Population-based Cancer Screening Research Articles

Navigating women's cancer prevention: Two cross-sectional studies to investigate psychosocial antecedents of cervical and breast cancer screening attendance.

Despite population-based cancer screening programmes effectively decreasing mortality, participation rates are unsatisfactory for both cervical and breast screening. This research tested an integrated theory of planned behaviour model applied to cervical cancer screening (CCS; Study 1) and breast cancer screening (BCS; Study 2) attendance. Women residing in Campania (Italy) and belonging to each screening target population joined two independent surveys (Study 1: n = 332, Mage = 41.03, SD = 11.45; Study 2: n = 298, Mage = 55.03; SD = 5.17). In both studies, screening behaviour was predicted by intention to undergo the screening, action and coping planning. Significant predictors of intention were subjective norms, perceived behavioural control and self-identity in Study 1, and subjective norms, anticipated regret and self-identity in Study 2. A mediation analysis confirmed the role of action and coping planning in the intention-behaviour relation. This model can guide forthcoming interventions and steer enhancements in healthcare access.

Coproduction process of decision aids for population-based cancer screening in Quebec

Coproduction process of decision aids for population-based cancer screening in Quebec

The association between health literacy and colorectal cancer screening uptake in Taiwan

Abstract Background Population-based cancer screening programs have been confirmed as a cost-effective strategy for early detection of colorectal cancer, leading to reduced mortality and morbidity. In Taiwan, the government has provided an immunochemical fecal occult blood test (iFOBT) every two years to all citizens aged 50 to 74 years since 2013. The study aims to determine the association between iFOBT uptake and health literacy (HL). Methods Data from the National Health Interview Survey (NHIS), a population-based cross-sectional survey conducted in 2021-22 in Taiwan, were applied. The European Health Literacy Survey Short Form (HLS-EU-Q16), self-reported iFOBT participation within the past 2 years, and covariates assessed by face-to-face interview. The present analysis included those age-eligible for screening (n = 3,871) and applied the survey-weighted multivariable logistic regression to estimate odds of iFOBT uptake between HL skill levels, controlling for age, education attainment, socioeconomic status, health status, and household urbanicity level. Results In general, 44.6% of participants had utilized the iFOBT, and 79.9% had adequate HL skills which reported higher iFOBT uptake rates (45.9%) than their counterparts (39.4%). Multivariable analysis showed that having adequate HL was associated with greater odds of iFOBT utilization (adjusted odds ratio [aOR] = 1.79; 95% CI: 1.29-2.49). Additionally, compared to those households registered in the township, participants in higher urbanicity levels had lower iFOBT uptake: city (aOR = 0.62; 95% CI: 0.47-0.82). Other predictors that contributed significantly were participants’ gender and having 2 or more chronic diseases. Conclusions Inadequate HL skills and urban residency may reduce participation in the CRC screening program, despite its free availability. More efforts should include literacy-friendly designed materials and the provision of tailored support in urban settings. Key messages • HL skills are significantly associated with the CRC screening uptake in Taiwan. Improving HL could have positive effects on people’s participation. • Urbanicity levels are also predictors associated with screening utilization. Disseminating health service information in localized ways should be a potential option.

Defining sensitivity and specificity for quality control of organized cancer screening using Prefectural Cancer Registry data in Japan

