Screening In Australia Research Articles

Understanding the mechanisms underlying the socioeconomic disparities in cancer screening among Australian women

BackgroundLittle is known about individual, as opposed to area-level, variance in socioeconomic status (SES) and how this impacts screening participation. This study explores potential mechanisms underlying the relationship between SES and cancer screening amongst women eligible for breast, cervical, and bowel cancer screening.MethodsAustralian women aged 50–74 years (N = 874) took part in an online survey examining participants’ health and cancer screening behaviours. Relationships between individual and area-level SES, cancer screening participation, stress, general self-efficacy, and screening literacy were examined using structural equation modelling. Frequency of cancer screening barriers were calculated for each cancer type and compared for SES categories.ResultsThe structural equation model including stress and screening literacy as mediators yielded excellent fit, χ2 (26) = 33.322, p = .153, TLI = 0.992. Lower individual level SES was associated with higher stress and lower screening literacy. Higher stress was related to lower screening participation in all three programs, and lower screening literacy was associated with low cervical and breast cancer screening. The only significant relationship between area-level SES and screening participation was with participation in cervical screening. All indirect effects between area level SES and screening were non-significant. The types of barriers reported for each cancer screening type were similar between high and low socioeconomic individuals. In all three screening programs, intending to participate in cancer screening but not getting around to it, and not liking the screening method were commonly reported reasons for non-participation.ConclusionsThis study is the first to investigate the effects of individual level SES on cancer screening in Australia and one of the few studies to examine underlying mechanisms simultaneously across various screening programs. Reducing stress and improving screening literacy may help to improve cancer screening participation among low SES individuals. Our results also suggest that tailoring interventions to the SES background of women may not enhance their effectiveness. Interventions aiming to reduce the SES screening disparities may achieve more success through addressing underlying mechanisms as opposed to the behavioural barriers themselves.

Pharmacogenetic-guided dosing for fluoropyrimidine (DPYD) and irinotecan (UGT1A1*28) chemotherapies for patients with cancer (PACIFIC-PGx): A multicenter clinical trial.

PACIFIC-PGx evaluated the feasibility of implementing pharmacogenetics (PGx) screening in Australia and the impact of DPYD/UGT1A1 genotype-guided dosing on severe fluoropyrimidine (FP) and irinotecan-related toxicities and hospitalizations, compared to historical controls. This prospective single arm trial enrolled patients starting FP/irinotecan for any cancer between 7 January 2021 and 25 February 2022 from four Australian hospitals (one metropolitan, three regional). During the accrual period, 462/487 (95%) consecutive patients screened for eligibility for DPYD and 50/109 (46%) for UGT1A1 were enrolled and genotyped (feasibility analysis), with 276/462 (60%) for DPYD and 30/50 (60%) for UGT1A1 received FP/irinotecan (safety analysis). DPYD genotyping identified 96% (n = 443/462) Wild-Type, 4% (n = 19/462) Intermediate Metabolizers (50% dose reduction), and 0% Poor Metabolizers. UGT1A1 genotyping identified 52% (n = 26/50) Wild-Type, 40% (n = 20/50) heterozygous, and 8% (n = 4/50) homozygous (30% dose reduction). Key demographics for the FP/irinotecan safety cohorts included: age range 23-89/34-74 years, male 56%/73%, Caucasian 83%/73%, lower gastrointestinal cancer 50%/57%. Genotype results were reported prior to cycle-1 (96%), average 5-7 days from sample collection. PGx-dosing for DPYD variant allele carriers reduced high-grade toxicities compared to historic controls (7% vs. 39%; OR = 0.11, 95% CI 0.01-0.97, p = 0.024). High-grade toxicities among Wild-Type were similar (14% vs. 14%; OR = 0.99, 95% CI 0.64-1.54, p = 0.490). PGx-dosing reduced FP-related hospitalizations (-22%) and deaths (-3.7%) compared to controls. There were no high-grade toxicities or hospitalizations for UGT1A1*28 homozygotes. PGx screening and prescribing were feasible in routine oncology care and improved patient outcomes. Findings may inform expanded PGx programs within cancer and other disease settings.

