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Differences in Knowledge of Colorectal Cancer Screening and Its Contribution to Screening Practices by Ob/Gyns [27F

INTRODUCTION: Colorectal cancer is the second most commonly diagnosed cancer in women. Surveys show that physicians have an influence in the rates of colorectal screening. This study investigates whether a lack of colorectal screening knowledge prevents Ob/Gyns of different academic levels and practice types from effectively screening colorectal cancer. METHODS: An IRB approved, validated survey eliciting colorectal screening guidelines, practices, and potential barriers to screening was circulated online, at the National Medical Association national conference, ACOG District II conference, and the New York City Health + Hospitals/Metropolitan Dept of Ob/Gyn between October 2018 to January 2019. RESULTS: A total of 142 respondents answered the survey. Only one out of 142 respondents (0.7%) answered correctly the question which identified all of the risk factors for colorectal cancer. A significant difference was noted in correctly identifying risk factors when comparing attendings (36.6%) and residents (75%) P=.004. Most respondents were able to correctly identify age to start screening (93.6%), but fewer were able to correctly identify age to stop screening (23.2%). For screening intervals, 76.8% correctly answered for colonoscopy, 66.9% correctly answered for flexible sigmoidoscopy. A significant difference was noted after stratifying for age (ages 20-40 vs 50-70s P=.003), gender (women vs men P=.01), and academic level (resident vs attending P=.03): younger, resident, and female physicians provided more correct answers. CONCLUSION: Difference in colorectal cancer screening knowledge between residents and attendings contributes to less than effective screening. Education on colorectal cancer should focus on attendings through maintenance of certification and continued integration in residency education.

Colorectal family polyadenomatous diseases. What management in 2020?

Nearly 5% of colorectal cancers are hereditary colorectal cancers, including adenomatous polyposis. The aim of this review was to highlight the current management of adenomatous polyposis. The two main genetic conditions responsible for adenomatous polyposis are familial adenomatous polyposis (FAP) (caused by an autosomal dominant mutation of the APC gene) and MUTYH-associated polyposis (MAP) (caused by bi-allelic recessive mutations of the MUTYH (MutY human homolog) gene). FAP is characterized by the presence of >1000 polyps and a young age at diagnosis (mean age of 10). In the absence of screening, the risk of colorectal cancer at age 40 is 100%. It is recommended to start screening at the age of 10-12 years. For patients with FAP and MAP, it is also recommended to screen the upper gastrointestinal tract (stomach and duodenum). In FAP, prophylactic surgery aims to reduce the risk of death without impairment of patient quality of life. The best age for prophylactic surgery is not well-defined; in Europe, prophylactic surgery is usually performed at age 20 as the risk of cancer increases sharply during the third decade. There are three main surgical procedures employed: total colectomy with an ileorectal anastomosis, restorative coloproctectomy with a J pouch anastomosis and coloproctectomy with a stoma. Restorative coloproctectomy with J pouch anastomosis is the reference procedure; however, disease can vary in severity from one patient to another and this must be taken into account to decide which procedure should be performed. In conclusion, the management of adenomatous polyposis is complex but is well-defined by guidelines, particularly in France.

Cost-utility of colorectal cancer screening at 40 years old for average-risk patients

