Screening Results Research Articles

Comparison of screening outcomes associated with advanced precancerous lesion versus colorectal cancer sensitivity for a blood-based test: A simulation study.

89 Background: With estimates of over 150,000 incident and 50,000 fatal colorectal cancer (CRC) cases in 2024, efforts are ongoing to improve the national screening performance and engagement in the US. The Centers for Medicare & Medicaid Services (CMS) have established criteria for covering new blood-based CRC screening tests if minimum CRC sensitivity and specificity thresholds are met. However, the current blood-based tests are challenged by their relative inability to detect advanced precancerous lesions (APLs). At present, the importance of APL versus CRC sensitivity on screening outcomes remains undetermined. To address this knowledge gap, we conducted a simulation study to compare the screening effectiveness and outcomes of a hypothetical blood-based test across a range of sensitivities for CRC and APL detection. Methods: Outcomes were simulated using the CRC-AIM microsimulation model, which has been previously calibrated and validated. Predicted outcomes were calculated for average-risk individuals screened triennially with a blood-based test between ages 45-75 years, assuming perfect adherence. Base-case screening sensitivity and specificity inputs were based on CMS minimum thresholds (74% CRC sensitivity, 90% specificity) with assumed 10% APL sensitivity. Additional scenarios considered an increase in either APL or CRC sensitivity. Outcomes of interest included life years-gained (LYG), CRC incidence, and mortality reductions. Results: Compared to the CMS minimum performance (Table), increasing APL sensitivity by 1% (from 10% to 11%) resulted in a similar increase in LYG as compared to increasing CRC sensitivity by 11% (from 74% to 85%). Additionally, increasing APL sensitivity by 1% resulted in greater reductions in CRC cases and deaths (3% decrease) as compared to increasing CRC sensitivity by 11% (0% and 1% reductions, respectively). Conclusions: Data from this study show that increased APL sensitivity is a key determinant of screening-related outcomes, such as LYG, derived from a blood-based strategy, and that similar results would require much larger increases in CRC sensitivity. With the current CMS minimum performance threshold, blood-based tests that are designed to have high APL sensitivity can outperform tests with higher CRC sensitivity and little to no APL sensitivity. Comparison of CRC screening health outcomes with CMS proposed minimum threshold blood-test versus hypothetical tests with either increased APL and CRC sensitivity. APL Sensitivity CRC Sensitivity CRC Specificity Follow-up Colonoscopies CRC Cases (% reduction) CRC Deaths (% reduction) Life-Years Gained (LYG) (% increase) 10% 74% 90% 809 50 (ref) 18 (ref) 220 (ref) 11% 74% 90% 813 48 (-3%) 17 (-3%) 226 (3%) 10% 85% 90% 809 50 (0%) 18 (-1%) 227 (3%) APL: Advanced precancerous lesions; CRC: Colorectal cancer.

Multi-target stool-DNA test for colorectal cancer screening and effects on health and economic outcomes compared to blood-based tests: Influence of adherence.

88 Background: There are an estimated 60 million individuals in the US who are not up-to-date with average-risk colorectal cancer (CRC) screening, as screening rates and adherence have remained stubbornly below the national target of 80%. Efforts are ongoing to improve CRC screening performance and participation, including the development of new blood-based tests. Despite high expectations for these tests, performance remains lower than other guideline-recommended strategies, particularly with respect to advanced precancerous lesion (APL) sensitivity. We conducted a simulation study of estimated clinical and economical outcomes for CRC screening with a blood-based test (at perfect adherence) compared to the multi-target stool-DNA (mt-sDNA) test (at published adherence rates). Methods: Utilizing CRC-AIM, a calibrated and validated microsimulation model, CRC screening outcomes were calculated for 1 million average-risk individuals screened between ages 45-75 years with triennial blood-based versus mt-sDNA testing. CRC and APL sensitivity and specificity inputs were derived from two large clinical validation studies for these screening modalities: ECLIPSE (NCT04136002) and DeeP-C (NCT01397747), respectively. To demonstrate the maximum benefits and burdens of blood-based screening, adherence to initial screening and follow-up colonoscopy after a positive blood test was modeled at 100%, while real-world adherence estimates of 65.6% were used for the mt-sDNA test. Outcomes of interest included life years-gained (LYG) and CRC cases missed by the blood-based test compared to the stool-based test, additional treatment costs imposed by theblood-based test, and additional CRC-related deaths per 1 million screened. Results: Compared to triennial screening with mt-sDNA at real-world adherence, blood-based screening at perfect adherence resulted in a higher number of incident (n=18,464) and fatal (n=6,483) CRC cases that would been avoided with the mt-sDNA test. Over a lifetime, screening with blood-based tests required 1,276,310 more tests (21% more) and 52,942 additional follow-up colonoscopies (7% more) compared to mt-sDNA screening. This increased testing burden did not generate additional benefits and instead reduced life-years gained by 67,645 per 1 million screened, resulting in an additional $1.6 billion in treatment costs compared to the mt-sDNA strategy. Conclusions: Data from this CRC-AIM modeling study show that even with perfect adherence, blood-based screening yields inferior clinical and economic benefits compared to mt-sDNA screening, due to suboptimal APL detection with the former test.

