Pilot Screening Program Research Articles

PCN231 - Colorectal Cancer Screening Pilot Program Results In Hungary

Colorectal cancer represents high burden for the society, including high incidence, mortality and treatment costs. Our aim is to present the results of the colorectal cancer pilot screening program in general practices that was implemented in county Csongrád, Hungary. The colorectal cancer pilot screening program was introduced in Hungary in 2015, in Csongrád county. This program offers fecal occult blood test to average risk subjects aged between 50-69 years. People with a positive test result are proposed a full colonoscopy. In the first round 19.5% (10431 patients) of the target population (53398 patients), in the second round 22.8% (11699 patients) of the target population (51276 patients) were received an invitation letter for screening. 47.3% of the screening kits allocated to patients were returned to the laboratory. Descriptive statistics, χ2-test were used (p<0.05). MS Excel 2010 program was applied for data analysis. The participation rate of females was significantly higher in both rounds (p<0.001 44.5% (male) vs 55.5% female). Non-negative results were found in 13.1% (1356 patients) of the samples. From among those accepting the invitation to colonoscopy, 57% (476 patients) took part. Polypoid lesions were found in 27.7% which meant 2.5% as compared to all screenings performed. Malignant lesions were found in 5.5% of all colonoscopies performed. Taking all screenings performed into consideration this amounted to 0.3%. 299 hystologies showed malignancy in 0.4% (3368 patient/12 patients) of males and 0.2% (7005 patients/14 patients) of females (p=0.435) according to implemented screening examination. In situ carcinoma was diagnosed in 10 cases out of which 16 were Stage I. Results of the colorectal cancer screening pilot program introduced in Csongrád county seem promising, participation numbers exceeded the rate expected. The program will be extended nationwide from 2018, following the implementation of the recommended changes and corrections.

Effectiveness of a Type 2 Diabetes Screening Intervention in the Canadian Workplace.

There is a lack of Canadian data concerning the effectiveness of diabetes interventions in the workplace. The objective of this study was to evaluate the effectiveness of Motivaction, a diabetes screening and education pilot program, in the workplace. The Motivaction program involves a voluntary web-based diabetes health-risk assessment, the Canadian Diabetes Risk Questionnaire (CANRISK), combined with an opportunity for those eligible (i.e. having diabetes or having a CANRISK score ≥21) to attend 2 on-site biometric screening meetings with a registered nurse and 4 educational sessions by telephone with a certified diabetes educator. Biometric data, as well as information about self-efficacy, lifestyle changes, productivity, well-being, mental health and program satisfaction, were collected at baseline and at 6 months. Attendance at the initial and 6-month clinical visits included 293 people. At baseline, 21% were identified as having prediabetes (13%) or having diabetes (8%). Statistically significant reductions in glycated hemoglobin levels from baseline to the study's end were observed in those with prediabetes or diabetes. No statistically significant changes in glycated hemoglobin levels were observed in individuals with normal levels or in those at risk for diabetes at baseline. No statistical differences were observed in terms of productivity or mental health for the full population or across diabetes-risk categories. More than 90% of employees would recommend the Motivaction program to other employers. This study provides a framework for future diabetes interventions in the workplace and demonstrates that workplace interventions may reduce employees' diabetes risk levels and are valued by employees.

A Pilot Program Integrating Hepatitis B Virus (HBV) Screening into an Outpatient Endoscopy Unit Improves HBV Screening Among an Ethnically Diverse Safety-Net Hospital

