Previous Screening History Research Articles

Beneficial effect of repeated participation in breast cancer screening upon survival.

552 Background: The benefit of mammography screening in reducing population mortality from breast cancer is well established. However, the effect of repeated participation at scheduled screens on case survival is less well documented. Methods: In this retrospective analysis of breast cancer survival, we analyzed incidence and survival data on 37,079 women ages 40-69 from nine Swedish counties who had between one and five invitations to mammography screening and were diagnosed with breast cancer between 1992 and 2016. Of these, 4,564 subsequently died of breast cancer. For each breast cancer diagnosed in each county’s period of observation, we obtained data on previous screening history, and subsequent death (or not) from breast cancer. Formal comparisons of survival with respect to numbers of screening exams attended prior to a diagnosis of breast cancer were carried out using Cox proportional hazards regression with time-varying covariates, ie, cumulative numbers of screens, yielding hazard ratios and 95% confidence intervals (CI). We corrected for potential self-selection using the method of Duffy et al, which gives a corrected estimate based on the proportion of participants, the uncorrected estimate, and the relative risk of breast cancer death for non-participants compared to an uninvited population. Results: Depending on number of invitations, 58-73% (average 65%) participated in all scheduled screens, and 73-96% (average 91%) participated in at least one examination. There was successively better survival among women with increasing numbers of screening exams. For a woman with five previous screening invitations who participated in all five screening exams, the hazard ratio was 0.28 (95% CI 0.25-0.33, p<0.0001), a 72% risk of dying from breast cancer, compared to a woman attending none. Following a conservative adjustment for potential self-selection factors, the hazard ratio was 0.34 (95% CI 0.26-0.43, p<0.0001). Conclusions: For those women who develop breast cancer, regular prior participation in mammography screening confers significantly better survival. Most women will not develop breast cancer in their lifetime. These results indicate that for those who do, regular participation in screening considerably improves the probability of surviving it. The distinction between the general, population benefit of mammography screening, and the benefit of regular participation in mammography screening should be clearly articulated in breast cancer screening messaging and decision aids. [Table: see text]

Cervical Cancer Screening in Women Aged Older Than 65 Years.

Considerable debate exists among guidelines regarding when cervical cancer screening can be safely stopped. The authors aimed to compare the efficiency of human papillomavirus (HPV) test, cytology, and previous screening history for the diagnosis of cervical intraepithelial neoplasia (CIN) 2+ lesions in women aged older than 65 years. This is a retrospective cohort study. Multiple logistic regressions were used to compare the efficiency of the HPV test, cytology, and previous screening history for the diagnosis of histologically proven CIN 2+ lesions. A total of 5,427 women were included in the study. A total of 2,143 women were tested with HPV and 52 (2.4%) of them were HPV-positive. Abnormal cytology was detected in 359 (6.6%) women. Most of the women (70.4%) had inadequate screening in the previous 10 years. According to regression analysis, an HPV-positive test increases the risk of probability of CIN 2+ 136.111 times [95% CI for odds ratio (OR) = 41.212-449.538] compared with an HPV-negative test ( p < .001). Abnormal cytology increases the probability of CIN 2+ 13.072 times (95% CI for OR = 3.878-44.062) compared with normal cytology ( p < .001). Inadequate or positive previous screening increases the likelihood of CIN 2+ 9.705 times (95% CI for OR = 1.603-58.756) compared with adequate and negative previous screening ( p = .013). Adequate previous screening is a valuable strategy, and abnormal cytology is an important screening test in women aged older than 65 years. However, the HPV test is the most determinant parameter for CIN 2+ risk in elderly women.