The role of artificial intelligence in colorectal cancer and polyp detection: A systematic review.

47 Background: Colorectal cancer (CRC) remains a leading cause of cancer-related mortality worldwide. Early detection and accurate diagnosis are essential for improving survival rates and optimizing therapeutic strategies. Recently, artificial intelligence (AI) technologies, such as machine learning algorithms, convolutional neural networks (CNNs), and computer-assisted diagnostic (CAD) systems, have significantly enhanced traditional diagnostic tools like colonoscopy and histopathology. This systematic review evaluates the current role of AI in CRC management, focusing on diagnostic improvements, predictive modeling, and outcome prediction. Methods: A comprehensive literature review was conducted using PubMed, Google Scholar, and MEDLINE using MeSH term to identify studies utilizing AI in CRC diagnosis and management, with a focus on diagnostic imaging, histopathological analysis, and predictive modeling. Studies were evaluated for the accuracy of AI-driven diagnostic systems and the predictive performance of AI models in clinical outcomes. Results: Out of 147 studies identified, 37 met the eligibility criteria for this review. AI tools such as CNNs, CAD systems, and EndoBRAIN showed high accuracy in CRC detection and polyp classification. Kudo et al. (2020) reported 98% CRC detection accuracy using EndoBRAIN. Blanes-Vidal et al. (2019) achieved 96.4% accuracy in polyp detection via DCNN. Additionally, Wang et al. (2019, 2020) demonstrated improved Adenoma Detection Rates (ADR) of 34.1% and 29.1%, respectively, using AI over traditional methods. For outcome prediction, AI models, including CNNs, predicted patient prognosis with reasonable accuracy, as highlighted by Skrede et al. (2020) with 76% accuracy in prognosis prediction. Conclusions: The systematic review and analysis of AI-assisted diagnostic modalities in colorectal cancer and polyp detection reveal promising results, with most models demonstrating high sensitivity, specificity, and accuracy. CNN-based models and CAD systems, in particular, show strong potential for improving detection rates and clinical outcomes in CRC screening. The studies included in this review demonstrate that AI can enhance diagnostic precision, particularly in identifying polyps and predicting clinical outcomes, with high validation rates. However, more external validation and long-term clinical studies are needed to fully establish the robustness of these AI tools in routine clinical practice.

Systematic, Pretransplant Screening by Aortoiliac CT Angiography: Impact on Surgical Decision-making and Clinical Outcomes.

Aortoiliac screening before kidney transplantation is suggested by some guidelines to select patients for transplantation and to assist surgical planning. We investigated the clinical outcomes of systematic screening for aortoiliac disease in potential kidney transplant candidates. In this observational study, 470 potential kidney transplant candidates underwent aortoiliac computed tomography angiography. Patients were characterized by the presence of peripheral artery disease and calcification of iliac arteries and aortoiliac arteries. The risk of graft loss and graft function at 1 y posttransplant were examined and clinical decisions based on the vascular findings were assessed. Clinically diagnosed peripheral artery disease was present in 66 patients (14%), circular calcifications in 101 patients (21%), and aortoiliac stenosis in 77 patients (16%). In 326 patients undergoing kidney transplantation, circular calcification or aortoiliac stenosis was not associated with an increased risk of graft loss (P = 0.45 and P = 0.28) or estimated glomerular filtration rate (P = 0.23 and P = 0.76) at 1 y posttransplant. When evaluated for transplantability, clinical decision-making based on vascular findings was recorded in 67 of 429 patients (16%), including rejection for transplantation in 7 patients (2%) and laterality for surgical implantation in 52 patients (12%). Systematic screening by aortoiliac computed tomography angiography may assist in surgical planning but seems of limited clinical value in assessing the risk of future graft loss and graft function in patients undergoing kidney transplantation.

