Search

Oral-health-related quality of life (OHRQoL) is expected to have multiple dimensions. It was the aim of this study to investigate the dimensional structure of OHRQoL measured by the Oral Health Impact Profile (German version) (OHIP-G) and to derive a summary score for the instrument. Subjects (N = 2050; age, 16-79 yrs) came from a national survey. We used rotated principal-components analysis to derive a summary score and to explore the dimensional structure of OHIP-G. The first principal component explained 50% of the variance in the data. The sum of OHIP-G item responses was highly associated with the first principal component (r = 0.99). This simple but informative OHIP-G summary score may indicate that simple sums are also potentially useful scores for other OHRQoL instruments. Four dimensions (psychosocial impact, orofacial pain, oral functions, appearance) were found. These OHIP-G dimensions may serve as a parsimonious set of OHRQoL dimensions in general. [ABSTRACT FROM AUTHOR]

Oral-health-related quality of life (OHRQoL) is expected to have multiple dimensions. It was the aim of this study to investigate the dimensional structure of OHRQoL measured by the Oral Health Impact Profile (German version) (OHIP-G) and to derive a summary score for the instrument. Subjects (N = 2050; age, 16-79 yrs) came from a national survey. We used rotated principal-components analysis to derive a summary score and to explore the dimensional structure of OHIPG. The first principal component explained 50% of the variance in the data. The sum of OHIP-G item responses was highly associated with the first principal component (r = 0.99). This simple but informative OHIP-G summary score may indicate that simple sums are also potentially useful scores for other OHRQoL instruments. Four dimensions (psychosocial impact, orofacial pain, oral functions, appearance) were found. These OHIP-G dimensions may serve as a parsimonious set of OHRQoL dimensions in general. [ABSTRACT FROM AUTHOR]

Due to an increasing comorbidity burden with aging, the margin of benefit from screening mammography in women ages ≥65 is highly variable. This study examined 10-year cumulative risk of non-breast cancer mortality and breast cancer by comorbidity and age in a screening population. Methods: We used prospective cohort data from the Breast Cancer Surveillance Consortium (BCSC), which included 198,362 women ages ≥65 years who have undergone at least one screening mammogram. We calculated cumulative incidence of non-breast cancer mortality and risk of breast cancer 10 years following the screening mammogram for women ages 65-74, 75-84 and ≥85 years stratified by the Charlson Comorbidity Index (CCI scores 0, 1 and ≥2). Results: During a median follow-up time of 8.1 years (interquartile range, 4.6 to 10 years), 34,768 died from non-breast cancer causes and 6,327 women were diagnosed with invasive breast cancer of whom 359 died from breast cancer and 942 from non-breast cancer causes. The 10-year cumulative risk of invasive breast cancer following a screening mammogram did not significantly decrease with elevating CCI score and age for women ages 65-74 [CCI 0 = 4.0% (95% CI, 3.9%-4.1%) vs. CCI ≥2 = 3.8% (95% CI, 3.3%-4.3%)], ages 75-84 [CCI 0 = 3.7% (95% CI, 3.5%-3.9%) vs. CCI ≥ 2 = 3.4% (95% CI, 2.8%-4.0%)], and ages ≥85 [CCI 0 = 2.7%, (95% CI, 2.3%-3.2%) vs. CCI ≥ 2 = 2.5% (95% CI, 1.4%-3.6%)]. Cumulative risk of non-breast cancer mortality significantly increased with increasing CCI and age for women ages 65-74 [CCI 0 = 11% (95% CI, 10%-11%] vs. CCI ≥ 2 = 45% (95% CI, [43%-46%)], ages 75-84 [CCI 0 = 29% (95% CI, 29%-30%) vs. CCI ≥2 = 62% (95% CI, 60%-63%)], and ages ≥85 [CCI 0 = 59%, (95% CI, 57%-60%) vs. CCI ≥2 = 84% (95% CI, 81%-86%)]. Conclusion: Risk of non-breast cancer mortality was high and significantly increased with rising comorbidity burden and age whereas breast cancer risk was low and non-significantly decreased with both. These results suggest that women with a CCI score of ≥2 or ages ≥75 years may experience minimal benefit from continuing routine screening mammography. Future research is needed to delineate the specific benefits and harms of screening mammography in subsets of older women defined by age and comorbidity burden. [ABSTRACT FROM AUTHOR]