A Pilot Study of Implementing Diabetic Retinopathy Screening in the Oslo Region, Norway: Baseline Results.

to gain insight into the baseline parameters of a population with diabetes mellitus (DM) included in a pilot diabetic retinopathy (DR) screening program at Oslo University Hospital (OUH), Norway. This was a cross-sectional study of a cohort of adult patients (≥18 years) with type 1 or 2 DM (T1D and T2D). We measured the best-corrected visual acuity (BCVA), blood pressure (BP), heart rate (HR), intraocular pressure (IOP), height and weight. We also collected HbA1c, total serum cholesterol and urine-albumin, -creatinine and -albumin-to-creatinine ratio (ACR), as well as socio-demographic parameters, medications and previous screening history. We obtained color fundus photographs, which were graded by two experienced ophthalmologists according to the International Clinical Disease Severity Scale for DR. The study included 180 eyes of 90 patients: 12 patients (13.3%) had T1D and 78 (86.7%) had T2D. In the T1D group, 5 patients (41.7%) had no DR, and 7 (58.3%) had some degree of DR. In the T2D group, 60 patients (76.9%) had no DR, and 18 (23.1%) had some degree of DR. None of the patients had proliferative DR. Of the 43 patients not newly diagnosed (time of diagnosis > 5 years for T1D and >1 years for T2D), 37.5% of the T1D patients and 5.7% of the T2D patients had previously undergone regular screening. Univariate analyses found for the whole cohort significant associations between DR and age, HbA1c, urine albumin-to-creatinine ratio, body mass index (BMI) and duration of DM. For the T2D group alone, there were significant associations between DR and HbA1c, BMI, urine creatinine, urine albumin-to-creatinine ratio and duration of DM. The analysis also showed three times higher odds for DR in the T1D group than the T2D group. This study underscores the need for implementing a systematic DR screening program in the Oslo region, Norway, to better reach out to patients with DM and improve their screening adherence. Timely and proper treatment can prevent or mitigate vision loss and improve the prognosis. A considerable number of patients were referred from general practitioners for not being followed by an ophthalmologist.Among patients not newly diagnosed with DM, 62.8% had never had an eye exam, and the duration of DM for these patients was up to 18 years (median: 8 years).

Abstract A123: Providing breast cancer screening in vulnerable communities: The impact of a mobile cancer screening van

Abstract Background: Mobile cancer screening vans (MCSV) are a promising approach to providing preventive cancer screenings to those in need. In 2021, the Sidney Kimmel Cancer Center (SKCC) at Jefferson launched an MCSV to cover its 7-county catchment area. The primary focus of the screening van is to provide breast cancer screenings, although other cancer screenings as well as connections to resources are periodically offered. Community organizations agree to host the MCSV at their site; up to 14 women can be screened for breast cancer at each event. Screening registration information as well as clinical outcomes from the mammogram are captured in the electronic health record (EMR). Here, we describe the impact of the MCSV during its first 8 months of operation. Methods: Data was pulled from the EMR for all women who received breast cancer screening on the MCSV between September 30, 2021 and May 31, 2022. Patient demographic information included age, gender, race and ethnicity, primary language spoken, insurance status, zip code of residence and breast cancer screening history. Clinical outcomes included screening result, need for follow-up and diagnosis of cancer, if relevant. Means and frequencies were calculated for each variable. Bivariate analyses investigated associations between patient demographics and previous screening history or screening exam results. Results: In partnership with community organizations, we have held 47 screening events and screened a total of 377 women in the previous 8 months. Of the 377 women screened, 175 (46%) were African American, 90 (24%) were Caucasian, and 61 (16%) were Hispanic. 279 (74%) of the women had health insurance while 98 (26%) were uninsured. Seventy (19%) women needed additional imaging or follow-up and one woman has been diagnosed with stage 1b invasive ductal carcinoma of the breast. The only significant difference among those screened was that those without health insurance were less likely to have a previous mammogram (X2 =4.002, p,.05).Conclusion: The SKCC MCSV is reaching a diverse population, based on race and ethnicity, and a population in need, based on insurance status. While we did not observe racial nor ethnic differences among those screened on the van in relation to screening results or previous screening, those without insurance are more likely to receive their first screening with the MCSV, another important marker that the van is reaching those in need. Citation Format: Christina L. Yurick, Nicola Cianci, Katie Bradley, Khaldoun Hamade, Christine Bonaccorso, Amy Leader. Providing breast cancer screening in vulnerable communities: The impact of a mobile cancer screening van [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A123.

