ResearchPad - cancer-screening https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[The association between cervical cancer screening participation and the deprivation index of the location of the family doctor’s office]]> https://www.researchpad.co/article/elastic_article_14737 Cervical cancer screening rates are known to be strongly associated with socioeconomic status. Our objective was to assess whether the rate is also associated with an aggregated deprivation marker, defined by the location of family doctors’ offices.MethodsTo access this association, we 1) collected data from the claim database of the French Health Insurance Fund about the registered family doctors and their enlisted female patients eligible for cervical screening; 2) carried out a telephone survey with all registered doctors to establish if they were carrying out Pap-smears in their practices; 3) geotracked all the doctors’ offices in the smallest existing blocks of socioeconomic homogenous populations (IRIS census units) that were assigned a census derived marker of deprivation, the European Deprivation Index (EDI), and a binary variable of urbanization; and 4) we used a multivariable linear mixed model with IRIS as a random effect.ResultsOf 348 eligible doctors, 343 responded to the telephone survey (98.6%) and were included in the analysis, encompassing 88,152 female enlisted patients aged 25–65 years old. In the multivariable analysis (adjusted by the gender of the family doctor, the practice of Pap-smears by the doctor and the urbanization of the office location), the EDI of the doctor’s office was strongly associated with the cervical cancer screening participation rate of eligible patients (p<0.001).ConclusionThe EDI linked to the location of the family doctor’s office seems to be a robust marker to predict female patients’ participation in cervical cancer screening. ]]> <![CDATA["Clicks, likes, shares and comments" a systematic review of breast cancer screening discourse in social media]]> https://www.researchpad.co/article/N8d8d3073-6769-4a60-aed8-e2beb958c228

Background

Unsatisfactory participation rate at population based organised breast cancer screening is a long standing problem. Social media, with 3.2 billion users in 2019, is potentially an important site of breast cancer related discourse. Determining whether these platforms might be used as channels by screening providers to reach under-screened women may have considerable public health significance.

Objectives

By systematically reviewing original research studies on breast cancer related social media discourse, we had two aims: first, to assess the volume, participants and content of breast screening social media communication and second, to find out whether social media can be used by screening organisers as a channel of patient education.

Methods

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). After searching PubMed, ScienceDirect, Web of Science, Springer and Ebsco, 17 studies were found that met our criteria. A systematic narrative framework was used for data synthesis. Owing to the high degree of heterogeneity in social media channels, outcomes and measurement included in this study, a meta-analytic approach was not appropriate.

Results

The volume of breast cancer related social media discourse is considerable. The majority of participants are lay individuals as opposed to healthcare professionals or advocacy groups. The lay misunderstandings surrounding the harms and benefits of mammography is well mirrored in the content of social media discourse. Although there is criticism, breast cancer screening sentiment on the social media ranges from the neutral to the positive. Social media is suitable for offering peer emotional support for potential participants.

Conclusion

Dedicated breast screening websites operated by screening organisers would ensure much needed quality controlled information and also provide space for reliable question and answer forums, the sharing of personal experience and the provision of peer and professional support.

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<![CDATA[Oral smokeless tobacco consumption pattern among rural Indian cancer patients: A prospective survey]]> https://www.researchpad.co/article/N2c7ec7f4-dc06-4546-a665-499b06839c9d

Background:

Oral tobacco consumption predisposes to cancer. The pattern of its use in rural Indian cancer patients is unknown.

Aim:

The aim of this study is to estimate the prevalence of oral tobacco consumption in cancer patients.

Objectives:

To identify oral tobacco consumption pattern with respect to demographic variables and clinical profiles in adult Indian rural cancer patients.

Materials and Methods:

All consecutive individual adult (age >18 years) patients diagnosed with any cancer and registered in the Medical Oncology Outpatient department were enrolled for questionnaire-based survey on oral tobacco consumption between July 2017 and October 2017. Demographic variables were also recorded, including income, education, and occupation. Frequency distribution and cross-tabulation were used for statistical analysis using SPSS version 17.

