reluctance to screening and the patient’s self-estimated life expectancy at 0, 6, 12, and 24 months using the Health Belief Model (HBM).DiscussionThis study will help to know if GPs motivational interviewing is useful to improve organized CRC screening. In addition, it may help to improve communication between patients and GPs. GPs will be able to improve their practice in other fields of application through motivational interviewing (other screenings, addictions…).Trial registration2019-A01776-51 NCT04492215.

Sero – Prevalence of Rubella Virus Igm among Pregnant Women Attending Aminu Kano Teaching Hospital Kano, Nigeria

The 96 well micro-titer plate was first secured in the holder, a data sheet with sample identification was prepared, leaving one well for blank, one hundred micro- liter of negative control was added to the next 3 wells, then 100μL of positive control to the following 2 wells. One hundred micro - liter of the sample diluents was added into each of the test wells which were followed by adding 10μL of specimen into each of the wells containing sample diluents. 300 pregnant women screened for the rubella IgM antibody, a total of 12(4.0%) were positive, in the young adults category of 15-24 years 88 pregnant women were screened with 5(1.7%) testing positive. One hundred and forty four were within 25-34 age group with 4(1.3%) seropositive. Three (1.0%) 0f the 68 women in 34-44 age group were positive. The highest prevalence was found in the young adult’s category of 15-24 age groups. The research provided an evidence of relatively low prevalence and a high percentage of susceptible population which is an evidence that many in the population are susceptible to rubella virus infection. The findings of an immune response in first trimester of pregnancy indicates 90% chances of passage to the feotus with serious complications. There is need for awareness creation on rubella virus and congenital rubella syndrome with increase in disease surveillance nationwide. With high level of susceptible population coupled with no immunization policy on rubella in the country underscores the need for initiating organized routine screening and vaccination among healthcare workers, children, adolescents and women of child bearing age as well as ascertaining the potency of vaccines prior to recommendation for vaccination.&#x0D; Keywords: Sero – Prevalence, Rubella Virus, Pregnant Women

Author commentary on Manuel Zorzi et al.

Manuel Zorzi et al. Adenoma detection by ndocuff-assisted versus standard colonoscopy in an organized screening program: the “ItaVision” randomized controlled trial

An observational study of workflows to support fecal testing for colorectal cancer screening in primary care practices serving Medicaid enrollees

BackgroundScreening supports early detection and treatment of colorectal cancer (CRC). Provision of fecal immunochemical tests/fecal occult blood tests (FIT/FOBT) in primary care can increase CRC screening, particularly in populations experiencing health disparities. This study was conducted to describe clinical workflows for FIT/FOBT in Oregon primary care practices and to identify specific workflow processes that might be associated (alone or in combination) with higher (versus lower) CRC screening rates.MethodsPrimary care practices were rank ordered by CRC screening rates in Oregon Medicaid enrollees who turned age 50 years from January 2013 to June 2014 (i.e., newly age-eligible). Practices were recruited via purposive sampling based on organizational characteristics and CRC screening rates. Data collected were from surveys, observation visits, and informal interviews, and used to create practice-level CRC screening workflow reports. Data were analyzed using descriptive statistics, qualitative data analysis using an immersion-crystallization process, and a matrix analysis approach.ResultsAll participating primary care practices (N=9) used visit-based workflows, and four higher performing and two lower performing used population outreach workflows to deliver FIT/FOBTs. However, higher performing practices (n=5) had more established workflows and staff to support activities. Visit-based strategies in higher performing practices included having dedicated staff identify patients due for CRC screening and training medical assistants to review FIT/FOBT instructions with patients. Population outreach strategies included having clinic staff generate lists and check them for accuracy prior to direct mailing of kits to patients. For both workflow types, higher performing clinics routinely utilized systems for patient reminders and follow-up after FIT/FOBT distribution.ConclusionsPrimary care practices with higher CRC screening rates among newly age-eligible Medicaid enrollees had more established visit-based and population outreach workflows to support identifying patients due for screening, FIT/FOBT distribution, reminders, and follow up. Key to practices with higher CRC screening was having medical assistants discuss and review FIT/FOBT screening and instructions with patients. Findings present important workflow processes for primary care practices and may facilitate the implementation of evidence-based interventions into real-world, clinical settings.