Abstract A094: Ethnic differences in indicators of prostate health among Asian American men

Abstract Background: Prostate cancer (PCa) is the most diagnosed non-skin cancer in American men. While Asian Americans have lower incidence and mortality rates of PCa compared to other ethnicities, this cancer type nonetheless has a significant burden on this population. Specifically, population-based studies have shown that when data on PCa in Asian Americans are disaggregated based on ethnicity, several subgroups of Asian American men, in fact, are more likely to be diagnosed with advanced (i.e., more aggressive or metastatic) PCa than non-Hispanic Whites. The heightened rates of advanced PCa at diagnosis among Asian American subgroups highlights the importance of reducing modifiable risk factors, such as smoking and obesity, and promoting early detection in these subgroups. Objective: Accordingly, to better understand and improve prostate health among Asian American men, the present study investigated within group differences in obesity and smoking, two known risk factors for advanced PCa incidence, along with previous history of PCa screening, between three large Asian American ethnic groups: Vietnamese, South Asian (Asian Indian/Pakistani), and Chinese in Houston, Texas. Methods: From 2003 to 2008, the University of Texas MD Anderson Cancer Center conducted a prostate screening project targeting minority men with low income, in which over 500 Asian American men (142 Chinese, 251 Vietnamese, and 128 South Asians) participated. The community-based program provided an educational session on PCa and participants were offered free prostate screening using the prostate-specific antigen (PSA) test and/or digital rectal examination (DRE). Along with socio-demographic and clinical variables, risk factors for advanced PCa (smoking, and obesity), and previous PCa screening history were collected, and differences across the Asian subgroups were examined. Results: Vietnamese men had the highest smoking rate of the three Asian subgroups (52% reported as former/current smokers) and the lowest previous PCa screening rate (15.9% compared to 25.4% of Chinese and 18.8% of South Asian). South Asian men had the highest obesity rate of the three Asian subgroups (12.9% were obese compared to 3.4% of Vietnamese and 4.8% of Chinese). Chinese men had the highest mean PSA and the highest percentage (15.5%) of PSA results ≥ 4 compared to Vietnamese and South Asian men. Chinese men also had the highest percentage (22.4%) of abnormal findings in DRE, compared to Vietnamese (6.6%) and South Asian men (4.8%). Discussion: This study demonstrates that subgroups of Asian Americans may have different PCa risk profiles, nullifying the assumption that all Asian American men are at low risk for the disease. Thus, aggregation of Asian American subgroups may mask meaningful differences in their prostate health. Interventions may need to be tailored to specific Asian subgroups given the heterogeneity of the data based on Asian heritage. Citation Format: Dalnim Cho, Beverly Gor, Mike Hernandez, Curtis A. Pettaway. Ethnic differences in indicators of prostate health among Asian American men [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A094.

Colon Cancer Screening and the End of Life: Is Age Just a Number?

Age is the strongest risk factor for colorectal cancer. Although there is updated guidance for the age at which to start screening, there is little guidance for individuals or their medical teams on how to decide when to stop. Current recommendations from the US Preventive Services Task Force and other societies focus primarily on age. For patients older than 85 years, guidelines discourage screening because the harms largely outweigh benefits. Although at a population level, the overall benefit of screening in older individuals decreases, one must individualize the recommendation based on comorbidities, functional status, screening history, and gender-not solely base it on age. Patient and caregiver preferences must also be thoroughly explored. Current models struggle with incorporating other colorectal cancer risk factors such as family history, previous adenomas, and modality of previous screening into recommendations and simulations, but are likely to improve with machine learning and whole electronic health record prediction-based approaches.

A walk-in clinic as an alternative approach to reaching non-attenders of the cervical cancer screening program in the North Denmark region-a pilot study.

Up to 39% of women in Denmark do not participate regularly in the cervical cancer screening program and initiatives to increase participation are called upon. The primary aim of this study was to describe previous screening history and characteristics of women attending screening in a walk-in clinic. Furthermore, we wanted to investigate barriers to cervical cancer screening. We designed a walk-in clinic that was open 2 days a week from 16.00 to 19.00 h, located in the Departments of Gynecology in the two main hospitals of the North Denmark Region. The main purpose of the clinic was cervical cancer screening and the study period was 5 months. Women who were not eligible for screening or had other health complaints were referred to their general practitioner. The women included in the study, filled out a questionnaire regarding educational and occupational status; their screening history was registered using data from the Danish Pathology Register. During the study period, 255 women visited the walk-in clinic. The final study population consisted of 249 women who met the inclusion criteria. Age range of participants was 23-77 years, with a median age of 45 years. The majority of the participants were currently employed (81%) or students (10%), the remaining being retired (5%) or unemployed (4%). Screening history showed that 138 (55.4%) of the women were on time for the screening or delayed less than 6 months compared to their recommended screening interval. Sixty-one women (24.5%) were delayed >6 months but <2 years. Fifty women (20.1%) were classified as non-attenders, with more than a 2-year delay in their screening. In the group of non-attenders, eight women had never been screened. Of the remaining 42 women, the median time since last screening was 8.2 years (range 5.0-25.3 years). Women attending the walk-in clinic tended to be primarily actively working or students (91%). All age groups in the screening population were represented. Screening history showed that 44.6% had not followed the recommended screening program.

