Prior Screening History Research Articles

Personalized Multilevel Intervention for Improving Appropriate Use of Colorectal Cancer Screening in Older Adults

Despite guideline recommendations, clinicians do not systematically use prior screening or health history to guide colorectal cancer (CRC) screening decisions in older adults. To evaluate the effect of a personalized multilevel intervention on screening orders in older adults due for average-risk CRC screening. Interventional 2-group parallel unmasked cluster randomized clinical trial conducted from November 2015 to February 2019 at 2 US Department of Veterans Affairs (VA) facilities: 1 academic VA medical center and 1 of its connected outpatient clinics. Randomization at the primary care physician/clinician (PCP) level, stratified by study site and clinical full-time equivalency. Participants were 431 average-risk, screen-due US veterans aged 70 to 75 years attending a primary care visit. Data analysis was performed from August 2018 to August 2023. The intervention group received a multilevel intervention including a decision-aid booklet with detailed information on screening benefits and harms, personalized for each participant based on age, sex, prior screening, and comorbidity. The control group received a multilevel intervention including a screening informational booklet. All participants received PCP education and system-level modifications to support personalized screening. The primary outcome was whether screening was ordered within 2 weeks of clinic visit. Secondary outcomes were concordance between screening orders and screening benefit and screening utilization within 6 months. A total of 436 patients were consented, and 431 were analyzed across 67 PCPs. Patients had a mean (SD) age of 71.5 (1.7) years; 424 were male (98.4%); 374 were White (86.8%); 89 were college graduates (21.5%); and 351 (81.4%) had undergone prior screening. A total of 258 (59.9%) were randomized to intervention, and 173 (40.1%) to control. Screening orders were placed for 162 of 258 intervention patients (62.8%) vs 114 of 173 control patients (65.9%) (adjusted difference, -4.0 percentage points [pp]; 95% CI, -15.4 to 7.4 pp). In a prespecified interaction analysis, the proportion receiving orders was lower in the intervention group than in the control group for those in the lowest benefit quartile (59.4% vs 71.1%). In contrast, the proportion receiving orders was higher in the intervention group than in the control group for those in the highest benefit quartile (67.6% vs 52.2%) (interaction P = .049). Fewer intervention patients (106 of 256 [41.4%]) utilized screening overall at 6 months than controls (96 of 173 [55.9%]) (adjusted difference, -13.4 pp; 95% CI, -25.3 to -1.6 pp). In this cluster randomized clinical trial, patients who were presented with personalized information about screening benefits and harms in the context of a multilevel intervention were more likely to receive screening orders concordant with benefit and were less likely to utilize screening. ClinicalTrials.gov Identifier: NCT02027545.

Screening for colorectal cancer : Arecommendation statement of the Austrian National Committee for Cancer Screening.

Colorectal cancer is the fourth most common cancer in Austria. To date, colorectal cancer screening in Austria remains opportunistic and includes colonoscopy or stool-based blood tests. The Austrian National Committee for Cancer Screening developed evidence-based recommendations for anationwide organized colorectal cancer screening program. The methodological framework followed the approach of the United States Preventive Services Task Force. The evidence base underlying the newly developed recommendations comprised areview of the existing published evidence and adecision analytic model tailored to the Austrian context. Using astructured process, committee members considered 1)the magnitude of the net benefit of each screening strategy, 2)the certainty of evidence, and 3)the level of acceptance of the interventions among the target population. The Austrian National Committee for Cancer Screening recommends the implementation of anationwide organized colorectal cancer screening program for all adults aged 45-75years. For persons 65years or older, screening decisions should occur on an individual basis in accordance with aperson's overall health, prior screening history, and preferences. Specifically, the committee recommends either a10-year screening colonoscopy or biennial fecal immunochemical tests with colonoscopy following apositive result, with both screening strategies considered equivalent. Each citizen should be able to make an informed decision about their preferred screening method. Switching between the two screening strategies should be possible. Following an unremarkable colonoscopy, screening by fecal immunochemical test (FIT) is only required after 10years. Screening recommendations apply only to asymptomatic persons at average risk for colorectal cancer. The screening program must be pilot tested, and accompanied by apublic information campaign, formative evaluation, quality assurance, and data collection.

Older women testing positive for HPV16/18 on cervical screening and risk of high-grade cervical abnormality.