Objective To decrease cancer mortality by implementing cancer screening programs, rigorous quality control measures that utilize standardized indicators are imperative. In Japan, although each municipality performing cancer screening programs implements quality control for their programs using the checklist authorized by the Ministry of Health, Labour and Welfare, compliance with all the items listed is not possible because calculating sensitivity and specificity using cancer registry data is difficult under these circumstances. This report elucidates the methodology for calculating indicators, including sensitivity and specificity, by delineating the parameters of false-negative cases within population-based cancer screening programs in Japan. Furthermore, the inherent challenges associated with ensuring the quality control of cancer screening procedures are expounded upon in this report.Method Data from the Prefectural Cancer Registry of Japan and cancer screening records compiled by municipalities were used to differentiate true-positive, true-negative, false-positive, and false-negative cases based on the combination of screening test outcomes and subsequent cancer incidence.Results A false-negative case was defined as an examinee who received a cancer diagnosis within one year after undergoing the screening test, notwithstanding the negative judgment of the cancer screening decision. The duration for judgment of true-positive, true-negative, and false-negative cases was also extended to one year. Cancer identification after cancer screening was ascertained using data from the Prefectural Cancer Registry, ensuring uniform categorization of the four cases. Subsequently, sensitivity and specificity values were calculated for municipalities conducting cancer screening programs.Conclusion Sensitivity and specificity are indispensable metrics for the inherent quality control of cancer screening because these parameters directly assess the efficacy of screening tests. The anticipated increase in the number of municipalities engaged in comprehensive quality control of cancer screening in Japan is poised to enhance the efficiency of cancer control policies. This augmentation will be accomplished through the meticulous utilization of the sensitivity and specificity values elucidated in the present report. The forthcoming challenges involve the proliferation of medical institutes reporting their adherence to the checklist stipulated by the National Cancer Center of Japan and the widespread dissemination of fundamental knowledge pertaining to cancer screening.

Exploring experiences and coping strategies of the surveillance of indeterminate pulmonary nodules: a qualitative content analysis among participants in the SCAPIS trial

ObjectiveTo elucidate experiences and coping strategies among adults in the surveillance of indeterminate pulmonary nodules detected with CT in the population-based Swedish CardioPulmonary bioImage Study (SCAPIS).DesignA qualitative study of conventional...

Prospective of Mitochondrial DNA Variations in Cancer on Genomic Medicine.

Mitochondrial DNA (mtDNA) has emerged as a pivotal component in understanding the etiology and susceptibility of cancer. A recent study by Chen and colleagues delineated the germline genetic effect of mtDNA single-nucleotide polymorphisms (SNP) and haplogroups across pan-cancer risk. They identified a subset of mtSNPs and the corresponding risk score, as well as haplogroups A and M7 alongside their genetic interactions, conferring a protective effect against various cancers. These findings underscored the value of mtDNA variations as biomarkers for cancer etiology and as tools for cancer risk stratification. Future investigations are encouraged to integrate comprehensive omics data of genomics, transcriptomics, proteomics, and metabolomics, etc., from nuclear DNA with mtDNA variations, alongside single-cell and spatial technologies, to unravel the tumor mechanism and identify the drug targets. Moreover, the incorporation of polygenic risk score, that included mtDNA variations with both rare and common frequencies, and liquid biopsy-based biomarkers would enhance the predictive performance of cancer risk assessment and refine the risk stratification of population-based cancer screening. This commentary advocates for the validation across diverse populations to harness the full potential of mitochondrial genomics, and ultimately paves the prospective way for advancements in personalized cancer therapeutics and prevention strategies. See related article by Chen and colleagues, Cancer Epidemiol Biomarkers Prev 2024;33:381-8.

Perceptions and beliefs of general practitioners on their role in the cancer screening programmes in the Netherlands: a mixed-methods study

BackgroundIn the Netherlands, population-based cancer screening programmes (CSPs) are organized aiming at cervical, breast and colorectal cancer. For a CSP to be effective, high participation rates are essential; however, there is an alarming downward trend, including wide regional variation in screening uptake. General practitioner (GP) involvement can have a stimulating effect on screening participation. Current GP involvement is however, limited, varies between the programmes and has changed over time. Unexplored is what GPs think of their role(s) in the CSPs. The aim of this study was therefore to map the perceptions and beliefs of GPs regarding their current and future role in the Dutch CSPs.MethodsA mixed-methods sequential explanatory study was conducted in the Leiden/The Hague area of the Netherlands, between the end of 2021 and 2022. A questionnaire was developed and distributed among 110 GPs. The aggregated results obtained from the questionnaires served as starting points for conducting semi-structured interviews, with purposefully selected GPs. With this sequential approach we aimed to further enhance the understanding of the questionnaire data, and delved into the topics that emerged from the questionnaire responses.ResultsIn total, 46 GPs completed the online questionnaire (response rate 42%). Subsequent five semi-structured comprehensive interviews were conducted. GPs indicated that they frequently encounter the CSP in their daily practice and consider it important. They also emphasised it is important that GPs remain closely involved with the CSPs in the future. Nevertheless, GPs also repeatedly mentioned that they are not eager to take on more logistical/organizational tasks. They are however willing to empower CSPs in a positive manner.ConclusionGPs were generally positive about the CSPs and their current role within these programmes. Nevertheless, several options have been proposed to improve the CSPs, especially to increase screening uptake for populations in a socioeconomically disadvantaged position. Since it is of utmost importance to screen those who are most at risk of developing the screening-specific tumours, efforts should be made to achieve this goal.