Prevalence and Risk Factors of Chlamydia Trachomatis Infection Among Women Consulting at the Sexually Transmitted Infection Centre in la Reunion: A Cross-Sectional Study

RésuméIntroductionL'infection à Chlamydia trachomatis (CT) est l'infection sexuellement transmissible (IST) bactérienne la plus répandue dans le monde. Souvent asymptomatique, elle peut mener à des complications significatives chez les femmes. L'objectif de cette étude était de déterminer la prévalence du CT en centre de dépistage à la Réunion et d'explorer les déterminants de cette infection.MéthodeEnquête transversale comprenant un questionnaire anonyme et une PCR par auto-écouvillon génital mené chez les femmes consultant dans deux centres de dépistage à la Réunion au cours d'une année.RésultatsParmi les 620 femmes testées, la prévalence du CT était de 6,6% (IC 95% [4, 7, 8, 6]). La prévalence maximale par classe d'âge se situait entre 12 et 17 ans avec une prévalence de 14,3% contre 7,5% chez les 18-24 ans et 3,9% chez les 25-67 ans (p = 0,003). Les facteurs de risques étaient le jeune âge (p = 0,02), un premier rapport sexuel entre 11 et 14 ans (p = 0,01), une absence d'antécédent de dépistage (p = 0,02) et les motifs de consultation « infidélité du partenaire » (p = 0,01) et « partenaire infecté » (p = 0,02).ConclusionLa prévalence du CT chez les mineures réunionnaises est élevée. Un dépistage plus systématique et un renforcement de la sensibilisation aux IST chez elles semblent primordiaux.

2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors.

2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors.

Performance of Sickle SCAN&amp;lt;sup&amp;gt;&amp;amp;reg;&amp;lt;/sup&amp;gt; in the Screening of Sickle Cell Disease in Kisangani Pregnant Women and Attitude towards Results

In the Democratic Republic of the Congo, the sickle cell trait carriage is estimated at 25%. Routine neonatal screening is not a common practice, leading to a very late diagnosis. In this study, the screening of pregnant women was assessed as well as their attitudes. This is an analytical cross-sectional study conducted in 245 pregnant women, sampled by convenience in four hospitals in Kisangani city (Democratic Republic of Congo) and screened using the sickle SCAN® test, from February 1 to July 31, 2019. The sensitivity and specificity of the latter were determined using liquid chromatography coupled with mass spectrometry as the gold standard. The attitudes of 240 pregnant women without previous screening history were assessed upon the announcement of the results. The sensitivity of screening for hemoglobin (Hb) AA and Hb AS was 96.69% and 98.39%, respectively; while the specificities were 99.43% and 96.32%, respectively. The Kappa coefficient (κ) was excellent. Concerning attitudes, Hb SS pregnant women and 55.17% of AS pregnant women worried when the results relating to their hemoglobin status were announced. The sickle SCAN® test was found reliable for sickle cell disease screening in Kisangani. The announcement of the results, mainly positive, raises worry among pregnant woman. Therefore, we recommend the involvement of a clinician psychologist for pre-screening counselling and for results announcement, as well as early newborns and unmarried teenage girls screening.

Emerging risk factors associated with prevalence of hepatitis c virus infection among Nigerians: Findings from blood donors in an academic hospital, Enugu South-Eastern Nigeria.

