Previous Screening History Research Articles

P053 HIV screening in the HIV negative population – A regional HIV network audit of screening offer, uptake and turn-around times

Background New BHIVA Standards of care for people living with HIV were published in 2013 for proportion of people newly attending sexual health services offered an HIV test in and time from HIV testing to lab reporting and sharing result with patient Aims Baseline regional audit to assess HIV screening offer, uptake and turn-around times within sexual health services to feedback to commissioners. Method Standards set from the ‘Management of Sexually transmitted Infections’ MEDFASH 2014. Retrospective audit of first 30 attendances between 01/09/14 and 30/11/14. Services reviewed notes coded as either HIV testing performed, inappropriate or declined. Information collected included documentation of offer, reason given for decline or deemed inappropriate. For those tested, times taken for lab reporting and sending patient result text was collected. Results 8 services took part. 0.1% HIV positivity rate. 70% overall had documented reason for HIV test decline. 13% were coded as declined with no documented offer. Percentage of people with needs relating to STI’s who had an HIV test at first attendance 97% offered (achieved in 84%, range 59 to 100%), 80% uptake (achieved in 70%, range 47 to 87%). 3/8 of services met both standards for turn-around times. Overall 92% of services received report from laboratory within 5 working days, range 1 to 20 days (standard 97%) and 90% of patients received their result within 10 working days, range 3 to 30 days (standard 95%). Discussion Not all patients appropriate to be tested were offered HIV test, training as to when HIV testing is not appropriate in Sexual health was recommended. Patients in a long term relationship were most likely not to be offered screening, regardless of previous screening history. There was a large variation between processing times in both laboratories and sexual health services. Good practices for those meeting standards were shared with the network.

Colorectal Cancer Screening With Multi-target Stool DNA-based Testing: Previous Screening History of the Initial Patient Cohort

Colorectal Cancer Screening With Multi-target Stool DNA-based Testing: Previous Screening History of the Initial Patient Cohort

Targeted Cancer Screening in Average-Risk Individuals.

Targeted cancer screening refers to use of disease risk information to identify those most likely to benefit from screening. Researchers have begun to explore the possibility of refining screening regimens for average-risk individuals using genetic and non-genetic risk factors and previous screening experience. Average-risk individuals are those not known to be at substantially elevated risk, including those without known inherited predisposition, without comorbidities known to increase cancer risk, and without previous diagnosis of cancer or pre-cancer. In this paper, we describe the goals of targeted cancer screening in average-risk individuals, present factors on which cancer screening has been targeted, discuss inclusion of targeting in screening guidelines issued by major U.S. professional organizations, and present evidence to support or question such inclusion. Screening guidelines for average-risk individuals currently target age; smoking (lung cancer only); and, in some instances, race; family history of cancer; and previous negative screening history (cervical cancer only). No guidelines include common genomic polymorphisms. RCTs suggest that targeting certain ages and smoking histories reduces disease-specific cancer mortality, although some guidelines extend ages and smoking histories based on statistical modeling. Guidelines that are based on modestly elevated disease risk typically have either no or little evidence of an ability to affect a mortality benefit. In time, targeted cancer screening is likely to include genetic factors and past screening experience as well as non-genetic factors other than age, smoking, and race, but it is of utmost importance that clinical implementation be evidence-based.

Prevalence of cardiovascular disease risk factors among a Nigerian adult population: relationship with income level and accessibility to CVD risks screening.

