Cancer Screening Tests Research Articles

Management of women with abnormal cervical cytology: Update of INCa recommendations after the implementation of HPV screening

To update the recommendations issued by the National Cancer Institute (INCa) on the management of women with abnormal cervical cytology. INCa recommendations on the management of women with abnormal cervical cytology were published in 2016. In 2019, the High Authority of Health (HAS) recommends HPV test for cervical cancer screening in women over 30. It was therefore necessary to update the initial management and follow-up of women with a reflex cytology abnormality after a positive HPV test. We used the modified Delphi method. Each decision tree was modified by the 3 members of the organizing committee and then presented to 35 experts over 2 rounds, in order to obtain their agreement in terms of validity and clarity. This formalized consensus of experts allowed the creation of 17 decision trees instead of 15 previously: 13 on the diagnostic management of abnormal cytology, stratified according to age, and 4 on therapeutic indications in abnormal histology. The median agreement scores were 89% (81-97). These 17 decision trees respond to the different situations that health professionals may encounter in order to enable them to act, to follow-up or delegate according to their specialties.

Performance of a blood-based test for colorectal cancer screening adjusted to the US census age and sex distribution.

18 Background: Despite availability of various screening options, nearly 40% of eligible U.S. adults were not up to date with the colorectal cancer (CRC) screening. Blood-based testing offers a promising complementary approach and may enhance patient adherence among unscreened individuals. In the PREEMPT CRC study, we evaluated clinical performance of an investigational blood-based screening test for detecting molecular signals of advanced colorectal neoplasia (ACN) in an average-risk population. Freenome blood-based CRC screening test met all primary endpoints demonstrating 79.2% sensitivity for CRC, 91.5% specificity for ACN, 90.8% negative predictive value (NPV) for ACN and 15.5% positive predictive value (PPV) for ACN. Sensitivity for advanced precancerous lesions (APLs) was 12.5%. To evaluate how the test would perform in the standard U.S. population, an analysis of test performance weighted to the U.S. census sex and age distribution was prespecified and performed. Methods: Between May 2020 and April 2022, the study enrolled participants aged 45-85 at average risk for CRC. Enrolled participants had a blood drawn before the bowel preparation for the standard of care screening colonoscopy (CS). CS and applicable histopathology reports underwent central pathologist review. Blood samples were processed blind to clinical findings. Primary endpoints included sensitivity for CRC, specificity for ACN, NPV for ACN and PPV for ACN. A secondary endpoint was sensitivity for APLs. Results: A subset of 32,731 sequentially enrolled participants were included in the clinical validation cohort. Out of those, 27,010 (82.5%) had evaluable blood samples and CS. The median age of the evaluable participants was 57.0 years, and 55.8% were women versus 50.5% in the U.S. Census. Age distribution included 11.0% participants in the 45-49 age group versus 15.3% in the U.S. Census, 33.0% in the 50-54 age group versus 15.6%, and 32.3% in the 55-64 age group versus 32.3%, 20.8% in the 65-74 age group versus 24.3%, 3.0% participants aged 75 or older versus 12.5%. After performance was weighted to match U.S. Census sex and age distributions, sensitivity for CRC was 81.1% (95% CI 71.3%-88.1%), specificity for those without ACN was 90.4% (95% CI 90.0%-90.7%), NPV for those without ACN was 90.5% (95% CI 90.5%-90.7%), and PPV for ACN was 15.5% (95% CI 13.8%-16.2%). Sensitivity for APL was 13.7% (95% CI 12.4%-15.0%). Conclusions: PREEMPT CRC is the largest study evaluating a CRC screening blood-based test to date. The study successfully met all primary endpoints, demonstrating acceptable clinical performance of the investigational blood-based test. The U.S. census sex-age adjusted clinical performance estimates showed improvement in CRC and APL sensitivity. This blood-based test may provide a convenient and effective option for CRC screening in the average-risk U.S. population. Clinical trial information: NCT04369053 .

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.

Are Non-invasive Multi-cancer Early Cancer Detection Tests the Future?