In Nigeria, reports on the prevalence of Hepatitis C risk factors have not been clearly elucidated, we investigate the risk factors that influence the prevalence and how the difference in awareness level of risk factors screening across age groups contributes to the disease. A total of 8790 aged 18-55years old, who attended the Department of Haematology and Blood Transfusion Services, University of Nigeria Teaching Hospital, Enugu were screened. Among them, 135 were diagnosed with hepatitis C infection from 1 January 2017 to 1 January 2019. Participants completed a questionnaire related to demographics, risk factors, history of previous medical screening. Age groups, income and education were indicators. Multivariate analyses were used to identify correlates. A total of 135 blood donors (95 males and 40 females) with a mean age of 35.9±10.5 and 36.4±10.7years respectively were positive for hepatitis C infection, giving overall prevalence (1.5%), injecting drug use (39%), unprotected multiple sex (22.2%), sacrification (14.8%), blood transfusion (11.1%). Multivariate analysis revealed that injecting drug use (P<.0001), unprotected multiple sex (P=.004), sacrification (P=.036) were independent risk factors that influence the prevalence among younger age groups. Blood transfusion was not significant (P=.053) but the mostly accessed. Low income and educational background were significantly more prevalent among the studied group. Injecting drug use, multiple sex and sacrification are independent predictors of prevalence of Hepatitis C infection. The early onset of the risk factors among the younger adult clearly underlines the need for early screening and interventions.

SCREENING OF NON-COMMUNICABLE DISEASE IN AN URBAN RESETTLEMENT COLONY IN DELHI, INDIA

Objective: NCDs are responsible for more than 2/3rd cases of premature mortality (30–69 years) in India. Screening for NCDs is the most effective means for detection of undiagnosed NCD cases and early treatment initiation that lowers morbidity and mortality due to these disease. The objective of the present study was to assess the non-communicable disease screening status in an urban resettlement colony of Delhi Design and method: A community-based cross-sectional study was conducted among residents of the area. Subjects with preexisting hypertension and diabetes and aged below 30 years were excluded. Data was collected using a patient-interview schedule to assess self-reported screening status for hypertension, diabetes, high blood cholesterol, breast cancer (mammogram) and Pap smear (cervical cancer).Diabetes risk was estimated in all the non-diabetic subjects (N = 422) using the Indian diabetes risk score (IDRS). Statistical analysis was conducted in IBM SPSS Version 17. Results: : A total of 110 men and 103 women (N = 213) met the inclusion criteria. The mean (± SD) age of the subjects was 40 (± 9.3) years. A history of previous screening for hypertension and diabetes was reported by 73 (34.2%) and 40 (35.4%) subjects respectively. The IDRS indicated a medium or high risk of having diabetes mellitus present in most (88.4%) of the subjects. On current screening, 9 (8.2%) men and 9 (8.7%) women were identified as undiagnosed hypertension cases. Only 4 (3.8%) women had undergone a clinical breast exam and just 9 (8.7%) women ever had a Pap smear examination. Conclusions: The subjects identified at risk of diabetes, newly diagnosed cases of hypertension and previously diagnosed hypertension cases who had never been tested for diabetes were counselled and referred to the nearby public health facilities for further management and evaluation. Health-talks for promotion of regular physical activity, avoiding and quitting tobacco smoking and alcohol use were also conducted in the area. The present study shows that the current strategy of opportunistic screening for NCDs has been unable to cover large segments of vulnerable and at risk populations.

Factors associated with late presentation of cervical cancer cases at a district hospital: a retrospective study