Results:

Of 517 cancer patients enrolled, 456 (88%) were rural. 230/517 (44%) consumed several forms of oral tobacco. Out of 230, 179 (78%) of them had dried tobacco leaves, whereas 23 (10%) and 26 (11%) had Gutkha and pan (betel leaves) alone, respectively. 63 (27%) consumed tobacco leaves and gutkha both. 163 (91%) of tobacco chewers were male, whereas 65% of pan chewers were male and 35% of females. About 48% of tobacco chewers were addicted since >20 years, whereas 13% started in the past 5 years. 47/179 (26%) of tobacco chewers were illiterate, whereas 13/179 (7.2%) were graduates. 106 (59%) had monthly income of between Rs. 5000–10,000. 57 (32%) and 40 (22%) were farmers and laborers, respectively. 25/215 (12%) housewives were addicted. 41/58 (70%) of the head-and-neck cancer patients consumed tobacco products, where 29/41 (70%) used dried tobacco leaves to chew.

Conclusion:

More than 40% of adult Indian rural cancer patients consume oral smokeless tobacco products. Dried tobacco leaves are the most common form of smokeless tobacco consumed.

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<![CDATA[Economics of cancer care: A community-based cross-sectional study in Kerala, India]]> https://www.researchpad.co/article/N203aa0f7-40fa-44c1-923e-880603972e11

Background:

The estimated incidence of cancer cases in Kerala for 2014 was 31,400 and the mortality associated with it was 13,816. Although the treatment of cancer has shown remarkable advances, it has come with increasing costs.

Objective:

The objective of this study is to estimate the economic burden of cancer in Vypin Block Panchayat at Ernakulam by analyzing the average total direct and indirect cost of cancer care, socioeconomic status, and cost of cancer care between government and private hospitals.

Materials and Methods:

A cross-sectional study was conducted for 2 months from March to April 2018. The study was conducted by utilizing an annotated cost questionnaire for completion by patients. Total direct and indirect cost was estimated. Appropriate statistical tests were used.

Results:

Direct cost for cancer care contributed 75% toward the cost of illness and the remaining was found to be indirect cost. Loss of income (44%) contributed to the largest chunk of indirect cost. The average direct cost for cancer care was found to be Rs. 25,606 and the average indirect cost was Rs. 8772. The average total cost of cancer care was calculated to be Rs. 34,378. Significant statistical variation was found between the cost of cancer care in private and government hospitals. The economic burden of cancer in this Vypin Block Panchayat was found to be Rs. 218,256,977/-

Conclusion:

The ratio of average income to average cost in this study is skewed which indicates the lack of affordability for cancer care in this population. A very large gap, therefore, exits between income levels and cost of cancer care clearly indicating a vast gap between affordability and cost of treatment, which clearly necessitates the need for a definite policy and state intervention for a mass cancer care program.

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<![CDATA[Reliability of conventional Papanicolaou smear in diagnosing bacterial vaginosis among women with clinical genital infection]]> https://www.researchpad.co/article/N993465e4-47d8-4b9b-8366-b4aa5ee3b316

Objective:

Bacterial vaginosis (BV) is a common reproductive tract infection (RTI) reported among Indian women. BV can influence the persistence of high-risk oncogenic human papillomavirus, a causative factor for cervical cancer. BV and cervical cancer are major public health issues in a developing country like India. It becomes important for a resource-constrained country like India with poor healthcare access to implement control measures to screen and treat RTI in an attempt to prevent the risk for cervical cancer. Papanicolaou (Pap) smear is an established screening tool for cervical cancer and the diagnosis of RTIs, forms a part of its evaluation. The present study explores the validity of conventional Pap smear in diagnosing BV.