MA18.03 Participant Eligibility for Lung Cancer Screening in Australia: An Analysis of Proposed Criteria

MA18.03 Participant Eligibility for Lung Cancer Screening in Australia: An Analysis of Proposed Criteria

P2.04B.15 Co-Design of Decision Support Tools for Lung Cancer Screening in Australia

P2.04B.15 Co-Design of Decision Support Tools for Lung Cancer Screening in Australia

Realising the benefits of modern fish-protection screening in Australia

Realising the benefits of modern fish-protection screening in Australia

Inclusive language in health policy – a timely case (study) of cervical screening in Australia

ABSTRACT Language is important in health policy development. Policy changes in Australia to increase cervical screening offers a timely case example to explore the function of inclusive language in health policy. Gender and sexuality diverse people with a cervix have been largely invisible within health promotion programs, which has led to reduced awareness of, and access to, cervical screening. Twenty-eight semi-structured interviews were conducted with 29 key informants between April and October 2022 about the role of inclusive language in cervical screening policy, promotion, and delivery in the context of a national program to promote cervical screening. Three themes were identified from what key informants believed to be the role of inclusive language: (1) the common goal of inclusive language as policy advocacy for broader inclusivity; (2) the inevitable partiality of inclusive language in policy as an opportunity to start conversation; and (3) policy as a bridge between essential but diffuse components of the health sector with multidirectional influences. Inclusive language was seen to operationalise equity in health policy within the broader aim of eliminating cervical cancer among under-screened populations.

Medicare-funded reproductive genetic carrier screening in Australia has arrived: are we ready?

Medicare-funded reproductive genetic carrier screening in Australia has arrived: are we ready?

"We need to work towards it, whatever it takes."-participation factors in the acceptability and feasibility of lung cancer screening in Australia: the perspectives of key stakeholders.

Low dose computed tomography (LDCT) screening, targeted at those at high-risk, has been shown to significantly reduce lung cancer mortality and detect cancers at an early stage. Practical, attitudinal and demographic factors can inhibit screening participation in high-risk populations. This study aimed to explore stakeholders' views about barriers and enablers (determinants) to participation in lung cancer screening (LCS) in Australia. Twenty-four focus groups (range 2-5 participants) were conducted in 2021 using the Zoom platform. Participants were 84 health professionals, researchers, policy makers and program managers of current screening programs. Focus groups consisted of a structured presentation with facilitated discussion lasting about 1 hour. The content was analysed thematically and mapped to the Consolidated Framework for Implementation Research (CFIR). Screening determinants were identified across each stage of the proposed screening and assessment pathway. Challenges included participant factors such as encouraging participation for individuals at high-risk, whilst ensuring that access and equity issues were carefully considered in program design. The development of awareness campaigns that engaged LCS participants and health professionals, as well as streamlined referral processes for initial entry and follow-up, were strongly advocated for. Considering practical factors included the use of mobile vans in convenient locations. Participants reported that LCS in Australia was acceptable and feasible. Participants identified a complex set of determinants across the proposed screening and assessment pathway. Strategies that enable the best chance for program success must be identified prior to implementation of a national LCS program.

Spatial variability in socio-demographic factors affecting participation in the Australian national bowel cancer screening program

ObjectivesThe objective of this paper is to analyse the socio-demographic and spatial patterns associated with bowel cancer screening in Australia. Despite the importance of screening in reducing mortality via early intervention, it remains the case that overall screening rates are uneven between different socio-demographic groups and geographic regions. Notwithstanding this, there is limited knowledge in Australia regarding the interplay between socio-demographics and geography in relation to bowel cancer screening. Thus, this paper explores the socio-demographic and spatial patterns of screening participation across Australian regions to better inform public health policy and programs. Study designThis is a nationwide ecological study based on aggregate spatial data. MethodsAn ecological study is conducted using bowel cancer screening rates and selected socio-demographic data measured at the Statistical Area 3 level. Geographically weighted regression software is used to conduct global and spatial regression analysis. ResultsThe global regression results show that higher rates of screening participation were associated with employment/education disengagement and volunteering while in contrast, lower rates of participation were associated with higher rates of indigenous populations, people with chronic health conditions, and people with poor English skills. Considering the spatial analysis, the analysis shows that once the spatial non-stationarity in the data is considered the influence of the variables shown to be significant in the global model, has significant spatial variability. ConclusionFrom a public health perspective, addressing shortfalls in bowel cancer screening participation is an important priority. In order to understand differences in participation rates it is important to consider both socio-demographic factors as well as the geographic or spatial distribution of these factors.