The incidence of colorectal cancer (CRC) is increasing in patients under the age of 50. The purpose of this study was to assess the cost-utility of available screening modalities starting at 40 years in the general population compared to standard screening at 50 years old. A decision tree modeling average-risk of CRC in the United States population was constructed for the cost per quality-adjusted life year (QALY) of the five most common and effective CRC screening modalities in average-risk 40-year olds versus deferring screening until 50 years old (standard of care) under a limited societal perspective. All parameters were derived from existing literature. We evaluated the incremental cost-utility ratio of each comparator at a willingness-to-pay threshold of $50,000/QALY and included multivariable probabilistic sensitivity analysis. All screening modalities assessed were more cost-effective with increased QALYs than current standard care (no screening until 50). The most favorable intervention by net monetary benefit was flexible sigmoidoscopy ($3284 per person). Flexible sigmoidoscopy, FOBT, and FIT all dominated the current standard of care. Colonoscopy and FIT-DNA were both cost-effective (respectively, $4777 and $11,532 per QALY). The cost-effective favorability of flexible sigmoidoscopy diminished relative to colonoscopy with increasing willingness-to-pay. Regardless of screening modality, CRC screening at 40 years old is cost-effective with increased QALYs compared to current screening initiation at 50 years old, with flexible sigmoidoscopy most preferred. Consideration should be given for a general recommendation to start screening at age 40 for average risk individuals.

Altered pain processing and sensitisation is evident in adults with patellofemoral pain: a systematic review including meta-analysis and meta-regression

Background and aims Previous systematic reviews have reported manifestations of pain sensitisation as a feature of painful knee disorders, in particular osteoarthritis, with moderate evidence for pain sensitisation in patellofemoral pain (PFP). However, despite past studies recruiting female mostly adolescent PFP patients, it is unclear if sex or age plays a role. Investigation is required to determine if altered pain processing is a key feature of PFP and if a subgroup of patients is at an increased risk to help provide targeted management. The primary aim of this systematic review was to examine evidence investigating pain processing in PFP. Secondary aims were to evaluate the relationship between pain processing and (1) sex, (2) age and (3) symptom duration. Methods The protocol was prospectively registered with PROSPERO (CRD42019129851). PubMed, CINAHL, Web of Science and EMBASE were systematically searched from inception to April 2019 for studies investigating pain processing in PFP patients compared to controls using quantitative sensory testing. Each included paper was assessed for methodological quality using a modified version of Downs and Black. Means and standard deviations were extracted to calculate standardised mean differences (SMD) and 95% confidence intervals (95% CI). Where possible meta-analysis and meta-regression were performed using a random effects model. Results Eleven studies were identified, two medium and nine high quality. Meta-analysis indicates moderate evidence for decreased pressure pain thresholds (SMD -0.68, 95% CI -0.93 to -0.43), increased tactile detection thresholds (SMD 1.35, 95% CI 0.49-2.22) and increased warmth detection thresholds (SMD 0.61, 95% CI 0.30-0.92) in PFP patients compared to controls. Secondary analysis indicates moderate evidence for decreased pressure pain thresholds in female compared to male patients (SMD -0.75, 95% CI -1.34 to -0.16). Meta-regression indicates a moderate correlation between decreasing local and distal pressure pain thresholds and decreasing patient age (local R2 = 0.556, p = 0.0211; distal R2 = 0.491, p = 0.0354) but no correlation with symptom duration (p > 0.05). Conclusions Evidence from this systematic review with meta-analysis and meta-regression appears to suggest the presence of altered pain processing and sensitisation in patients with PFP with increased sensitivity indicated in female patients and younger patients. Implications With evidence of altered pain processing and sensitisation in PFP, it may be beneficial for clinicians to consider management approaches that aim specifically at adressing neuropathic pain, for example neuroscience education, to improve patients outcomes. With female patients and younger patients indicated as experiencing greater degree of sensitivity, this may be a good demographic to start screening for sensitisation, in order to better identify and treat those most affected.

Breast cancer screening in average-risk women: towards personalized screening.

Breast cancer screening is widely recognized for reducing breast cancer mortality. The objective in screening is to diagnose asymptomatic early stage disease, thereby improving treatment efficacy. Screening recommendations have been widely debated over the past years and controversies remain regarding the optimal screening frequency, age to start screening, and age to end screening. While there are no new trials, follow-up information of randomized controlled trials has become available. The American College of Physicians recently issued a new guidance statement on screening for breast cancer in average-risk women, with similar recommendations to the U.S. Preventive Services Task Force and to European guidelines. However, these guidelines differ from those ofother American specialty societies. The variations reflect differences in the organizations' values, the metrics used to evaluate screening results, and the differences in healthcare organization (individualized or state-organized healthcare). False-positive rates and overdiagnosis of biologically insignificant cancer are perceived as the most important potential harms associated with mammographic screening; however, there is limited evidence on their actual consequences. Most specialty societies agree that physicians should offer mammographic screening at age 40 years for average-risk women and discuss its benefits and potential harms to achieve a personalized screening strategy through a shared decision-making process.