BackgroundIn Nigeria, reports on the prevalence of modifiable cardiovascular disease (CVD) risk factors are scarce. In addition, socio-economic status (SES), an important component of the socioeconomic gradient in CVD and its risk factors has not been clearly elucidated. This study sought to assess the prevalence of CVD risk factors and how the difference in prevalence and accessibility to CVD risk screening across income levels and educational backgrounds contributes to disease diagnosis in rural and urban Nigerian adults.MethodsA cross sectional study was carried out on a sociocultural ethnic group of persons living in rural and urban settings. All participants were aged ≥ 18 years. The WHO STEPS questionnaire was used to document the demographics, history of previous medical check-up or screening, anthropometric and biochemical measurements of the participants. Average income level and educational status were indicators used to assess the impact of SES. Multivariate analyses were performed to assess any difference between the geographical locations and SES indicators, and prevalence of CVD risk factors and access to CVD risk screening.ResultsThe 422 participants (149 males and 273 females) had mean age (± standard deviation) of 38.3 ± 20.5 and 42.9 ± 20.7 years, respectively. Only total cholesterol (p = 0.001), triglyceride (p = 0.005), high density lipoprotein cholesterol (HDL) (p < 0.0001), body mass index (BMI) (p = 0.03) and average income rate (p = 0.01) showed significant difference between gender groups. Overall prevalence of prediabetes (4.9%), diabetes (5.4%), hypertension (35.7%), low HDL (17.8%), hypertriglyceridemia (23.2%), hypercholesterolemia (38.1%) and central obesity of 52.2% was recorded. Except between total cholesterol (p = 0.042) and HDL (p = 0.017), other CVD risk factors did not show a statistical significance across income levels. Participants with ‘university and postgraduate education’ had higher access to blood pressure and blood glucose screening compared to other educational groups; and this showed a statistical significance.ConclusionThis study has shown that a significant number of modifiable CVD risk factors exist in the rural and urban migrants of an adult Nigerian population. While income level did not affect the CVD risk factor prevalence, it did affect accessibility to CVD risk screening. There is a need for access to diagnosis of modifiable risk factors at all levels of society.

Education efforts may contribute to wider acceptance of human papillomavirus self-sampling.

BackgroundInformation about women’s acceptance of new screening methods in Sub-Saharan Africa is limited. The aim of this study was to report on women’s acceptance of human papillomavirus (HPV) self-sampling following an educational intervention on cervical cancer and HPV.MethodsWomen were recruited from the city of Tiko and a low-income neighborhood of Yaoundé, both in Cameroon. Written and oral instructions about how to perform an unsupervised HPV self-sample were given to participants, who performed the test in a private room. Acceptability of HPV self-sampling was evaluated by questionnaire. Participants previously screened for cervical cancer by a physician were asked additional questions to assess their personal preferences about HPV self-sampling.ResultsA sample of 540 women were prospectively enrolled in the study; median age was 43 years old (range 30–65 years). Participants expressed a high level of acceptance of HPV self-sampling as a screening method following information sessions about cervical cancer and HPV. Most expressed no embarrassment, pain, anxiety, or discomfort (95.6%, 87.8%, 91.3%, and 85.0%, respectively) during the information sessions. Acceptance of the method had no correlation with education, knowledge, age, or socio-professional class. Eighty-six women (16%) had a history of previous screening; they also reported high acceptance of HPV self-sampling.ConclusionEducational interventions on cancer and HPV were associated with high acceptability of HPV self-testing by Cameroonian women. Further evaluation of the intervention in a larger sample and using a control group is recommended.

Joint breast and colorectal cancer screenings in medically underserved women.

Breast and colon cancer screening in rural community clinics is underused. To evaluate the effectiveness and cost-effectiveness of alternative interventions designed to promote simultaneous screening for breast and colon cancer in community clinics. A 3-arm, quasi-experimental evaluation was conducted during May 2008-August 2011 in 8 federally qualified health clinics in predominately rural Louisiana. Baseline screening rates reported by the clinics was <10% for breast cancer (using mammography) and 1%-2% for colon cancer (using the fecal occult blood test [FOBT]). 744 women aged 50 years or older who were eligible for routine mammography and an FOBT were recruited. The combined screening efforts included: enhanced care; health literacy-informed education (education alone), or health literacy-informed education with nurse support (nurse support). Postintervention screening rates for completing both tests were 28.1% with enhanced care, 23.7% with education alone, and 38.7% with nurse support. After adjusting for age, race, and literacy, patients who received nurse support were 2.21 times more likely to complete both screenings than were those who received the education alone (95% confidence interval [CI], 1.12-4.38; P = .023). The incremental cost per additional woman completing both screenings was $3,987 for education with nurse support over education alone, and $5,987 over enhanced care. There were differences between the 3 arms in sociodemographic characteristics, literacy, and previous screening history. Not all variables that were significantly different between arms were adjusted for, therefore adjustments for key variables (age, race, literacy) were made in statistical analyses. Other limitations related generalizability of results. Although joint breast and colon cancer screening rates were increased substantially over existing baseline rates in all 3 arms, the completion rate for both tests was modest. Nurse support and telephone follow-up were most effective. However, it is not likely to be cost effective or affordable in clinics with limited resources.