Using a theory informed approach to design, execute, and evaluate implementation strategies to support offering reproductive genetic carrier screening in Australia

BackgroundHealth care professionals play a central role in offering reproductive genetic carrier screening but face challenges when integrating the offer into practice. The aim of this study was to design, execute, and evaluate theory-informed implementation strategies to support health care professionals in offering carrier screening.MethodsAn exploratory multi-method approach was systematically employed based on the Theoretical Domain Framework (TDF). Implementation strategies were designed by aligning TDF barriers reported by health care professionals involved in a large carrier screening study, to behaviour change techniques combined with study genetic counsellors’ experiential knowledge. The strategies were trialled with a subset of health care professionals and evaluated against controls, using findings from questionnaires and interviews with healthcare professionals. The primary outcome measure was the number of couples who initiated enrolment.ResultsHealth care professionals (n = 151) reported barriers in the TDF Domains of skills, e.g., lack of practice in offering screening, and challenges of environmental context and resources, e.g., lack of time, which informed the design of a skills video and a waiting room poster using the TDF-behaviour change technique linking tool. Following implementation, (Skills video n = 29 vs control n = 31 and Poster n = 46 vs control n = 34) TDF barrier scores decreased across all groups and little change was observed in the primary outcome measure. The skills video, though welcomed by health care professionals, was reportedly too long at seven minutes. The waiting room poster was seen as easily implementable.ConclusionsAs carrier screening moves towards mainstream healthcare, health care professionals report barriers to offering screening. To meet their needs, developing and testing experiential and theory-informed strategies that acknowledge contextual factors are essential.

Colorectal adenomatous and serrated polyps in rural South Australia: who, why, what and where?

The adenoma-carcinoma and serrated pathways offer a window of opportunity for the removal of pre-malignant polyps and prevention of colorectal cancer (CRC) through the use of colonoscopy. The aim of this study was to investigate variation in polyp incidence in different age groups, gender and indications for undertaking colonoscopy. We also address histological types of polyps found and where in the bowel they are located. This study is based on the colonoscopy data collected prospectively over a one-year period in multiple South Australian rural centres, 24 general surgeons contributed to this study. All histopathology results were subsequently entered into the dataset. A total of 3497 colonoscopies were performed, with a total of 2221 adenomatous and serrated polyps removed. Both serrated and adenomatous polyps were more common in the distal colon. Patients of male gender, aged 70 years and over and with an indication of polyp surveillance had higher adenoma and serrated polyp detection rates (ADR and SPDR). Patients aged 40-49 years old who underwent colonoscopy for positive faecal occult blood had an ADR and SPDR of 25.0% and 6.3%, respectively. This study has shown variation in ADR and SPDR depending on age, gender and indication for colonoscopy. This variation will help further develop key performance indicators in colonoscopy. The high ADR and SPDR in patients aged 40-49 years old whom underwent colonoscopy for positive faecal occult blood may support lowering the age of commencement of CRC screening in Australia.

"What do I think about implementing lung cancer screening? It all depends on how." Acceptability and feasibility of lung cancer screening in Australia: The view of key stakeholders about health system factors.

Lung cancer is the number one cause of cancer death worldwide. Although international trials demonstrate that targeted screening using low dose computed tomography (LDCT) significantly reduces lung cancer mortality, implementation of screening in the high-risk population presents complex health system challenges that need to be thoroughly understood to support policy change. To elicit health care providers' and policymakers' views about the acceptability and feasibility of lung cancer screening (LCS) and barriers and enablers to implementation in the Australian setting. We conducted 24 focus groups and three interviews (22 focus groups and all interviews online) in 2021 with 84 health professionals, researchers, and current cancer screening program managers and policy makers across all Australian states and territories. Focus groups included a structured presentation about lung cancer and screening and lasted approximately one hour each. A qualitative approach to analysis was used to map topics to the Consolidated Framework for Implementation Research. Nearly all participants considered LCS to be acceptable and feasible but identified a wide range of implementation challenges. Topics (five specific to health systems and five cross-cutting with participant factors) identified were mapped to CFIR constructs, of which 'readiness for implementation', 'planning' and 'executing' were most salient. Health system factor topics included delivery of the LCS program, cost, workforce considerations, quality assurance and complexity of health systems. Participants strongly advocated for streamlined referral processes. Practical strategies to address equity and access, such as using mobile screening vans, were emphasised. Key stakeholders readily identified the complex challenges associated with the acceptability and feasibility of LCS in Australia. The barriers and facilitators across health system and cross-cutting topics were clearly elicited. These findings are highly relevant to the scoping of a national LCS program by the Australian Government and a subsequent recommendation for implementation.

152 - Accelerating implementation of lung cancer screening in Australia: what evidence-based strategies are recommended?

152 - Accelerating implementation of lung cancer screening in Australia: what evidence-based strategies are recommended?

Lung cancer screening: The pulmonologist, the thoracic surgeon and working together in a team.

Lung cancer screening: The pulmonologist, the thoracic surgeon and working together in a team.

Cardiovascular disease risk screening in Australia: evidence and data gaps.

Cardiovascular disease risk screening in Australia: evidence and data gaps.