Optimizing Lower Extremity Duplex Ultrasound Screening After Traumatic Injury

BackgroundThe risk assessment profile (RAP) score has been used to determine patients who would most benefit from lower extremity duplex ultrasound screening (LEDUS). We hypothesized that revising our LEDUS protocol to perform screening ultrasound examinations in patients with an RAP ≥8 within 48 h of admission would reduce the number of LEDUS performed without changing outcomes. MethodsA retrospective review was conducted on trauma patients admitted from July 1, 2014, to June 30, 2015, and July 1, 2016, to June 30, 2017. In 2014-2015, patients with an RAP score ≥5 underwent weekly LEDUS examinations starting on hospital day 4. In 2016-2017, the protocol was changed to start screening patients with an RAP score ≥8 by hospital day 2. Both protocols screened with weekly ultrasounds after the first examination. Demographic data, injury characteristics, LEDUS examination findings, chemoprophylaxis type, and venous thromboembolism incidence were collected. ResultsA total of 602 patients underwent LEDUS examination in 2014-2015, whereas only 412 underwent LEDUS in 2016-2017. No significant difference was seen in the number of patients diagnosed with deep vein thrombosis (DVT) or pulmonary embolism. DVTs were most often identified on the first LEDUS examination in both cohorts. Of patients diagnosed with a DVT on an LEDUS examination, a significantly higher RAP score (12 versus 10), and a shorter time to first duplex (1 versus 3 d), and DVT diagnosis (2 versus 4 d) were observed in the 2016-2017 cohort. In patients diagnosed with a pulmonary embolism, no significant differences were demonstrated between cohorts. ConclusionsRefinement of LEDUS protocols can decrease overutilization of hospital resources without compromising trauma patient outcomes.

Racial disparities in clinico-pathological features and survival rates of early-onset colorectal cancer.

e15089 Background: Early-onset colorectal cancer (EO-CRC) incidence is increasing disproportionately among minorities compared to Non-Hispanic Whites (NHW). EO-CRC have aggressive features such as higher grade and advanced stages. The appropriate age to start screening colonoscopy (SC) in NHW and minorities remains controversial; varying between 45 and 50 years old. We aim to compare EO-CRC clinico-pathological characteristics and survival rates by race groups. Methods: Patients with colorectal adenocarcinoma (CRC) with available race and stage as per AJCC 6th edition were identified using the SEER registry (1973-2010). EO-CRC was defined as CRC before age 50 years. Clinico-pathological features, overall survival (OS) by Kaplan Meier curves and mortality predictors by multivariate analysis were evaluated by race groups. Results: 180 605 patients with CRC were identified; 10.2% had EO-CRC. Mean age of diagnosis was 42.7 years and EO-CRC frequency was higher in minorities (Hispanics (H):16.7%, Non-Hispanic Black (NHB):12.7% and Asian (A): 12.8%) compared to NHW (8.7%). EO-CRC in NHB was predominantly seen in females. The rectum was the most common location for all races. Two-thirds of tumors were located between the sigmoid and anal regions in all races except NHB that had higher frequencies of right-sided tumors. Compared to other races, NHB had worse OS at all stages and tumor locations. NHB was associated with 72% increased risk of death by multivariate analysis. Conclusions: Our data suggest that EO-CRC frequency, pathological features and OS differ by race group; hence SC guidelines should be tailored accordingly. SC would be considered early; especially in minorities. Complete colonoscopy should be considered for NHB given higher rates of right-sided tumors and worse OS; while sigmoidoscopy may be adequate for others up to age 50, given higher rates of tumors located in the sigmoid to anal region. [Table: see text]