Safety-net hospitals are enriched in ethnic minorities and provide opportunities for high-impact hepatitis B virus (HBV) screening. We aim to evaluate the impact of a pilot program integrating HBV screening into outpatient endoscopy among urban safety-net populations. From July 2015 to May 2017, consecutive adults undergoing outpatient endoscopy were prospectively assessed for HBV screening eligibility using US Preventative Services Task Force guidelines. Rates of prior HBV screening were assessed, and those eligible but not screened were offered HBV testing. Multivariate logistic regression models evaluated predictors of test acceptance among eligible patients. Among 1557 patients (47.1% male, 69.4% foreign born), 65.1% were eligible for HBV screening, among which 24.5% received prior screening. In our pilot screening program in the endoscopy unit, 91.4% (n=855) of eligible patients accepted HBV testing. However, only 55.3% (n=415) of those that accepted actually completed HBV testing. While there was a trend toward higher rates of test acceptance among African-Americans compared to non-Hispanic whites (OR 3.31, 95% CI 0.96-11.38, p=0.06), no other sex-specific or race/ethnicity-specific disparities in HBV test acceptance were observed. Among those who completed HBV testing, we identified 10 new patients with chronic HBV (2.4% prevalence). Only 24.5% of eligible patients received prior HBV screening among our cohort. Our pilot program integrating HBV screening into outpatient endoscopy successfully tested an additional 415 patients, improving overall HBV screening from 24.5 to 75.6%. Integrating HBV testing into non-traditional settings has potential to bridge the gap in HBV screening among safety-net systems.

Cost Effectiveness Of Urban Breast Cancer Screening Programme In China

This study aimed to analyse the cost-effectiveness of the breast cancer screening pilot program among urban Chinese women, as well as to conduct sensitivity analysis, scenario analysis, and the budget impact analysis. A Markov model was developed from a societal perspective among asymptomatic Chinese women over 40 years at risk for breast cancer over a lifetime horizon in urban China. We obtained the incremental cost-effectiveness ratio (ICER) and explored the uncertainty using one-way and probabilistic sensitivity analysis. We also explored the ICERs in different geographic areas and cities as well as with different screening intervals and population coverage. In the budget impact analysis, we analysed the screening funding to detect one case in the program, and the impact of the issued questionnaires’ number on the screening funding. The ICER of screening was ¥-3195/QALY in the urban programme. Compared to no screening, breast screening was cost-saving in all levels of cities and all geographic areas in China. Also, the results did not change with screening intervals. When the population coverage increased, the breast screening was more cost-saving. The treatment costs, the screening costs, and the effectiveness of the screening methods can influence the ICERs but they did not change the results. At the threshold of ¥140000/QALY, the probability of breast screening being cost-effective compared to no screening in urban areas was almost 100%. The budget impact analysis showed that the screening cost was ¥17806 to detect one case in the urban program. If the number of issued questionnaires reached the target, the screening cost for one detected case was only ¥7122. The urban breast cancer screening program in China was effective and cost-saving. We recommend to expand the population coverage and to ensure that the issued questionnaires reach the target quantity.

Covering the Cover

Covering the Cover

Diabetic retinopathy screening and treatment in Myanmar: a pilot study

Background/aimsThe goals of this pilot study were (a) to demonstrate the feasibility of identifying patients with vision-threatening diabetic retinopathy (DR) in a provincial area of Myanmar and treating them with...

Experience of carrier couples identified through a population-based carrier screening pilot program for four founder autosomal recessive diseases in Saguenay-Lac-Saint-Jean.

The objective of this study was to describe the experience of carrier couples identified through this program. Semi-structured interviews were performed with carrier couples. Thematic analysis of interview transcripts was performed to identify emerging themes. Interviews were performed with 15 carrier couples (56% response rate). Carrier couples had little knowledge about the target diseases before being identified as carriers, despite pre-test education sessions. The main motivation for screening was a recommendation by a peer who had been screened, even for those with a positive family history of one of the target conditions. Couples perceived themselves at low risk of being a carrier couple, whatever their family history. Being found to be a carrier couple was initially a shock, illustrating how ill prepared they were for such a result, but carrier couples appreciated knowing their status. Our results emphasize the informational needs of couples to make informed decisions and the importance of post-test counseling for those with positive results. Our findings can inform counseling procedures in expanded carrier screening. © 2017 John Wiley & Sons, Ltd.

Education and screening for chronic kidney disease in Indian youth: pilot program results.