Assessing Traumatic Brain Injury in Refugees: Feasibility, Usability, and Prevalence Insights From a US-Based Clinical Sample.

This study assessed (1) the feasibility and usability of traumatic brain injury (TBI) assessment using the Ohio State University TBI Identification Method (OSU-TBI-ID) in a sample of English and Spanish-speaking refugees and asylum seekers (hereafter refugees), and (2) the prevalence and characteristics of TBI in this population. Refugees seeking care from Massachusetts General Hospital (MGH) Asylum Clinic, the MGH Chelsea HealthCare Center, and other asylum programs in the Greater Boston Area. Bilingual clinical research coordinators screened 158 English and Spanish-speaking refugees using the OSU-TBI-ID. A "positive" screen for TBI was made if a participant reported loss of consciousness (LOC) or being dazed or confused following a head injury, with determinations of mild, moderate, and severe TBI based on established metrics of TBI severity using duration of LOC. We conducted descriptive statistics of the sample demographics and screening outcomes, including group comparisons between those with and without TBI and associated demographic characteristics. The mean age was 36.8years (SD: 9.1), with participants predominantly from Latin America and the Caribbean (51%), followed by Sub-Saharan Africa (35%). Less than half (43%) identified as men. The majority (59%) screened positive for having experienced at least 1 TBI in their lifetime. Among those with a TBI history, nearly three-quarters (73%) had a mild TBI, and about a third (38%) had sustained a moderate-to-severe TBI. A majority (56%) had more than 1 TBI and about 40% had sustained a childhood TBI. The most common mechanisms of injury were interpersonal assault (55%) and blunt trauma by an object (46%). There were no significant statistical differences in demographics and TBI characteristics. Our findings demonstrate the feasibility and usability of the OSU-TBI-ID in a sample of refugees. We call for greater and improved detection of TBI among refugees to ensure they receive the optimal care they need.

Clinical outcomes of atrial fibrillation screening: a meta-analysis of randomized controlled trials

Background Several randomized controlled trials (RCTs) have investigated the benefits of atrial fibrillation (AF) screening. However, since none have shown a significant reduction in stroke rates, the impact of screening on clinical outcomes remains uncertain. Materials and methods We conducted a systematic review and meta-analysis of RCTs reporting clinical outcomes of systematic AF screening in participants without known AF. Pooled risk ratios (RRs) were computed for all-cause stroke or systemic embolism, major bleeding, and all-cause mortality, comparing screening with no screening. Results Seven RCTs encompassing 76 458 participants were identified. One trial utilized implantable loop recorders for rhythm monitoring, while the others employed non-invasive screening methods. Pooled results indicated that AF screening was associated with a significant reduction in all-cause stroke or systemic embolism (RR 0.932, 95% CI 0.873–0.996, I2 = 0%, p = 0.037), but had no effect on major bleeding (RR 0.996, 95% CI 0.935–1.060, I2 = 0%, p = 0.876) or all-cause mortality (RR 0.987, 95% CI 0.945–1.031, I2 = 0%, p = 0.550). We estimated a number needed to screen of 148 to prevent one stroke or systemic embolism over a 10-year period in a population of 75-year-olds. When only non-invasive screening methods were considered, the reduction in strokes was not statistically significant (RR 0.942, 95% CI 0.880–1.008, I2 = 0%, p = 0.083). Conclusions Systematic AF screening is associated with a modest yet statistically significant 7% relative reduction in stroke and systemic embolism, with no observed impact on major bleeding or all-cause mortality.

Generation of ribosomal protein S1 mutants for improving of expression of difficult to translate mRNAs

Metagenomes present a source for novel enzymes, but under 1% of environmental microbes are cultivatable. Because of its useful properties, Escherichia coli has been used as a host organism in functional genomic screens. However, due to differing expression machineries in the expression host compared to the source organism of the DNA sequences, screening outcomes can be biased. Here, we focused on one of the limiting processes—translation initiation. To that end, we created an operon-like screening system in E. coli to select mutants of the ribosomal protein S1 with more relaxed sequence requirements for 5’-untranslated regions of mRNAs. We created two mutation libraries of the ribosomal protein S1, one covering domains 3 and 4 (D3-D4) and the second covering domains 3 to 5 (D3-D5). Most mutants from library D3-D4 proofed to be specific for a particular UTR sequence and improved only expression from a single construct. Only mutant 3 from library D3-D4 led to increased expression of four different reporters improving fluorescence levels by up to 21%. Mutants isolated from D3-D5 library led up to 90% higher expression compared to the control, though the mutants with highest improvements exhibited a specialist phenotype. The most promising mutant, mutant 4, exhibited a generalist phenotype and showed increased expression in all six reporter strains compared to the control. This could indicate the potential for a more promiscuous translation initiation of metagenomic sequences in E. coli although at the price of smaller increases compared to specialist mutants.Key points• An operon-like selection system allowed to isolate generalist and specialist S1 mutants.• S1 mutants improved translation of mRNAs with 5'-UTRs from metagenomic sequences.• Use of S1 mutants could increase coverage from metagenomic libraries in functional screens.