Is There a Correlation Between Elevated Healthy Start Screen Scores and Development of Postpartum Depression? [32L

INTRODUCTION: The incidence of postpartum depression is 15-20%. ACOG currently recommends pregnant women be assessed for depression at least once during the perinatal period. The Healthy Start Screen (HSS), a mandated screening tool of all pregnant women during initial prenatal care in Florida, assesses women at risk for adverse pregnancy related outcomes. HSS scores >6 (maximum score of 14) trigger referrals for additional services. Our aim was to determine whether elevated prenatal HSS scores correlate with elevated postpartum Edinburgh Postnatal Depression Scale (EPDS) scores, thus identifying women at risk for developing postpartum depression (PPD). METHODS: A retrospective chart review of 2,816 pregnant women seen within the Department of OBGYN between January 1, 2016 and March 1, 2018 was completed. Patients who had both a HSS and a postpartum EPDS were included (total n=1,738). A HSS score >6 was considered positive, identifying the patient as at-risk. An EPDS score >12 was considered positive for postpartum depression. Logistic regression estimated the relationship between HSS and EPDS. RESULTS: An elevated HSS score at the initial prenatal screening was significantly associated with an elevated EPDS score at postnatal assessment (P<0.001). Each additional point on the HSS, regardless of the total HSS score, resulted in a 13% increase in likelihood of having a positive EPDS (OR 1.13; 95% CI 1.09-1.17). CONCLUSION: The HSS is a useful tool to identify women at risk for postpartum depression. At-risk women could be screened more frequently, and depression identified earlier, leading to more timely evaluation and treatment. Future studies are warranted.

Prevalence and Predictors of Adenomas in the 40-49 Year Old Patients Undergoing Colonoscopy

Background: Recently the American Cancer Society made a qualified recommendation to start screening for colorectal cancer (CRC) at 45 years of age in all average risk individuals. In this study, our primary aim is to calculate the prevalence and also evaluate the predictors of increased prevalence of detected adenomas in the 40 to 49-year-old individuals undergoing colonoscopy. Methods: A retrospective cross sectional study was performed using our electronic endoscopy database. Study subjects included all 40 to 49-year-old patients undergoing their first colonoscopy at our institution from January 1, 2010 to September 30, 2017. Exclusion criteria included patients who underwent colonoscopy for overt gastrointestinal bleeding, inflammatory bowel disease, a history of familial adenomatous polyposis, hereditary non polyposis CRC. Univariate analysis and multivariate analysis was performed to identify factors associated with increased adenoma detection rate (ADR). Findings: A total of 2059 patients were included in the study and 317 of these patients had family history (FH) of CRC. Patients with FH of CRC had significantly higher ADR (27.8% versus 19.7%, p=0.001) as compared to those without family history of CRC. There was no significant difference in ADR in patients between 40-44-years versus 45-49-years of age (17.7% vs 21.4%, p=0.058). On a multivariate analysis while adjusting for multiple patient and procedural variables; FH of CRC, male gender, BMI > 30 kg/m2, chronic kidney disease, and age were associated with high ADR. Interpretation: Our study shows that in addition to FH of CRC, age, male gender, BMI, and CKD are independent predictors of increased ADR in patients between 40 to 49 years of age. Funding Statement: The authors state: No funding sources to be declared. Declaration of Interests: The authors report no conflicts of interest. Ethics Approval Statement: The study protocol was approved by the institutional review board (IRB) at the University of Texas Medical Branch, Galveston, TX.

Characteristics and survival among early onset and standard onset colorectal cancer by race.