BackgroundCervical cancer is the leading and most common female cancer among women in Ghana. Although there are screening methods to detect premalignant lesions for treatment, screening coverage in Ghana is 2.8% and late presentation of cases complicates treatment efforts.This study examined the sociodemographic, clinical and histological characteristics associated with late presentation of cervical cancer cases attending Gynecological Oncology care at Catholic Hospital, Battor.MethodsOne hundred and fifty-seven medical records of confirmed cases of cervical cancer reporting to the Outpatient Obstetrics and Gynecology Department between 2012 and 2016 were reviewed. Relevant data were retrieved using abstraction forms. Socio demographic variables investigated were level of education attained, marital status, National Health Insurance Scheme membership, employment status, place of residence and distance from hospital. Clinical variables included intermenstrual/postmenopausal bleeding, previous screening history, previous smoking history, age at menarche and number of children. Histological variables included subtypes of tumour and characteristics of tumour. Pearson’s chi-square test and logistic regression analysis were used to determine correlates of late stage at presentation with cervical cancer. Sensitivity analysis was performed to assess the effect of missing data.ResultsApproximately two-thirds (65.97%) of the cases presented in advanced stages of cervical cancer. Level of education, age at menarche and previous screening history were included in a regression model and adjusted for age. Age at menarche (n = 66) was eliminated from the model after sensitivity analysis. Among the remaining variables, only previous screening history was predictive of late stage at presentation of cervical cancer cases. Previously unscreened cases of cervical cancer were nearly four times more likely to present late, compared to those who had been screened previously (OR 3.91; 95% CI 1.43–10.69). No association was observed with sociodemographic and histological characteristics.ConclusionLack of previous screening was associated with late presentation of cervical cancer at Catholic Hospital, Battor. Efforts to promote early cervical cancer screening should be intensified and future studies may explore an association with age at menarche.

Risks of cervical intraepithelial neoplasia grade 3 or invasive cancers in ASCUS women with different management: a population-based cohort study.

ObjectiveTo investigate the progression risk of atypical squamous cells of undetermined significance (ASCUS) with different clinical managements.MethodsWomen with their first diagnosis of ASCUS cytology were retrieved from the national cervical cancer screening database and linked to the national health insurance research database to identify the management of these women. The incidences of developing cervical intraepithelial neoplasia grade 3 and invasive cervical cancer (CIN3+) were calculated, and the hazard ratios (HRs) were estimated using a Cox proportional hazards model. This study was approved by the Research Ethics Committee of the National Taiwan University Hospital and is registered at ClinicalTrials.gov (Identifier: NCT02063152).ResultsThere were total 69,741 women included. Various management strategies including colposcopy, cervical biopsies and/or endocervical curettage, and cryotherapy, failed to reduce the risk of subsequent CIN3+ compared with repeat cervical smears. Loop electrosurgical excision procedure/conization significantly decreased risk of subsequent CIN3+ lesions (HR=0.22; 95% confidence interval [CI]=0.07–0.68; p=0.010). Women in their 40s–50s had an approximately 30% risk reduction compared to other age groups. Women with a previous screening history >5 years from the present ASCUS diagnosis were at increased risk for CIN3+ (HR=1.24; 95% CI=1.03–1.49; p=0.020).ConclusionIn women of first-time ASCUS cytology, a program of repeat cytology can be an acceptable clinical option in low-resource settings. Caution should be taken especially in women with remote cervical screening history more than 5 years.

Status of Noncommunicable Disease Screening in an Urban Resettlement Colony in Delhi, India: A Descriptive Cross-Sectional Study

Background Noncommunicable diseases (NCDs) are responsible for more than two-third cases of premature mortality (30–69 years) in India. Screening for NCDs is the most effective means for detection of undiagnosed NCD cases and early treatment initiation that lowers morbidity and mortality due to these diseases. The objective of the present study was to assess the NCD screening status in an urban resettlement colony of Delhi. Materials and Methods A community-based cross-sectional study was conducted among residents of the area. Patients with preexisting hypertension and diabetes and aged below 30 years were excluded. The patients were further screened for hypertension by taking three separate readings using an aneroid sphygmomanometer. The Indian Diabetes Risk Score (IDRS) was calculated to evaluate diabetes risk. Results A total of 110 men and 103 women (N = 213) met the inclusion criteria. The mean (±standard deviation) age of the patients was 40 (±9.3) years. A history of previous screening for hypertension and diabetes was reported by 73 (34.2%) and 40 (35.4%) patients, respectively. A medium or high-risk of having diabetes mellitus as per the IDRS score was present in most (88.4%) patients. On current screening, nine (8.2%) men and nine (8.7%) women were identified as undiagnosed hypertension cases. Only four (3.8%) women had undergone a clinical breast exam, and just nine (8.7%) women ever had a Pap smear examination. Conclusion The present study shows that the current strategy of opportunistic screening for NCDs has been unable to reach large segments of vulnerable and at risk populations.