Retrospective Analysis of the Prevalence and Risk Factors of Retinopathy of Prematurity in a Single-Center Cohort in Romania and Comparison with National and European Data.

Background and Objectives: This study investigated and compared with European literature data the incidence, severity, and perinatal risk factors of retinopathy of prematurity (ROP) in preterm infants admitted to the Premature Department of Mureş County Clinical Hospital over a two-year period (January 2022-December 2023). Materials and Methods: ROP screening was performed in 96 infants (76.8%) according to professional guidelines. A literature review was conducted to compare our findings with national and European data. Significant differences were identified in comparisons with studies from Cluj-Napoca (p = 0.0125), Timișoara, and Bucharest (p < 0.0074), as well as Serbia and Croatia when stratified by gestational age limits. The variations in GA thresholds (32 vs. 34 weeks) between studies required stratified analyses to ensure meaningful comparisons. The included European studies provided data on screening criteria, prevalence, and associated risk factors, offering a comprehensive perspective on screening effectiveness. Results: Among the 149 admitted patients, 125 were preterm (n = 125). Of the screened patients, 20 (20.83%) infants were diagnosed with ROP, including 13 boys (65%) and 7 girls (35%), all requiring prolonged respiratory support, and 55% of them needed blood transfusion. The average birth weight of affected infants was 1030.5 g (550-1700 g ), and the mean gestational age was 28.3 weeks (25-34 weeks). In those found to have stage 2 and 3 ROP in zone II with plus disease (n = 6), intravitreal anti-VEGF injections and/or retinal laser treatments were performed. Notably, no cases of ROP-related blindness were recorded. Conclusions: To our knowledge, this is the first study to compare ROP prevalence and screening outcomes across Romanian national centers. Identified risk factors in this cohort, such as respiratory distress syndrome, oxygen therapy, blood transfusion, and intraventricular hemorrhage, are consistent with the existing literature data. These findings underscore the importance of standardized screening criteria and effective management protocols to prevent ROP-related blindness. The comparative approach of this study highlights the necessity of harmonized internationally applied criteria to facilitate robust comparisons and, more importantly, improve patient care outcomes.

Bias Detection and Mitigation in HR Algorithms: Ensuring Fairness in Machine Learning Models

Additional efforts are necessary to guarantee that the machine learning algorithms employed in healthcare do not perpetuate or exacerbate any preexisting discriminatory or objectionable biases that may be present in the data. In order to reduce the impact of any biases that may have developed during the data collection procedure, we implement a reinforcement learning approach. We assessed the effectiveness of our model in accurately predicting the incidence of COVID-19 in patients seeking medical attention at hospital emergency departments in order to reduce the impact of potential biases associated with ethnicity and hospital location. By utilizing an innovative incentive function and training strategy, we have proven that our methodology outperforms the most advanced machine learning techniques in terms of clinically significant screening outcomes and equitable results. To illustrate the adaptability of our methodology, we implemented a comprehensive evaluation of our approach in an intensive care unit by administering a discharge status test. Additionally, we conducted external validation at three distinct institutions.

Evaluating the Impact of Changes in AI-derived Case Scores over Time on Digital Breast Tomosynthesis Screening Outcomes.