522 Background: The incidence of early-onset colorectal cancer (EO) is increasing. Guidelines recommend to start screening colonoscopy at 45 yo in Non-Hispanic Black (NHB). We compare the clinical features and outcomes between EO and standard-onset (SO) colorectal cancer (CRC) among racial groups. Methods: Patients with CRC adenocarcinoma; available race/ethnicity and stage were identified using the SEER registry. Clinical features and 5 year-overall survival (OS) is described by racial and age groups. Results: 190 670 patients were identified. EO rates were higher for minorities than NHW. Median age at diagnosis in EO was 44 and was similar among racial groups; while it was 71 in SO, being lower among minorities compared to NHW (67 vs. 72 years, p < 0.01). Left-sided tumors accounted for 77.4% of tumors in EO while it was 60.8% in SO for minorities versus NHW. The most common CRC location for EO was the rectum and sigmoid colon for SO. EO was most commonly diagnosed as stage III. Surgery and radiation rates were higher for EO for all stages. OS was higher in all stages of EO compared to SO. Conclusions: EO frequency is higher in all minority groups and most commonly located in the rectum. Despite higher stage and grade, OS is higher for EO which might be due to higher treatment rates. Early screening should be extended to all minority groups. [Table: see text]

Starting cervical cancer screening at 25 years of age: the time has come

Key points In 2013, the Canadian Task Force on Preventive Health Care updated its recommendations for cervical cancer screening, which included increasing the age to start screening to 25 years.[1][1] Six years on, with only 2 provinces updating their guidelines accordingly, it is timely to review

Human Machine Interface Design Analysis of Defect Detection Prototype by Wonderware InTouch Software

Human Machine Interface (HMI) serves as a bridge for operators to understand the processes that occur on the machine. Without HMI, operators will have difficulty in monitoring and controlling the machine. HMI used in this study using Wonderware InTouch software. The HMI design that is used, displays the home button, as the start screen. There are two options in the home menu, which is the option to login as an identification and classification operator. To start operation and enter the monitoring window, any operator that uses this HMI must login using a username and password. The function of HMI in this research is as a connector between operators with machine. In this paper we have presented the human machine interface design of defect detection prototype by wonderware intouch software. Based on the tested results can be concluded that the designed is successfully.

Validity and reliability of Turkish version of STarT Back Screening Tool.

The psychosocial factors that may affect the prognosis of patients with low back pain are generally disregarded. The StarT Back Screening Tool can help clinicians to analyze prognostic indicators and the risk associated with outcome by examining physical and psychosocial factors. The aim of this study was to investigate the psychometric properties of the Turkish version of the StarT Back Screening Tool, including cross-cultural adaptation, internal consistency, test-retest reliability, and construct validity. In this study, 120 patients with non-specific low back pain were included. The Roland Morris Disability Questionnaire, Oswestry Disability Index, Beck Depression Inventory, Tampa Scale for Kinesiophobia, and the StarT Back Screening Tool were administered. One week after the initial testing, the same examiner repeated the tests. The mean age of the patients who participated in the study was 35.54±12.45 years. Cronbach's alpha coefficients in the analysis of scale reliability were 0.747 for the overall scale and 0.738 for the psychosocial subscale. The test-retest reliability of StarT Back Screening Tool (intraclass correlation coefficient: 0.90-0.93) was found to be excellent. Pearson correlation coefficients for the correlations between the overall StarT Back Screening Tool and the other measures were very good (r=0.678; p<0.001) for the Roland Morris Disability Questionnaire, good (r=0.473; p<0.001) for the Tampa Scale for Kinesiophobia, good (r=0.541; p<0.001) for the Oswestry Disability Index, and moderate (r=0.336; p<0.001) for the Beck Depression Inventory. The Turkish version of the StarT Screening Tool for non-specific back pain was determined to be valid and reliable. A good assessment of both physical and psychosocial factors in symptomatic patients can help clinicians make a thorough prognosis.