In Australia's HPV-based cervical screening program, we previously showed that risk of histological high-grade abnormality at 1year post screening decreased with age in women with oncogenic HPV. In this study, we followed 878 HPV16/18 positive women aged 55 years and over for up to 3 years post screening test, to determine the proportion with histological high-grade abnormality (HGA, incorporating high-grade squamous intraepithelial abnormality (HSIL), adenocarcinoma in situ (AIS), squamous cell carcinoma (SCC) and adenocarcinoma) and to correlate risk of HGA with liquid-based cytology result and with prior screening history. HGA was detected in 7.8% at 1year and 10.0% at 3 years, with no significant difference (P=.136), despite the number of women with follow-up information significantly increasing from 82.9% to 91.0% (P < .0001). The proportion of HPV16/18 positive women with HGA at 3 years was highest in those with an HSIL cytology result (79.0%) and lowest in those with negative cytology (6.2%). Women with an adequate screening history had fewer HGA than such women with inadequate prior screening (6.6% vs 16.0%, P=.001) or with a history of an abnormality (6.6% vs 14.4%, P=.001). HPV16/18 infection in women over 55 years may have a different natural history from that in younger women, in whom HGA are more common after HPV16/18 detection. In HPV-based cervical screening programs, management algorithms for screen-detected abnormalities based on risk stratification should include factors such as age, screening history and index cytology result, so that women receive appropriate investigation and follow-up.

Modelling the impact of the coronavirus pandemic on bowel cancer screening outcomes in England: A decision analysis to prepare for future screening disruption

The English Bowel Cancer Screening Programme invites people between the ages of 60 and 74 to take a Faecal Immunochemical Test every two years. This programme was interrupted during the coronavirus pandemic. The research aimed: (1) to estimate the impact of colorectal cancer (CRC) Faecal Immunochemical Test screening pauses of different lengths and the actual coronavirus-related screening pause in England, and (2) to analyse the most effective and cost-effective strategies to re-start CRC screening to prepare for future disruptions.The analysis used the validated Microsimulation Model in Cancer of the Bowel built in the R programming language. The model simulated the life course of a representative English screening population from 2019, by age, sex, socio-economic deprivation, and prior screening history. The modelling scenarios were based on assumptions and data from screening centres in England.Pausing bowel screening in England due to coronavirus pandemic is predicted to increase CRC deaths by 0.73% within 10 years and 0.13% over the population's lifetime, with excess deaths due to peak in 2023. More deaths are expected in men and people aged over 70. Pausing screening for longer would result in greater additional CRC cases and deaths.Postponing screening for everyone would be the most cost-effective strategy to minimise the impact of screening disruption without any additional endoscopy capacity. If endoscopy capacity can be increased, temporarily raising the Faecal Immunochemical Test threshold to 190 μg/g may help to minimise CRC deaths, particularly if screening programmes start from age 50 in the future.

Impact of prior underinsurance on cervical cancer screening among Davidson County, Tennessee, women diagnosed with invasive cervical cancer, 2008\u20132018

IntroductionWe sought to investigate the association between insurance coverage history and cervical cancer screening among Davidson County, Tennessee, women diagnosed with incident cervical cancer.MethodsWe reviewed medical records of women diagnosed with invasive cervical cancer from 2008 through 2018 identified via the state's cancer registry and by active surveillance of diagnostic pathology reports for the HPV-IMPACT project. Per 2012 United States Preventive Services Task Force recommended cervical cancer screening guidelines, women were characterized into three screening history categories: “no screening”, “no follow-up” and “test/screening failure”. Multivariable logistic regression measured the association of prior inadequate insurance (underinsurance) and screening history (“no screening/no follow-up” compared to “test/screening failure”).ResultsOf 212 women, most (77%) had not undergone recommended cervical cancer screening or follow-up prior to cancer diagnosis. Overall, 28% of women had history of underinsurance in 5 years prior to diagnosis. In adjusted analyses, underinsured women were more likely to have a “no screening/no follow-up” prior to cancer diagnosis (aOR 4.26; 95% CI 1.15–15.80) compared to “test/screening failure” history. Non-white race (aOR 2.73; 95% CI 0.98–7.61), older age (aOR 1.03 per year; 95% CI 1.00–1.07), and history of smoking (aOR 4.07; 95% CI 1.54–10.74) were also associated with increased likelihood of “no screening/no follow-up”.ConclusionsPrevious underinsurance was independently associated with non-adherence to cervical cancer screening and follow-up guidelines among women with incident cervical cancer. Further study of factors contributing to inadequate cervical cancer screening and interventions to increase cervical cancer screening in high-risk populations is needed.