This study examined whether breast density is associated with risk of breast cancer in women age =65 years undergoing screening mammography in community practice. Methods: We used prospective cohort data between 1996 and 2012 from the Breast Cancer Surveillance Consortium (BCSC). We calculated separate cumulative incidence models for breast cancer incidence according to Breast Imaging Reporting and Data System (BI-RADS) breast density for women ages 65-74 and ages ≥75. Multivariable Cox proportional hazards regression models were fitted to determine the risk of invasive breast cancer adjusted for BCSC registry, race/ethnicity, BMI, hormone therapy use and benign breast disease. Results: Among the 403,268 women included in the study, approximately 40% were ages ≥75. The annual incidence rate of invasive breast cancer increased with increasing breast density among women ages 65-74 [BI- RADS fatty breasts: 2.2% (95% CI, 2.1%-2.4%) vs. heterogeneously or extremely dense breasts: 4.7% (95% CI, 4.6%-4.9%)] and women ages 75+ [BI-RADS fatty breasts: 2.3% (95% CI, 2.1%-2.5%) vs. heterogeneously or extremely dense: 4.3% (95% CI, 4.1%-4.5%)]. Women with BI-RADS fatty breasts had a decreased risk of breast cancer among women ages 65-74 [HR: 0.66 (95% CI: 0.58%-0.78%) and women ages ≥75 [HR: 0.73 (95% CI: 0.62%-0.87%). Women with BI-RADS heterogeneously or extremely dense breasts were found to have increased risk of breast cancer among women ages 65-74 [HR: 1.39 (95% CI: 1.28%-1.51%)] and women ages ≥75 [HR: 1.23 (95% CI: 1.10%-1.37%)]. Conclusions: Older women with higher BI-RADS density had a significantly increased risk of breast cancer. These findings add further evidence that breast density continues to be associated with an increased risk of breast cancer, even among women age ≥75 years. [ABSTRACT FROM AUTHOR]

The impact of the rise in breast cancer incidence associated with mammography diffusion on the prevalence of breast cancer family history is unknown, and may attenuate risk associations between family history and breast cancer. Methods: The proportions of women 40-74 years reporting a first-degree family history of breast cancer were estimated in the Breast Cancer Surveillance Consortium (BCSC, N = 1,170,900) from 1996-2012 and Collaborative Breast Cancer Study (CBCS; cases N = 23,400; controls N = 25,460) from 1987-2007. Breast cancer (ductal carcinoma in situ and invasive) relative risk estimates associated with family history and 95% confidence intervals (CI) were calculated using multivariable Cox proportional hazard (BCSC) and logistic regression (CBCS) models. Results: The proportion of women reporting a family history increased from 11% in the 1980s to 16% in 2010-13. Family history was associated with a 60% increased risk of breast cancer in the BCSC (hazard ratio = 1.61, 95% CI = 1.55-1.66) and CBCS (odds ratio = 1.66, 95% CI = 1.58-1.74), with relative risks decreasing with age. Trends in relative risks were not evident over time or stage of disease at diagnosis, except among older women (60-74) where estimates were attenuated in more recent years (P-trend = 0.08 for both cohorts). Conclusion: The proportion of women with a first-degree family history of breast cancer increased over time and by age, nonetheless breast cancer risk associations with family history were constant over time for women 40-59. First-degree family history of breast cancer remains an important breast cancer risk factor, especially for younger women, despite its increasing prevalence in the mammography screening era. [ABSTRACT FROM AUTHOR]

Presents the results of a study on the effect of breast augmentation on the accuracy of mammography and cancer characteristics. Use of mammography registries in the study; Level of the sensitivity for mammographic screening in women with and without augmentation; Characteristics of breast tumor in asymptomatic patients diagnosed with breast cancer.

Abstract Background Microsimulation models are an important tool for estimating the comparative effectiveness of interventions through prediction of individual-level disease outcomes for a hypothetical population. To estimate the effectiveness of interventions targeted toward high risk groups, the mechanism by which risk factors influence the natural history of disease must be specified. We propose a method for evaluating these risk factor assumptions as part of model-building. Methods We used simulation studies to examine the impact of risk factor assumptions on the relative rate (RR) of colorectal cancer (CRC) incidence and mortality for a cohort with a risk factor compared to a cohort without the risk factor using an extension of the CRC-SPIN model for colorectal cancer. We also compared the impact of changing age at initiation of screening colonoscopy for different risk mechanisms. Results Across CRC-specific risk factor mechanisms, the RR of CRC incidence and mortality decreased (towards one) with increasing age. The rate of change in RRs across age groups depended on both the risk factor mechanism and the strength of the risk factor effect. Increased non-CRC mortality attenuated the effect of CRC-specific risk factors on the RR of CRC when both were present. For each risk factor mechanism, earlier initiation of screening resulted in more life years gained, though the magnitude of life years gained varied across risk mechanisms. Conclusions Simulation studies can provide insight into both the effect of risk factor assumptions on model predictions and the type of data needed to calibrate risk factor models.