"Just Accepted" papers have undergone full peer review and have been accepted for publication in Radiology: Artificial Intelligence. This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content. Purpose To evaluate the change in DBT-AI (digital breast tomosynthesis-artificial intelligence) case scores over sequential screens. Materials and Methods This retrospective review included 21,108 female patients (mean age, 58.1 ± [SD] 11.5 years) with 31,741 DBT screening examinations performed at a single site from 2/3/2020 to 9/12/2022. Among 7,000 patients with two or more DBT-AI screenings, 1,799 had one year follow up and were included in the analysis. DBT-AI case scores and differences in case score over time were determined. Case scores ranged from 0-100. For each screening outcome (true positive (TP), false positive (FP), true negative (TN), false negative (FN)), mean and median case score change was calculated. Results The highest average case score was seen in TP examinations (average 75, range 7-100, n = 41), and the lowest average case score was seen in TN examinations (average 34, range 0-100, n = 1640). The largest positive case score change was seen in TP examinations (mean case score change 21.1, median case score change 17). FN examinations included mammographically occult cancers diagnosed following supplemental screening and those found on symptomatic diagnostic imaging. Differences between TP and TN mean case score change (P < .001) and between TP and FP mean case score change (P = .02) were statistically significant. Conclusion Using the combination of DBT-AI case score with change in case score over time may help radiologists make recall decisions in DBT screening. All studies with high case score and/or case score changes should be carefully scrutinized to maximize screening performance. ©RSNA, 2025.

ANALYZING RISK FACTORS AND OUTCOMES OF NEONATAL HEARING SCREENING

Objective: Neonatal hearing loss can significantly impact a child's developmental trajectory. This study evaluates the risk factors associated with neonatal hearing impairment and analyzes the outcomes of a hearing screening program at a tertiary care center. Methods: This prospective observational study involved 1175 neonates screened for hearing loss using Otoacoustic Emissions (OAE). Data were collected on high-risk factors such as consanguinity, family history of deafness, ototoxic drug exposure, and low birth weight, and their association with screening outcomes. Results: The prevalence of high-risk factors included consanguinity (13.53%), family history of deafness (0.17%), ototoxic drug intake (0.26%), and low birth weight (19.91%). Of those initially referred for additional testing, 50% were lost to follow-up, and 50% confirmed for further diagnostic evaluation. Associations were noted between consanguinity and referral rates, as well as a strong correlation between family history and referrals. Conclusion: The study highlights the effectiveness of initial neonatal hearing screenings but indicates the need for improved follow-up systems to ensure comprehensive care for all neonates at risk of hearing loss.

ASSESSMENT OF UNIVERSAL NEONATAL HEARING SCREENING: OUTCOMES AND PREVALENCE AT A TERTIARY CARE CENTER

Objective: Early detection of hearing impairment through Universal Neonatal Hearing Screening (UNHS) is crucial for timely intervention. This study assesses the outcomes and prevalence of hearing loss in neonates screened at a tertiary care center. Methods: This prospective observational study involved 1175 neonates born at SDM Medical College and Hospital between December 2019 and November 2020. Neonates underwent initial and, if necessary, repeat hearing screenings using the Otoacoustic Emission (OAE) technique. Data on gender and birth weight distribution were also analyzed to explore demographic correlations with screening outcomes. Results: Of the neonates screened, 99.40% passed the initial hearing test, while 0.60% were referred for further evaluation. Among those referred, 71.43% passed on repeat screening, with 28.57% continuing to show potential hearing issues. The majority of neonates weighed over 2.5 kg, indicating a lower presence of very low birth weight infants in the screened population. Conclusion: The high pass rate in initial screenings demonstrates the effectiveness of the OAE method in a tertiary care setting, though the importance of follow-up testing for those referred remains critical. The study highlights the successful implementation of UNHS and underscores the need for continuous monitoring and adaptation of screening protocols to address all potential risks in neonatal hearing loss.

Annual Screening Mammography as a Standard for All Women: Counterpoint-Equity in Screening Outcome Requires Inequality in Screening Approach.

Annual Screening Mammography as a Standard for All Women: Counterpoint-Equity in Screening Outcome Requires Inequality in Screening Approach.

Gender Disparities and Lung Cancer Screening Outcomes Among Individuals Who Have Never Smoked