Abstract OT2-10-01: The VIOLA study: Validating individualized breast cancer screening by offering a new link in access

Abstract The VIOLA Study is a Clinical Utility Study designed to investigate the useability of Melody®, a tear-based screening assay for breast cancer developed and validated by Namida Lab, Inc., a high complexity CLIA certified lab. It is well established that disparities exist in breast health, preventative care, and screening mammography. Namida Lab believes in the potential of Melody® to be a tool that bridges the gap between underserved populations and positive health outcomes. As such, Namida Lab, Inc. is partnering with federally qualified health centers and large employers to evaluate the clinical utility of Melody®. Melody® consists of two parts: tear sample collection and clinical lab assay. Participants will have a tear sample collected at a study site. The clinical lab assay, Melody®, will be performed at Namida Lab, Inc. The results of the Melody® assay will be returned to the site clinician to be discussed with the participant. The administration of Melody® does not require additional appointments or trips and can be done by any member of a medical team. A minimum participation of 205 women who are 40 to 74 years of age, at average risk for developing breast cancer, asymptomatic, and have no concerns or breast abnormalities. To date 28 participants have been enrolled in the study. Study enrollment and eConsent will be conducted through our mobile application. Each participant will be required to take an enrollment survey that collects information on race, ethnicity, and socio-economic status. Participant's addresses will be obtained as part of the requisition process for the CLIA lab, from which information on geographic location can be obtained. In addition to the factors listed above, the enrollment survey also collects information on status and type of health insurance, reproductive health, breast health knowledge, prior screening history, and family and personal history of cancer The exit survey has been designed to collect information on the participant experience with Melody® and comprehension of the Melody® results relayed through their site clinician. In addition, information is collected on participant''s intention to schedule/participate in future screening mammograms and/or change in intention to participate in a previously scheduled screening mammogram. Primary endpoint: The VIOLA Study is designed to assess how incorporating Melody® into a primary care provider setting affects participation and confidence in the current breast health continuum of care. Secondary endpoint: Quantifying the relationship between Melody® and increased participation in breast health care offers the clinical utility evidence required for adoption into the Standard of Care. Citation Format: Anna Daily. The VIOLA study: Validating individualized breast cancer screening by offering a new link in access [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT2-10-01.

Updates on Age to Start and Stop Colorectal Cancer Screening: Recommendations From the U.S. Multi-Society Task Force on Colorectal Cancer.

This document is a focused update to the 2017 colorectal cancer (CRC) screening recommendations from the U.S. Multi-Society Task Force on Colorectal Cancer, which represents the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy. This update is restricted to addressing the age to start and stop CRC screening in average-risk individuals and the recommended screening modalities. Although there is no literature demonstrating that CRC screening in individuals under age 50 improves health outcomes such as CRC incidence or CRC-related mortality, sufficient data support the U.S. Multi-Society Task Force to suggest average-risk CRC screening begin at age 45. This recommendation is based on the increasing disease burden among individuals under age 50, emerging data that the prevalence of advanced colorectal neoplasia in individuals ages 45 to 49 approaches rates in individuals 50 to 59, and modeling studies that demonstrate the benefits of screening outweigh the potential harms and costs. For individuals ages 76 to 85, the decision to start or continue screening should be individualized and based on prior screening history, life expectancy, CRC risk, and personal preference. Screening is not recommended after age 85.

Risk-stratified strategies in population screening for colorectal cancer.

