Organized Screening Research Articles

Does it matter for the radiologists\u2019 performance whether they read short or long batches in organized mammographic screening?

ObjectiveTo analyze the association between radiologists’ performance and image position within a batch in screen reading of mammograms in Norway.MethodWe described true and false positives and true and false negatives by groups of image positions and batch sizes for 2,937,312 screen readings performed from 2012 to 2018. Mixed-effects models were used to obtain adjusted proportions of true and false positive, true and false negative, sensitivity, and specificity for different image positions. We adjusted for time of day and weekday and included the individual variation between the radiologists as random effects. Time spent reading was included in an additional model to explore a possible mediation effect.ResultTrue and false positives were negatively associated with image position within the batch, while the rates of true and false negatives were positively associated. In the adjusted analyses, the rate of true positives was 4.0 per 1000 (95% CI: 3.8–4.2) readings for image position 10 and 3.9 (95% CI: 3.7–4.1) for image position 60. The rate of true negatives was 94.4% (95% CI: 94.0–94.8) for image position 10 and 94.8% (95% CI: 94.4–95.2) for image position 60. Per 1000 readings, the rate of false negative was 0.60 (95% CI: 0.53–0.67) for image position 10 and 0.62 (95% CI: 0.55–0.69) for image position 60.ConclusionThere was a decrease in the radiologists’ sensitivity throughout the batch, and although this effect was small, our results may be clinically relevant at a population level or when multiplying the differences with the number of screen readings for the individual radiologists.Key Points• True and false positive reading scores were negatively associated with image position within a batch.• A decreasing trend of positive scores indicated a beneficial effect of a certain number of screen readings within a batch.• False negative scores increased throughout the batch but the association was not statistically significant.

Cervical testing beyond the screening target age – A register-based cohort study from Finland

ObjectiveIt has been proposed that cervical cancer screening should be continued in women with previous abnormal results or irregular attendance. We examined the coverage and factors that might influence cervical testing beyond the age range of the organized cervical screening programme in Finland. The national programme invites women in every five years least until the age of 60. After the stopping age, only opportunistic service is available. MethodsData on cervical testing were collected from the Mass Screening Registry and providers of opportunistic Pap/HPV-testing and were linked with information on socio-economic variables. The study included 373,353 women who had at least one invitation to the national screening programme between ages 50–60 years, and who were aged 65–74 years in the follow-up period 2006–2016. Multivariable binomial regression models were conducted to determine associations. ResultsAltogether 33% of the study population had been tested at least once at ages 65–74 years. Previous regular screening attendance (adjRR 1.70; 95% CI 1.67–1.73) and earlier abnormal results (adjRR 2.08; 95% CI 2.04–2.12) were most clearly related to higher testing adherence at older age. Other factors related to higher testing adherence were urban area of residence, domestic mother tongue, high education level, and high socio-economic status. ConclusionTesting at older age was frequent with normal results, whereas only a small proportion of women with earlier abnormal results or irregular attendance were tested. The upper age limit of the national programme should be raised to 65 years, and the invitations thereafter should be targeted to selected high-risk groups.

Women in Punjab are in Dire Need of Awareness Initiatives Related to Cervical Cancer and its Screening Tests

Cervical cancer is the third most common cancer and the fourth dominant cause of cancer related death in women throughout the globe. Eighty percent of cases occur in the developing nations1,2. The extent of this cancer is tough to be evaluated in Pakistanbecause of differing insufficient epidemiological figures obtainable in small scale studies, dealing only reported limited number of cases which are not representative of its true burden3,4,5. As stated by World Health Organization, in 2002, the pervasiveness of cervical cancer in Pakistan was 9 in 100,000; in 2008 it jumped up to 19.5/100,000. Claimed by various studies, this cancer is among the list of first ten frequent cancers in Pakistan6,7,8,9. It is one of the most avoidable cancers nowadays and we have all the tools to eradicate it, still the number of lives lost due to cervical cancer is very high in Pakistan as it is an ignored ailment here in terms of screening, prevention and vaccination9. Economically developed countries who invested capitals for organized screening projects have made notable progress in reducing both occurrence and mortality due to this specific cancer10. The out of proportion load of cervical cancer in developing countries is largely attributable to scarcity of functional screening projects11. In our over 500 bedded teaching hospital with a well running gynecology outdoor, we do receive cervical biopsies positive for invasive malignancies but hardly receive any Pap smear tests in laboratory that prompted us to check for cervical cancer screening especially Pap smear test related awareness among our non-medical ladies.As the foundation of cervical cancer eradication is screening and prevention, each country and its regions must device an elimination plan that fits into its own culture and geographic landscape. Keywords: perception and understanding of existing screening tests, preventive measures, cervical cancer