Brief mental health screening of prison entrants: psychiatric history versus symptom screening for the prediction of in-prison outcomes

While prisoners are known to suffer very high rates of mental illness, evidence is often lacking to inform the development of effective approaches to prison mental health service provision, including the approach to mental health screening. In addition, research to date has been dominated by prevalence studies and little is known about the mental health needs of prisoners over time. A random sample of prison entrants was recruited from a large remand and reception prison in New South Wales, Australia (n = 707) for the completion of a brief health survey. A second survey was completed during the subsequent six months (n = 317) in order to examine the effect of timing of assessment on mental health status. Those followed up within three months (n = 182) were further included in an analysis of predictive validity comparing the performance at baseline of self-reported history of previous diagnosis versus current symptom screening for psychological distress, in predicting subsequent mental illness. When assessed over six months from prison entry, mental health status was found to vary by timing of assessment. At prison entry, self-reported history of previous diagnosis of a mental health disorder was found to be a better predictor of mental illness over three months than screening for psychological distress.

Risk-adjusted colorectal cancer screening using the FIT and routine screening data: development of a risk prediction model

Background:The faecal immunochemical test (FIT) is replacing the guaiac faecal occult blood test in colorectal cancer screening. Increased uptake and FIT positivity will challenge colonoscopy services. We developed a risk prediction model combining routine screening data with FIT concentration to improve the accuracy of screening referrals.Methods:Multivariate analysis used complete cases of those with a positive FIT (⩾20 μg g−1) and diagnostic outcome (n=1810; 549 cancers and advanced adenomas). Logistic regression was used to develop a risk prediction model using the FIT result and screening data: age, sex and previous screening history. The model was developed further using a feedforward neural network. Model performance was assessed by discrimination and calibration, and test accuracy was investigated using clinical sensitivity, specificity and receiver operating characteristic curves.Results:Discrimination improved from 0.628 with just FIT to 0.659 with the risk-adjusted model (P=0.01). Calibration using the Hosmer–Lemeshow test was 0.90 for the risk-adjusted model. The sensitivity improved from 30.78% to 33.15% at similar specificity (FIT threshold of 160 μg g−1). The neural network further improved model performance and test accuracy.Conclusions:Combining routinely available risk predictors with the FIT improves the clinical sensitivity of the FIT with an increase in the diagnostic yield of high-risk adenomas.

Cervical cancer screening in rural Bhutan with the careHPV test on self-collected samples: an ongoing cross-sectional, population-based study (REACH-Bhutan)

ObjectivesThe Bhutanese Screening Programme recommends a Pap smear every 3 years for women aged 25–65 years, and coverage ranges from 20% to 60%, being especially challenging in rural settings. The...

Estimating the Effect of Targeted Screening Strategies: An Application to Colonoscopy and Colorectal Cancer.

Screening behavior depends on previous screening history and family members' behaviors, which can act as both confounders and intermediate variables on a causal pathway from screening to disease risk. Conventional analyses that adjust for these variables can lead to incorrect inferences about the causal effect of screening if high-risk individuals are more likely to be screened. Analyzing the data in a manner that treats screening as randomized conditional on covariates allows causal parameters to be estimated; inverse probability weighting based on propensity of exposure scores is one such method considered here. I simulated family data under plausible models for the underlying disease process and for screening behavior to assess the performance of alternative methods of analysis and whether a targeted screening approach based on individuals' risk factors would lead to a greater reduction in cancer incidence in the population than a uniform screening policy. Simulation results indicate that there can be a substantial underestimation of the effect of screening on subsequent cancer risk when using conventional analysis approaches, which is avoided by using inverse probability weighting. A large case-control study of colonoscopy and colorectal cancer from Germany shows a strong protective effect of screening, but inverse probability weighting makes this effect even stronger. Targeted screening approaches based on either fixed risk factors or family history yield somewhat greater reductions in cancer incidence with fewer screens needed to prevent one cancer than population-wide approaches, but the differences may not be large enough to justify the additional effort required. See video abstract at, http://links.lww.com/EDE/B207.

Risk stratification based on screening history: the NELSON lung cancer screening study

BackgroundDebate about the optimal lung cancer screening strategy is ongoing. In this study, previous screening history of the Dutch-Belgian Lung Cancer Screening trial (NELSON) is investigated on if it predicts...