Colorectal cancer (CRC) screening has been demonstrated to reduce CRC incidence and mortality. However, besides such benefits, CRC screening is also associated with potential harmful effects. In an ideal world, screening would only be directed to the small proportion of the population that might potentially benefit. Risk‐based screening can be seen as a first step towards this ideal world, by redistributing screening resources from low‐risk to high‐risk individuals. In theory, this should result in scarce resources being used in individuals who benefit most, while intensity of screening is reduced in individuals who benefit less, hence improving the benefit‐harm ratio among all invitees. Available strategies that have been proposed for risk‐based CRC screening include using information on age, sex, prior screening history, lifestyle and/or genetic information. Implementation of risk‐based screening requires careful consideration of reliable risk prediction models, participation with screening and informed decision‐making. While it is important to recognise the limitations of current approaches, available evidence suggests that it might be feasible to start planning the introduction of tailored strategies within screening programmes. Implementing risk‐based screening based on age, sex and prior screening history alone would already represent a substantial improvement over current uniform screening approaches. We propose that it is time that screening programmes start there and continue striving towards more comprehensive approaches embedding primary prevention as an effective approach to lower risk for everyone.

Characterization of women diagnosed with cervical cancer at age 65 or older

<h3>Objectives:</h3> The objective of this study is to characterize the population of women who are diagnosed with cervical cancer after age 65. Current guidelines allow for discontinuation of cervical cancer screening at age 65 if women have met criteria for adequate screening, which is defined as three consecutive negative cytology results or two consecutive negative co-testing results within ten years before stopping screening, with the most recent test occurring within five years. However, twenty percent of incident cervical cancers occur in women over the age of 65. <h3>Methods:</h3> A retrospective analysis of patients diagnosed with cervical cancer at age 65 or older from 2000-2020 at our institutions. Study subjects were identified by ICD-9 and ICD-10 codes. Demographic information, pathologic data, treatment history, and screening history were abstracted from the electronic medical record. <h3>Results:</h3> There were 53 patients diagnosed with cervical cancer at age 65 or older from 2000-2020 with sufficient records for review. The median age at diagnosis was 73.8 years, 59% were smokers, and 94% were White. The most common method of detection was the presence of symptoms (81%), and the most common presenting symptom was vaginal bleeding (70%), followed by vaginal discharge (23%), pelvic pain (17%), and bowel or urinary symptoms (13%). At diagnosis, 40% of patients had localized disease, 57% had regional disease, and 4% had distant disease at diagnosis. The histology distribution was 70% squamous cell carcinoma, 19% adenocarcinoma, 6% clear cell carcinoma, 4% small cell carcinoma, and 2% poorly differentiated carcinoma, unspecified. Only 19% of patients had a known history of prior abnormal screening, but prior screening history was not available for 32% of patients. A total of twelve patients (23%) had not met criteria for adequate cervical cancer screening; 3 patients (6%) had met criteria for adequate screening, and 4 patients (8%) were still undergoing screening due to abnormal results. For 34 patients (64%), however, there were insufficient screening records to determine whether they met criteria for adequate screening. <h3>Conclusions:</h3> Twenty percent of patients with complete records had met criteria to stop cervical cancer screening prior and went on to develop cervical cancer after age 65. This calls into question the current guidelines defining adequate screening prior to discontinuation. The remaining 80% of patients did not meet criteria for adequate screening and, thus, their cancers may have been detected and treated while still at a pre-invasive stage. Notably, there was not sufficient documented history of cervical cancer screening in 64% of these patients who were diagnosed with cervical cancer after age 65.

Colorectal Cancer Screening and Surveillance Colonoscopy in Older Adults.

The purpose of this chapter is to highlight current recommendations regarding colorectal cancer (CRC) screening and post-polypectomy surveillance colonoscopy in older adults and to review the available literature in order to help inform decision-making in this age group. Age is a risk factor for CRC; however, older adults with a history of prior screening are at lower risk for CRC compared to those who have never been screened. Decision-making for CRC screening and post-polypectomy surveillance colonoscopy in older adults is complex and several factors including age, screening history, comorbidities, functional status, bowel preparation, prior experiences, preferences, and barriers need to be considered when weighing risks and benefits. Recent guidelines have started to incorporate life expectancy and prior screening history into their recommendations; however, how to incorporate these factors into actual clinical practice is less clear. There are limited data on the relative benefits of screening and surveillance in older adults and therefore, at this time, decision-making should be individualized and incorporate patient preferences in addition to medical factors.

Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society.