Impact of a sustainable breast and cervical cancer screening program in spite of COVID-19 pandemic: The AMPATH experience in Kenya.

10556 Background: Cancer is the third leading cause of death with about 48,000 new yearly diagnoses in Kenya. Breast and cervical cancers are the major leading cancers in females, both of which are curable with access to timely and effective care. To meet population health goals, early abnormalities of the cervix and breast must be treated promptly to maximize the chance for cure. The AMPATH Breast and Cervical Cancer Control Program (ABCCCP) was initiated to improve access to screening and diagnostic services for breast and cervical cancer in Kenya by addressing the barriers of cancer care through a population health approach, working with communities and the Ministry of Health in Kenya with a potential for scaling these efforts to other parts of the region. Methods: We performed an interim analysis 3 years into a 5-year program, to assess the impact of COVID-19 on our screening program. Statistical descriptive summaries were used to show the trend of screening using visual inspection with acetic acid and breast clinical examination. The screening was conducted facility-based along with community screening upon requests across nine counties. Also, we conducted capacity building through mentoring of health care providers and initiating a telemedicine program to improve patient care and management plans. Results: From 2018-2021, we conducted training, connected 12 centers with telemedicine capacity and screened a total of 100,973 persons were for breast and cervical cancer. The yearly trends demonstrate that the facility routine screenings were maintained: 23,421 (2018); 27,997 (2019); and 28,045 (2020). The total women seen through organized mass screenings however declined (10,304 (2018); 10,107 (2019); and 1,099 (2020), respectively) as this type of screening was stopped after the onset of COVID-19 pandemic. Of all women screened, 3,019 (2.98%) had clinical abnormalities requiring follow-up per standard of care including 1,781(1.8%) who were eventually histologically confirmed to have cancer. During our first and second year of the program, 83 physicians were trained on cancer management and treatment, 341 nurses were trained on breast and cervical cancer screening procedures, and 247 community health workers (CHW) were trained on the importance of screening to enlighten the community on awareness. However, this training was suspended in our year three due to COVID-19. Conclusions: An integrated training program utilizing CHW, nurses and physicians are an effective means for breast and cervical cancer screening in LMC, such as Kenya. This capacity building allows flexibility and sustainability even in the midst of the global COVID-19 pandemic. We also demonstrated successful integration with the county government for program sustainability. The use of telemedicine has greatly enhanced our screening and patient care across several facilities in western Kenya.

Socioeconomic background in relation to stage at diagnosis in women with breast cancer.