Interactions between folate metabolism-related nutrients and polymorphisms on colorectal cancer risk: a case-control study in the Basque country

Folate-mediated one-carbon metabolism (FOCM) plays an important role in colorectal carcinogenesis. Previous studies have assessed the role of folate-mediated one-carbon metabolism (FOCM)-related gene-diet interaction in the aetiology of colorectal cancer (CRC), however, the results remained inconclusive. Thus, this study aimed to investigate dietary factors and genetic variants related to FOCM, as well as potential nutrient-gene and nutrient-lifestyle interactions, on CRC risk. This observational study included 229 patients diagnosed with CRC and 229 age- and sex-matched subjects as controls from a population-based bowel cancer screening program. Conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (95%CI) for CRC risk. A Bonferroni-corrected threshold of α = 0.005 was considered significant, and P values less than 0.05 were considered to be suggestive of an association. After Bonferroni correction, a high dietary intake of betaine was associated with a decreased risk of CRC in the adjusted model (OR, 95% CI: 0.21, 0.10–0.40, P < 0.001). Two SNPs, rs1476413 and rs17824591, exhibited significant gene-diet interactions with total choline ad vitamin B12 intakes, respectively, in adjusted models (total choline, tertile 3 vs. 1, OR, 95% CI: 0.25, 0.11–0.66, Pinteraction = 0.012; vitamin B12, tertile 2 vs. tertile 1, OR, 95% CI: 2.48, 1.04-5.00, Pinteraction = 0.003). These findings suggest that betaine intake and interactions between some dietary factors and variants in MTHFR and MTHFD1 genes have an influence on CRC risk in the population studied. If these results are confirmed, specific nutritional intervention strategies could be designed.

Abstract LB232: Implementation of population-based risk assessment for hereditary cancer in primary care: Results from the Early Detection of Genetic Risk (EDGE) Trial

