Search

Background: Hepatitis is a serious global health issue. To reduce mortality, early screening for liver disease has been recommended in community health policies, particularly for asymptomatic individuals. Aim: This study explored the link between liver function biomarkers and how quickly people adopt a new multiple cancer screening program, using the diffusion of innovation (DOI) Theory. Methods: The study included 57,939 participants from a community‐based screening program in Keelung, Taiwan, between January 1, 2001, and December 31, 2010. Data on demographics and lifestyle habits were collected through questionnaires, and blood samples were analyzed to measure biomarkers related to liver function. Results: On average, participants took 3.48 years to accept the new screening program. People with healthier lifestyles, such as those who drank alcohol less often, were more likely to adopt the screening early. Additionally, those with higher levels of liver‐related biomarkers like albumin, total protein, and ALT joined even sooner. In conclusion, using DOI theory, the study found that personal lifestyle and liver function play a role in how quickly individuals adopt a new screening system. Conclusion: These insights can help healthcare providers improve early screening efforts, particularly for people at risk of hepatitis and liver cancer, potentially reducing related deaths. [ABSTRACT FROM AUTHOR]

The purpose of this research is to elucidate whether metabolic syndrome affects the rate of adoption of a new multiple cancer screening programme, based on the Diffusion of Innovation theory. The time to attend the screening programme, conducted in Keelung, Taiwan, within 10 years was assessed by innovativeness (innovators, early adaptors, early majority, late majority and laggard) using data from 79,303 residents, with the information on metabolic syndrome accrued from routine adult health check‐ups. The median time of adopting the programme and the relative rates of early adoption by metabolic syndrome and its severity score were estimated. The results show that the estimated times to adopt the programme ranged from 3 months for innovators to 10 years for the laggard. The rate of early adoption was 34% higher for participants without metabolic syndrome than for those with the disease, and the gradient relationship of disease severity was noted. The adjusted median time to adopt innovativeness was 0.82 years earlier for participants who were disease‐free than those with the disease. Meanwhile, the adjusted median time was wider by up to 2.25 years for those with severe disease. The study suggests that innovation should prioritise the potential risk of the metabolic syndrome population. [ABSTRACT FROM AUTHOR]

Objectives: To explain apparent differences among mammography screening services in Sweden using individual data on participation in screening and with breast cancer–specific survival as an outcome. Methods: We analysed breast cancer survival data from the Swedish Cancer Register on breast cancer cases from nine Swedish counties diagnosed in women eligible for screening. Data were available on 38,278 breast cancers diagnosed and 4312 breast cancer deaths. Survival to death from breast cancer was estimated using the Kaplan–Meier estimate, for all cases in each county, and separately for cases of women participating and not participating in their last invitation to screening. Formal statistical comparisons of survival were made using proportional hazards regression. Results: All counties showed a reduction in the hazard of breast cancer death with participation in screening, but the reductions for individual counties varied substantially, ranging from 51% (95% confidence interval 46–55%) to 81% (95% confidence interval 74–85%). Survival rates in nonparticipating women ranged from 53% (95% confidence interval 40–65%) to 74% (95% confidence interval 72–77%), while the corresponding survival in women participating in screening varied from 80% (95% confidence interval 77–84%) to 86% (95% confidence interval 83–88%), a considerably narrower range. Conclusions: Differences among counties in the effect of screening on breast cancer outcomes were mainly due to variation in survival in women not participating in screening. Screening conferred similarly high survival rates in all counties. This indicates that the performance of screening services was similar across counties and that detection and treatment of breast cancer in early-stage reduces inequalities in breast cancer outcome. [ABSTRACT FROM AUTHOR]

Background: It is of paramount importance to evaluate the impact of participation in organized mammography service screening independently from changes in breast cancer treatment. This can be done by measuring the incidence of fatal breast cancer, which is based on the date of diagnosis and not on the date of death.Methods: Among 549,091 women, covering approximately 30% of the Swedish screening-eligible population, the authors calculated the incidence rates of 2473 breast cancers that were fatal within 10 years after diagnosis and the incidence rates of 9737 advanced breast cancers. Data regarding each breast cancer diagnosis and the cause and date of death of each breast cancer case were gathered from national Swedish registries. Tumor characteristics were collected from regional cancer centers. Aggregated data concerning invitation and participation were provided by Sectra Medical Systems AB. Incidence rates were analyzed using Poisson regression.Results: Women who participated in mammography screening had a statistically significant 41% reduction in their risk of dying of breast cancer within 10 years (relative risk, 0.59; 95% CI, 0.51-0.68 [P < .001]) and a 25% reduction in the rate of advanced breast cancers (relative risk, 0.75; 95% CI, 0.66-0.84 [P < .001]).Conclusions: Substantial reductions in the incidence rate of breast cancers that were fatal within 10 years after diagnosis and in the advanced breast cancer rate were found in this contemporaneous comparison of women participating versus those not participating in screening. These benefits appeared to be independent of recent changes in treatment regimens. [ABSTRACT FROM AUTHOR]