The Impact of the Rising Colorectal Cancer Incidence in Young Adults on the Optimal Age to Start Screening in the US: A Microsimulation Analysis

Background: In 2016, the MISCAN-Colon model was used to inform the US Preventive Services Task Force (USPSTF) colorectal cancer (CRC) screening guidelines, which recommend screening from ages 50 to 75 years for average risk individuals. However, these models did not take into account the increase in CRC incidence below the age of 50 years. Aim: In this study, we reevaluated the optimal age to start screening, age to end screening and screening interval in light of the increase in CRC incidence observed in young adults. Methods: We adjusted the simulated lifetime CRC incidence in the MISCAN-Colon model to reflect the observed increase in young onset incidence. In line with the strong birth cohort effect, the current generation of 40-year-olds was assumed to carry forward escalated disease risk as they age. Life-years gained (benefit), the number of colonoscopies (burden) and the ratios of incremental burden to benefit (efficiency ratio) were projected for different screening strategies. Strategies differed with respect to test modality, ages to start screening (40, 45, 50), ages to stop screening (75, 80, 85), and screening intervals (depending on screening modality). We then determined the model-recommended strategies in a similar way as we did for the USPSTF, using similar efficiency ratio thresholds to the previously accepted efficiency ratio of 39 incremental colonoscopies per life-year gained. Results: The life-years gained and the number of colonoscopies for each colonoscopy strategy are plotted in Fig 1. Because of the higher CRC incidence, model-predicted life-years gained from screening increased compared with our previous analyses for the USPSTF. Consequently, the balance of burden to benefit of screening improved, with colonoscopy screening every 10 years starting at age 45 years resulting in an efficiency ratio of 32 incremental colonoscopies per life-year gained. Conclusion: This decision-analytic modeling approach suggests that based on the increase in young-onset CRC incidence, screening initiation at age 45 years has a favorable balance between screening benefits and burden. Screening until age 75 years with colonoscopy every 10 years, fecal immunochemical testing annually, flexible sigmoidoscopy every 5 years, and computed tomographic colonography every 5 years was recommended by the model as these strategies provided similar life-years gained at an acceptable screening burden.[Figure: see text]

ADR of ‘Average Risk’ Males Aged 45-50 and &gt;50 Screening Population Are Equivalent

Introduction: The American Cancer Society recently released updated “qualified recommendations” on Colorectal screening, recommending to start screening at age 45 for average risk population. These recommendations came out as a response to the increasing rates of CRC among adults less an age 50. The goal of our study was to analyze the adenoma detection rates (ADR) among people less than age 50 based on indication, particularly in compared to those who underwent “early” colonoscopy for average risk. Methods: Colonoscopy quality data was collected prospectively at our single tertiary referral center from June 2012 to June 2018. Inclusion criteria for the current study included all colonoscopies in patients aged 20 - 49, excluding those with inflammatory bowel disease and indications that had less than 30 total procedures. Within this cohort, ADR was analyzed by indication for colonoscopy. Significance was determined via a two-tailed Fisher’s exact test. Results: 1393 colonoscopies met our inclusion criteria. Average age (SD) of patients was 38.8 years (8.4). A breakdown of indications for this group are shown in Table 1. Subgroup analysis showed that ADR of patients 45-50 years old getting colonoscopy for “average risk” was 0.39 (OR 0.87 95% CI 0.59 to 1.3), 0.28 for females and 0.46 for males. The ADR for our average risk population > age 50 in our database is also 0.46. Conclusion: We are in the early days of the new ACS recommendation. The USPSTF and GI societies will soon decide if new guidelines will lower the screening age for colonoscopy. In the setting of what can be a pivotal moment in CRC screening guidelines, we present data showing that the risk of having a precancerous adenoma in the average risk population is near that of the population we are currently screening, and in the case of males aged 45-50 the risk of a precancerous adenoma is equal to that of the established screening population, further warranting CRC screening for all people aged 45-50 years.228_A Figure 1. Indications and ADR for Colonoscopy in Patients < 50 years228_B Figure 2. ADR for Average Risk Patients aged 45-50 Compared to Average Risk age > 50