The article discusses a study on the effectiveness of ultrasonography and computed tomography as the initial imaging method for patients with suspected nephrolithiasis. It mentions the administration of either point-of-care ultrasonography, radiology ultrasonography and abdominal computed tomography (CT), primary outcomes of high-risk diagnosis with complications, cumulative radiation exposure and total costs, and finding that ultrasonography results to lower cumulative radiation exposure.

Purpose: To describe the area-level rate of breast cancers, the percentage of early-stage diagnoses (stage I-IIa), and associations between area-level measures of poverty, racial/ethnic composition, primary care shortage, and urban/rural/frontier status for the UC Davis Comprehensive Cancer Center (UCDCCC) catchment area., Methods: Using data from the SEER Cancer Registry of Greater California (2014-2018) and the California Department of Health Care Access and Information Medical Service Study Area, we conducted an ecological study in the UCDCCC catchment area to identify geographies that need screening interventions and their demographic characteristics., Results: The higher the percentage of the population identifying as Hispanic/Latino/Latinx, and the higher the percentage of the population below the 100% poverty level, the lower the odds of being diagnosed at an early-stage (OR = 0.98, 95% CI 0.96-0.99 and OR = 0.96, 95% CI 0.93-0.99, respectively). The association with poverty level was attenuated in the multivariable model when the Hispanic/Latino/Latinx population percentage was added. Several California counties had high poverty levels and differences in cancer stage distribution between racial/ethnic category groups. For all individuals combined, 65% was the lowest proportion of early-stage diagnoses for any geography. However, when stratified by racial/ethnic category, 11 geographies were below 65% for Hispanic/Latino/Latinx individuals, six for non-Hispanic Asian and Pacific Islander individuals, and seven for non-Hispanic African American/Black individuals, in contrast to one for non-Hispanic White individuals., Conclusions: Areas with lower percentages of breast cancers diagnosed at an early-stage were characterized by high levels of poverty. Variation in the proportion of early-stage diagnosis was also observed by race/ethnicity where the proportion of Hispanic/Latino/Latinx individuals was associated with fewer early-stage diagnoses., Impact: Results will inform the implementation of the UCDCCC mobile cancer prevention and early detection program, providing specific locations and populations to prioritize for tailored outreach, education, and screening., Competing Interests: Declarations. Competing Interests: The authors declare no competing interests. Ethical approval Ethics approval was not required for this non-interventional ecological study as we utilized retrospective, anonymized surveillance data containing no private health information and involving no human subjects., (© 2024. The Author(s).)

Background: S100A8 is a melanoma biomarker expressed in the melanoma-associated epidermal keratinocytes, but its diagnostic utility has not been compared with other biomarkers, including PRAME., Objectives: To compare the utility of S100A8 and PRAME immunohistochemistry (IHC) in the differential diagnosis of melanoma and naevi in a case-control study., Methods: A previously described cohort of 209 melanomas (case samples) and naevi (control samples) dual-immunostained for S100A8 and PRAME were included. For S100A8, previously reported scores indicating the proportion of tumour-associated epidermis stained (0 = indeterminate; 1 = 0-4%; 2 = 5-25%; 3 = 26-50%; 4 = 51-75%; 5 = > 75%) were utilized. PRAME IHC was reviewed by at least two reviewers and a consensus score assigned, with score indicating the proportion of tumour stained (0 = indeterminate; 1 = 0%; 2 = 1-50%; 3 = > 50%). A positive test was defined as > 50% staining., Results: The area under the receiver operating characteristic curves for S100A8 (0.833) and PRAME (0.874) were not significantly different from each other (P = 0.22). The diagnostic sensitivity and specificity were 42.4% [95% confidence interval (CI) 32.6-52.8%] and 98.2% (95% CI 93.6-99.8%) for S100A8, and 79.8% (95% CI 70.5-87.2%) and 87.3% (95% CI 79.6-92.9%) for PRAME, respectively. A combined test requiring both S100A8 and PRAME IHC positivity had a sensitivity of 39.4% (95% CI 29.7-49.7%) and specificity of 99.1% (95% CI 95.0-100.0%)., Conclusions: S100A8 and PRAME have utility in the diagnostic workup of melanoma, with S100A8 being more specific and PRAME being more sensitive when using this threshold. Our findings suggest that these two immunohistochemical markers may favourably complement one another to improve the detection of melanoma., Competing Interests: Conflicts of interest M.K. reports a pending patent application. The other authors declare no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Despite increased attention on how to conduct pragmatic trials and their importance, there remains an under-appreciation for the reality of what they take to design, compete and secure funding and execute. Many barriers are surmountable through increased exposure to experiences from completed trials. This report summarizes our experience in designing, securing funding and implementing the Home-Based Options to Make screening Easier (HOME) pragmatic trial, which was designed to evaluate home human papillomavirus testing for cervical cancer screening in underscreened women (women who had not received a cervical cancer screening test in ≥3.5 years). This report highlights factors at the level of research teams, organizations seeking to conduct embedded research, reviewers and funding agencies that challenge pragmatic trial design and execution. There is an urgent need to train on peer-reviewers how to evaluate embedded trial grant proposals, for agencies to pursue more rapid and innovative funding strategies, and to consider strategies for reviewers and funders to evaluate stakeholder buy-in (beyond letters of support). These factors together are needed to realize the promise of pragmatic trials to more efficiently and effectively generate critical data that inform changes in health care delivery and benefit patients., Competing Interests: None.