In the United States, colorectal cancer (CRC) is the fourth most common cancer diagnosed among adults and the second leading cause of death from cancer. For this guideline update, the American Cancer Society (ACS) used an existing systematic evidence review of the CRC screening literature and microsimulation modeling analyses, including a new evaluation of the age to begin screening by race and sex and additional modeling that incorporates changes in US CRC incidence. Screening with any one of multiple options is associated with a significant reduction in CRC incidence through the detection and removal of adenomatous polyps and other precancerous lesions and with a reduction in mortality through incidence reduction and early detection of CRC. Results from modeling analyses identified efficient and model-recommendable strategies that started screening at age 45 years. The ACS Guideline Development Group applied the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria in developing and rating the recommendations. The ACS recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high-sensitivity stool-based test or a structural (visual) examination, depending on patient preference and test availability. As a part of the screening process, all positive results on noncolonoscopy screening tests should be followed up with timely colonoscopy. The recommendation to begin screening at age 45 years is a qualified recommendation. The recommendation for regular screening in adults aged 50 years and older is a strong recommendation. The ACS recommends (qualified recommendations) that: 1) average-risk adults in good health with a life expectancy of more than 10 years continue CRC screening through the age of 75 years; 2) clinicians individualize CRC screening decisions for individuals aged 76 through 85 years based on patient preferences, life expectancy, health status, and prior screening history; and 3) clinicians discourage individuals older than 85 years from continuing CRC screening. The options for CRC screening are: fecal immunochemical test annually; high-sensitivity, guaiac-based fecal occult blood test annually; multitarget stool DNA test every 3 years; colonoscopy every 10 years; computed tomography colonography every 5 years; and flexible sigmoidoscopy every 5 years. CA Cancer J Clin 2018;68:250-281. © 2018 American Cancer Society.

Implications of false-positive results for future cancer screenings.

False-positive cancer screening results may affect a patient's willingness to obtain future screening. The authors conducted logistic regression analysis of 450,484 person-years of electronic medical records (2006-2015) in 92,405 individuals aged 50 to 75 years. Exposures were false-positive breast, prostate, or colorectal cancer screening test results (repeat breast imaging or negative breast biopsy ≤3 months after screening mammography, repeat prostate-specific antigen [PSA] test ≤3 months after PSA test result ≥4.0 ng/mL or negative prostate biopsy ≤3 months after any PSA result, or negative colonoscopy [without biopsy/polypectomy] ≤6 months after a positive fecal occult blood test). Outcomes were up-to-date status with breast or colorectal cancer screening. Covariates included prior screening history, clinical information (eg, family history, obesity, and smoking status), comorbidity, and demographics. Women were more likely to be up to date with breast cancer screening if they previously had false-positive mammography findings (adjusted odds ratio [AOR], 1.43 [95% confidence interval, 1.34-1.51] without breast biopsy and AOR, 2.02 [95% confidence interval, 1.56-2.62] with breast biopsy; both P<.001). The same women were more likely to be up to date with colorectal cancer screening (AOR range, 1.25-1.47 depending on breast biopsy; both P<.001). Men who previously had false-positive PSA testing were more likely to be up to date with colorectal cancer screening (AOR, 1.22 [P = .039] without prostate imaging/biopsy and AOR, 1.60 [P = .028] with imaging/biopsy). Results were stronger for individuals with more false-positive results (all P≤.005). However, women with previous false-positive colorectal cancer fecal occult blood test screening results were found to be less likely to be up to date with breast cancer screening (AOR, 0.73; P<.001). Patients who previously had a false-positive breast or prostate cancer screening test were more likely to engage in future screening. Cancer 2018;124:2390-8. © 2018 American Cancer Society.

Cervical Cancer Screening and Incidence by Age: Unmet Needs Near and After the Stopping Age for Screening

Leading professional organizations recommend cervical cancer screening for average-risk women aged 21-65 years. For average-risk women aged >65 years, routine screening may be discontinued if "adequate" screening with negative results is documented. Screening is recommended after age 65 years for women who do not meet adequate prior screening criteria or are at special risk. Authors examined the most recent cervical cancer incidence data from two federal cancer surveillance programs for all women by age and race, corrected for hysterectomy status. The 2013 and 2015 National Health Interview Surveys were analyzed in 2016 to examine the proportion of women aged 41-70 years without a hysterectomy who reported that they never had a Pap test or that their most recent Pap test was >5 years ago (not recently screened). The incidence rate for cervical cancer among older women, corrected for hysterectomy status, did not decline until age ≥85 years. The proportion not recently screened increased with age, from 12.1% for women aged 41-45 years to 18.4% for women aged 61-65 years. Even among women within the recommended age range for routine screening, many are not up to date, and a substantial number of women approach the "stopping" age for cervical cancer screening without an adequate prior screening history. Efforts are needed to reach women who have not been adequately screened, including women aged >65 years, to prevent invasive cervical cancer cases and deaths among older women.