10574 Background: Breast cancer (BC) has been associated with socioeconomic deprivation and rural residence. However, it’s still unclear how these factors interplay to affect the frequency and incidence of early and advanced BC. Methods: Taking advantage of the Loire-Atlantique/Vendée cancer registry (France), we investigated the association between early (TNM stage < 2) and advanced (TNM stage ≥2) BC and the socio-economic background (SB) of women diagnosed in the study region from 2008 to 2015. Socioeconomic status was studied using the residence information of every patient linked to the European Deprivation Index (EDI), an ecological index constructed to reflect individual deprivation experienced at the smallest geographical unit of France (IRIS = 2000 inhabitants). To investigate SB, we created a composite variable using the EDI and the urban/rural context information, to define 4 categories: affluent-urban, affluent-rural, deprived-urban, and deprived-rural. Two statistical approaches were implemented: i) mixed-effects logistic regression models to examine the likelihood (relative risk, RR) of being diagnosed with advanced BC, and ii) Poisson regression for modeling incidence rates of early and advanced stages. Analyses were stratified by age ( < 45, 45 to 74, > 75 years) with a random intercept at the IRIS level. For the strata 45 to 74, the models were adjusted for organized screening. Results: During the study period, 14,542 BC cases were recorded. Compared to the women diagnosed in the most affluent-urban areas, a higher proportion of cancer diagnosed at an advanced stage was observed in the women living in more deprived-rural areas (aged < 45 years, RR = 1.48 95% CI 1.17 - 1.73; aged 45 to 74 years, RR = 1.22, 95% CI 1.02-1.42; aged > 74 years, RR = 1.08, 95% CI 0.85-1.27). Furthermore, while in the population under 74 years, incidence rates of early BC in deprived-rural women were reduced by 25-85 % in comparison to affluent-urban women (IRR: 0.33 to 0.97 95% CI 0.16 -0.98), the rates of advanced BC were unaffected by deprivation-rurality (Deprived rural vs Affluent urban, IRR: 1.06 to 1.13 95% CI 0.79 -1.72). For the population over 74 years, we were unable to detect any associations between SB and BC incidence by stage at diagnosis. Conclusions: Advanced stage at diagnosis was more frequent among deprived–rural women aged under 74 years and coincided with the low incidence rates of early stages in this population. No disparities in the incidence rates of advanced BC were detected according to their SB in any age classes, suggesting other factors may be stronger contributors to the advanced stage at diagnosis. Future research should investigate whether screening practices may influence the disparities in the early stage at diagnosis for women under 74.

The present scenario of colorectal cancer in Southeastern Brazil.

e18782 Background: Cancer is the second leading cause of death in the world and in Brazil. Most of colorectal cancers (CRC) are sporadic and occur in individuals over the age of 50. Since almost all CRC originate from a polyp , the early detection and excision of an adenomatous polyp is essential to avoid the adenoma-carcinoma sequence that occurs over the years. Most colorectal polyps are asymptomatic and identified during screening colonoscopies or in patients with positive fecal occult blood test . There is evidence that detecting and removing these cancer precursor lesions can prevent many cases of cancer and reduce mortality. The CRC are public health problem in Brazil and fulfills criteria to merit the implementation of a structured screening program. and in this sense, several medical societies recommend screening through organized programs and not just opportunistic as done in Brazil. It is believed that this strategy is related to late diagnosis and has impact on high mortality. Most evidence on CRC screening interventions comes from high-income countries. The large disparities in CRC incidence and mortality rates between high-income and low-income countries are attribute to screening. The study will evaluate the stage of colorectal cancer at diagnosis at Southeastern Brazil. Methods: We collected retrospective data of patients with CRC registered in the Hospital Evangélico de Cachoeiro de Itapemirim (HECI) Health Information System - SISRHC from 2010 to 2017 to know the clinical characteristics (TNM) of the patients diagnosed during this period, age and sex. From January 1, 2010 to December 31, 2017, 6,962 newly diagnosed cases of cancer were identified. Of this total, 676 (9.7%) were new cases of colorectal cancer. When submitting to the inclusion and exclusion criteria of the present study 91 cases were excluded (1 case under the age of 18 years; 64 cases that started their first cancer treatment before the pathological result; 26 cases without information from the anatomopathological diagnosis). Data from the remaining 585 cases were analyzed. Results: Among 585 analyzed, the distribution of stage at diagnosis was : 0 (0,68%), I 45 (7,69%), II 109 (18,63%), III 225 (38,45%), IV 129 (22,05%) and 73 (12,48%) had this information missing. Mean age at diagnosis was 62 years, with 411(70,50%) between ages 51-80 years. Regarding sex we found 306 (52,49%) male and 277 (47,51%) female. Conclusions: The results found in the studied population are in agreement with the literature regarding age at diagnosis and sex. Unfortunately demonstrates that most of colorectal,cancer in southeastern region of Brazil are diagnosed in late stages. The lack of screening is an explanation to this fact. Only the implemention of national organized screening program can improve cancer detection and provide better chances of cancer survival.

Comparison of the clinical and analytical performance of Alinity m HR HPV and cobas 4800 HPV assays in a population-based screening setting.