Methodology:

Pap smear and Gram stain smear were collected for 254 women with clinically evident cervicitis/cervicovaginitis (genital infection). Using the Nugent score on Gram stain as a gold standard, we determined the sensitivity and specificity of Pap smear to diagnose BV.

Results:

The overall prevalence of BV in the study population was 44% using the Nugent score. Pap smear showed sensitivity and specificity of 70.9%. (CI- 61.5% - 79.2%) and 56.8% (CI – 48.2%–65.2%), respectively. The positive predictive value of Pap smear to diagnose BV was 56.5% (CI – 47.8%–64.9%), and the negative predictive value was 71.2% (CI – 61.8%–79.4%).

Conclusion:

In the present study, conventional Pap smear demonstrates good accuracy to detect BV. Pap testing for cervical cancer screening can additionally serve as an effective screening tool for diagnosing BV among women with genital infection in healthcare settings.

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<![CDATA[A natural history model for planning prostate cancer testing: Calibration and validation using Swedish registry data]]> https://www.researchpad.co/article/5c6f1520d5eed0c48467ae2e

Recent prostate cancer screening trials have given conflicting results and it is unclear how to reduce prostate cancer mortality while minimising overdiagnosis and overtreatment. Prostate cancer testing is a partially observable process, and planning for testing requires either extrapolation from randomised controlled trials or, more flexibly, modelling of the cancer natural history. An existing US prostate cancer natural history model (Gulati et al, Biostatistics 2010;11:707-719) did not model for differences in survival between Gleason 6 and 7 cancers and predicted too few Gleason 7 cancers for contemporary Sweden. We re-implemented and re-calibrated the US model to Sweden. We extended the model to more finely describe the disease states, their time to biopsy-detectable cancer and prostate cancer survival. We first calibrated the model to the incidence rate ratio observed in the European Randomised Study of Screening for Prostate Cancer (ERSPC) together with age-specific cancer staging observed in the Stockholm PSA (prostate-specific antigen) and Biopsy Register; we then calibrated age-specific survival by disease states under contemporary testing and treatment using the Swedish National Prostate Cancer Register. After calibration, we were able to closely match observed prostate cancer incidence trends in Sweden. Assuming that patients detected at an earlier stage by screening receive a commensurate survival improvement, we find that the calibrated model replicates the observed mortality reduction in a simulation of ERSPC. Using the resulting model, we predicted incidence and mortality following the introduction of regular testing. Compared with a model of the current testing pattern, organised 8 yearly testing for men aged 55–69 years was predicted to reduce prostate cancer incidence by 14% and increase prostate cancer mortality by 2%. The model is open source and suitable for planning for effective prostate cancer screening into the future.

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<![CDATA[Perceptions of cervical cancer prevention on Twitter uncovered by different sampling strategies]]> https://www.researchpad.co/article/5c6b269dd5eed0c484289d78

Introduction

Cervical cancer prevention is possible through use of the HPV vaccine and Pap tests, yet the vaccine remains underutilized.

Methods

We obtained publicly-available Twitter data from 2014 using three sampling strategies (top-ranked, simple random sample, and topic model) based on key words related to cervical cancer prevention. We conducted a content analysis of 100 tweets from each of the three samples and examined the extent to which the narratives and frequency of themes differed across samples.

Results

Advocacy-related tweets constituted the most prevalent theme to emerge across all three sample types, and were most frequently found in the top-ranked sample. A random sample detected the same themes as topic modeling, but the relative frequency of themes identified from topic modeling fell in-between top-ranked and random samples.

Discussion

Variations in themes uncovered by different sampling methods suggest it is useful to qualitatively assess the relative frequency of themes to better understand the breadth and depth of social media conversations about health.

Conclusions

Future studies using social media data should consider sampling methods to uncover a wider breadth of conversations about health on social media.