Lung cancer in individuals who have never smoked (INS) is a growing global concern, with a rapidly increasing incidence and proportion among all lung cancer cases. Particularly in East Asia, opportunistic lung cancer screening (LCS) programs targeting INS have gained popularity. However, the sex-specific outcomes and drawbacks of screening INS remain unexplored, with data predominantly focused on women. To compare LCS outcomes between Asian women and men with no smoking history. This multicenter cohort study was conducted at health checkup centers in South Korea from 2009 to 2021. Participants included individuals aged 50 to 80 years with no smoking history who underwent low-dose computed tomography (LDCT) screening. Data were retrospectively analyzed from November 2023 to June 2024. Opportunistic LDCT screening for lung cancer. Participants were followed up until December 2022 for the outcome of death. Lung cancer diagnosis, diagnostic characteristics, clinical course, and lung cancer-specific deaths (LCSD) were compared between women and men. A total of 21 062 participants (16 133 [76.6%] women and 4929 [23.4%] men) with a mean (SD) age of 59.8 (7.2) years were included. From baseline screening, 176 participants (139 women [0.9%] and 37 men [0.8%]) were diagnosed with lung cancer (screen-detected); 131 of 139 women (94.3%) and 33 of 37 men (89.2%) were diagnosed with stage 0 to I disease, with 133 of 139 women (95.7%) and 36 of 37 men (97.3%) having adenocarcinoma. There were no significant sex-based differences in stage or histologic type distribution. Among the 21 062 screened individuals, LCSD was reported in 8 women and 3 men during a mean (SD) follow-up of 83.8 (41.7) months. Multivariable analyses found no significant association between sex and cumulative hazards of lung cancer diagnosis (adjusted hazard ratio [aHR], 0.90 [95% CI, 0.64-1.26] for men vs women) or LCSD (aHR, 1.06 [95% CI, 0.28-4.00] for men vs women). The estimated 5-year lung cancer-specific survival rate was 97.7% for women and 100% for men with screen-detected lung cancer, showing no significant sex differences. In this cohort study of Asian individuals with no smoking history who underwent LDCT screening, no significant sex-based differences were detected in lung cancer diagnosis, stage distribution, or LCSD. These findings suggest that men and women who have never smoked would experience similar risks of overdiagnosis with little to no benefit when exposed to indiscriminate screening.

Nationwide cervical precancer screening in Ghana: concurrent HPV DNA testing and visual inspection under an expanded hub-and-spoke model

Cervical cancer continues to disproportionately burden women in sub-Saharan Africa, and is the commonest gynecological cancer in Ghana. The Cervical Cancer Prevention and Training Centre (CCPTC), Battor, Ghana spearheaded the Ghana arm of the mPharma 10,000 Women Initiative (mTTWI) between September 2021 and October 2022. The aim of this study was to examine the outcomes of nationwide concurrent screening using high-risk human papillomavirus (hr-HPV) DNA testing and visual inspection methods, as well as factors associated with the screening outcomes. We conducted a descriptive retrospective cross-sectional study to estimate the prevalence of hr-HPV infection (nationally and regionally) and cervical lesions among women screened by graduates of our training center in their own settings (spokes) with remote supervision and mentoring by CCPTC trainers (hub). We modeled factors associated with hr-HPV infection using nominal logistic regression. Among 5217 women screened (mean age, 40.1 years), the overall prevalence of hr-HPV infection and cervical lesions were 29.1% (95% confidence interval [CI] 27.9–30.3) and 3.7% (95% CI 3.2–4.2), respectively. The prevalence distribution varied widely among regions, with the highest recorded in the Oti Region (32.8%) and the lowest recorded in the Upper West (20.7%) and North-East (20.7%) regions. The most frequently detected HPV genotype was other hr-HPV type(s) only (non-HPV16, non-HPV18) (23.5%; 95% CI 22.3–24.7), followed by HPV16 only (1.5%; 95% CI 1.2–1.8), and mixed infection with HPV18 + other hr-HPV type(s) (1.2%; 95% CI 0.9–1.5). Factors found to be significantly associated with hr-HPV infection among women screened included age < 35 years, having a relationship status apart from married/cohabitation, nulliparity, and HIV positivity. Drawing from our implementation of this model within the mTTWI, we posit that while Ghana prepares for organized screening, coordinating opportunistic screening could enable a phased expansion of cervical precancer screening with the help of international and local partners. This approach, combined with concurrent testing (hr-HPV DNA testing and visual inspection), holds promise for mitigating loss to follow-up among women requiring additional evaluation and lesion management.

The Screening Tomosynthesis Trial with Advanced Reader Methods (STREAM): design and rationale of a population-based breast cancer screening trial.