The recently launched Abbott Alinity m HR HPV (Alinity) assay separately identifies high-risk human papillomavirus (hrHPV) genotypes HPV16, HPV18, and HPV45, and reports 11 other genotypes as two aggregates. Clinical and analytical performance of Alinity was compared with the cobas 4800 HPV assay on 4,334 women aged 20-64 years attending routine, population-based organized cervical cancer screening during 2009/2010. After 36 months, they were invited to participate in the second screening round (2012-2014) and later followed-up through centralized national cervical cancer screening registry. In women 30 and older, the clinical sensitivity for cervical intraepithelial neoplasia grade 2+ (CIN2+) was 100.0% (95% CI, 88.2-100.0%) for Alinity and 100.0% (95% CI, 88.2-100.0%) for cobas, and for CIN3+ 100.0% (95% CI, 78.9-100.0%) for both assays. The clinical specificity for ≤ CIN1 in women 30 and older was 92.4% (95% CI, 91.4-93.3%) and 92.9% (95% CI, 91.9-93.7%), respectively. The assays demonstrated excellent overall agreement for hrHPV detection (97.9%) and genotype-specific agreement for HPV16 (99.6%), HPV18 (99.8%), and other hrHPV (98.1%). Overall positive agreement and positive agreements for HPV16, HPV18, and other hrHPV genotypes were 84.3%, 89.1%, 73.2%, and 82.3%. Based on a 5-year CIN3+ risk, slightly more HPV-positive women would require referral to immediate colposcopy after testing with Alinity vs. cobas (4.1% vs. 3.8%; p=0.470), but significantly fewer Alinity-tested women would need a 6- to 12-month follow-up visit compared with those tested with cobas (5.0% vs. 8.6%; p < 0.0001). Alinity and cobas have comparable clinical performance and showed excellent overall and genotype-specific agreement. The Alinity's extended genotyping ability could help predict the 5-year CIN3+ risk and cost-saving management of HPV-screen-positive women.

Advancing health equity in cancer care: The lived experiences of poverty and access to lung cancer screening.

Individuals living with low income are more likely to smoke, have a higher risk of lung cancer, and are less likely to participate in preventative healthcare (i.e., low-dose computed tomography (LDCT) for lung cancer screening), leading to equity concerns. To inform the delivery of an organized pilot lung cancer screening program in Ontario, we sought to contextualize the lived experiences of poverty and the choice to participate in lung cancer screening. At three Toronto academic primary-care clinics, high-risk screen-eligible patients who chose or declined LDCT screening were consented; sociodemographic data was collected. Qualitative interviews were conducted. Theoretical thematic analysis was used to organize, describe and interpret the data using the morphogenetic approach as a guiding theoretical lens. Eight participants chose to undergo screening; ten did not. From interviews, we identified three themes: Pathways of disadvantage (social trajectories of events that influence lung-cancer risk and health-seeking behaviour), lung-cancer risk and early detection (upstream factors that shape smoking behaviour and lung-cancer screening choices), and safe spaces of care (care that is free of bias, conflict, criticism, or potentially threatening actions, ideas or conversations). We illuminate how 'choice' is contextual to the availability of material resources such as income and housing, and how 'choice' is influenced by having access to spaces of care that are free of judgement and personal bias. Underserved populations will require multiprong interventions that work at the individual, system and structural level to reduce inequities in lung-cancer risk and access to healthcare services such as cancer screening.

Cancer Screening Interventions in Indigenous Populations: A Rapid Review.

Cancer screening is an important component of a cancer control strategy. Indigenous people in Canada have higher incidence rates for many types of cancer, including those that can be detected early or prevented through organized screening programs. Increased participation and retention in cancer screening is critical to improved population health outcomes amongst Indigenous people. This rapid review evaluates cancer screening interventions published in the last six years. Included studies demonstrated increased participation in breast, colorectal, or cervical cancer screening programs in Indigenous populations or showed promise of increased participation based on the factors that influence people’s screening practices, such as knowledge, attitude, or intent to screen. The Preferred Reporting Items for Systematic Reviews guided the search strategy. The review identified 85 articles with 12 meeting the specified criteria: seven studies reported an increase in cancer screening participation and five studies reported improved knowledge, attitude, or intent to screen. The use of multiple culturally appropriate strategies in co-designed studies were the most effective. This review will be used to inform First Nations (FN) populations and Screening Programs in Alberta of potential strategies to address disparities identified through a recent data analysis comparing cancer screening and outcomes between FN and non-FN people.