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<![CDATA[Screening-based approach to discover effective platinum-based chemotherapies for cancers with poor prognosis]]> https://www.researchpad.co/article/5c59ff02d5eed0c4841358d8

Drug combinations are extensively used to treat cancer and are often selected according to complementary mechanisms. Here, we describe a cell-based high-throughput screening assay for identification of synergistic combinations between broadly applied platinum-based chemotherapeutics and drugs from a library composed of 1280 chemically and pharmacologically diverse (mostly FDA approved) compounds. The assay was performed on chemoresistant cell lines derived from lung (A549) and pancreatic (PANC-1) carcinoma, where platinum-based combination regimens are currently applied though with limited success. The synergistic combinations identified during the screening were validated by synergy quantification using the combination index method and via high content fluorescent microscopy analysis. New promising synergistic combinations discovered using this approach include compounds currently not used as anticancer drugs, such as cisplatin or carboplatin with hycanthone and cisplatin with spironolactone in pancreatic carcinoma, and carboplatin and deferoxamine in non-small cell lung cancer. Strong synergy between cisplatin or carboplatin and topotecan in PANC-1 cells, compared to A549 cells, suggests that this combination, currently used in lung cancer treatment regimens, could be applied to pancreatic carcinoma as well. Several drugs used to treat diseases other than cancer, including pyrvinium pamoate, auranofin, terfenadine and haloprogin, showed strong cytotoxicity on their own and synergistic interactions with platinum drugs. This study demonstrates that non-obvious drug combinations that would not be selected based on complementary mechanisms can be identified via high-throughput screening.

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<![CDATA[Recent incidence and surgery trends for prostate cancer: Towards an attenuation of overdiagnosis and overtreatment?]]> https://www.researchpad.co/article/5c61e937d5eed0c48496f9f2

Background

Screening for prostate cancer is frequent in high-income countries, including Switzerland. Notably due to overdiagnosis and overtreatment, various organisations have recently recommended against routine screening, potentially having an impact on incidence, mortality, and surgery rates. Our aim was therefore to examine whether secular trends in the incidence and mortality of prostate cancer, and in prostatectomy rates, have recently changed in Switzerland.

Methods

We conducted a population-based trend study in Switzerland from 1998 to 2012. Cases of invasive prostate cancer, deaths from prostate cancer, and prostatectomies were analysed. We calculated changes in age-standardised prostate cancer incidence rates, stratified by tumor stage (early, advanced), prostate cancer-specific mortality, and prostatectomy rates.

Results

The age-standardised incidence rate of prostate cancer increased greatly in men aged 50–69 years (absolute mean annual change +4.6/100,000, 95% CI: +2.9 to +6.2) between 1998 and 2002, and stabilised afterwards. In men aged ≥ 70 years, the incidence decreased slightly between 1998 and 2002, and more substantially since 2003. The incidence of early tumor stages increased between 1998 and 2002 only in men aged 50–69 years, and then stabilised, while the incidence of advanced stages remained stable across both age strata. The rate of prostatectomy increased markedly until 2002, more so in the 50 to 69 age range than among men aged ≥ 70 years; it leveled off after 2002 in both age strata. Trends in surgery were driven by radical prostatectomy. Since 1998, the annual age-standardised mortality rate of prostate cancer slightly declined in men aged 50–69 years (absolute mean annual change -0.1/100,000, 95% CI: -0.2 to -0.1) and ≥ 70 years (absolute mean annual change -0.5/100,000, 95% CI: -0.7 to -0.3).

Conclusions

The increases in the incidence of early stage prostate cancer and prostatectomy observed in Switzerland among men younger than 70 years have concomitantly leveled off around 2002/2003. Given the decreasing mortality, these trends may reflect recent changes in screening and clinical workup practices, with a possible attenuation of overdiagnosis and overtreatment.