Diagnosing Nonfunctional Pancreatic NETs in MEN1: The Evidence Base

In multiple endocrine neoplasia type 1 (MEN1), nonfunctional pancreatic neuroendocrine tumors (NF-pNETs) are the most frequently diagnosed NETs and a leading cause of MEN1-related death. The high prevalence and malignant potential of NF-pNETs outline the need for an evidence-based screening program, as early diagnosis and timely intervention could reduce morbidity and mortality. Controversies exist regarding the value of several diagnostic tests. This systematic review aims to evaluate current literature and amplify an up-to-date evidence-based approach to NF-pNET diagnosis in MEN1. Three databases were systematically searched on the diagnostic value of biomarkers and imaging modalities. Twenty-seven studies were included and critically appraised (modified Quality Assessment of Diagnostic Accuracy Studies). Another 12 studies, providing data on age-related penetrance and tumor growth, were included to assess the optimal frequency and timing of screening. Based on current literature, biomarkers should no longer play a role in the diagnostic process for NF-pNETs, as accuracies are too low. Studies evaluating the diagnostic value of imaging modalities are heterogeneous with varying risks of bias. For the detection of NF-pNETs, endoscopic ultrasound (EUS) has the highest sensitivity. A combined strategy of EUS and MRI seems to be the most useful. Gallium 68 octreotate-DOTA positron emission tomography-CT could be added if NF-pNETs are diagnosed to identify metastasis. Reported growth rates were generally low, and two distinct phenotypes were observed. Surveillance programs should focus on and be adapted to the presence of substantial growth in NF-pNETs. The optimal age to start screening must yet be determined, as insufficient evidence for an evidence-based recommendation was available.

The impact of the rising colorectal cancer incidence in young adults on the optimal age to start screening: Microsimulation analysis I to inform the American Cancer Society colorectal cancer screening guideline.

BACKGROUNDIn 2016, the Microsimulation Screening Analysis‐Colon (MISCAN‐Colon) model was used to inform the US Preventive Services Task Force colorectal cancer (CRC) screening guidelines. In this study, 1 of 2 microsimulation analyses to inform the update of the American Cancer Society CRC screening guideline, the authors re‐evaluated the optimal screening strategies in light of the increase in CRC diagnosed in young adults.METHODSThe authors adjusted the MISCAN‐Colon model to reflect the higher CRC incidence in young adults, who were assumed to carry forward escalated disease risk as they age. Life‐years gained (LYG; benefit), the number of colonoscopies (COL; burden) and the ratios of incremental burden to benefit (efficiency ratio [ER] = ΔCOL/ΔLYG) were projected for different screening strategies. Strategies differed with respect to test modality, ages to start (40 years, 45 years, and 50 years) and ages to stop (75 years, 80 years, and 85 years) screening, and screening intervals (depending on screening modality). The authors then determined the model‐recommended strategies in a similar way as was done for the US Preventive Services Task Force, using ER thresholds in accordance with the previously accepted ER of 39.RESULTSBecause of the higher CRC incidence, model‐predicted LYG from screening increased compared with the previous analyses. Consequently, the balance of burden to benefit of screening improved and now 10‐yearly colonoscopy screening starting at age 45 years resulted in an ER of 32. Other recommended strategies included fecal immunochemical testing annually, flexible sigmoidoscopy screening every 5 years, and computed tomographic colonography every 5 years.CONCLUSIONSThis decision‐analysis suggests that in light of the increase in CRC incidence among young adults, screening may be offered earlier than has previously been recommended. Cancer 2018;124:2964‐73. © 2018 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

Optimizing colorectal cancer screening by race and sex: Microsimulation analysis II to inform the American Cancer Society colorectal cancer screening guideline.