Six years of colorectal cancer mortality surveillance in the screening population for a risk stratified screening program

ObjectiveTo evaluate the impact of a colorectal cancer (CRC) risk predicting system on CRC mortality rates. MethodAn organized population screening program targeted at all the subjects (n = 102,076) at age 40–74 in nine towns of Jiashan county, China was conducted from 2007 to 2012. All of the screening participants were first triaged into high-risk & low-risk groups by a questionnaire and two fecal immunuochemical tests, only the high-risk subjects were subject to colonocopy. The screening participants were surveyed death caused by CRC for a total of six years after the enrollment. The CRC mortality in subgroups of the screening population was analyzed. ResultsA total of 82,184 (80.51 % of the targeted population) screening participants were identified. CRC death were recorded for 142 subjects (28.819 per 105 person-years). The age-adjusted relative risk(RR) of CRC death in the high-risk subjects (n = 12862, 84.48 per 105 person-years) was 3.92 (95 % CI = 2.81–5.49) compared with the low-risk subjects (n = 69322, 18.52 per 105 person-years). In the high-risk group, the age-adjusted RR of CRC death for those accepted colonoscopies (51.44 per 105 person-years) compared with those refused colonoscopies (187.94 per 105 person-years, P < 0.0001) was 0.34 (95 % CI = 0.21−0.56). The first three years after screening has seen the largest difference of CRC death hazard in both comparing groups. ConclusionThe high-risk subjects triaged by the risk predicting system have a higher CRC mortality rate than the low-risk subjects, especially in the first three years after screening. Refusal of colonoscopy is risky behavior for the high-risk subject.

Breast cancer screening patterns in Jamaican women: review of the largest national mammography clinic

BackgroundBreast cancer is the leading cause of cancer and cancer related deaths in Jamaican women. In Jamaica, women often present with advanced stages of breast cancer, despite the availability of screening mammography for early detection. The utilization of screening mammography for early breast cancer diagnosis seems to be limited, and this study investigated the national patterns of mammographic screening and the impact of mammography on the diagnosis of breast cancer in Jamaica.MethodsA retrospective analysis of the records of the largest mammography clinic in Jamaica was done for the period January 2011 to December 2016. Descriptive statistics was performed on relevant patient characteristics with calculation of rates and proportions; cross-tabulations were utilized to assess relationship of covariates being studied on the outcomes of interest. Results are reported in aggregate form with no identifiable patient data.Results48,203 mammograms were performed during the study period. 574 women (1.2%) had mammograms suspicious for breast cancer with median age of 57 years (range 30–95 years); 35% were under the age of 50. 4 women with suspicious findings had undergone ‘screening mammography’, with the remaining having ‘diagnostic mammography’. 38% reported previous mammograms, with a mean interval of 8 years between previous normal mammogram and mammogram suspicious for breast cancer. Median age at first screening mammogram was 51 years (range 41–77).ConclusionBreast cancer screening mammography is underutilized in Jamaica. An organized national breast cancer screening programme is recommended to improve adherence to international breast cancer screening guidelines.

Adenoma detection by Endocuff-assisted versus standard colonoscopy in an organized screening program: the “ItaVision” randomized controlled trial

The Endocuff Vision device (Arc Medical Design Ltd., Leeds, UK) has been shown to increase mucosal exposure, and consequently adenoma detection rate (ADR), during colonoscopy. This nationwide multicenter study assessed possible benefits and harms of using Endocuff Vision in a fecal immunochemical test (FIT)-based screening program. Patients undergoing colonoscopy after a FIT-positive test were randomized 1:1 to undergo Endocuff-assisted colonoscopy or standard colonoscopy, stratified by sex, age, and screening history. Primary outcome was ADR. Secondary outcomes were ADR stratified by endoscopists' ADR, advanced ADR (AADR), adenomas per colonoscopy (APC), withdrawal time, and adverse events. 1866 patients were enrolled across 13 centers. After exclusions, 1813 (mean age 60.1 years; male 53.8 %) were randomized (908 Endocuff Vision, 905 standard colonoscopy). ADR was significantly higher in the Endocuff Vision arm (47.8 % vs. 40.8 %; relative risk [RR] 1.17, 95 % confidence interval [CI] 1.06-1.30), with no differences between arms regarding size or morphology. When stratifying for endoscopists' ADR, only low detectors (ADR < 33.3 %) showed a statistically significant ADR increase (Endocuff Vision 41.1 % [95 %CI 35.7-46.7] vs. standard colonoscopy 26.0 % [95 %CI 21.3-31.4]). AADR (24.8 % vs. 20.5 %, RR 1.21, 95 %CI 1.02-1.43) and APC (0.94 vs. 0.77; P = 0.001) were higher in the Endocuff Vision arm. Withdrawal time and adverse events were similar between arms. Endocuff Vision increased ADR in a FIT-based screening program by improving examination of the whole colonic mucosa. Utility was highest among endoscopists with a low ADR.