Ethnic differences and predictors of colonoscopy, prostate-specific antigen, and mammography screening participation in the multiethnic cohort

PurposeGiven the relation between screening and improved cancer outcomes and the persistence of ethnic disparities in cancer mortality, we explored ethnic differences in colonoscopy, prostate-specific antigen (PSA), and mammography screening in the Multiethnic Cohort Study. MethodsLogistic regression was applied to examine the influence of ethnicity as well as demographics, lifestyle factors, comorbidities, family history of cancer, and previous screening history on self-reported screening participation collected in 1999–2002. ResultsThe analysis included 140,398 participants who identified as white, African American, Native Hawaiian, Japanese American, US born-Latino, or Mexican born-Latino. The screening prevalences overall were mammography: 88% of women, PSA: 45% of men, and colonoscopy: 35% of men and women. All minority groups reported 10–40% lower screening utilization than whites, but Mexican-born Latinos and Native Hawaiian were lowest. Men were nearly twice as likely to have a colonoscopy (OR=1.94, 95% CI=1.89–1.99) as women. A personal screening history, presence of comorbidities, and family history of cancer predicted higher screening utilization across modalities, but to different degrees across ethnic groups. ConclusionsThis study confirms previously reported sex differences in colorectal cancer screening and ethnic disparities in screening participation. The findings suggest it may be useful to include personal screening history and family history of cancer into counseling patients about screening participation.

2368 – Intravenous drug users- screening &amp; vaccination programme

Prevalence and incidence rates of both Hepatitis B and C is on the rise in United Kingdom, and worldwide. Intravenous drug users (IVDU) are particularly at risk due to their chaotic lifestyle. Testing enables early treatment, and vaccination is an effective method of prevention. Assess awareness of screening and vaccination programmes (VP) amongst IVDUs, and willingness to engage in these if they were available and accessible. Our sample population was IVDUs presenting to a Community Substance Misuse team, in central England and the criteria we assessed were: whether they admitted to needle-sharing, awareness of screening and VPs, previous screening and vaccination history, and willingness to engage in VPs. Data was collected through a performa with related questions, after identifying and communicating to key workers; and presented in graphs. We looked at the first 100 responses. More than a third of IVDU in the population shared needles, one-third had not even been tested for Hep B/C, a half had been immunised. Most of them are aware of the risks, and would agree to the immunisation programme if available, at Lantern House. Prevalence of IVDU presenting to a Substance Misuse clinic is quite high. Screening and vaccination against Hepatitis of IVDU is lacking, despite it being feasible, necessary and acceptable by patients. Screening for the disease will aid diagnosis and hence early treatment, and will create a gateway for prevention by using VPs.

Association between allergic rhinitis and asthma in a Northern Alberta cohort

BackgroundMany published epidemiologic studies confirm a marked increase in the prevalence of asthma and allergic rhinitis. The link between allergic rhinitis and asthma has been extensively studied and approximately 75% of patients with asthma have allergic rhinitis. The proportion of patients with asthma in populations of allergic rhinitis patients has not been well studied.ObjectiveThe purpose of this study is to estimate the prevalence of undiagnosed asthma in a specific population of patients presenting to an Otolaryngologist with symptoms of allergic rhinitis.Study designProspective cohort study. Methods: Patients presenting with symptoms of allergic rhinitis to two tertiary care Rhinology practices in Northern Alberta were asked to undergo allergy skin testing, serum IgE quantification, and pulmonary functional testing. Patients with previous asthma screening or known history of reactive airway disease or asthma were excluded.Results107 patients with allergic rhinitis symptoms were recruited between September 2010 to January 2013. Patients predominantly had perennial or persistent rhinitis (64.5%) with moderate-severe symptoms (50.5%). While only 14.9% of patients had abnormal IgE levels, 68.8% had positive skin testing. Abnormal pulmonary function tests were obtained in 39.1% of patients and 26.1% of patients were diagnosed with asthma.ConclusionsThere is a high prevalence of undiagnosed asthma in patients presenting to tertiary Rhinology care with moderate to severe allergic rhinitis symptoms. Screening lung function testing should be considered in this patient population.

Distribution of high-risk human papillomavirus genotypes among HIV-negative women with and without cervical intraepithelial neoplasia in South Africa.