Current cancer screening methods are effective for detecting early stage cancers and even preventing some cancers, but their effectiveness has only been demonstrated for a handful of cancers,and for many cancers, there are noscreening tests clinically available. In addition, the majority of the screening methods are not ideal, resulting in suboptimal compliance and the occurrence of preventable cancers. A screening test that is convenient, safe, accurate and that can screen for multiple cancers is an ideal screening test that would addressmany of the shortcomings of the current tests. Multi-cancer detection tests (MCD) have the potential to meet these challenges and have engendered substantial enthusiasm in light of this. Using advances in DNA sequencing technology, cancer epigenetics and artificial intelligence, they are able to detect a large number of cancers predominantly via the patterns of methylated DNA alterations, DNA sequence alterations, and DNA fragment patterns of cell free DNA in the plasma and can accurately distinguish the cancer site of origin. Of note, some of the tests also combine circulating free DNA (cfDNA) with protein-based markers. However, for the majority of early stage cancers, the sensitivity is modest and below that of most of the current standard of care cancer screening tests. Furthermore, the clinical utility of screening for many of the cancers detectable by MCD tests remains to be proven. Here we describe the features of MCD tests, review the current data supporting their potential to be used in the clinic for cancer screening, and discuss the knowledge gaps surrounding understanding their clinical utility, with a focus on GI cancer screening.

What does cancer screening have to do with tomato growing?

Cancer screening is considered to be a major strategy for combatting cancer. The United States Preventive Services Task Force (USPSTF) recommends screening for five cancers, but the strength of evidence about the effectiveness of screening is limited. To gain insights into the efficacy of early detection requires prospective, blinded, placebo-controlled clinical trials with decades of follow-up and inclusion of millions of participants. Recently, Bretthauer etal. estimated lifetime gained with cancer screening tests by using a meta-analysis of 18 large randomized clinical trials which included more than two million subjects. They asked if cancer screening tests are saving lives and how much life is extended due to commonly used cancer screening tests. Colorectal cancer screening with sigmoidoscopy prolonged lifetime by 110days, while fecal testing and mammography screening did not prolong life. A modest extension of 37days was noted for prostate cancer screening with prostate-specific antigen testing and 107days with lung cancer screening using computed tomography, but these estimates were not statistically significant. The authors concluded that current cancer screening strategies do not significantly prolong life. Based on these data, and the known biological behavior of some cancers, we hypothesized that the current strategies of treating cancer, after detection, could be modified to avoid the side effects of screening, which is a major determinant of the patient's overall survival.

Adherence to multi-target stool DNA testing for colorectal cancer screening in the United States

PurposeColorectal cancer (CRC) is the second leading cause of cancer mortality in the USA and is highly preventable, with early screening vital for improving outcomes. This study aimed to evaluate adherence rates of multi-target stool DNA (mt-sDNA) testing, following updated guidelines recommending screening starting at age 45.MethodsThis retrospective cohort study used aggregated data from Exact Sciences Laboratories LLC, examining new users (first-time testers) aged 45–85 with commercial, Medicare, or Medicaid insurance who received mt-sDNA test kits (point-of-care) between January 1, 2023, and June 1, 2023. Adherence was defined as the percentage of eligible participants returning a valid non-empty test kit within 365 days of initial shipment date. Descriptive statistics and logistic regression were used to analyze adherence.ResultsAmong 1,557,915 patients, the overall adherence rate to mt-sDNA testing was 71.3% (commercial insurance 72.3%, Medicare Advantage 70.2%, Medicare 69.9%, Medicaid 52.0%) (p < 0.001). Females had slightly higher adherence than males, except for commercial insurance (72.2% vs. 72.6%, p < 0.001). Adherence was highest in commercial insurance for individuals aged 76–85 (79.2%, p < 0.001), gastroenterology patients (82.5%, p < 0.001), and rural residents (73.2%, p < 0.001), along with those in Medicare Advantage earning $200 K + (78.5%, p < 0.001).ConclusionsAdherence to mt-sDNA testing was robust, particularly among individuals with commercial insurance, older adults, gastroenterology patients, higher income groups, and rural residents. With a 71% adherence rate, the test demonstrates substantial engagement and value in colorectal cancer screening. Future research should assess its long-term impact and address disparities to optimize its benefits.