Organized Breast and Cervical Cancer Screening: Attendance and Determinants in Southern Italy.

Simple SummaryAlthough the effectiveness of screening in reducing the mortality of breast and cervical cancer in the EU is established, the impact of these cancers continues to be substantial among women. The aims of this study were to evaluate the attendance to breast and cervical cancer screening and the role of related determinants in an area of Southern Italy. Only 49.7% of the sample reported to have undergone mammography in the previous two years, 27.7% within an organized program and 22% as an opportunistic procedure. The attendance to cervical cancer screening interval of three years was reported by 56.1% of women, 16.1% within an organized program and 40% as an opportunistic procedure. A very low attendance was thus detected for both breast and cervical cancer organized screening programs. A strong commitment to the promotion of these programs is urgently needed, also to support their role in the reduction of inequalities of attendance of disadvantaged women.The aims of this study were to evaluate the attendance to breast and cervical cancer screening and the related determinants in a low attendance area. A cross-sectional study was conducted among mothers of students attending secondary schools and university courses in Campania region, Southern Italy. Only 49.7% of the eligible women reported to have undergone mammography in the previous two years. Unemployed women, unsatisfied about their health status, with a family history of breast cancer, and having visited a physician in the previous 12 months were significantly more likely to have undergone mammography in the previous two years within an organized screening program. The attendance to cervical cancer screening in the interval of three years was reported to be 56.1% of women. Having a lower than graduation degree, being smokers, and having visited a physician in the previous 12 months were significant predictors of having had a Pap-smear in the previous three years in an organized screening program. In this study a very low attendance was found to both breast and cervical cancer organized screening programs. A strong commitment to their promotion is urgently needed, also to reduce inequalities of attendance of disadvantaged women.

Screening is associated with lower mastectomy rates in eastern Switzerland beyond stage effects

BackgroundA recent study found an influence of organized mammography screening programmes (MSPs) on geographical and temporal variation of mastectomy rates. We aimed to quantify the effect on the example of one of the cantonal programmes in Switzerland.MethodsWe used incidence data for the years 2010–2017 from the cancer registry of Eastern Switzerland. We included women with invasive-non-metastatic breast cancer (BC) in the screening age group 50–69-year-olds in the canton of St.Gallen. We compared mastectomy rates among cancer patients detected through the organised screening programme (MSP) vs. otherwise detected by stage.ResultsMSP-detected patients in St.Gallen presented with lower stages. 95% of MSP-detected had stages I-II vs 76% of Non-MSP-detected. Within all non-metastatic stage, tumour size and nodal status groups, MSP-detected patients had lower mastectomy rates, overall 10% vs 24% in 50–69-year-old non-participants. Their odds of receiving a mastectomy are about half of the Non-MSP-detected (OR = 0.48, p = 0.002).ConclusionsOur study showed that MSPs have a positive effect on lowering mastectomy rates. Screening participants are significantly less likely to receive a mastectomy compared to non-participants, which must be attributed to additional factors than just lower stages. Lower mastectomy rates lead to a higher quality of life for many patients.