BackgroundThere is a paucity of information on kidney education and screening programs in Indian youth.MethodsParticipants (n=2,158) from Chennai colleges were educated about the kidneys and chronic kidney disease (CKD) and screened in a pilot program from April to May 2013. This entailed: 1) a presentation and educational video and 2) an on-site assessment of weight, blood pressure, and demographic information. Urinalysis (UA) kits were distributed and returned in ≤48 hours. We examined participant characteristics and their association with dipstick proteinuria using logistic regression.ResultsThe mean (standard deviation [SD]) age was 18.9 (1.6) years, and 1,451 (68%) were men. Mean (SD) body mass index (BMI) was 21.9 (4.3) kg/m2; 745 (36%) had a BMI consistent with being overweight or obese. Mean (SD) systolic blood pressure (SBP) was 118.7 (13.1) mm Hg, and 94 (5%) of the participants had SBP ≥140. Mean (SD) diastolic blood pressure (DBP) was 70.9 (11.4) mm Hg, with 119 participants (6%) having ≥90 mm Hg. A total of 136 participants had glycosuria (UA≥1+) and 120 (6%) had proteinuria (UA≥1+). In unadjusted analyses, sex (odds ratio [OR]=1.64 [confidence interval, CI 1.06–2.55]; p=0.026 men vs. women) and age (OR=1.13 per year [CI 1.01–1.26]; p=0.032) were significantly associated with proteinuria. In the analysis adjusted for age, sex, SBP, DBP, glycosuria, and BMI, age remained independently associated with higher odds for proteinuria (OR=1.14 per year [1.02–1.29]; p=0.026). Males showed a trend of higher risk compared with women (OR=1.57 [CI 1.00–2.50]; p=0.051).ConclusionThis education and screening pilot program in a population of college students offers unique opportunities for identification, education, and early intervention for CKD.

Newborn Screening for Lysosomal Storage Diseases: A Concise Review of the Literature on Screening Methods, Therapeutic Possibilities and Regional Programs.

Newborn screening for lysosomal storage diseases (LSDs) is increasingly being considered as an option. The development of analytical screening methods, of second-tier methods, and of therapeutic possibilities, are paving the way for routine screening for LSDs in the coming years. Here, we give a brief description of the current status quo, what screening methods are currently available or are in the pipeline, what is the current status of therapeutic possibilities for LSDs, what LSDs are the most obvious candidates for introduction in screening programs, and what LSDs are already part of regional or national pilot or routine screening programs worldwide.

1685 - Population-based organized cervical cancer screening pilot program in France

In France, cervical cancer screening is recommended every 3 years for women aged 25-65 years. With the exception of a few local organized programs, screening is mainly opportunistic. In view of setting up a nationwide population-based organized screening program, a pilot intervention was implemented in nine geographic areas using a common protocol. Women aged 25-65 years who had not undergone a cytological screening in the past 3 years were invited for screening during 2010-2012 and reminded up to 1 year after the initial invitation. Cytological results and follow-up data were collected up to the end of 2014 for all women screened irrespective of whether spontaneously or following invitation. Aggregate data were centralized nationally. Among the 2.4 million women from the total target population aged 25-65 years, 1.3 million were invited for screening. The overall screening coverage during 2010-2012 was 62.3%, with wide variations across geographic areas, ranging from 41.6 to 72.5%. Initial invitations and reminders enabled nearly 280 000 women to be screened, corresponding to an estimated increase in coverage of 12% points. Overall, 4.2% of the women screened had an abnormal smear. A total of 5180 high-grade cervical precancers and 323 invasive cervical cancers were reported, corresponding to detection rates of, respectively, 623 and 39 per 100 000 women screened 3-yearly. This study indicates that such organized screening may markedly improve the uptake of cervical cancer screening. On the basis of this pilot program, nationwide organized cervical cancer screening is currently being rolled out in France.