A Comparative Environmental Impact Analysis of Screening Tests for Colorectal Cancer.

Healthcare is a major contributor to global greenhouse gas emissions. Colorectal cancer (CRC) screening is one of the most widely used healthcare services in the US, indicated for approximately 134 million adults. Recommended screening options include fecal immunochemical tests (FITs) every year, CT colonographies (CTCs) every 5 years, or colonoscopies every 10 years. We compared the environmental impacts of these tests and identified opportunities for impact reduction. We conducted a comparative life cycle assessment of three CRC screening strategies at the University of California, San Francisco. We performed on site audits to document the materials and energy used for each screening test. We used the ReCiPe 2016 method to estimate the environmental impacts of these procedures, measured by global warming potential (GWP) and damage to human health. We estimated the 10-year cumulative impacts of each screening strategy using a Markov reward model. We accounted for model uncertainty using hierarchical Monte Carlo simulations. FIT-based screening had the lowest environmental impacts, with a roughly 20% margin of superiority over colonoscopies, and this finding was robust in sensitivity analyses. Across tests, the biggest cause of environmental harm was car-based transportation of patients and staff. Prioritizing FITs over screening colonoscopies in the US could enhance population health by roughly 5.2 million disability adjusted life years per decade. Transitioning to electric vehicles could reduce the GWP of all screening tests by 15-20%. Given the similar efficacy and safety of these tests, payors should prioritize FITs for low-risk patients. Government initiatives to decarbonize transportation, incentivize telehealth, and mandate environmental product declarations will help reduce the environmental impacts of healthcare more generally. Our results call for a closer look at resource-intensive preventative health strategies, which could result in more harm than good if applied to a low-risk population. NIH, UCSF.

Rethinking prostate cancer screening in transgender women

Introduction: Over the years, the number of people openly identifying as transgender has steadily increased, leading to a greater need for transgender-specific healthcare information. Among transgender women (TW), there remains a risk of prostate cancer since the prostate is not removed during gender-affirming hormone therapy (GAHT) or surgery; however, there is limited knowledge about prostate cancer screening in the transgender population. Although there are few reported cases of prostate cancer screening or prostate-specific antigen (PSA) testing in TW, the impact of hormone therapies on PSA levels is well-documented. Notably, GAHT for TW and hormone therapy for treating prostate cancer share similarities. Drawing on these similarities, we aimed to develop guidelines for baseline PSA levels and prostate cancer screening in TW. Methods: Through a systematic review, we examined the existing PubMed publications on PSA levels and prostate cancer screening in TW, as well as expected PSA levels in patients with prostate cancer undergoing hormone therapies. We also investigated other aspects considered for the diagnosis of prostate cancer. Given the limited research on TW, we also included relevant case studies. These publications and case reports were reviewed and analyzed to create a comprehensive overview of expected baseline PSA levels and prostate cancer screening guidelines for TW. Results: Currently, there are no established guidelines for PSA or prostate cancer screening in TW; however, these case studies indicated a range of PSA values from 3.3 to &lt;100 ng/ml. Existing literature on expected PSA levels in prostate cancer patients undergoing hormone therapy shows a reduction in PSA of over 50% post-therapy. This evidence suggests that PSA values in TW presenting with prostate cancer may be lower than those observed in cisgender males with the disease. Conclusions: While TW exhibit lower prostate cancer incidence compared to cisgender men, the impact of hormone therapy on PSA levels presents significant challenges for screening and diagnosis. The parallels between PSA level reductions in TG women and cisgender men undergoing estrogen therapy highlight the need for revised screening protocols. Addressing these challenges through targeted research and personalized care approaches will be vital for improving prostate cancer management in transgender individuals.

Modeling and the Use of Surrogate Endpoints: Is This a Valid Approach?