A decade of non-invasive prenatal screening in Australia: National impact on prenatal screening and diagnostic testing.

Prenatal screening for aneuploidy has undergone immense changes over the past two decades. In 2013 cell-free DNA-based non-invasive prenatal testing (NIPT) became a new self-funded option primarily for Down syndrome screening, but also other aneuploidies and genetic conditions. The numbers of Medicare item claims for prenatal diagnostic procedures have halved since the introduction of NIPT, while billings for serum screening fell by 40% over the same period, on a background of steady births. Australia is now observing historically low rates of prenatal diagnostic testing. These data provide an informative snapshot of historic changes in prenatal screening and diagnosis, as our sector prepares for the impending impacts of other advances in genomics on maternity care. They also highlight the need to address equity and quality issues that arise when consumers must bear the full costs of improved genomic tests in the absence of Medicare funding.

Cost-effectiveness of polygenic risk profiling for primary open-angle glaucoma in the United Kingdom and Australia.

Primary open-angle glaucoma (POAG) is the most common subtype of glaucoma. We evaluate the cost-effectiveness of polygenic risk score (PRS) profiling as a screening tool for POAG. We used a Markov cohort model to evaluate the cost-effectiveness of implementing PRS screening in the UK and Australia, conducted from the healthcare payer's perspective. We used published data to calculate prevalence, transition probabilities, utility, cost and other parameters in the model. Our main outcome measure was the incremental cost-effectiveness ratio (ICER) and secondary outcomes were years of blindness avoided and a 'Blindness ICER'. We did one-way as well as two-way deterministic and probabilistic sensitivity analyses. The proposed screening programme for POAG in the UK is predicted to result in ICER of £24,783 (95% CI: £13,373-66,960) and would avoid 1 year of blindness at ICER of £10,095 (95% CI: £5513-27,656). In Australia, it is predicted to result in ICER of AU$34,252 (95% CI: AU$21,324-95,497) and would avoid 1 year of blindness at ICER of AU$13,359 (95% CI: AU$8143-37,448). Using the willingness to pay thresholds of $54,808 and £30,000, the proposed screening model is 79.2% likely to be cost-effective in Australia and is 60.2% likely to be cost-effective in the UK, respectively. We describe and model the cost-efficacy of incorporating a polygenic risk score for POAG screening in Australia and the UK for the first time and results indicated this is a promising cost-effectiveness strategy.

Public willingness to participate in population DNA screening in Australia

BackgroundPopulation-based DNA screening for medically actionable conditions has the potential to improve public health by enabling early detection, treatment and/or prevention; however, public attitudes and willingness to participate in DNA...

EP01.03-012 Acceptability and Feasibility of Lung Cancer Screening in Australia: The View of Key Stakeholders

Lung cancer is the number one cause of cancer death worldwide. International trials have demonstrated that targeted screening using low dose computed tomography (LDCT) is effective in significantly reducing lung cancer mortality and detecting cancers at an early stage. Implementation of screening in the high-risk population presents complex challenges that need to be clearly understood prior to policy change. The aim of this study was to elicit stakeholders’ (health care providers, policymakers) views about barriers and enablers for potential implementation of lung cancer screening in the Australian setting.

Emotions and lung cancer screening: Prioritising a humanistic approach to care.

Low-dose computed tomography lung cancer screening has mortality benefits. Yet, uptake has been low. To inform strategies to better deliver and promote screening, in 2018, we interviewed 27 long-term smokers immediately following lung cancer screening in Australia, prior to receiving scan results. Existing lung screening studies employ the Health Belief Model. Reflecting growing acknowledgement of the centrality of emotions to screening uptake, we draw on psychological and sociological theories on emotions to thematically and abductively analyse the emotional dimensions of lung cancer screening, with implications for screening promotion and delivery. As smokers, interviewees described feeling stigmatised, with female participants internalising and male participants resisting stigma. Guilt and fear related to lung cancer were described as screening motivators. The screening itself elicited mild positive emotions. Notably, interviewees expressed gratitude for the care implicitly shown through lung screening to smokers. More than individual risk assessment, findings suggest lung screening campaigns should prioritise emotions. Peer workers have been found to increase cancer screening uptake in marginalised communities, however the risk to confidentiality-especially for female smokers-limits its feasibility in lung cancer screening. Instead, we suggest involving peer consultants in developing targeted screening strategies that foreground emotions. Furthermore, findings suggest prioritising humanistic care in lung screening delivery. Such an approach may be especially important for smokers from low socioeconomic backgrounds, who perceive lung cancer screening and smoking as sources of stigma and face a higher risk of dying from lung cancer and lower engagement with screening.