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<![CDATA[Risk factors for Luminal A ductal carcinoma in situ (DCIS) and invasive breast cancer in the Carolina Breast Cancer Study]]> https://www.researchpad.co/article/5c57e67ed5eed0c484ef3431

Purpose

Invasive breast cancers are thought to arise from in situ lesions, but some ductal carcinoma in situ (DCIS) are indolent with low likelihood of progressing to invasive carcinoma. Comparison of risk factor associations between DCIS and invasive disease may elucidate which factors influence early versus late stages of carcinogenesis. Therefore, we determined whether there were differences in risk factor profiles for screen-detected DCIS and invasive breast cancer among Luminal A lesions.

Methods

We conducted a case-control analysis using data from the Carolina Breast Cancer Study (1993–2001). Analyses were restricted to Luminal A tumors and screen-detected tumors among mammography-eligible women, to limit confounding by mode of detection (N = 108 DCIS; N = 203 invasive). Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for associations between risk factors and lesion type.

Results

In stratified analyses, we observed qualitative differences in the direction of association for ever smoking, obese BMI, high waist-to-hip-ratio (WHR), and ≥10 years of oral contraceptive use between DCIS and invasive disease. Breastfeeding was inversely associated with invasive disease and was not associated with DCIS. Interaction tests for risk factor associations between Luminal A DCIS and invasive breast cancer were not statistically significant (p>0.05).

Conclusions

Among Luminal A tumors, established breast cancer risk factors may exert stronger effects on progression of early lesions to invasive disease, with lesser effects on risk of DCIS.

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<![CDATA[Estimation of lung cancer risk using homology-based emphysema quantification in patients with lung nodules]]> https://www.researchpad.co/article/5c50c491d5eed0c4845e893e

The purpose of this study was to assess whether homology-based emphysema quantification (HEQ) is significantly associated with lung cancer risk. This retrospective study was approved by our institutional review board. We included 576 patients with lung nodules (317 men and 259 women; age, 66.8 ± 12.3 years), who were selected from a database previously generated for computer-aided diagnosis. Of these, 283 were diagnosed with lung cancer, whereas the remaining 293 showed benign lung nodules. HEQ was performed and percentage of low-attenuation lung area (LAA%) was calculated on the basis of computed tomography scans. Statistical models were constructed to estimate lung cancer risk using logistic regression; sex, age, smoking history (Brinkman index), LAA%, and HEQ were considered independent variables. The following three models were evaluated: the base model (sex, age, and smoking history); the LAA% model (the base model + LAA%); and the HEQ model (the base model + HEQ). Model performance was assessed using receiver operating characteristic analysis and the associated area under the curve (AUC). Differences in AUCs among the models were evaluated using Delong’s test. AUCs of the base, LAA%, and HEQ models were 0.585, 0.593, and 0.622, respectively. HEQ coefficient was statistically significant in the HEQ model (P = 0.00487), but LAA% coefficient was not significant in the LAA% model (P = 0.199). Delong’s test revealed significant difference in AUCs between the LAA% and HEQ models (P = 0.0455). In conclusion, after adjusting for age, sex, and smoking history (Brinkman index), HEQ was significantly associated with lung cancer risk.

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<![CDATA[Rapid antiretroviral therapy initiation in low- and middle-income countries: A resource-based approach]]> https://www.researchpad.co/article/5c478c99d5eed0c484bd356f

In an Essay, Mark Tenforde and colleagues advocate continued provision of baseline CD4 cell count testing in HIV care in low- and middle-income countries.

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<![CDATA[Developing key performance indicators for guaranteeing right to health and access to medical service for persons with disabilities in Korea: Using a modified Delphi]]> https://www.researchpad.co/article/5c141ed3d5eed0c484d286ad