BACKGROUNDColorectal cancer (CRC) risk varies by race and sex. This study, 1 of 2 microsimulation analyses to inform the 2018 American Cancer Society CRC screening guideline, explored the influence of race and sex on optimal CRC screening strategies.METHODSTwo Cancer Intervention and Surveillance Modeling Network microsimulation models, informed by US incidence data, were used to evaluate a variety of screening methods, ages to start and stop, and intervals for 4 demographic subgroups (black and white males and females) under 2 scenarios for the projected lifetime CRC risk for 40‐year‐olds: 1) assuming that risk had remained stable since the early screening era and 2) assuming that risk had increased proportionally to observed incidence trends under the age of 40 years. Model‐based screening recommendations were based on the predicted level of benefit (life‐years gained) and burden (required number of colonoscopies), the incremental burden‐to‐benefit ratio, and the relative efficiency in comparison with strategies with similar burdens.RESULTSWhen lifetime CRC risk was assumed to be stable over time, the models differed in the recommended age to start screening for whites (45 vs 50 years) but consistently recommended screening from the age of 45 years for blacks. When CRC risk was assumed to be increased, the models recommended starting at the age of 45 years, regardless of race and sex. Strategies recommended under both scenarios included colonoscopy every 10 or 15 years, annual fecal immunochemical testing, and computed tomographic colonography every 5 years through the age of 75 years.CONCLUSIONSMicrosimulation modeling suggests that CRC screening should be considered from the age of 45 years for blacks and for whites if the lifetime risk has increased proportionally to the incidence for younger adults. Cancer 2018;124:2974‐85. © 2018 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

Knowledge and attitudes about cervical cancer and its prevention among female secondary school students in Nigeria.

To ascertain the level of awareness and attitudes towards cervical cancer among secondary school students in Nigeria. Cross-sectional survey of 432 female senior secondary school students in south-eastern Nigeria. A total of 321 (74.3%) responses were valid; 42.7% had heard of cervical cancer, 32.8% of screening, 23.2% of Pap smears and 22.0% of HPV/HPV vaccinations. No widely available reliable source of information exists. General knowledge about Pap smears (41.8%) and HPV (43.1%) was poor, as was specific knowledge about their benefits, timing and frequency, and about HPV vaccinations, but associated attitudes were moderately positive at 60.2% and 65.1%, respectively. Awareness of cervical cancers increases knowledge about when to start screening (OR=2.30; P=0.02) and about early symptoms of cervical cancer (OR=2.56; P=0.001). Overall knowledge of cervical cancer is poor, but attitudes are positive. Awareness campaigns are therefore necessary, and are expected to be effective. Campaigns should target teenage females, and commencing teaching in high schools of developing countries, through materials included in their academic curricula, is recommended.

Medical Home-Head Start Partnership to Promote Early Learning for Low-Income Children.

To improve Early Head Start/Head Start (EHS/HS) screening, referral, and enrollment for children from diverse, low-income communities. Using existing resources, we built a pediatric clinic-Head Start partnership. Key steps included (1) screening protocol and tracking system, (2) a community partner as a single point of referral contact, (3) provider education, and (4) monthly outcome reporting. A pre- and post-cross-sectional study design was used to evaluate outcomes, with medical chart review conducted for all wellness visits among children aged 0 to 4 years pre- and postintervention. The preintervention group included 223 patients. The postintervention group included 235 patients. EHS/HS screening improved significantly after the intervention, rising from 8% in the preintervention period to 46% in the postintervention period (odds ratio [OR] 10.5, 95% confidence interval [CI] [5.9, 19.4]). EHS/HS documented referral rates increased from 1% in the preintervention period to 20% in the postintervention period (OR 18.3, 95% CI [5.7, 93.6]). Thirty-two of the 42 patients in the postintervention group referred to EHS/HS were reached to determine enrollment status. Six children (14%) had enrolled in EHS/HS. With use of existing resources, a medical home-Head Start partnership can build an integrated system that significantly improves screening and referral rates to early learning programs.