It is uncertain what the effects of introducing digital breast tomosynthesis (DBT) in the Dutch breast cancer screening programme would be on detection, recall, and interval cancers (ICs), while reading times are expected to increase. Therefore, an investigation into the efficiency and cost-effectiveness of DBT screening while optimising reading is required. The Screening Tomosynthesis trial with advanced REAding Methods (STREAM) aims to include 17,275 women (age 50-72 years) eligible for breast cancer screening in the Netherlands for two biennial DBT screening rounds to determine the short-, medium-, and long-term effects and acceptability of DBT screening and identify an optimised strategy for reading DBT. The control group will consist of 86,400 women selected from the database of the Dutch breast cancer screening programme screened with digital mammography. The intervention group will undergo DBT examinations only. Four different reading strategies will be evaluated on a subset of first-round screening exams. These four strategies will also be evaluated combined with replacing one of the two readers with AI predictions. The Microsimulation Screening Analysis (MISCAN)-Breast model will be used to estimate the long-term outcomes of DBT screening assuming the best-performing reading method. The primary outcome measure is the IC and advanced cancer rate at the second round (combined endpoint) in the DBT group compared to the control group. Secondary outcome measures are participation, recall and detection rates, positive predictive value, acceptability, reading method with the best case-based area under the curve and reading time, predicted breast cancer mortality, number of cancers overdiagnosed, and cost-effectiveness. Question The short-, medium-, and long-term effects of digital breast tomosynthesis (DBT)imaging in the Dutch breast cancer screening programme are unknown, but essential to decide about implementation. Findings This protocol paper describes the primary endpoint of the STREAM trial: the combined interval and advanced cancer detection rate at the second DBT round. Clinical relevance The STREAM trial is a prospective, non-randomised, population-based study in the Dutch breast cancer screening programme, that aims to evaluate the effects and acceptability of two rounds of DBT screening to determine if DBT can enhance the programme's outcomes.

Progression of diabetic retinopathy during pregnancy: Retrospective study from Birmingham and Solihull

Aims/Purpose: To assess the progression of diabetic retinopathy (DR) in pregnant women with pre‐existing diabetes in the Birmingham and Solihull area and to evaluate adherence to recommended screening guidelines.Methods: A retrospective review was conducted over 12 months (01/09/2022‐31/08/2023) using data from the Diabetic Eye Screening Program (DESP) and hospital records (Medisoft, OCT, and retina images). The study included pregnant women with pre‐existing diabetes who received maternity services at University Hospitals Birmingham (UHB) and were referred to DESP. Patients with gestational diabetes were excluded. Data collected included demographics, DR screening attendance, progression rates, and clinical outcomes.Results: Out of 149 pregnant women with pre‐existing diabetes, 54 (36.2%) were not referred for initial screening by 12 weeks due to late presentation and delayed diabetes status confirmation. Of the total, 88 (59%) missed the 12‐week screening, 57 (40%) missed the 16‐20 week screening, and 67 (48%) missed the 28‐week screening. At 12 weeks, 27% were R0M0, 9% R1M0, 3% R1M1, and 1% R2M0/R2M1, with 8 referred to HES. At 16‐20 weeks, 43% were R0M0, 16% R1M0, 1% R3SM0, and 1% were unable to assess, with 2 referred to HES. By 28 weeks, 37% were R0M0, 12% R1M0, 1% R3SM1, and 2% were still being graded, with 1 referred to HES. The study highlighted significant cases, including one patient who progressed to severe NPDR and required bilateral PRP and Ozurdex treatment, and another who developed DMO treated with Ozurdex.Conclusions: Diabetic retinopathy progression during pregnancy remains a significant concern, with many patients missing critical screening appointments, leading to advanced DR stages and severe visual impairment. Despite adherence to screening guidelines, patient non‐compliance and late referrals hinder effective management. Improved patient education and follow‐up strategies are essential to enhance screening attendance and outcomes, thereby preventing severe DR progression during pregnancy. Further research is necessary to develop targeted interventions for better compliance and timely treatment.

Progression of diabetic retinopathy during pregnancy: Retrospective study from birmingham and solihull