Abstract IA14: Decision analysis for colorectal cancer screening recommendations

Abstract IA14: Decision analysis for colorectal cancer screening recommendations

Poor Cervical Cancer Screening Attendance and False Negatives. A Call for Organized Screening.

ObjectiveThe objective of this study was to describe prior negative screening history and symptoms around the time of diagnosis of incident cervical cancer (CC) cases diagnosed between 2000 and 2010 within the Asturias public health system.MethodsRecords from 374 women diagnosed with CC between 2000 and 2010 from all public hospitals in Asturias were retrieved. Clinical information, FIGO stage and all previous cytological data were extracted from clinical and histopathological records. Proportional differences were assessed using chi-square tests. Logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Inter-observer agreement in cytology was checked by comparing concordance values using k-statistics.ResultsNo prior screening history was recorded in 60.7% of CC cases and its absence increased with age and advanced stage. Advanced stage (e.g., ≥ II) at diagnosis was associated with age (>50 years) and adenocarcinoma (ADC) compared to younger women and those with a squamous cell carcinoma (SCC). False negative smears were identified in 27.1% of women with CC (ADC 52.6% vs. SCC 16.2%, p<0.05).ConclusionsAbsence of prior screening history was common among CC cases. Organized actions to reduce “under screening” and the use of highly sensitive HPV-based tests could be useful strategies in reducing the burden of CC in Asturias.

Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement.

Colorectal cancer is the second leading cause of cancer death in the United States. In 2016, an estimated 134,000 persons will be diagnosed with the disease, and about 49,000 will die from it. Colorectal cancer is most frequently diagnosed among adults aged 65 to 74 years; the median age at death from colorectal cancer is 68 years. To update the 2008 US Preventive Services Task Force (USPSTF) recommendation on screening for colorectal cancer. The USPSTF reviewed the evidence on the effectiveness of screening with colonoscopy, flexible sigmoidoscopy, computed tomography colonography, the guaiac-based fecal occult blood test, the fecal immunochemical test, the multitargeted stool DNA test, and the methylated SEPT9 DNA test in reducing the incidence of and mortality from colorectal cancer or all-cause mortality; the harms of these screening tests; and the test performance characteristics of these tests for detecting adenomatous polyps, advanced adenomas based on size, or both, as well as colorectal cancer. The USPSTF also commissioned a comparative modeling study to provide information on optimal starting and stopping ages and screening intervals across the different available screening methods. The USPSTF concludes with high certainty that screening for colorectal cancer in average-risk, asymptomatic adults aged 50 to 75 years is of substantial net benefit. Multiple screening strategies are available to choose from, with different levels of evidence to support their effectiveness, as well as unique advantages and limitations, although there are no empirical data to demonstrate that any of the reviewed strategies provide a greater net benefit. Screening for colorectal cancer is a substantially underused preventive health strategy in the United States. The USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years (A recommendation). The decision to screen for colorectal cancer in adults aged 76 to 85 years should be an individual one, taking into account the patient's overall health and prior screening history (C recommendation).

Screening History Among Women with Invasive Cervical Cancer in an Academic Medical Center: Will We Miss Cancers Following Updated Guidelines?

Updated guidelines for the screening and management of cervical cancer in the United States recommend starting Papanicolaou (Pap) testing at age 21 and screening less frequently with less aggressive management for abnormalities. We sought to examine updated Pap test screening guidelines and how they may affect the detection of invasive cervical cancer, especially among women <30 years of age. Patients diagnosed at Brigham and Women's Hospital with invasive cervical cancer between 2002 and 2012 were retrospectively identified. Prior screening history was obtained and patients were divided into two groups based on age <30 years or age ≥30 years. The two groups were then compared with respect to demographics, pathological findings, and time to diagnosis. A total of 288 patients with invasive cervical carcinoma were identified. Among these patients, 109 had adequate information on prior screening history. Invasive adenocarcinoma (IAC) was diagnosed in 37 (33.94%) patients, whereas 64 (58.72%) patients were diagnosed with invasive squamous cell carcinoma (ISCC). The remaining eight patients were diagnosed with other types of cancers of the cervix. A total of 13 patients were younger than 30 while 96 patients were 30 or older. The mean time from normal Pap to diagnosis of IAC was 15 months in patients younger than 30 years of age compared to 56 months in patients aged 30 and older (p < 0.001). The mean time from normal Pap to diagnosis of ISCC was 38 months in patients younger than 30 years of age and 82 months in patients aged 30 and older (p = 0.018). In this small retrospective study, updated Pap test screening guidelines would not have missed invasive cancer on average among screened women age 30 and older. However, young patients aged 21-29 years may be at increased risk of developing IAC of the cervix between the recommended screening intervals.