Abstract The EDGE (Early Detection of GEnetic risk) trial compared two population-based engagement strategies for identifying primary care patients with a family or personal history of cancer and offered eligible individuals genetic testing for cancer susceptibility (GT). A total of twelve clinics from two healthcare systems (6 clinics each) participated in Montana, Wyoming and Washington State. Clinics were cluster-randomized to one of two engagement approaches: 1) point of care screening (POC), conducted by clinic staff when a patient came in for their appointment and 2) direct patient engagement (DPE), where letter and email outreach facilitated online home screening. Patients who completed screening and met pre-specified personal and family history criteria were offered GT via a home-delivered saliva kit at no cost. The two primary outcomes of the trial were the fraction of active clinic patients who 1) completed the risk assessment tool and 2) completed GT. Logistic regression models were used to compare POC and DPE, allowing for overdispersion and including clinic as a design factor. Analyses in the screened population were adjusted for age, sex, personal and/or family history of cancer, and healthcare system. Over a 12-month engagement window, 95,623 patients were seen in the 12 clinics (Table 1). The POC approach resulted in a higher proportion screened for hereditary risk (19.1% vs. 8.7%), but a similar proportion completed testing (1.5% vs. 1.6%). Notably, the rate of testing among eligible patients approached via POC was approximately half the rate observed with DPE (24.7% vs. 44.7%). POC screen completers were less likely to have a personal history of cancer (9.1% vs. 10.7%), a significant family history of cancer (9.5% vs. 12.8%), and, if eligible, order a test kit (33.8% vs. 58.1%). Overall, a POC approach resulted in higher screening rates for familial cancer risk but a similar fraction completing GT, with DPE screeners self-selecting due to greater personal and/or family history of cancer. Analyses are ongoing to examine patient, clinic and system-level factors predicting screening and testing uptake, which can inform best practices for population-based hereditary cancer screening efforts. POC % (N) DPE % (N) Unadjusted OR (POC vs DPE) Adjusted OR * (POC vs DPE) p-value Patient Denominator 51,693 43,930 Completed Screening 19.1% (9892) 8.7% (3813) 2.49 - 0.0074 Completed GT 1.5% (757) 1.6% (717) 0.89 - 0.75 Screened Participants 9892 3813 % screened with any personal cancer history 9.1% (902) 10.7% (406) 0.77 &amp;lt;0.0001 % of screened with significant** family history of cancer 9.5% (935) 12.8% (487) - 0.69 &amp;lt;0.0001 % of screened found eligible for GT 31.0% (3070) 42.0% (1603) - 0.65 &amp;lt;0.0001 Participants eligible for GT 3070 1603 % of eligible who ordered test kit 33.8% (1039) 58.1% (932) - 0.43 &amp;lt;0.0001 % of eligible who completed GT 24.7% (757) 44.7% (717) - 0.49 &amp;lt;0.0001 *Adjusted ORs - Adjusted for age, sex, personal cancer history, family cancer history, healthcare system.**Significant family history: 2 or more first degree relatives with a high-risk cancer Citation Format: Elizabeth M. Swisher, Heather M. Harris, Barbara M. Norquist, Jeannine Brant, Brian Shirts, Sarah Knerr, Emerson J. Dusic, Faith Beers, Tesla N. Theoryn, DaLaina Cameron, Howard Cabral, Laurie A. Riemann, Michael Raff, Beth Devine, Deborah J. Bowen, Catharine Wang. Implementation of population-based risk assessment for hereditary cancer in primary care: Results from the Early Detection of Genetic Risk (EDGE) Trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB232.

Willingness of healthcare providers to perform population-based cancer screening: a cross-sectional study in primary healthcare institutions in Tianjin, China

ObjectiveTo evaluate the willingness of healthcare providers to perform population-based screening in primary healthcare institutions in China.MethodsHealthcare providers of 262 primary healthcare institutions in Tianjin were invited to fill out...

Population-based X-ray gastric cancer screening in Hiroshima prefecture, Japan.

X-ray gastric cancer (GC) screening has been shown to decrease mortality. Population-based X-ray GC screening has been performed in Hiroshima Prefecture, Japan, since 1983 but time trends and the efficacy of the method over 39 years have not been assessed. To evaluate time trends and efficacy of population-based X-ray GC screening and identify challenges and suggested solutions for the future. This was a population-based retrospective study. The data were derived from aggregated data of the Hiroshima Regional Health Medical Promotion Organization, including the number and rate of participants and those requiring esophagogastroduodenoscopies (EGDs), the number and rate of participants diagnosed as having GC, and the positive predictive value of the abnormal findings detected by X-ray and confirmed by EGDs. The number and rate of esophageal cancers were also collected. Further, the cost of detecting one GC was evaluated. The number of participants has decreased during the last four decades, from 39925 in 1983 to 12923 in 2021. The rate of those requiring EGDs decreased significantly in recent years (P < 0.001). The number of participants diagnosed as having GC has also declined, from 76 to 10 cases. However, the rate of cases diagnosed as GC among the participants remained around 0.1%. The positive predictive value increased significantly in recent years except during 1983-1991. The number and rate of accidentally detected esophageal cancers have risen recently, from 0% in 2008 to 0.02% in 2021, one-fifth of the diagnosis rate of GC. One GC diagnosis costs approximately 4200000 Japanese Yen (30000 United States Dollars) for the X-ray screenings and EGDs. X-ray GC screening in Hiroshima has been efficient, but one challenge is the cost. Esophageal cancers may also need to be considered because they have gradually increased in recent years.