Embracing Change In Dental Practice To Deliver Better Health Outcomes- A Type 2 Diabetes Screening and Oral Health Pilot Program

Disadvantaged communities carry the highest burden of disease with respect to oral and general health. Diabetes is a growing chronic-condition in Australia with those living in regional or lower socio-economic areas at a higher risk of developing diabetes and experiencing the associated complications. Oral and periodontal disease has been linked to diabetes. Within the community dental clinic we aimed to determine the feasibility of screening for diabetes and reduce the burden of both diseases. All patients presenting to the community dental clinic of the Colac Area Health Service were given the opportunity to participate in a Diabetes screening assessment. Adults who consented completed the Australian Type 2 Diabetes Risk Assessment (AUSDRISK) with those at high risk offered an HbA1c blood test. Six hundred and seventy patients were invited to participate. Seventy-five reported confirmed diabetes and 125 were currently being monitored by their general practitioner. Ninety-six of the remaining 470 eligible patients declined to participate (participation rate 80%). The AUSDRISK was completed by 371 patients (n=3 incomplete) and identified 56 (15%) as low risk, 123 (33%) at intermediate risk and 192 (52%) at high risk. Following HbA1c blood testing, 14 patients were in the high risk range (>6.0%). The high risk category according to the AUSDRISK included 31% emergency patients, an average of 25 (IQR 19-29) Decayed Missing or Filled Teeth, 49% with early signs of periodontal disease, 73% aged 55 years or older, 48% male, 36% had a direct relative with diabetes, 18% had hypertension, 29% currently smoked and 75% had waist measurements >90 cm for men and 80cm for women. The study demonstrated that 68% of patients willing to participate in the study presenting to the community dental clinic had either confirmed diabetes, were being tested by their general practitioner or were in a high risk category (AUSDRISK).

Performance of a quantitative fecal immunochemical test in a colorectal cancer screening pilot program: a prospective cohort study.

British Columbia undertook a colorectal cancer screening pilot program in 3 communities. Our objective was to assess the performance of 2-specimen fecal immunochemical testing in the detection of colorectal neoplasms in this population-based screening program. A prospective cohort of asymptomatic, average-risk people aged 50 to 74 years completed 2 quantitative fecal immunochemical tests every 2 years, with follow-up colonoscopy if the result of either test was positive. Participant demographics, fecal immunochemical test results, colonoscopy quality indicators and pathology results were recorded. Non-screen-detected colorectal cancer that developed in program participants was identified through review of data from the BC Cancer Registry. A total of 16 234 people completed a first round of fecal immunochemical testing, with a positivity rate of 8.6%; 5378 (86.0% of eligible participants) completed a second round before the end of the pilot program, with a positivity rate of 6.7%. Of the 1756 who had a positive test result, 1555 (88.6%) underwent colonoscopy. The detection rate of colorectal cancer was 3.5 per 1000 participants. The positive predictive value of the fecal immunochemical test was 4.9% (95% confidence interval [CI] 3.8%-6.0%) for colorectal cancer, 35.0% (95% CI 32.5%-37.2%) for high-risk polyps and 62.0% (95% CI 59.6%-64.4%) for all neoplasms. The number needed to screen was 283 to detect 1 cancer, 40 to detect 1 high-risk polyp and 22 to detect any neoplasm. Screening every 2 years with a 2-specimen fecal immunochemical test surpassed the current benchmark for colorectal cancer detection in population-based screening. This study has implications for other jurisdictions planning colorectal cancer screening programs.

PHS86 - Experiences And Attitudes Related To Screening of Patients Attended on A Colorectal Screening Pilot Program In Hungary

PHS86 - Experiences And Attitudes Related To Screening of Patients Attended on A Colorectal Screening Pilot Program In Hungary

Screening women for cervical cancer carcinoma with a HPV mRNA test: first results from the Venice pilot program.