Recently, the Act on Guarantee of Right to Health and Access to Medical Service for Persons with Disabilities was implemented to legally define the health care system for persons with disabilities (PWDs) and the guarantee of access to medical care in Korea. This study aimed to develop specific goals and performance indicators to establish a system to guarantee right to health and access to medical service for PWDs. The first procedure was the establishment of the performance indicators, and the second was the content validity verification of the established performance indicators. To establish the performance indicators, we used the policy indicators of the government to improve the health of the Korean people. The indicators that needed to be newly developed were established based on literature review and expert consultation. Three Delphi surveys were conducted to verify the content validity of the established performance indicators. The content validity index (CVI) was obtained for the importance and possibility of the performance indicators. The indicators using the existing policy indicators are “proportion of public health centers” and “rate of health checkup of PWDs,” and newly developed indicators are “establishment of facilities for PWDs in health care facilities (buildings and personnel)” and “diagnosis of autism spectrum disorder in early childhood (average age and awareness).” The final performance indicators consist of a total of six areas, 22 sub-areas, and 40 individual indicators. The final performance indicators in this study can be used as basic data for continuously identifying the health status of PWDs in Korea and establishing the national policy for their health promotion. This study is also expected to serve as a framework to guarantee the right to health and access to medical service for PWDs rather than simply containing declarative content.

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<![CDATA[Cervical cancer screening in Sweden 2014-2016]]> https://www.researchpad.co/article/5c215143d5eed0c4843f9669

Background

To enable incremental optimization of screening, regular reporting of quality indicators is required.

Aim

To report key quality indicators and basic statistics about cervical screening in Sweden.

Methods

We collected individual level data on all cervical cytologies, histopathologies, human papillomavirus tests and all invitations for cervical screening in Sweden during 2013–2016.

Results

There were over 2,278,000 cervical samples collected in Sweden in 2014–2016. Organized samples (resulting from an invitation) constituted 69% of samples. The screening test coverage of all resident women aged 23–60 was 82%. The coverage has slowly increased for >10 years. There is large variability between counties (from 71% to 92%) over time. There were 25,725 women with high-grade lesions in cytology during 2013–2015. Only 96% of these women had a follow-up histopathology within a year. Cervical cancer incidence showed an increasing trend.

Conclusion

Key quality indicators such as population coverage and follow-up rates were stable or improving, but there was nevertheless an unexplained cervical cancer increase.

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<![CDATA[Family history–based colorectal cancer screening in Australia: A modelling study of the costs, benefits, and harms of different participation scenarios]]> https://www.researchpad.co/article/5b8b29df40307c405292ca51

Background

The Australian National Bowel Cancer Screening Programme (NBCSP) was introduced in 2006. When fully implemented, the programme will invite people aged 50 to 74 to complete an immunochemical faecal occult blood test (iFOBT) every 2 years.

Methods and findings

To investigate colorectal cancer (CRC) screening occurring outside of the NBCSP, we classified participants (n = 2,480) in the Australasian Colorectal Cancer Family Registry (ACCFR) into 3 risk categories (average, moderately increased, and potentially high) based on CRC family history and assessed their screening practices according to national guidelines. We developed a microsimulation to compare hypothetical screening scenarios (70% and 100% uptake) to current participation levels (baseline) and evaluated clinical outcomes and cost for each risk category. The 2 main limitations of this study are as follows: first, the fact that our cost-effectiveness analysis was performed from a third-party payer perspective, which does not include indirect costs and results in overestimated cost-effectiveness ratios, and second, that our natural history model of CRC does not include polyp sojourn time, which determines the rate of cancerous transformation.

Screening uptake was low across all family history risk categories (64%–56% reported no screening). For participants at average risk, 18% reported overscreening, while 37% of those in the highest risk categories screened according to guidelines. Higher screening levels would substantially reduce CRC mortality across all risk categories (95 to 305 fewer deaths per 100,000 persons in the 70% scenario versus baseline). For those at average risk, a fully implemented NBCSP represented the most cost-effective approach to prevent CRC deaths (AUS$13,000–16,000 per quality-adjusted life year [QALY]). For those at moderately increased risk, higher adherence to recommended screening was also highly cost-effective (AUS$19,000–24,000 per QALY).

Conclusion

Investing in public health strategies to increase adherence to appropriate CRC screening will save lives and deliver high value for money.