Development of novel colorectal cancer (CRC) screening tests is a dynamic field. Decision analytic modeling based on inputs derived from rigorous prospective studies informs CRC screening guidelines. Exploratory modeling may have a place in early phases of test development. We explored whether (1) surrogate endpoints for long-term, programmatic effectiveness, and cost-effectiveness could be potentially informative in early stages of test development and (2) whether rapid exploratory modeling with a web-based tool would be feasible. First, based on comparisons with published estimates for reductions in CRC mortality with various screening tests in four established decision analytic models of CRC screening, the surrogate endpoint of the number needed to colonoscope to detect one CRC or advanced precancerous lesion (APL) in round 1 of screening appears to hold promise as a measure of clinical effectiveness. Similarly, based on comparisons with published estimates for cost/quality-adjusted life-year gained with screening in the four models, the surrogate endpoint of cost to detect one CRC or APL in round 1 of screening appears to hold promise as a measure of cost-effectiveness. Second, exploration of the impact of lowering the screening initiation age in Israel from age 50 to 45 with the web-based EU-TOPIA tool, compared with the results of a recently published comprehensive modeling study, suggests that exploratory modeling of programmatic screening may be feasible with relatively low time demand vs. that required for typical full-length modeling publications. Further validation in other models and with a broader set of test performance characteristics is prudent before surrogate endpoints or rapid modeling are incorporated into the novel test development process.

Public awareness and knowledge of Pap smear as a screening test for cervical cancer among females in Al-Qunfudhah, Saudi Arabia: a cross-sectional study

Objective: This study aimed to assess the knowledge and awareness of cervical cancer (CC) screening among married women in Al-Qunfudhah, Saudi Arabia. Methods: This study was a web-based descriptive cross-sectional study. Data were collected via an online questionnaire from January 2023 to January 2024, targeting all married women in Al-Qunfudhah, with no exclusion criteria. The structured questionnaire, created in Arabic using Google Forms, included closed-ended questions on sociodemographic characteristics, knowledge, awareness, and practices related to cervical cancer and its screening. Knowledge level and practice were assessed and compared based on participants&amp;apos; characteristics. Results: The study analyzed responses from 389 participants, with a mean age of 34.8 years ± 9.4 years. Most participants were Saudi (99.0%), married (89.5%), and highly educated (77.6%). Only 13.4% demonstrated good knowledge of cervical cancer, and 23.4% had undergone a Pap smear. A significant difference was found between age and knowledge level, with younger women (&amp;lt; 35 years) exhibited higher knowledge (19.4%) compared to those &amp;ge; 35 years (6.6%). While educational attainment did not significantly impact knowledge, university graduates showed slightly better knowledge levels. Differences in Pap smear practice based on occupation were noted, but not statistically significant. Conclusion: The low levels of knowledge and screening practices related to cervical cancer among women in Al-Qunfudhah underscore the urgent need for comprehensive awareness programs to improve knowledge and screening participation in the region.

Multi-Cancer Early Detection Tests: State of the Art and Implications for Radiologists.

Multi-cancer early detection (MCED) tests are already being marketed as noninvasive, convenient opportunities to test for multiple cancer types with a single blood sample. The technology varies-involving detection of circulating tumor DNA, fragments of DNA, RNA, or proteins unique to each targeted cancer. The priorities and tradeoffs of reaching diagnostic resolution in the setting of possible false positives and negatives remain under active study. Given the well-established role of imaging in lesion detection and characterization for most cancers, radiologists have an essential role to play in selecting diagnostic pathways, determining the validity of test results, resolving false-positive MCED test results, and evaluating tradeoffs for clinical policy. Appropriate access to and use of imaging tests will also factor into clinical guidelines. Thus, all clinicians potentially involved with MCED tests for cancer screening will need to weigh the benefits and harms of MCED testing, including consideration of how the tests will be used alongside or in place of other screening options, how diagnostic confirmation tests should be selected, and what the implications are for policy and reimbursement decisions. Further, patients will need regular support to make informed decisions about screening using MCED tests in the context of their personal cancer risks, health-related values, and access to care.