Effects of personalized colorectal cancer risk information on laypersons’ interest in colorectal cancer screening: The importance of individual differences

ObjectiveTo evaluate how personalized quantitative colorectal cancer (CRC) risk information affects laypersons’ interest in CRC screening, and to explore factors influencing these effects. MethodsAn online pre-post experiment was conducted in which a convenience sample (N=578) of laypersons, aged >50, were provided quantitative personalized estimates of lifetime CRC risk, calculated by the National Cancer Institute Colorectal Cancer Risk Assessment Tool (CCRAT). Self-reported interest in CRC screening was measured immediately before and after CCRAT use; sociodemographic characteristics and prior CRC screening history were also assessed. Multivariable analyses assessed participants’ change in interest in screening, and subgroup differences in this change. ResultsPersonalized CRC risk information had no overall effect on CRC screening interest, but significant subgroup differences were observed. Change in screening interest was greater among individuals with recent screening (p=.015), higher model-estimated cancer risk (p=.0002), and lower baseline interest (p<.0001), with individuals at highest baseline interest demonstrating negative (not neutral) change in interest. ConclusionEffects of quantitative personalized CRC risk information on laypersons’ interest in CRC screening differ among individuals depending on prior screening history, estimated cancer risk, and baseline screening interest. Practice implicationsPersonalized cancer risk information has personalized effects—increasing and decreasing screening interest in different individuals.

How patient compliance impacts the recommendations for colorectal cancer screening

Colorectal cancer (CRC) is one of the most common cancers and the second leading cause of cancer death in the U.S. As a measure of prevention, timely screening is necessary for patients as it can spell the difference between life and death. Fecal occult blood tests (FOBTs) is used for the average-risk patient. Colonoscopy is used for the high-risk and the average-risk patient whose outcome of FOBTs is positive. While colonoscopy is considered to be the most accurate test for detecting colorectal cancer, its side-effects have serious consequences that could result in intestinal perforation and even death. As a result, some patients do not follow the physicians' advices. It is therefore important to design a good screening schedule that balances the risk of CRC and the side-effects of colonoscopy, and at the same time to take the patient's personal characteristics and compliance into account. We formulate a finite-horizon, partially observable Markov decision process model to optimize the CRC screening program for both average and high-risk patients. Our model incorporates information of prior screening history, patient compliance and more personal risk factors. We find that the patients with low compliance rate should be recommended to undergo colonoscopy more frequently.

Underscreened Women Remain Overrepresented in the Pool of Cervical Cancer Cases in Spain: A Need to Rethink the Screening Interventions.

Objective. Audit of women with invasive cervical cancer (CC) is critical for quality control within screening activities. We analysed the screening history in the 10 years preceding the study entry in women with and without CC during 2000–2011. Methods. 323 women with CC from six pathology departments in Catalonia (Spain) and 23,782 women with negative cytology were compared. Age, previous history of cytologies, and histological type and FIGO stage were collected from the pathology registries. Logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI95%). Results. History of cytology was registered in 26.2% of CC cases and in 78% of the control women (P < 0.0001) and its frequency decreased with increasing age. Compared to women with squamous cell carcinoma, adenocarcinoma cases were significantly more likely to have a cytology within the 3-year interval preceding cancer diagnosis (OR = 2.6 CI 95%: 1.2–5.6) and to have normal cytology results in previous screenings (OR = 2.4 CI 95%: 1.2–4.5). FIGO II–IV cases were more common among older women (older than 60 years). Conclusions. Absence of prior screening history was extremely common among CC cases compared to controls. Organized actions to reduce underscreened women and use of highly sensitive HPV-based tests could be important to reduce CC burden.