ObjectiveLarge studies describing the profile of high-risk Human papillomavirus (hrHPV) genotypes among women in sub-Saharan Africa are lacking. Here we describe the prevalence and distribution of hrHPV genotypes among HIV-negative women in South Africa, with and without cervical intraepithelial neoplasia (CIN).MethodsWe report data on 8,050 HIV-negative women, aged 17–65 years, recruited into three sequential studies undertaken in Cape Town, South Africa. Women had no history of previous cervical cancer screening. Cervical samples were tested for hrHPV DNA using the Hybrid Capture 2 (HC2) assay and all positive samples were genotyped using a PCR-based assay (Line Blot). Women underwent colposcopy and biopsy/endocervical curettage to determine CIN status. The prevalence and distribution of specific hrHPV genotypes were examined by age and CIN status.ResultsOverall, 20.7% (95% CI, 19.9–21.6%) of women were hrHPV-positive by HC2, with women with CIN having the highest rates of positivity. Prevalence decreased with increasing age among women without CIN; but, a bimodal age curve was observed among women with CIN. HPV 16 and 35 were the most common hrHPV genotypes in all age and CIN groups. HPV 45 became more frequent among older women with CIN grade 2 or 3 (CIN2,3). Younger women (17–29 years) had more multiple hrHPV genotypes overall and in each cervical disease group than older women (40–65 years).ConclusionHPV 16, 35, and 45 were the leading contributors to CIN 2,3. The current HPV vaccines could significantly reduce HPV-related cervical disease; however, next generation vaccines that include HPV 35 and 45 would further reduce cervical disease in this population.

Adherence to follow‐up after a positive fecal occult blood test in an organized colorectal cancer screening program in Korea, 2004–2008

To investigate the participation rates, positivity rates, and follow-up rates from 2004 to 2008 in an organized colorectal cancer (CRC) screening program using a fecal occult blood test (FOBT) in Korea. The study population was men and women aged 50 years or older who were invited to participate in the National Cancer Screening Program for CRC between 1 January 2004 and 31 December 2008. We collected the FOBT results and follow-up information for the FOBT positives. Participation rates increased steadily each year from 10.5% in 2004 to 21.1% in 2008. Between 2004 and 2008, FOBT positivity rates declined from 8.0% to 6.8%. Among the FOBT-positives, 61.3% of participants underwent either colonoscopy or double contrast barium enema (DCBE) in 2004, and this rate decreased to 38.6% in 2008. Age, health insurance type, and screening history were associated with adherence to follow-up test after a positive FOBT. With regard to follow-up tests, colonoscopy rates increased from 17.9% in 2004 to 27.6% in 2008, while DCBE decreased from 43.4% in 2004 to 11.0% in 2008. Colonoscopy was significantly more likely to be chosen as a follow-up test by men, participants aged 50-59 years, and National Health Insurance beneficiaries. These findings suggest that targeting participants for follow-up, based on age and previous screening history, could be a good way to improve the follow-up rate.

Screening Outcomes in Women over Age 70 Who Self-refer in the Nhsbsp in England

The NHS breast screening programme (NHSBSP) in England currently invites women aged 50-70 every three years. Whilst screening is acknowledged as efficacious for women aged 50-69, several countries routinely invite women up to the age of 74. The NHSBSP in England is beginning to invite women up to the age of 73. Although the incidence of breast cancer increases with age, the possible benefits of screening older women must be balanced against shorter life expectancies and possible overdiagnosis. In England women can self-refer after reaching the invitation upper age limit. We examined the extent to which older women in England self-referred over a three-year period and studied the screening outcomes in these women. Routinely collected data from screening units in England were used to calculate screening performance measures for women who self-referred between 1 April 2005 and 31 March 2008. The tumour characteristics of all screen-detected cancers were examined by previous screening history and age group (71-74 and ≥75 years). During the three-year period 139,910 women aged over 70 self-referred; equivalent to 4% of the female population aged over 70 having been screened. The majority of women who self-referred had been screened within the previous five years (76% of those aged 71-74 and 65% of those aged 75 or over). Approximately 4% of these women were recalled for assessment and cancer detection rates were similar in both age groups. Only a small proportion of all women aged over 70 utilize the self-referral policy of the NHSBSP, and most such women are aged below 80.