Secondary prevention of gastric cancer: An alternative strategy

Background: Early detection and treatment provide the only curative possibility for gastric cancer. A cost-effective strategy is imperative in developing countries with high mortality rates. The objective of this study is to analyse the results of an organized endoscopic screening in a symptomatic population 40 years and older. Methods: This was a prospective observational study of patients with gastrointestinal symptomology referred by primary care who had direct access to an endoscopy unit at the secondary referral centre. Physicians were trained, and an endoscopy request form and a flowchart for referral and patient management were designed. Endoscopic performance, early detection rates, resectability and survival, overall and disaggregated by sex, were evaluated. Findings: From July 1, 1996, to June 30, 2013, 25.304 endoscopies were performed, of which 14.521 were in individuals in risk groups (70% women). A total of 339 gastric cancers were detected, for a detection rate of 2.3%. The rate of early gastric cancer (EGC) among all cancers was 34% (f: 46.6%, m: 27.6%). The resectability for both sexes was 68.1% (f: 78.8%, m: 62.4%). The EGC rate in resected patients was 45% (f: 54.8%, m: 38.4%). The five-year survival rate for all cancers was 38.1% (f: 51.7%, m: 30.8%), and that for patients who underwent resection was 57.6% (f: 69.0%, m: 50.0%). The 10-year survival for all cancers was 27.5% (f: 40.5%, m: 20.5%), and that for patients who underwent resection was 43.1% (f: 55.0%, m: 35.0%). Interpretation: Organized screening in a symptomatic population aged 40 years and older by endoscopy has high performance, increases the rate of EGC and impacts survival. Women achieved results similar to those reported by countries with mass survey. For men to achieve these results, it is necessary to educate the population at risk, especially the most vulnerable. Keywords: gastric cancer; endoscopic screening; resectability; early detection; survival.

Challenges of Implementing Lung Cancer Screening in a Developing Country: Results of the Second Brazilian Early Lung Cancer Screening Trial (BRELT2).

PURPOSEThis paper aims to present the results of a series of several Brazilian institutions that have been carrying out lung cancer screening (LCS).MATERIALS AND METHODSThis is a retrospective, cohort study, with follow-up of individuals of both sexes, with a heavy smoking history, who participated in LCS programs between December 2013 and January 2021 in six Brazilian institutions located in the states of São Paulo, Rio Grande do Sul, and Bahia.RESULTSThree thousand four hundred seventy individuals were included, of which 59.8% were male (n = 2,074) and 50.6% were current smokers (n = 1,758), with 60.7 years (standard deviation 8.8 years). Lung-RADS 4 was observed in 233 (6.7%) patients. Biopsy was indicated by minimally invasive methods in 122 patients (3.5%). Two patients who demonstrated false-negative biopsies and lung cancer were diagnosed in follow-up. Diagnosis of lung cancer was observed in 74 patients (prevalence rate of 2.1%), with 52 (70.3%) in stage I or II. Granulomatous disease was found in 20 patients. There were no statistical differences in the incidence of lung cancer, biopsies, granulomatous disease, and Lung-RADS 4 nodules between public and private patients.CONCLUSIONThere are still many challenges and obstacles in the implementation of LCS in developing countries; however, our multi-institutional data were possible to obtain satisfactory results in these scenarios and to achieve similar results to the main international studies. Granulomatous diseases did not increase the number of lung biopsies. The authors hope that it could stimulate the creation of organized screening programs in regions still endemic for tuberculosis and other granulomatous diseases.

Evaluating the impact of the COVID-19 pandemic on cancer screening in a central Canadian province

We evaluated the impact of COVID-19 on cancer screening in Manitoba, Canada using an interrupted time series (ITS) design and data from Manitoba's population-based, organized cancer screening programs from April 2020 to August 2021. In June 2020 (breast screening was suspended during April and May 2020), there was a 54% decrease between the predicted (i.e., observed data produced from regression models) and expected (i.e., counterfactual values produced for the COVID-19 period by assuming COVID-19 did not occur) number of screening mammograms (ratio = 0.46, 95% Confidence Interval (CI) 0.28–0.64). By December 2020, there was no significant difference between predicted and expected number of screening mammograms (ratio = 0.95, 95% CI 0.80–1.10). In April 2020, there was an 83% decrease in the number of Pap tests (ratio = 0.17, 95% CI 0.04–0.30). By January 2021, there was no significant difference between predicted and expected number of Pap tests (ratio = 0.93, 95% CI 0.81–1.06). In April 2020, there was an 81% decrease in the number of screening program fecal occult blood tests (FOBTs) (ratio = 0.19, 95% CI 0.0–0.44). By September 2020, there was no significant difference between predicted and expected number of FOBTs (ratio = 0.95, 95% CI 0.65–1.24). The estimated cumulative deficit (i.e., backlog) from April 2020 to August 2021 was 17,370 screening mammograms, 22,086 Pap tests, and 5253 screening program FOBTs. Overall, screening programs adapted quickly to the COVID-19 pandemic. Additional strategies may be needed to address remaining backlogs.