Objective: To investigate the risk for second primary cancer in the hypopharynx and esophagus (SPC‐HE) among individuals with an initial oral/oropharyngeal cancer. Materials and Methods: Mass screening data from Taiwan (2004–2009) included individuals who were ≥18 years old and smoked cigarettes and/or chewed betel quid. Occurrence of SPC‐HE was monitored until December 31, 2014. Results were expressed as adjusted relative risk (aRR) and 95% confidence interval (CI). Results: One hundred and fifty‐eight out of 4,494 subjects with oral cancer developed SPC‐HE (incidence rate: 6.47 per 1,000 person‐years). Relative to patients with primary cancers in the lip, the risk of an SPC‐HE was higher in patients with primary cancers in oropharynx (aRR: 19.98, 95% CI: 4.72–84.55), floor of mouth (aRR: 12.13, 95% CI: 2.67–55.15), and hard palate (aRR: 7.31, 95% CI: 1.65–32.37), but not in patients with cancers in tongue (aRR: 3.67, 95% CI: 0.89–15.17) or gum (aRR: 3.99, 95% CI: 0.92–17.35). Regression analyses also showed the risk of an SPC‐HE was greater in alcohol drinkers than those who did not (aRR: 1.65, 95% CI: 1.10–2.48). Conclusions: Compared with the initial cancer in the lip, patients with a cancer in the oropharynx, floor of mouth, and hard palate had a higher risk for the SPC‐HE. [ABSTRACT FROM AUTHOR]

Objective Because colorectal cancer (CRC) has a long natural history, estimating the effectiveness of CRC screening programmes requires long-term follow-up. As an alternative, we here demonstrate the use of a temporal multi-state natural history model to predict the effectiveness of CRC screening. Methods In the Finnish population-based biennial CRC screening programme using faecal occult blood tests (FOBT), which was conducted in a randomised health services study, we estimated the pre-clinical incidence, the mean sojourn time (MST), and the sensitivity of FOBT using a Markov model to analyse data from 2004 to 2007. These estimates were applied to predict, through simulation, the effects of five rounds of screening on the relative rate of reducing advanced CRC with 6 years of follow-up, and on the reduction in mortality with 10 years of follow-up, in a cohort of 500,000 subjects aged 60 to 69. Results For localised and non-localised CRC, respectively, the MST was 2.06 and 1.36 years and the sensitivity estimates were 65.12% and 73.70%. The predicted relative risk of non-localised CRC and death from CRC in the screened compared with the control population was 0.86 (95% CI: 0.79–0.98) and 0.91 (95% CI: 0.85–1.02), respectively. Conclusion Based on the preliminary results of the Finnish CRC screening programme, our model predicted a 9% reduction in CRC mortality and a 14% reduction in advanced CRC. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to evaluate the long-term effectiveness of a school-based child oral hygiene program on oral heath after approximately 10 years of follow-up. Methods A prospective cohort study was designed to include 120 schoolchildren aged 10-11 years with instructions on how to practice daily flossing and brushing under the supervision of school nurses for one semester (the intervention group) and to recruit a comparison group with no intervention from 120 classmates matched by gender (the nonintervention group). Both groups participated in a questionnaire survey and received dental examinations after long-term follow-up. Results The mean value of overall plaque score in the intervention group (16.9%) was lower than that of the nonintervention group (32.6%); the adjusted relative risk ( aRR) of having a plaque score for the intervention group versus the nonintervention group was 0.4 (95% CI: 0.3, 0.5). The percentage of pocketing ( CPI ≧ 2) in the intervention group (75.0%) was lower than that of the nonintervention group (90.8%); the aRR of having calculus or pocketing ( CPI ≧ 2) was 0.3 (95% CI: 0.1, 0.6). The intervention group had lower DMFT values and DMFS score than the nonintervention group (4.1 and 6.6 versus 6.2 and 11.0). Moreover, the intervention group had significantly better dental knowledge and habits and dental conditions than the nonintervention group. Conclusions This longitudinal follow-up study demonstrated that a highly targeted oral hygiene program can display positive long-term effectiveness. [ABSTRACT FROM AUTHOR]