Survival Outcome Associated with the Screening Interval for Gastric Cancer in Korea

Background/Aims: Early gastric cancer (EGC) can be treated by endoscopic resection, which results in an excellent prognosis. Optimal screening intervals considering risk factors for gastric cancer have not been established. The aim of this study was to determine the maximum gastric cancer screening interval in terms of long-term survival. Methods: Curative resection was performed in 561 patients with gastric cancer who had completed a questionnaire on their previous history of screening tests and risk factors. The association between EGC detection rate and previous screening history was evaluated, and 5-year disease-free survival rates were compared between various screening intervals. Results: Multivariate analysis showed that intestinal metaplasia [hazard ratio (HR) 9.690, 95% confidence interval (CI) 5.896–15.927] and previous screening history (HR 0.077, 95% CI 0.048–0.125) were independent factors associated with advanced gastric cancer. In patients without intestinal metaplasia, there was no significant difference in the extent of gastric cancer progression and the 5-year disease-free survival rate between groups with screening intervals of less than 3 years. In patients with intestinal metaplasia, the cutoff screening interval for detection of EGC and disease-free survival was 2 years. Conclusion: The optimum screening interval for disease-free survival for gastric cancer in a normal population is 3 years, but a screening interval of 2 years should be used for patients with intestinal metaplasia in Korea.

Screening for proteinuria and glycosuria among dental patients in Benin City

Objective: To screen for the presence of proteinuria and glycosuria amongst patients attending for routine care in a dental clinic in Benin- City, Edo State, Nigeria. Method: A prospective survey over a period of thirty-six months involving all new consecutive and consenting patients. All consenting patients, yet to have breakfast and with no history of previous screening for proteinuria and glycosuria were screened, using Clinistix test strips. Medical and drug history, and relative risk were given due considerations in patient selection. Athletes, specifically marathon runners were excluded. Findings were analysed as simple frequency tables and percentages. Results: A total of four thousand, four hundred and ninety patients who attended the Oral Diagnosis Clinic of the Faculty of Dentistry, University of Benin and met inclusion criteria were screened. Fifty three (1.2%) positive cases of glycosuria were recorded. The male: female ratio was 1:1.1 and the majority of patients (49%) were in age group 19-29 years. Forty three (1.0%) were positive, for proteinuria. There was a preponderance of females (1.7%) over males (0.8%) and most patients (65.1%) were in the 19-29 years age group. Conclusion: Most patients were asymptomatic and accepted a referral to the physician. It is recommended for the benefit of attending patients to the dental surgery to include routine urine analysis for glucose and protein in addition to the usual assessment of vital signs. Key words: proteinuria, glycosuria, screening, dental patients

2031 PATIENT PREFERENCES FOR PROSTATE-SPECIFIC ANTIGEN TESTING: ANALYSIS OF THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY

You have accessJournal of UrologyProstate Cancer: Detection and Screening1 Apr 20112031 PATIENT PREFERENCES FOR PROSTATE-SPECIFIC ANTIGEN TESTING: ANALYSIS OF THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY Steven L. Chang, Joseph C. Presti, and Jerome P. Richie Steven L. ChangSteven L. Chang Boston, MA More articles by this author , Joseph C. PrestiJoseph C. Presti Stanford, CA More articles by this author , and Jerome P. RichieJerome P. Richie Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2260AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The American Urological Association currently recommends that clinicians involve patients in a shared decision-making process for prostate cancer screening with PSA testing. Data are limited regarding baseline patient preferences for PSA evaluation in the US. We assessed the socio-demographic and clinical characteristics of men who proceeded with or opted out of PSA testing in a large nationally representative population-based cohort. METHODS We analyzed male participants from the 2001 to 2008 cycles of the National Health and Nutrition Examination Survey (NHANES) who were 40 years old or older without a history of prostate cancer, recent prostate manipulation, or hormonal therapy use (n=6,032). All men were given an opportunity to undergo or refuse PSA testing after a standardized explanation about prostate cancer screening with a physician. A multivariate logistic regression was conducted after adjusting for survey weights to identify independent socio-demographic and clinical predictors for opting out of PSA testing. RESULTS Overall, 5% of the study cohort refused PSA testing. The multivariate analysis revealed independent predictors for refusing PSA testing (Table). Preference for PSA testing was not associated with a family history of prostate cancer, previous prostate cancer screening, education level, socioeconomic status, insurance status, or tobacco history. There were no significant time trends for PSA testing over the course of the study. Table. Adjusted odds ratio for the independent predictors for opting out of PSA testing Variable Odds Ratio 95% Confidence Interval p-value Age (years) ≥80 (vs 60–69) 1.53 1.06–2.21 0.024 Race/Ethnicity African American (vs Caucasian) 2.33 1.64–3.30 Patient-reported Health Status Poor (vs Excellent) 2.13 1.18–3.83 0.013 Body Mass Index (kg/m2) <25 (vs ≥30–35) 1.67 1.04–2.68 0.034 > 35 (vs ≥30–35) 1.62 1.06–2.45 0.025 Medical History History of cancer (vs no history of cancer) 2.61 1.71–3.99 *The multivariate logistic regression model adjusted for marital status, education level, socio-economic status, tobacco use, previous PSA, previous DRE, and history of hypercholesterolemia. Only the statistically significant associations are displayed in the table. CONCLUSIONS Despite equal access to PSA testing in our study, there was unequal utilization. The adjusted analysis demonstrates that African-American men are more likely to opt out of PSA testing. Our findings also suggest that a perception of suboptimal health or uncertain future outlook may discourage men from undergoing PSA evaluation. These patient preferences for PSA evaluation should be factored into the shared decision-making process for prostate cancer screening. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e812 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Steven L. Chang Boston, MA More articles by this author Joseph C. Presti Stanford, CA More articles by this author Jerome P. Richie Boston, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Patient preference for prostate-specific antigen testing: A population-based analysis.

188 Background: The AUA and American Cancer Society both recommend a shared decision-making process between clinicians and patients for prostate cancer screening with PSA testing. Data are limited data regarding patient preferences for PSA evaluation in the United States. We assessed the sociodemographic and clinical characteristics of men who proceeded with or opted out of PSA testing in a nationally representative population-based cohort. Methods: We analyzed male participants from the 2001 to 2008 cycles of the National Health and Nutrition Examination Survey (NHANES) who were 40 years old or older without a history of prostate cancer, recent prostate manipulation, or hormone therapy use (n = 6,032). All men underwent or refused PSA testing after a standardized explanation about prostate cancer screening by a physician. A multivariate logistic regression was conducted after adjusting for survey weights to identify independent sociodemographic and clinical predictors for opting out of PSA testing. Results: Overall, 5% of the study cohort refused PSA testing. The analysis revealed predictors for refusing PSA testing (Table). PSA testing preference was not influenced by a family history of prostate cancer, previous prostate cancer screening, education level, socioeconomic status, insurance status, or tobacco history. There were no significant time trends for PSA testing. Conclusions: Despite equal access to PSA testing in our study, there was unequal utilization. We found that Black men were more likely to refuse PSA testing. Our analysis also suggests that a perception of suboptimal health or uncertain future outlook may discourage men from undergoing PSA evaluation. These patient preferences for PSA evaluation should be factored into the shared decision-making process for prostate cancer screening. [Table: see text] No significant financial relationships to disclose.

The community uptake of an online CRC risk assessment and its utility to assess for a potential hereditary colon cancer syndrome

Purpose The identification of individuals with Hereditary Non Polyposis Colorectal Cancer (HNPCC) in the population is suboptimal. Causes include lack of physician recognition or failure to take an accurate family history. While colorectal cancer (CRC) in HNPCC is preventable by annual colonoscopy it is underutilized in part by lack of physician recommendation or poor understanding of personal risk of disease. We developed an online CRC risk assessment (http://www.clevelandclinic.org/score) incorporating family and personal history of adenomas and CRC which generated a pedigree, risk category and screening recommendations based on ACG guidelines. Modifiable lifestyle factors were also assessed and personalized recommendations were provided to minimize neoplasia due to those factors. We assessed the feasibility and online uptake of this tool and determined the proportion of high risk individuals who meet criteria suspicious for HNPCC. Methods The assessment included questions on demographics, use of previous CRC screening, and family and personal history of adenomas and CRC in 3 generations. Height, weight, age > or < 50, race, smoking exposure, physical activity, and dietary habits assessed. Risk categories included average, low, medium, and high.