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<![CDATA[A qualitative study exploring patient motivations for screening for lung cancer]]> https://www.researchpad.co/article/5b4a1971463d7e428027f8b5

Background

Low-dose computed tomography (LDCT) of the chest for lung cancer screening of heavy smokers was given a ‘B’ rating by the U.S. Preventive Services Task Force (USPSTF) in 2013, and gained widespread insurance coverage in the U.S. in 2015. Lung cancer screening has since had low uptake. However, for those that do choose to screen, little is known about patient motivations for completing screening in real-world practice.

Objective

To explore the motivations for screening-eligible patients to screen for lung cancer.

Methods

Semi-structured qualitative interviews were conducted with 20 LDCT screen-completed men and women who were members of an integrated mixed-model healthcare system in Washington State. From June to September 2015, participants were recruited and individual interviews performed about motivations to screen for lung cancer. Audio-recorded interviews were transcribed and analyzed using inductive content analysis by three investigators.

Results

Four primary themes emerged as motivations for completing LDCT lung cancer screening: 1) trust in the referring clinician; 2) early-detection benefit; 3) low or limited harm perception; and 4) friends or family with advanced cancer.

Conclusion

Participants in our study were primarily motivated to screen for lung cancer based on perceived benefit of early-detection, absence of safety concerns, and personal relationships. Our findings provide new insights about patient motivations to screen, and can potentially be used to improve lung cancer screening uptake and shared decision-making processes.

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<![CDATA[Does mammogram attendance influence participation in cervical and colorectal cancer screening? A prospective study among 1856 French women]]> https://www.researchpad.co/article/5b49cacc463d7e33e4eac05e

Background

We aimed to determine participation rates and factors associated with participation in colorectal (fecal occul blood test) and cervical cancer (Pap-smear) screening among a population of women participating in breast cancer screening.

Methods

From August to October 2015, a self-administered questionnaire was sent by post to 2 900 women aged 50–65, living in Côte-d’Or, France, and who were up to date with mammogram screening. Polytomic logistic regression was used to identify correlates of participation in both cervical and colorectal cancer screenings. Participation in all 3 screenings was chosen as the reference.

Results

Study participation rate was 66.3% (n = 1856). Besides being compliant with mammogram, respectively 78.3% and 56.6% of respondents were up to date for cervical and colorectal cancer screenings, while 46.2% were compliant with the 3 screenings. Consultation with a gynecologist in the past year was associated with higher chance of undergoing the 3 screenings or female cancer screenings (p<10–4), when consultation with a GP was associated with higher chance of undergoing the 3 screenings or organized cancer screenings (p<0.05). Unemployment, obesity, age>59 and yearly flu vaccine were associated with a lower involvement in cervical cancer screening. Women from high socio-economic classes were more likely to attend only female cancer screenings (p = 0.009). Finally, a low level of physical activity and tobacco use were associated with higher risk of no additional screening participation (p<10–3 and p = 0.027).

Conclusions

Among women participating in breast screening, colorectal and cervical cancer screening rates could be improved. Including communication about these 2 cancer screenings in the mammogram invitation could be worth to explore.

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<![CDATA[An Accurate Prostate Cancer Prognosticator Using a Seven-Gene Signature Plus Gleason Score and Taking Cell Type Heterogeneity into Account]]> https://www.researchpad.co/article/5989da1fab0ee8fa60b7e4ce