Background: Outreach (i.e., to invite those who do not use, or who under use screening services) and inreach (i.e., to invite an existing population who have already accessed the medical system) approaches may influence people to increase their use of screening test; however, whether their outcomes would be equivalent remains unclear. Methods: A total of 3,363,896 subjects, 50–69 years of age, participated in a colorectal cancer (CRC) screening program using biennial fecal immunochemical tests; 34.5% participated during 2004–2009 when the outreach approach alone was used, and 65.5% participated from 2010–2013 when outreach was integrated with an inreach approach. We compared the outcomes of the two approaches in delivery of screening services. Results: Coverage rates increased from 21.4% to 36.9% and the positivity rate increased from 4.0% to 7.9%, while referral for confirmatory diagnostic examinations declined from 80.0% to 53.3%. The first period detected CRC in 0.20% of subjects screened, with a positive predictive value (PPV) of 6.1%, and the second detected CRC in 0.34% of subjects, with a PPV of 8.0%. After adjusting for confounders, differences were observed in the PPV for CRC (adjusted relative risk, 1.50; 95% confidence interval [CI], 1.41–1.60), cancer detection rate (1.20; 95% CI, 1.13–1.27), and interval cancer rate (0.72; 95% CI, 0.65–0.80). When we focused on the comparison between two approaches during the same study period of 2010–2013, the positivity rate of fecal testing (8.2% vs. 7.6%) and the PPV for CRC detection remained higher (1.07; 95% CI, 1.01–1.12) in subjects who were recruited from the inreach approach. Conclusions: Outcomes of screening were equivalent or better after integration of outreach and inreach approaches. Impact: The results will encourage makers of health-care policy to adopt the integration approach to deliver screening services. [ABSTRACT FROM AUTHOR]

It is desirable to have a strategy for evaluation of breast cancer service screening programs years before the long-term breast cancer mortality data are available. Since successful mammography screening has a significant impact on two components of the TNM (tumor size, node status, presence or absence of distant metastases) classification system, tumor size and node status, we investigated the effect of the randomized breast screening trials on incidence of advanced stage disease and on the subsequent breast cancer death rate. In the trials that achieved a 20% or greater reduction in advanced stage disease, there was an average breast cancer mortality reduction of 28% among women invited to screening (attenders and nonattenders combined). In the trials that achieved a reduction in advanced stage disease of less than 10%, there was no reduction in breast cancer mortality among women invited to screening. This study provides evidence that the average mortality reduction in all the trials underestimates the true mortality reduction, and that substantially greater breast cancer mortality reductions can be expected in screening programs that are effective in reducing advanced stage breast cancer. In addition, monitoring the incidence of advanced stage breast cancer in an ongoing screening program can provide a sensitive and early indicator of the subsequent mortality from the disease. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study estimated the excess incidence (overdiagnosis) of breast cancer associated with starting mammographic screening at an earlier age, by using data from the Dalarna County component of the Swedish Two-County Trial of breast cancer screening. METHODS: In Dalarna County, Sweden, 38,589 women aged 40 to 74 years were randomized to invitation to regular mammographic screening (active study population [ASP]) and 18,582 women to usual care (passive study population [PSP]). After 3 screening rounds (6-8 years after randomization), the PSP was invited to screening. The cumulative incidence of breast cancer was calculated in the ASP and PSP from randomization to 29 years later. In addition, cumulative incidence was calculated for invasive cancers, advanced invasive cancers (≥2 cm in maximum diameter or node-positive), and nonadvanced cancers (<2 cm and node negative). RESULTS: There was no excess of cancers in the ASP at 29 year follow-up (relative risk, 1.00; 95% confidence interval, 0.92-1.08). Cumulative incidence in the 2 arms approximately equalized at the conclusion of the first round of screening of the PSP. There was an excess of nonadvanced cancers and a deficit of advanced cancers in the ASP, both of which persisted to 29 years. CONCLUSIONS: There was no additional breast cancer incidence associated with 100,000 additional screens in the ASP. Results suggest that overdiagnosis is small and largely confined to the prevalence screen. Cancer 2012. © 2012 American Cancer Society. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses active and passive methodologies for detecting idiopathic Parkinson's disease (IPD).

The aim was to evaluate how the inter-screening interval affected the performance of screening by mammographic appearances. This was a Swedish retrospective screening cohort study with information on screening history and mammography features in two periods (1977–1985 and 1996–2010). The pre-clinical incidence and the mean sojourn time (MST) for small breast cancer allowing for sensitivity by mammographic appearances were estimated. The percentage of interval cancer against background incidence (I/E ratio) was used to assess the performance of mammography screening by different inter-screening intervals. The sensitivity-adjusted MSTs (in years) were heterogeneous with mammographic features, being longer for powdery and crushed stone-like calcifications (4.26, (95% CI, 3.50–5.26)) and stellate masses (3.76, (95% CI, 3.15–4.53)) but shorter for circular masses (2.65, (95% CI, 2.06–3.55)) in 1996–2010. The similar trends, albeit longer MSTs, were also noted in 1977–1985. The I/E ratios for the stellate type were 23% and 32% for biennial and triennial screening, respectively. The corresponding figures were 32% and 43% for the circular type and 21% and 29% for powdery and crushed stone-like calcifications, respectively. Mammography-featured progressions of small invasive breast cancer provides a new insight into personalized quality assurance, surveillance, treatment and therapy of early-detected breast cancer. [ABSTRACT FROM AUTHOR]