PAP Smear in Pregnant Women: A Hospital Based Study

Introduction: Pregnancy provides an important opportunity to screen the cervix for neoplastic and infectious diseases and to spread awareness. A Papanicolaou(Pap) smear is simple, cost effective and safe during pregnancy. In low resource countries, this may be the only opportunity when woman visits a health care centre. Objective of this study is to use Pap smear as a cervical cancer screening test in pregnant women and to determine the prevalence of abnormal Pap smear among pregnant women attending the antenatal outpatient department. Methods: A prospective study conducted in the department of Obstetrics and Gynaecology of Shree Birendra Hospital for a period of 12 months from September 2020 to August 2021. Inclusion criteria was pregnant women in the first trimester. Exclusion criteria were pregnancy greater than 12 weeks, symptoms of vaginal infection, history of sexual intercourse or vaginal medication or bleeding in the last 48 hours or normal Pap smear in last 3 years. Ayre’s spatula was used to conduct smear test in this study. All the smears were immediately fixatived in 95% ethanol and sent to the department of pathology. The cytological result were reported on the Bethesteda classification system 2014. Results: Out of 300 pregnant women enrolled in the study, the Pap smear report revealed that 28.3% of the study subjects had inflammatory smear 65.7% of the subjects showed negative for intraepithelial lesion or malignancy and only 0.3% of subjects had Atypical Squamous Cells of Undetermined Significance (ASCUS). No satisfactory sample was reported in 5.7% of the subjects. Conclusions: The antenatal period should be utilized as an opportunity to screen women for cancer cervix. Pap smear during pregnancy not only gives the opportunity to screen but also helps to create awareness.

Multitarget Stool DNA Testing for Colorectal Cancer Screening in Clinical Practice.

Few studies have evaluated multitarget stool DNA (mt-sDNA) in clinical practice. We analyzed mt-sDNA utilization at the University of Pittsburgh Medical Center. We assessed mt-sDNA orders between January 1, 2017, and December 31, 2021. Data collection included electronic capture of mt-sDNA orders, completed stool submissions, and test results. Multivariable models were used to assess associations between mt-sDNA completion and results and age, sex, and race. There were 91,664 mt-sDNA orders in 73,704 patients. A total of 54.7% (40,337/73,704) completed an mt-sDNA test, and 7,424 (18.6%) tested positive. Completion rates increased by age <50-59 years (N = 12,818; 48.2%), 60-69 years (14,982; 56.3%), and ≥70 years (N = 9,850; 55.6%) ( P < 0.0001). The completion rate for males (52.7%; 15,297/29,025) did not differ significantly from females (53.3%; 22,353/41,901) ( P = 0.09). By race, the completion rates of White patients (54.1%; 34,874/64,512) and Asian patients (56.9%; 493/867) were higher than those of Black patients (38.8%; 1,699/4,376) ( P < 0.0001). Test completion declined with repeat mt-sDNA orders, with ≤32% completion rate after ≥3 orders. In a multivariable model, older age was associated with greater likelihood of a positive test (odds ratio 1.22, 95% confidence interval 1.20-1.24, P < 0.0001), and Black patients had lower odds of a positive test (odds ratio 0.65, 95% confidence interval 0.56-0.76, P < 0.0001). Only 54.7% of patients completed their mt-sDNA test order. Older individuals were more likely to complete testing and test positive. Black patients were less likely to complete testing and, unexpectedly, less likely to test positive. Further exploration of mt-sDNA utilization including better understanding of the determinants of uptake, appropriateness, and evaluation of outcomes at colonoscopy is needed.

RE: Characteristics of a cost-effective blood test for colorectal cancer screening

RE: Characteristics of a cost-effective blood test for colorectal cancer screening

Estimating the incremental population health impact of a multi-cancer early detection (MCED) test to complement existing screening among elevated risk populations with multiple cancer risk factors: a mathematical modeling study