One of the major challenges in the development of prostate cancer prognostic biomarkers is the cellular heterogeneity in tissue samples. We developed an objective Cluster-Correlation (CC) analysis to identify gene expression changes in various cell types that are associated with progression. In the Cluster step, samples were clustered (unsupervised) based on the expression values of each gene through a mixture model combined with a multiple linear regression model in which cell-type percent data were used for decomposition. In the Correlation step, a Chi-square test was used to select potential prognostic genes. With CC analysis, we identified 324 significantly expressed genes (68 tumor and 256 stroma cell expressed genes) which were strongly associated with the observed biochemical relapse status. Significance Analysis of Microarray (SAM) was then utilized to develop a seven-gene classifier. The Classifier has been validated using two independent Data Sets. The overall prediction accuracy and sensitivity is 71% and 76%, respectively. The inclusion of the Gleason sum to the seven-gene classifier raised the prediction accuracy and sensitivity to 83% and 76% respectively based on independent testing. These results indicated that our prognostic model that includes cell type adjustments and using Gleason score and the seven-gene signature has some utility for predicting outcomes for prostate cancer for individual patients at the time of prognosis. The strategy could have applications for improving marker performance in other cancers and other diseases.

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<![CDATA[Effectiveness Modelling and Economic Evaluation of Primary HPV Screening for Cervical Cancer Prevention in New Zealand]]> https://www.researchpad.co/article/5989da6eab0ee8fa60b940c6

Background

New Zealand (NZ) is considering transitioning from 3-yearly cervical cytology screening in women 20–69 years (current practice) to primary HPV screening. We evaluated HPV-based screening in both HPV-unvaccinated women and cohorts offered HPV vaccination in New Zealand (vaccination coverage ~50%).

Methods

A complex model of HPV transmission, vaccination, cervical screening, and invasive cervical cancer was extensively validated against national population-based datasets. Sixteen potential strategies for HPV screening were considered.

Results

Most primary HPV strategies were more effective than current practice, for both unvaccinated women and cohorts offered vaccination. The optimal strategy for both groups was 5-yearly HPV screening in women aged 25–69 years with partial genotyping for HPV 16/18 and referral to colposcopy, and cytological triage of other oncogenic types. This is predicted to reduce cervical cancer incidence and mortality by a further 12–16% and to save 4–13% annually in program costs (excluding overheads). The findings are sensitive to assumptions about future adherence to initiating screening at 25 years.

Conclusion

Primary HPV screening with partial genotyping would be more effective and less costly than the current cytology-based screening program, in both unvaccinated women and cohorts offered vaccination. These findings have been considered in a review of cervical screening in NZ.

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<![CDATA[Leukocyte DNA Methylation Signature Differentiates Pancreatic Cancer Patients from Healthy Controls]]> https://www.researchpad.co/article/5989d9f2ab0ee8fa60b6efeb

Pancreatic adenocarcinoma (PaC) is one of most difficult tumors to treat. Much of this is attributed to the late diagnosis. To identify biomarkers for early detection, we examined DNA methylation differences in leukocyte DNA between PaC cases and controls in a two-phase study. In phase I, we measured methylation levels at 1,505 CpG sites in treatment-naïve leukocyte DNA from 132 never-smoker PaC patients and 60 never-smoker healthy controls. We found significant differences in 110 CpG sites (false discovery rate <0.05). In phase II, we tested and validated 88 of 96 phase I selected CpG sites in 240 PaC cases and 240 matched controls (p≤0.05). Using penalized logistic regression, we built a prediction model consisting of five CpG sites (IL10_P348, LCN2_P86, ZAP70_P220, AIM2_P624, TAL1_P817) that discriminated PaC patients from controls (C-statistic = 0.85 in phase I; 0.76 in phase II). Interestingly, one CpG site (LCN2_P86) alone could discriminate resectable patients from controls (C-statistic  = 0.78 in phase I; 0.74 in phase II). We also performed methylation quantitative trait loci (methQTL) analysis and identified three CpG sites (AGXT_P180_F, ALOX12_E85_R, JAK3_P1075_R) where the methylation levels were significantly associated with single nucleotide polymorphisms (SNPs) (false discovery rate <0.05). Our results demonstrate that epigenetic variation in easily obtainable leukocyte DNA, manifested by reproducible methylation differences, may be used to detect PaC patients. The methylation differences at certain CpG sites are partially attributable to genetic variation. This study strongly supports future epigenome-wide association study using leukocyte DNA for biomarker discovery in human diseases.

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