LUNG CANCER SCREENING- THE ONTARIO? CANADA EXPERIENCE

Lung cancer remains the most significant cause of cancer death, accounting for about 20% of all cancer-related mortality. A significant reason for this is delayed diagnosis mostly related to lack of symptoms in early-stage disease. Low-dose computed tomography screening of high-risk, asymptomatic populations has been shown to reduce lung cancer mortality. Various approaches have been taken on the implementation of lung cancer screening programs. Ontario Health Cancer Care Ontario OHCCO believes that screening that is delivered through organized programs is more likely to reduce cancer incidence and mortality, minimize the potential harms of screening and be cost effective when compared to screening that happens outside of organized programs. Based on lessons learned from a pilot project the province has now transitioned to a full provincial Ontario Lung Cancer Screening program. The key objectives of this presentation are to: discuss the need for early lung cancer detection; to clarify the use of the word Screening; to outline the essential components or the foundations of a screening program; and to summarize the Ontario experience on implementation of a population-based lung cancer screening program.

Primary care practice-based interventions and their effect on participation in population-based cancer screening programs: a systematic narrative review.

To provide a systematic synthesis of primary care practice-based interventions and their effect on participation in population-based cancer screening programs. Globally, population-based cancer screening programs (bowel, breast, and cervical) have sub-optimal participation rates. Primary healthcare workers (PHCWs) have an important role in facilitating a patient's decision to screen; however, barriers exist to their engagement. It remains unclear how to best optimize the role of PHCWs to increase screening participation. A comprehensive search was conducted from January 2010 until November 2023 in the following databases: Medline (OVID), EMBASE, and CINAHL. Data extraction, quality assessment, and synthesis were conducted. Studies were separated by whether they assessed the effect of a single-component or multi-component intervention and study type. Forty-nine studies were identified, of which 36 originated from the USA. Fifteen studies were investigations of single-component interventions, and 34 studies were of multi-component interventions. Interventions with a positive effect on screening participation were predominantly multi-component, and most included combinations of audit and feedback, provider reminders, practice-facilitated assessment and improvement, and patient education across all screening programs. Regarding bowel screening, provision of screening kits at point-of-care was an effective strategy to increase participation. Taking a 'whole-of-practice approach' and identifying a 'practice champion' were found to be contextual factors of effective interventions.The findings suggest that complex interventions comprised of practitioner-focused and patient-focused components are required to increase cancer screening participation in primary care settings. This study provides novel understanding as to what components and contextual factors should be included in primary care practice-based interventions.

The use of text messages as an alternative invitation method for breast cancer screening: A randomized controlled trial (M-TICS study).

This study aimed to determine whether a text message is as good as a postal letter as an invitation method for previous screenees in a breast cancer screening program, considering a non-inferiority margin of -2 percent points on participation rate. A non-inferiority randomized control trial was conducted. Women in the intervention group (n = 5,362) were invited by text message, and women in the control group (n = 5,482) were invited by letter, which is the standard invitation procedure of the program. In both groups, the invitation included a fixed appointment for mammography and a text message reminder 96 hours before the appointment. The primary outcome was screening participation rate (completing mammography within 12 weeks of invitation). Secondary outcomes included mammography attendance to initial or rescheduled appointments and cancellation rate. The intention-to-treat analysis showed a participation rate of 87.3% and 86.6% in the control and intervention groups, respectively. The difference in participation rate was -0.7 percentage points (95% confidence interval [CI], -1.8 to ∞), indicating non-inferiority of text messages compared to letter invitations. The per-protocol analysis showed similar results. Attendance at the initial appointment was higher in women who received the text message invitation compared to those in the control group (P<0.002). Women who received the invitation by letter canceled more the initial appointment scheduled compared to the text message group (21.1% and 15.1%, P<0.007). In conclusion, we found that a text message invitation for women who had previously participated in breast cancer screening was not inferior to the standard letter. This randomized controlled trial provides valuable insights into the use of alternative invitation methods for population-based cancer screening programs. However, further research is needed to determine the best timing and frequency of text messages for better outcomes and identify strategies for facilitating rescheduling or cancellation. Trial Registration: Clinicaltrials.gov NCT04343950, (04/09/2020).