Background:HPV DNA-based screening is more effective than a Pap test in preventing cervical cancer, but the test is less specific. New HPV tests have been proposed for primary screening. The HPV mRNA test showed a similar or slightly lower sensitivity than the HPV DNA tests but with a higher specificity. We report the results of an organised HPV mRNA-based screening pilot program in Venice, Italy.Methods:From October 2011 to May 2014, women aged 25–64 years were invited to undergo a HPV mRNA test (Aptima). Those testing positive underwent cytological triage. Women with positive cytology were referred to colposcopy, whereas those with negative cytology were referred to repeat the HPV mRNA test 1 year later. The results of the HPV mRNA test program were compared with both the local historical cytology-based program and with four neighbouring DNA HPV-based pilot projects.Results:Overall, 23 211 women underwent a HPV mRNA test. The age-standardised positivity rate was 7.0%, higher than in HPV DNA programs (6.8% relative rate (RR) 1.11, 95% confidence interval (CI) 1.05–1.17). The total colposcopy referral was 5.1%, double than with cytology (2.6% RR 2.02, 95% CI 1.82–2.25) but similar to the HPV DNA programs (4.8% RR 1.02; 95% CI 0.96–1.08). The cervical intraepithelial neoplasia grade 2+ detection rate with HPV mRNA was greater than in the HPV DNA programs at baseline (RR 1.50; 95% CI 1.19–1.88) and not significantly lower at the 1-year repeat (RR 0.70; 95% CI 0.40–1.16). The overall RR was 1.29 (95% CI 1.05–1.59), which was much higher than with cytology (detection rate 5.5‰ vs 2.1‰ RR 2.50, 95% CI 1.76–3.62).Conclusions:A screening programme based on the HPV mRNA obtained results similar to those observed with the HPV DNA test. In routine screening programmes, even a limited increase in HPV prevalence may conceal the advantage represented by the higher specificity of HPV mRNA.

Fragile X syndrome screening in pregnant women and women planning pregnancy shows a remarkably high FMR1 premutation prevalence in the Balearic Islands.

There are no reported studies to determine incidence of Fragile X Syndrome (FXS) in women within the Spanish population. For this reason, together with the high incidence of FXS in the general population, the exclusively maternal expansion, the familial and social impact of the syndrome, and the ease of use and level of detection of current PCR-based techniques, we have conducted a population-based screening pilot program of which we present here the molecular results. We typed prospectively 3,413 pregnant and 318 non-pregnant women and found a prevalence of premutation (PM) carriers of 1 in 106, which is the highest described to date in any population. We also found 230 different alleles of which the most frequent are 10A9A9 (38.4%), 9A9A9 (15.1%), and 10A9 (10.5%). Furthermore, alleles with 0 AGG interruptions or with a pure (uninterrupted) CGG repeat run larger than 34 (presumably more unstable), were more frequent among PM alleles compared to normal alleles. Theà unexpected high frequency of expanded PM alleles in females in the general population makes a very compelling argument for the need for prenatal or preconceptional FXS screening in our community. Furthermore, we find FMR1 triplet primed PCR (TP-PCR) confidently and precisely determines sizes for both alleles of the CGG repeat in women and offers AGG information which greatly improves CGG expansion risk estimations for genetic counselling. Thus, TP-PCR is an informative, efficient and robust method for FXS screening in the female population. © 2016 Wiley Periodicals, Inc.

Visual health screening by schoolteachers in remote communities of Peru: implementation research.

ObjectiveTo describe the adaptation and scaling-up of an intervention to improve the visual health of children in the Apurimac region, Peru.MethodsIn a pilot screening programme in 2009–2010, 26 schoolteachers were trained to detect and refer visual acuity problems in schoolchildren in one district in Apurimac. To scale-up the intervention, lessons learnt from the pilot were used to design strategies for: (i) strengthening multisector partnerships; (ii) promoting the engagement and participation of teachers and (iii) increasing children’s attendance at referral eye clinics. Implementation began in February 2015 in two out of eight provinces of Apurimac, including hard-to-reach communities. We made an observational study of the processes and outcomes of adapting and scaling-up the intervention. Qualitative and quantitative analyses were made of data collected from March 2015 to January 2016 from programme documents, routine reports and structured evaluation questionnaires completed by teachers.FindingsPartnerships were expanded after sharing the results of the pilot phase. Training was completed by 355 teachers and directors in both provinces, belonging to 315 schools distributed in 24 districts. Teachers’ appraisal of the training achieved high positive scores. Outreach eye clinics and subsidies for glasses were provided for poorer families. Data from six districts showed that attendance at the eye clinic increased from 66% (45/68 children referred) in the pilot phase to 92% (237/259) in the implementation phase.ConclusionAdaptation to the local context allowed the scaling-up of an intervention to improve visual health in children and enhanced the equity of the programme.