BackgroundThe added benefits of a multi-cancer early detection (MCED) test among individuals with multiple risk factors will help policy decision-makers allocate limited healthcare resources. This study sought to estimate the population health implications of adding an MCED test to standard-of-care (SOC) cancer screening tests among individuals aged 50–79 years with additional cancer risk factors (i.e., tobacco use, family history of cancer, and/or obesity).MethodsA mathematical model was developed to assess the potential screening efficiency of an MCED test in addition to current guideline-recommended screenings. Among the US population of 107 million adults aged 50–79 years, the size of, and cancer risk among specific subgroups (i.e., smokers, obese individuals, those with a family history of cancer) as well as the general population were estimated from the literature. Published estimates of screening uptake and/or performance were used to model the number of cancers detected by SOC screening alone, and the number of incremental cancers that could be detected by an MCED test. Screening efficiency outcomes included the true-positive:false-positive (TP:FP) ratio, diagnostic yield (DY), and cancer detection rate (CDR). Sensitivity analyses were conducted by varying the values of key parameters.ResultsAmong all subgroups, the TP:FP ratios were higher with an MCED test than with SOC screening alone, and higher than in the general population, suggesting improved screening efficiency with an MCED test. The estimated TP:FP ratios were 1:43.3 (SOC)/1:1.1 (MCED), 1:40.4/1:0.8, 1:36.9/1:0.5 among former, ever, and current smokers, respectively, 1:38.3/1:0.9 (those with a family history of cancer), and 1:39.3/1:1.1 (obese individuals). Among the general population, the TP:FP ratios were 1:43.5/1:1.1. Across all subpopulations, the DY and CDR increased by up to threefold with an MCED test, when compared to SOC screening alone, with up to 75% of cancers detected with an MCED test lacking a screening paradigm. These results were robust in sensitivity analyses.ConclusionsAdding an MCED test could improve screening efficiency among individuals with multiple risk factors, as well as the general population.

Colonoscopy Remains an Important Option for Primary Screening for Colorectal Cancer.

Colonoscopy remains the most commonly used colorectal cancer screening test in the United States. A substantial portion of the screening population value the high sensitivity of colonoscopy for precancerous colorectal lesions of all sizes, which allows it to be performed at 10year intervals in average-risk persons with negative examinations. Emerging evidence supports the eventual endorsement of 15year intervals for patients with normal examinations. Considerable evidence supports an impact of colonoscopy on colorectal cancer incidence and mortality, including a randomized controlled trial of colonoscopy vs. no screening, numerous case-control and cohort studies, an impact of fecal blood testing on cancer incidence, and the impact of one randomized controlled trial of flexible sigmoidoscopy on proximal colon cancer incidence. Colonoscopy is the gold standard for detection of colorectal precancerous lesions, and continues to evolve with regard to sensitivity for precancerous lesions and the effectiveness and safety of precancerous lesion resection. Gains in detection of precancerous lesions have followed from a robust movement to improve colonoscopy quality, and development of non-device techniques such as patient rotation during withdrawal, water exchange colonoscopy, and double examination of one or more colonic segments. Further, development of devices to improve mucosal exposure during withdrawal (e.g. Endocuff Vision, distal cap attachment, and Computer-Aided Quality), and devices that highlight flat lesions (e.g. chromoendoscopy, electronic chromoendoscopy, and Computer-Aided Detection) have created opportunities to achieve very high levels of detection and thereby increase the protective benefits of colonoscopy. Further, colonoscopy resection safety has improved via the widespread use of cold resection for lesions < 10mm in size, as well as sessile serrated lesions of all sizes. Colonoscopy can be offered to patients as one of multiple options for screening, or as the test of choice for patients with the highest pre-screening probability of cancer and precancerous lesions, or as the first test offered followed by offers of other screening tests if colonoscopy is declined (sequential offers of screening). Sequential offers of screening result in overall adherence to screening similar to offering multiple options, but with a higher fraction of patients undergoing colonoscopy. Given the long-lasting protective effects of colonoscopy and its improving effectiveness and safety, colonoscopy remains a useful option for primary average-risk colorectal cancer screening.

Performance characteristics of the point-of-care tests for HPV-based cervical cancer screening: a systematic review and meta-analysis.