Exercise-Induced Bronchospasm in Elite Athletes.

Exercise is one of the most common triggers of exercise-induced bronchospasm (EIB), with less trained athletes showing more symptoms. Exercise-induced bronchospasm is a common and frequent problem among elite athletes with obvious implications on competing performance, health, and quality of life. Classical pathways in the development of EIB in this population include the osmotic and the thermal theory as well as the presence of epithelial injury and inflammation in the airway. Moreover, neuronic stimulation has been suggested as a potential modulator of EIB in elite athletes. In this category of population, the diagnosis of EIB is a serious challenge, especially as spirometry before and after bronchodilation is not diagnostic and specific tests are required. To date, there is no organized screening in asymptomatic elite athletes to detect EIB. This review aims to summarize the pathophysiology, clinical manipulations, and therapeutic approach of EIB in elite athletes. We searched for published studies related to the aim of this study. Exercise-induced bronchospasm is a serious and common disorder in elite athletes, and its symptoms are nonspecific with a need to confirm the diagnosis with specific tests.

Organizovani skrining raka grlića materice u Domu zdravlja "Novi Sad"

Cervical cancer can be prevented and cured by early detection. Yet, it is the fourth most common type of cancer among women worldwide. According to data from the Cancer Registry of the Institute of Public Health of Serbia "Dr. Milan Jovanović Batut," 1044 newly diagnosed cases were registered among women and 438 women died from this malignant localization in 2019. Human papillomavirus infection (hereinafter referred to as: HPV) is the most important risk factor for the development of cervical cancer. Thanks to the natural course of HPV infection and the biological behaviour of premalignant changes in the cervix, cervical cancer prevention can be carried out at the primary, secondary and tertiary prevention levels. Secondary prevention involves screening (early detection of asymptomatic forms of the disease) and represents an organized mass invitation of the target population of women (aged between 25 and 64 years) for testing and interpretation of test results, followed by quality assurance control and reporting. Organized screening is done at threeyear intervals in the healthy population and allows for detecting not only malignant disease but also precancerous changes whose removal prevents the occurrence of malignant diseases. The methodology used in this paper included the monitoring of screening results performed at the "Novi Sad" Health Centre in the period from 2013 to 2022. The documentation of the institution's regular reporting on screening results, which contains depersonalized aggregated data, was used as a data source. In the statistical data analysis, descriptive statistics was used and the data have been presented in tabular form. The Women's Health Care Service with its Cytology laboratory has been the implementer of the organized cervical cancer screening program at the "Novi Sad" Health Centre since 2013 (covering a population of 110,067 women aged 25 to 64 for the territory of the municipality of Novi Sad and the municipality of Sremski Karlovci). The gynaecology service of the "Novi Sad" Health Centre was highly commended by the Cervical Cancer Screening Office for the results achieved in terms of the highest coverage of the target population and the largest number of Pap smear tests performed. In the period from March 2013 to July 2022, a total of 210,410 swabs, of which 9,469 (4.5%) showed atypia, were taken for screening purposes at the "Novi Sad" Health Centre. The aim of the paper was to show the organization of the "Novi Sad" Health Centre as well as the results achieved in organized cervical cancer screening, as a secondary prevention measure that can contribute to the reduction in cervical cancer incidence and mortality rates among women.