Community Health Worker Intervention to Decrease Cervical Cancer Disparities in Hispanic Women

U.S. Hispanic women suffer a disproportionate burden of cervical cancer, with incidence and mortality rates almost twice that of whites. Community health workers, or promotoras, are considered a potential strategy for eliminating such racial and ethnic health disparities. The current study is a randomized trial of a promotora-led educational intervention focused on cervical cancer in a local Hispanic community. Four promotoras led a series of two workshops with community members covering content related to cervical cancer. Sociodemographic characteristics, cervical cancer risk, previous screening history, cervical cancer knowledge, and self-efficacy were measured by a pre-intervention questionnaire. The post-intervention questionnaire measured the following outcomes: cervical cancer knowledge (on a 0-6 scale), self-efficacy (on a 0-5 scale), and receipt of Pap smear screening during the previous 6 months (dichotomous). Univariate analyses were performed using chi square, t-test, and the Mann-Whitney test. Multivariate logistic regression was used to model the association between explanatory variables and receipt of Pap smear screening. There were no statistically significant differences between the two experimental groups at baseline. Follow-up data revealed significant improvements in all outcome measures: Pap smear screening (65% vs. 36%, p-value 0.02), cervical cancer knowledge (5.4 vs. 3.5, p-value<0.001), and self-efficacy (4.7 vs. 4.0, p-value 0.002). In multivariate analysis, cervical cancer knowledge (OR 1.68, 95% CI 1.10-2.81) and intervention group assignment (OR 6.74, 95% CI 1.77-25.66) were associated with receiving a Pap smear during the follow-up period. Our randomized trial of a promotora-led educational intervention demonstrated improved Pap screening rates, in addition to increased knowledge about cervical cancer and self-efficacy. The observed association between cervical cancer knowledge and Pap smear receipt underscores the importance of educating vulnerable populations about the diseases that disproportionately affect them. Future research should evaluate such programs on a larger scale, and identify novel targets for intervention.

Screening history in those requiring fast track referral for proliferative diabetic retinopathy (PDR) in the ni diabetic retinopathy screening programme

Abstract Purpose If PDR is detected at screening, an urgent referral to an ophthalmologist ensues. This outcome can be stressful for patients and for the ophthalmologists who may need to treat very quickly. Aim: To examine the screening history of those deemed to require an urgent referral, with a view to identifying missed cases of referable diabetic retinopathy in previous screening encounters; and risk factors for interval cases. Methods Fast tracked urgent referrals were identified from the NI DRSP database. Demographic factors and previous screening history were analysed. Results In 2006‐7 18,887 attended for screening. 5.6% required referral to an eye clinic of which 0.3% were deemed urgent referrals (52 cases) 47 showed PDR; 5 had advanced NPDR in an only eye. 47% had Type 1 Diabetes; 52% had been diabetic for 20 years or more; 8% had been diabetic for 5 years or less. On feedback 98% were found to be appropriate referrals. At time of screening, 6 people had been lost to follow up from previous eye clinics. PDR was identified at the first screening event in the other 46 (88%). No cases were found where referral at a previous screening encounter would have been appropriate. Conclusion Especially during the early years, screening programmes are very likely to encounter sight threatening retinopathy not previously identified. Over time, the balance between referral early in the disease process, and late, will hopefully be achieved but until then clinics must be prepared to manage the unpredictable urgent referral. Commercial interest

Persistence and clearance of human papillomavirus infection: a prospective cohort study

The objective of the study was to identify epidemiological correlates for persistence and clearance of human papillomavirus (HPV) infection. Cervical smears collected in a prospective cohort study to perform Papanicoloau cytology and HPV deoxyribonucleic acid (DNA) detection at baseline and during the follow-up. Outcomes analyzed were: (1) persistence of HPV DNA; (2) conversion; and (3) clearance of HPV. Among 501 women the incidence of HPV was 12.3%. Thirty-four women were persistently infected with HPV, which was associated with age below 21 years at first intercourse and 4 or more sexual partners during their lifetime. In a median of 19 months, 80.7% of women had clearance of HPV, which was associated with black race, coinfection with Chlamydia trachomatis at baseline, and a history of previous Papanicoloau smear. Strategies for sexual orientation may modify the rates of HPV persistence. The association of HPV clearance with a history of previous Papanicolaou smear screening highlights the importance of improving cervical screening programs. Further studies on the association of gynecological infections with HPV clearance are needed.