Impact of altering the invitation package on screening participation among never-screeners in the Flemish population-based cancer screening programs.

The total coverage of both the Flemish breast cancer and cervical screening program remain suboptimal, with approximately 63% for both. Of all the women invited to the breast cancer screening program, 14.1% never underwent any type of breast cancer screening (any type of mammogram, ultrasound, or clinical breast examination). For the cervical cancer screening, this proportion of 'never-screeners' is 12.1%. We conducted two randomized controlled trials to assess whether various communication and presentation styles in the invitation package, were effective at motivating women who had never participated to attend. The study population was limited to never-screeners (women who had never participated in the screening program). The RCT embedded in the breast cancer screening consisted of seven intervention arms and one control arm (all of them included a fixed appointment by letter). The RCT embedded in the cervical cancer screening consisted of three intervention arms and two control arms. In both RCTs, several content and style adaptations were made to the invitation letter, information leaflet, and envelope. None of the intervention arms in either the breast cancer screening or the cervical cancer screening had a statistically significant impact on the participation rate compared to 'usual care' (the regular invitation package used in the screening program). Sending adapted invitation packages to never-screeners, from the Flemish breast and cervical cancer screening program, does not seem to be effective in increasing the proportion of women screened. Innovative methods are needed to motivate never-screeners to be screened.

OA16.06 Trends of Positive Rates of Initial Screening And Repeated Screening in National Organized Population-Based Lung Cancer Screening in Korea

OA16.06 Trends of Positive Rates of Initial Screening And Repeated Screening in National Organized Population-Based Lung Cancer Screening in Korea

Impact of the COVID-19 pandemic on population-based cancer screening, a nationwide retrospective study in Taiwan

BackgroundThe Coronavirus disease 2019 (COVID-19) pandemic has placed a great burden on Taiwan’s health care system. It has also had a great impact on other public health issues, including cancer screening. Delayed cancer screening was also noticed in the U.S. during the pandemic, which may have led to both delayed diagnosis and poor prognosis. In Taiwan, population-based cancer screening for breast cancer, oral cancer, colon cancer and cervical cancer has been executed and ongoing for years.MethodIn this study we have analyzed the change in screening numbers for cancer during the period of the 2019 to 2021 COVID-19 outbreak in Taiwan.ResultsThrough our results we found that total cancer screening numbers decreased from 307,547 to 103,289 (a 66% decrease) from the years 2020 to 2021. Specifically, a 63%, 79%, 65% and 71% decrease in screening cases was seen for colon cancer, oral cancer, cervical cancer and breast cancer, respectively, during that period. A similar condition was noticed when comparing 2019 to 2021 when the disclosed total cancer screening numbers decreased by 70% (2019–2021); 65%, 83%, 70% and 76% in colon cancer, oral cancer, cervical cancer and breast cancer, respectively. Among these various cancer screenings, oral cancer screening showed the greatest reduction rate (a drop of 83% compared to 2019 and 79% compared to 2020). We also compared the reduction rates taken from different regions in Taiwan. It was in Taipei, where most COVID-19 cases were noted, that the greatest reduction rate of cancer screening numbers occurred (a drop of76% compared to 2019 and 74% compared to 2020). A proportional decrease of screening cases was also noticed in all areas when confirmed COVID-19 cases rose.ConclusionsScreening for cancers dropped significantly due to the pandemic and its effect on long-term health needs to be evaluated. Additionally, efforts should be taken to address these cancer screening number deficits which have taken place during the COVID-19 pandemic.

Endoscopic evaluation by the Kyoto classification of gastritis combined with serum anti-Helicobacter pylori antibody testing reliably risk-stratifies subjects in a population-based gastric cancer screening program.