A63 REFINING THE CANADIAN ASSOCIATION OF GASTROENTEROLOGY GUIDELINE ON SCREENING IN PERSONS WITH A FAMILY HISTORY OF NONHEREDITARY COLORECTAL CANCER OR ADENOMA: A MODIFIED DELPHI PROCESS

Abstract Background In 2018, the Canadian Association of Gastroenterology (CAG) published an extensive systematic review and guideline on screening in persons with a family history (FHx) of nonhereditary colorectal cancer (CRC) and adenoma. While CAG’s recommendations were evidence-based, some recommendations lacked precision (e.g. ranges for some start ages &amp; intervals) and screening cessation age was not addressed, leading to implementation challenges for practitioners and CRC screening programs. Aims To review and update the evidence since the 2018 guideline and to formulate implementable recommendations in the Ontario context that are aligned with the CAG guideline. Methods ColonCancerCheck (Ontario’s organized CRC screening program) conducted a modified version of the literature search used by CAG (Jan 2017 - Sept 2019). A 19-member expert panel with Canadian and international representatives from endoscopy, primary care, epidemiology, organized CRC screening programs, Ontario’s cancer system and the general public refined the recommendations of the CAG guideline for the purposes of implementation in an organized CRC screening program using a modified Delphi process. This iterative process involved a series of webinars and anonymous survey rounds where the panel reviewed evidence materials and provided online feedback to develop, refine &amp; achieve consensus on screening recommendations in persons with a FHx of CRC/adenoma. Consensus was achieved if ≥75% of members agreed or strongly agreed with the statement. Results Six new systematic reviews and 2 new guidelines were identified. New evidence included data on the absolute risk (10 year &amp; lifetime risk) of CRC by type of FHx, as well as the performance of fecal immunochemical testing (FIT) and barriers to CRC screening in persons with a FHx of CRC. The expert panel participated in 3 webinars and 4 online surveys to arrive at consensus. Panel recommendations and level of consensus will be reported for the 6 statements (Table). Conclusions Building from the CAG guideline, we derived evidence-based and implementable recommendations for screening persons with a FHx of CRC or adenoma. Funding Agencies Ontario Health (Cancer Care Ontario)

Which communication strategies can improve interventions aimed at tackling social inequalities in organized cancer screening in France?

Interventions to increase participation in cancer screening programs have been developed and evaluated by our research team. The results observed provide an opportunity to consider which methods of communication should be encouraged to improve those interventions. The objective of this commentary is to recommend communication strategies which should be adopted to efficiently reach and support disadvantaged individuals to engage in cancer screening, as a healthy behaviour.

Gaps between recommendations and their implementation: A register-based study of follow-up after abnormalities in cervical cancer screening

Follow-up after screen-detected abnormalities is crucial for the success of cervical cancer screening programs but is usually not closely monitored in official screening statistics. We determined how the follow-up deviated from the recommendations in the Danish organized program. Using Danish nationwide population-based registers, the follow-up pathways of 60,199 women aged 23–59 with non-negative screening samples from 2012 to 2014 were mapped until end of 2018. We studied the timeliness and appropriateness of follow-up tests after cervical cytology screening and the total resource use in accordance with the national recommendations. Regression analyses were used to determine variations in adherence according to age, provider type, region, and history of abnormalities. Among women referred for immediate colposcopy, 91.3% (95% CI: 90.9%–91.6%) attended within four months as recommended, whereas up to about half of the women with a recommendation for a repeat test received this test either too early or very late. Overall, only 43% (95% CI: 42.9%–43.7%) of women with non-negative screening tests received the recommended follow-up, whereas 18% (95% CI: 17.6%–18.2%) received more than was recommended, 35% (95% CI: 34.4%–35.1%) received some follow-up but less than recommended and 4% (95% CI: 3.9%–4.2%) were not followed up at all. These proportions varied by screening diagnosis, woman's age, type of health care provider, region, and history of abnormalities. On average, women underwent more tests of each type than recommended by the guidelines. Deviations from follow-up recommendations are very frequent even in organized cervical screening programs and should be routinely monitored by screening program statistics.

Recent advances in the approach to hepatopulmonary syndrome and portopulmonary hypertension.