КОМПЛЕКСНАЯ ДИАГНОСТИКА ЦЕРВИКАЛЬНОЙ ИНТРАЭПИТЕЛИАЛЬНОЙ НЕОПЛАЗИИ В РЕСПУБЛИКЕ ТАДЖИКИСТАН

Objective: To study the experience of a comprehensive diagnosis of cervical intraepithelial neoplasia (CIN) based on the results of the first pilot visual screening in the Republic of Tajikistan. Methods: The first pilot visual screening in two large districts of the Republic of Tajikistan was carried out in 2016. A total of 68,391 women of the target groups took part in this study, of which 26,691 (39%) were from the Kushoniyon district and 41,700 (61%) from the B. Gafurov district. According to the algorithm of organized visual screening, extended colposcopy, cytological examination, and biopsy with histological examination were performed. Results: According to the results of the tests performed, in 164 cases (0.24%) CIN was diagnosed, while in 20 cases (0.03%) cervical cancer (CC) was detected (p&lt;0.001). Mild low-grade squamous intraepithelial lesions (LSIL) lesions were detected in 99 cases (70 women from B. Gafurov district and 29 patients from Kushoniyon district), while severe high-grade squamous intraepithelial lesions (HSIL) were detected in 65 cases (59 women from B. Gafurov district and 6 women from Kushoniyon district). Patients with histologically confirmed precancerous pathology and cervical cancer were referred for outpatient and inpatient treatment. Conclusion: The strategy of organized visual screening 'detection-diagnosis-treatment', recommended by WHO for countries with limited resources, is optimal for implementation in the conditions of the Republic of Tajikistan at the national level. Keywords: Cervical intraepithelial neoplasia, visual screening, VIA/VILI visual method, colposcopy.

Health inequalities among Russian-born immigrant women in Finland: Longitudinal analysis on cervical cancer incidence and participation in screening

Research has documented both lower and higher cancer incidence among migrants. Evidence among the large Russian-born migrant population, however, is scarce. We examined cervical cancer incidence and screening participation among Russian-born immigrant women in Finland, a country with complete cancer registration and universal public health care including organized cancer screening. Our study population included all the women that resided in Finland during 1970–2017 and was formed linking individual-level data from four nationwide registries. The linked data sets on cancer and cancer screening were analysed separately using different statistical models. Russian-born immigrant women had increased (+62%) incidence of cervical cancer compared to the general Finnish female population, and they participated in cervical cancer screening slightly less than other women. Our findings showed no consistent transition pattern in cancer incidence or screening participation rate with duration of stay. Potential explanations for the observed differences include institutional and behavioural factors. Cervical cancer is one of the most preventable cancers, and cancer screening can both prevent and reduce incidence and mortality of cervical cancer. Efforts should be made to encourage migrant populations to participate in cervical screening.

Cost-effectiveness of colonoscopy and related procedures: population screening perspectives

Colorectal cancer (CRC) screening can reduce the incidence and mortality of CRC, and many countries with moderate-to-high incidences of CRC have implemented population screening programs. Colonoscopy plays a pivotal role in the context of CRC screening as the primary screening modality, the diagnostic exam after a positive noninvasive test, the therapeutic procedure for resecting detected neoplasms, and the surveillance exam after the removal of neoplastic lesions. Although colonoscopy outperforms other noninvasive tests in detecting colorectal neoplasms, it is associated with higher cost, manpower, and invasiveness. Owing to the heterogeneity of healthcare systems in terms of the scale of health revenue, population demographics, and the payment systems in each country, the optimal or most cost-effective screening strategy may vary. Accordingly, economic appraisal of different approaches is essential, especially in organized screening programs within which the resources and the clinical capacity are constrained, and each step of the screening flow needs careful monitoring. The therapeutic procedures applied to manage screening-detected lesions and subsequent surveillance procedures also contribute to substantial additional costs. The level of willingness to pay is affected by various factors, including demographics, income, educational level, and health consciousness, and largely affects the optimal strategies. Herein, we systematically review and summarize the current evidence regarding the cost-effectiveness of colonoscopic screening, related therapeutic procedures, and subsequent surveillance and provide a balanced view from the perspective of population screening programs. It was revealed that 10-year colonoscopy is the most effective strategy compared to other strategies under the higher willingness-to-pay threshold or low colonoscopy cost. There are, however, discrepancies in the results among studies from different countries, which could be associated with the different cost parameters and assumptions used in the models. As for various therapeutic procedures for colorectal neoplasms such as polypectomy, endoscopic mucosal resection, or endoscopic submucosal dissection, strategies based on the risk of advanced histology or deep submucosal invasion based on image-enhanced endoscopy are the least expensive and avoid more recurrences. Furthermore, subsequent surveillance strategies that are based on the risk of CRC are more cost-effective. This article provides a comprehensive review of the literatures and a balanced view from the perspective of population screening programs.