We previously demonstrated that the Kyoto classification of gastritis was useful for judging the status of Helicobacter pylori infection in a population-based screening program, and that adding H. pylori antibody test improved its accuracy (UMIN000028629). Here, we tested whether our endoscopic diagnosis of H. pylori infection status reliably estimated gastric cancer risk in the program. Data were collected from1345 subjects who underwent endoscopic follow-up 4years after the end of the registration. We analyzed the association of three diagnostic methods of H. pylori infection with gastric cancer detection: (1) endoscopic diagnosis based on the Kyoto classification of gastritis; (2) serum diagnosis according to the ABC method (H. pylori antibody and pepsinogen I and II); and (3) endoscopic diagnosis together with H. pylori antibody test. During the follow-up, 19 cases of gastric cancer were detected. By Kaplan-Meier analysis, the detection rates of cancer were significantly higher in the past or current H. pylori infection groups than in the never-infected group with all 3 methods. By the Cox proportional hazards model, the hazard ratio for cancer detection was highest in evaluation with the combined endoscopic diagnosis and the antibody test (method 3; hazard ratio 22.6, 95% confidence interval 2.99-171) among the three methods (the endoscopic diagnosis (method 1); 11.3, 2.58-49.8, and the ABC method (method 2); 7.52, 2.49-22.7). Endoscopic evaluation of H. pylori status with the Kyoto classification of gastritis, especially combined with serum anti-Helicobacter pylori antibody testing, reliably risk-stratified subjects in a population-based gastric cancer screening program.

Profiles and Findings of Population-Based Esophageal Cancer Screening With Endoscopy in China: Systematic Review and Meta-analysis.

Population-based esophageal cancer (EC) screening trials and programs have been conducted in China for decades; however, screening strategies have been adopted in different regions and screening profiles are unclear. We performed a meta-analysis to profile EC screening in China by positivity rate, compliance rate, and endoscopy findings, aiming to provide explicit evidence and recommendations for EC screening programs. English (PubMed, Embase) and Chinese (China National Knowledge Infrastructure, Wanfang) language databases were systematically searched for population-based EC screening studies in the Chinese population until December 31, 2022. A meta-analysis was performed by standard methodology using a random-effects model. Pooled prevalence rates were calculated for three groups: high-risk areas with a universal endoscopy strategy, rural China with a risk-stratified endoscopic screening (RSES) strategy, and urban China with an RSES strategy. Positive cases included lesions of severe dysplasia, carcinoma in situ, intramucosal carcinoma, submucosal carcinoma, and invasive carcinoma. The pooled positivity rate of the high-risk population was higher in rural China (44.12%) than in urban China (23.11%). The compliance rate of endoscopic examinations was the highest in rural China (52.40%), followed by high-risk areas (50.11%), and was the lowest in urban China (23.67%). The pooled detection rate of positive cases decreased from 1.03% (95% CI 0.82%-1.30%) in high-risk areas to 0.48% (95% CI 0.25%-0.93%) in rural China and 0.12% (95% CI 0.07%-0.21%) in urban China. The pooled detection rate of low-grade intraepithelial neoplasia (LGIN) was also in the same order, being the highest in high-risk areas (3.99%, 95% CI 2.78%-5.69%), followed by rural China (2.55%, 95% CI 1.03%-6.19%) and urban China (0.34%, 95% CI 0.14%-0.81%). Higher detection rates of positive cases and LGIN were observed among males than among females and at older ages. The pooled early detection rate was 81.90% (95% CI 75.58%-86.88%), which was similar to the rates in high-risk areas (82.09%), in rural China (80.76%), and in urban China (80.08%). Under the current screening framework, a higher screening benefit was observed in high-risk areas than in other regions. To promote EC screening and reduce the current inequality of screening in China, more focus should be given to optimizing strategies of high-risk individual assessment and surveillance management to improve compliance with endoscopic examination. PROSPERO CRD42022375720; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=375720.

Attendance characteristics of the breast and colorectal cancer screening programmes in a highly urbanised region of the Netherlands: a retrospective observational study

ObjectivesThroughout Europe, many countries offer population-based cancer screening programmes (CSPs). In the Netherlands, two implemented CSPs are targeting people of 50 years and older, aiming at breast cancer (BC) and...