Liver disease, cirrhosis and portal hypertension can be complicated by pulmonary vascular disease, which may affect prognosis and influence liver transplantation (LT) candidacy. Pulmonary vascular complications comprise hepatopulmonary syndrome (HPS) and portopulmonary hypertension (POPH). Although these two conditions develop on a same background and share a common trigger, pulmonary responses are distinct and occur at different anatomical sites of the pulmonary circulation. HPS affects 10-30% of patients referred for LT, and is characterized by gas exchange abnormalities due to pulmonary vasodilation and right-to-left shunting. POPH occurs in 5%, and is defined by pulmonary arterial hypertension due to increased pulmonary vascular resistance, which leads to hemodynamic failure. Even though HPS and POPH may have a substantial negative impact on survival, both entities are clinically underrecognized and frequently misdiagnosed. Without intervention, the 5-year survival rate is 23% in HPS and 14% in POPH. Their presence should be actively sought by organized screening in patients presenting with dyspnea and in all patients on the waitlist for LT, also because clinical symptoms are commonly non-specific or even absent. LT may lead to resolution, however, advanced stages of either HPS or POPH may jeopardize safe and successful LT. This implicates the need of proper identification of HPS and POPH cases, as well as the need to be able to successfully 'bridge' patients to LT by medical intervention. A review article on this topic has been published in this journal in 2007 (1). This updated review focuses on recent advances in the diagnosis and management of these 2 liver-induced pulmonary vascular disorders and incorporates results from our recent work.

Psychological predictors of intention and avoidance of attending organized mammography screening in Norway: applying the Extended Parallel Process Model

BackgroundMammography screening is the main method for early detection of breast cancer in Norway. Few studies have focused on psychological determinants of both attendance and non-attendance of publicly available mammography screening programs. The aim of the current study, guided by the Extended Parallel Process Model, was to examine how psychological factors influence defensive avoidance of breast cancer screening and intention to attend mammography.MethodsCross-sectional survey data from a community sample of women living in Norway aged ≥ 18 (N = 270), and without a history of breast cancer, was collected from September 2018 to June 2019 and used to investigate the relationships between the Extended Parallel Process Model (EPPM) constructs and two outcomes: defensive avoidance of breast cancer screening and intention to attend mammography within the next two years. After adjusting for confounding factors, the hierarchical multiple linear regression analyses was conducted to assess the ability of the independent variables based on the EPPM to predict the two outcome variables. Significance level was chosen at p < 0.05.ResultsMultivariate analyses showed that defensive avoidance of breast cancer screening was predicted by lower perceived susceptibility to breast cancer (β = − 0.22, p = 0.001), lower response efficacy of mammography screening (β = − 0.33, p = 0.001), higher breast cancer fear (β = 0.15, p = 0.014), and checking breasts for lumps (β = − 0.23, p = 0.001). Intention to attend mammography within the next two years was predicted by higher response efficacy of mammography screening (β = 0.13, p = 0.032), having a lower educational level (β = − 0.10, p = 0.041), and regular previous mammography attendance compared to never attending (β = 0.49, p = 0.001).ConclusionsThe study revealed that defensive avoidance of breast cancer screening and intention to attend mammography were not predicted by the same pattern of psychological factors. Our findings suggest future health promotion campaigns need to focus not only on the psychological factors that encourage women’s decision to attend the screening, but also to counter factors that contribute to women’s decision to avoid it.

Risk Factor Associations of Breast Cancer Among Women Attending Out-Patients Department of the Hospital: A Case vs. Control Study

Breast cancer is the first most common cancer in Indian women. The main factors that influence risk of breast cancer include being a woman and getting older, sociodemographic factors, family history of cancer, OCP, etc. The aim of the study was to report the sociodemographic factors, habits, personal history, clinical presentation of women and analyze risk factors with breast cancer in comparison with without breast cancer. This study is based on data collection from women (N = 606) from out-patients department of a regional cancer hospital who attended the Centre during the study period. Data analysis for 606 women showed the overall mean age of the participants was 39.32 ± 9.79 (mean ± SD) years with most (46.6%) of them belonging to the age group of 40–49 years. Most of them (39.6%) complain about feeling lumps inside the breast. Age at menarche starts at the age below 13 years, early marriage, parity more than 4, taking oral contraceptive pills as a method of contraception, do not feed to their child, most of them are housewife’s and have a family history of breast cancer. Age at menarche starts at the age below 13 years, early marriage, parity more than 4, taking oral contraceptive pills as a method of contraception, do not feed to the child and family history were highlighted as significant risk factors for breast cancer in Indian women. Hence, effective methods with routine organized screening programs are recommended to detect early breast cancer.