Assessment of Awareness towards Pap Smear among Nursing Staff – Experience at A Tertiary Care Hospital

Cancer of the cervix, is second most frequent cancer among the Indian women. To bring down the burden of cancer, in addition to opportunistic cervical cytology along with Mass screening programs, it is imperative to involve nursing staff & paramedical personnel in educating the masses. This cross sectional study describes findings of a pilot screening program, undertaken among nursing staff of a tertiary care hospital. It was found that even among the educated nursing staff there is low level of awareness for usage of pap testing. Cervical cytology revealed wide variety of inflammatory lesions. With the low doctor to population, involvement of the nursing personnel for Periodical cytological screening for prevention of cervical cancer would go a long way in early detection of various cervical abnormalities and increasing awareness among them.

Comparison of One versus Two Fecal Immunochemical Tests in the Detection of Colorectal Neoplasia in a Population-Based Colorectal Cancer Screening Program

Objective. To determine the positive predictive value (PPV) of two versus one abnormal FIT in the detection of colorectal neoplasia in a Canadian population. Methods. Three communities enrolled in a colorectal cancer (CRC) screening pilot program from 01/2009 to 04/2013 using 2 FITs. Data collected included demographics, colonoscopy, pathology, and FIT results. Participants completed both FITs and had one positive FIT and colonoscopy. PPV of one versus two abnormal FITs was calculated using a weighted-generalized score statistic. A two-sided 5% significance level was used. Results. 1576 of 17,031 average-risk participants, 50–75 years old, had a positive FIT. Colonoscopy revealed 58 (3.7%) cancers, 419 (31.6%) high-risk polyps, and 374 (23.7%) low-risk polyps as the most significant lesion. PPV of one versus two positive FITs for cancer, high-risk polyps, and any neoplasia were 1% versus 8%, 20% versus 40%, and 48% versus 67%, respectively (p value < 0.0001). When the first FIT was negative, the second positive FIT detected 7 CRCs and 98 high-risk polyps. Conclusions. PPV of two positive FITs is superior to one positive FIT for CRC and high-risk polyps. The added value of the second FIT was 12% of total CRCs and 23% of total high-risk polyps.

High cost effectiveness of newborn screening for sickle cell disease in resource-limited Angola

In this issue of The Journal, McCann et al provide rare cost and cost-effectiveness analyses of a healthcare intervention in Africa. They show that a pilot screening program for sickle cell disease in newborns in Luanda, Angola, and enrollment of affected infants into a care and education program were highly cost effective in terms of healthy life-years gained during the first 5 years of life. Their findings help to enlighten arguments made against newborn screening in resource-limited countries. Their use of standard analytic methodology and World Health Organization and Global Burden of Disease Study 2010 estimates of mortality in the Angolan population make the study a reliable benchmark for Angola and provides a template for replicable methodology for other countries. Article page 1314▶ A Cost-Effectiveness Analysis of a Pilot Neonatal Screening Program for Sickle Cell Anemia in the Republic of AngolaThe Journal of PediatricsVol. 167Issue 6PreviewTo assess the cost-effectiveness of a pilot newborn screening (NBS) and treatment program for sickle cell anemia (SCA) in Luanda, Angola. Full-Text PDF

Molecular Heterogeneity of Thalassemia among Pregnant Laotian Women

Background and Aims: A pilot screening program for thalassemia was initiated in the Lao People's Democratic Republic. This study aimed to describe the genotype diversity and hematologic features of thalassemia among the participating pregnant women. Methods: Blood samples of 411 pregnant Laotian women were collected. Hemoglobin (Hb) profiles were determined using a capillary zone electrophoresis system. Mutations of α- and β-globin genes were investigated using a polymerase chain reaction and related techniques. Results: As many as 26 different thalassemia genotypes including non-transfusion-dependent thalassemia, i.e. Hb E-β-thalassemia, Hb H, and EA Bart's diseases, were identified. A variety of phenotypic expressions of hematologic features and Hb profiles were observed, including an unusual phenotype of Hb E-β⁰ thalassemia with 89.1% Hb E, 1.6% Hb F, and 9.3% Hb A₂. Conclusions: The remarkable genotype-phenotype diversity indicates a need for careful laboratory interpretation in order to provide appropriate genetic counseling and care to the Laotian population.