We aimed to conduct an updated and comprehensive summary of the sensitivity and specificity of three human papillomavirus (HPV) point-of-care (POC) tests (careHPV™, oncoE6™ cervical test, Xpert® HPV) to guide resource-constrained countries for their implementation in cervical cancer screening. Databases including Medline, Embase, Web of Science and cumulated index in nursing and allied health literature (CINAHL) were searched between January 2004 and October 2024. Observational studies analyzing the three tests for cervical cancer screening were included. Pooled estimates for the performance characteristics were calculated using random-effect models. Of the 3976 records, 33 studies were included. The sensitivity and specificity of careHPV™ for detection of CIN2+ lesions in self-collected samples were 75.6% and 85.6% compared to 86.4% and 80.4% for physician-collected samples. The sensitivity and specificity of OncoE6™ cervical test were 54.5% and 98.4%, respectively, for physician-collected samples. Xpert® HPV had a sensitivity and specificity of 91.5% and 56.5% in self-collected vaginal samples (SCSs), 92.3% and 53.3%, respectively, in physician-collected cervical samples. Both careHPV™ and Xpert® HPV have a good sensitivity and specificity as a POC cervical cancer screening method. These methods also hold potential for use on SCSs. None.

EPH71 A Systematic Review and Meta-Analysis of Interval Cancer of Stool Testing for Colorectal Cancer Screening

EPH71 A Systematic Review and Meta-Analysis of Interval Cancer of Stool Testing for Colorectal Cancer Screening

Adherence to recommended blood-based screening tests for cancer and chronic diseases: A systematic literature review.

Blood-based tests represent a compelling option for early detection and management of cancers and other chronic diseases. While they may increase patient engagement, assumptions about greater adherence in clinical practice need further evaluation. This systematic review aimed to evaluate real-world adherence to established blood-based tests for commonly recommended screening indications to inform expectations for average-risk colorectal cancer (CRC) screening. A comprehensive and systematic search of PubMed, Embase, and citations was conducted to identify literature published from 2010 to 2023. Included studies examined adherence to United States Preventive Services Task Force (USPSTF) grade A/B blood test recommendations for type 2 diabetes, dyslipidemia, hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Prostate-specific antigen (PSA) testing adherence for prostate cancer screening (grade C USPSTF recommendation), the only widely accessible blood-based single-cancer screening test for average-risk adults, was also included. Studies without venipuncture-derived blood were excluded. Of 53,067 articles, 69 were included. Adherence rates of blood-based screening tests were highly variable, with median values and interquartile range (IQR) of 66.3 % (59.2-71.1), 67.8 % (54.4-72.4), 34 % (21.9-50.5), and 36.8 % (29.1-59.1) for diabetes, dyslipidemia, HCV, and HIV, respectively. PSA testing adherence was 37.2 % (30-48.5). Information and selection bias were common risks of bias. Real-world adherence to recommended blood-based screening is suboptimal. Future research is needed to determine whether these findings are generalizable to blood-based CRC screening and to assess how such a strategy could impact clinical, economic, and health equity outcomes.

Performance of HPV Self-Sample Collected by a Novel Kit in Comparison with Clinician Collected Sample for Cervical Cancer Screening.

We are reporting the performance of HPV self-sample collected by a novel kit in comparison with clinician collected cervical sample for HPV testing for cervical cancer screening. Consenting, eligible women aged 25 to 60, with a positive cervical cancer screening test report in the past one year but without any prior treatment for cervical abnormalities were enrolled in the study. Each woman provided 2 samples for the HPV test (vaginal self-sample collected with the CERVICHECKTM, an indigenous kit from India and cervical sample collected by the clinician). These samples were analysed using cobas HPV test on 4800 platform and for liquid-based cytology. We enrolled 156 eligible, consenting participants at 2 study sites. The agreement for the sample collected by CERVICHECKTM and clinician collected sample for any high-risk HPV was 95.1% (k= 0.90, SE 0.036, 95% CI 0.83-0.97). The agreement for HPV 16 or 18 only was 95.1%, (k=0.88, SE 0.045, 95% CI 0.79-0.97). The overall acceptability of the kit was good, participants expressed that self-sampling was easy and > 90% women were willing to recommend it to their friends. There was almost perfect or perfect agreement between the HPV self-sample collected by CERVICHECKTM and clinician collected cervical sample. Self-sampling was highly acceptable to the participating women.