Aims/Purpose: To assess the progression of diabetic retinopathy (DR) in pregnant women with pre‐existing diabetes in the Birmingham and Solihull area and to evaluate adherence to recommended screening guidelines.Methods: A retrospective review was conducted over 12 months (01/09/2022‐31/08/2023) using data from the Diabetic Eye Screening Program (DESP) and hospital records (Medisoft, OCT, and retina images). The study included pregnant women with pre‐existing diabetes who received maternity services at University Hospitals Birmingham (UHB) and were referred to DESP. Patients with gestational diabetes were excluded. Data collected included demographics, DR screening attendance, progression rates, and clinical outcomes.Results: Out of 149 pregnant women with pre‐existing diabetes, 54 (36.2%) were not referred for initial screening by 12 weeks due to late presentation and delayed diabetes status confirmation. Of the total, 88 (59%) missed the 12‐week screening, 57 (40%) missed the 16‐20 week screening, and 67 (48%) missed the 28‐week screening. At 12 weeks, 27% were R0M0, 9% R1M0, 3% R1M1, and 1% R2M0/R2M1, with 8 referred to HES. At 16‐20 weeks, 43% were R0M0, 16% R1M0, 1% R3SM0, and 1% were unable to assess, with 2 referred to HES. By 28 weeks, 37% were R0M0, 12% R1M0, 1% R3SM1, and 2% were still being graded, with 1 referred to HES. The study highlighted significant cases, including one patient who progressed to severe NPDR and required bilateral PRP and Ozurdex treatment, and another who developed DMO treated with Ozurdex.Conclusions: Diabetic retinopathy progression during pregnancy remains a significant concern, with many patients missing critical screening appointments, leading to advanced DR stages and severe visual impairment. Despite adherence to screening guidelines, patient non‐compliance and late referrals hinder effective management. Improved patient education and follow‐up strategies are essential to enhance screening attendance and outcomes, thereby preventing severe DR progression during pregnancy. Further research is necessary to develop targeted interventions for better compliance and timely treatment.

Family-Based Education for Prevention and Management of Injuries in Vulnerable Populations

Injuries contribute to disability and morbidity in countries around the world. Among the elderly, falls are the most common type of injury, with an incidence rate of approximately 2.3–7% per 1,000 individuals. Injuries can lead to physical impairments, including reduced limb function. In the elderly population, particularly those aged 65 years and older, injuries are associated with a high risk of mortality and severe disability. Preventing injuries and falls is a critical public health concern. Families serve as essential support systems for addressing injuryrelated issues within households and the surrounding environment. This activity aimed to provide families with education on preventing and managing injuries in vulnerable populations. Health education sessions were delivered to health cadres and community members through lectures, discussions, and expert-led questionand-answer sessions. Educational materials included PowerPoint presentations and pocketbooks. At the conclusion of the sessions, a group demonstration was conducted on the management of splints in community settings. Knowledge was assessed using a questionnaire developed based on the health education materials. Fall risk screening was conducted using the First Time Injury Falls (FIF) instrument. The results revealed that among the 27 respondents, knowledge levels significantly improved after the educational sessions (p-value &lt; 0.05). Fall risk screening outcomes indicated that 20 respondents (74.1%) were at low risk for falls, 5 respondents (18.5%) were at moderate risk, and 2 respondents (7.4%) were at high risk. Based on these findings, it can be concluded that health education is effective in enhancing family knowledge about injury prevention and management in vulnerable populations.

Agreement Between High-Risk Human Papillomavirus Testing in Paired Self-Collected and Clinician-Collected Samples from Cervical Cancer Screening in Spain.

Background: Implementing self-sampling (SS) in cervical cancer screening requires comparable results to clinician-collected samples (CCS). Agreement measures are essential for evaluating HPV test performance. Previous studies on non-paired samples have reported higher viral cycle threshold (Ct) values in SS compared to CCS, affecting sensitivity for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Objectives: We aimed to evaluate the agreement of high-risk (hr)HPV testing results between SS and CCS using paired samples and to explore differences in Ct values. Methods: Women aged 30 to 65 years attending cervical cancer screening in two regions of Spain were invited to participated in this study. For each woman there was: CCS collected during the screening visit using liquid-based cytology and cytobrush, and a SS using a brush at home one month later. A PCR-based assay was used for hrHPV detection. Agreement in hrHPV results among both samples, Ct value differences, and their association with screening outcomes were analyzed. Results: This study included 981 women with paired samples. SS had a higher hrHPV prevalence than CCS (overall ratio of 1.3). Positive agreement for all hrHPV genotypes, HPV16, HPV18, and other hrHPV types were 85%, 91.3%, 66.7%, and 83.3%, respectively. Negative agreement was >95% for all results. Median Ct values was slightly higher in SS than in CSS (32.9 vs. 30.6, p = 0.02). Seven CIN2+ cases HPV positive were detected by both methods. One CIN3 case was missed by SS. Conclusions: This study showed a good agreement between SS and CCS for hrHPV testing in a routine screening in Spain. Despite the slightly higher Ct values for SS, no significant impact on sensitivity could be determined due to the low incidence of CIN2+ cases. Further research on larger paired samples is needed to assess the implications of Ct values on test sensitivity.