Importance: Radiation doses for computed tomography (CT) vary substantially across institutions., Objective: To assess the impact of institutional-level audit and collaborative efforts to share best practices on CT radiation doses across 5 University of California (UC) medical centers., Design, Setting, and Participants: In this before/after interventional study, we prospectively collected radiation dose metrics on all diagnostic CT examinations performed between October 1, 2013, and December 31, 2014, at 5 medical centers. Using data from January to March (baseline), we created audit reports detailing the distribution of radiation dose metrics for chest, abdomen, and head CT scans. In April, we shared reports with the medical centers and invited radiology professionals from the centers to a 1.5-day in-person meeting to review reports and share best practices., Main Outcomes and Measures: We calculated changes in mean effective dose 12 weeks before and after the audits and meeting, excluding a 12-week implementation period when medical centers could make changes. We compared proportions of examinations exceeding previously published benchmarks at baseline and following the audit and meeting, and calculated changes in proportion of examinations exceeding benchmarks., Results: Of 158 274 diagnostic CT scans performed in the study period, 29 594 CT scans were performed in the 3 months before and 32 839 CT scans were performed 12 to 24 weeks after the audit and meeting. Reductions in mean effective dose were considerable for chest and abdomen. Mean effective dose for chest CT decreased from 13.2 to 10.7 mSv (18.9% reduction; 95% CI, 18.0%-19.8%). Reductions at individual medical centers ranged from 3.8% to 23.5%. The mean effective dose for abdominal CT decreased from 20.0 to 15.0 mSv (25.0% reduction; 95% CI, 24.3%-25.8%). Reductions at individual medical centers ranged from 10.8% to 34.7%. The number of CT scans that had an effective dose measurement that exceeded benchmarks was reduced considerably by 48% and 54% for chest and abdomen, respectively. After the audit and meeting, head CT doses varied less, although some institutions increased and some decreased mean head CT doses and the proportion above benchmarks., Conclusions and Relevance: Reviewing institutional doses and sharing dose-optimization best practices resulted in lower radiation doses for chest and abdominal CT and more consistent doses for head CT.

Background: Women screened with digital mammography may receive false-positive and false-negative results and subsequent imaging and biopsies. How these outcomes vary by age, time since the last screening, and individual risk factors is unclear., Objective: To determine factors associated with false-positive and false-negative digital mammography results, additional imaging, and biopsies among a general population of women screened for breast cancer., Design: Analysis of registry data., Setting: Participating facilities at 5 U.S. Breast Cancer Surveillance Consortium breast imaging registries with linkages to pathology databases and tumor registries., Patients: 405,191 women aged 40 to 89 years screened with digital mammography between 2003 and 2011. A total of 2963 were diagnosed with invasive cancer or ductal carcinoma in situ within 12 months of screening., Measurements: Rates of false-positive and false-negative results and recommendations for additional imaging and biopsies from a single screening round; comparisons by age, time since the last screening, and risk factors., Results: Rates of false-positive results (121.2 per 1000 women [95% CI, 105.6 to 138.7]) and recommendations for additional imaging (124.9 per 1000 women [CI, 109.3 to 142.3]) were highest among women aged 40 to 49 years and decreased with increasing age. Rates of false-negative results (1.0 to 1.5 per 1000 women) and recommendations for biopsy (15.6 to 17.5 per 1000 women) did not differ greatly by age. Results did not differ by time since the last screening. False-positive rates were higher for women with risk factors, particularly family history of breast cancer; previous benign breast biopsy result; high breast density; and, for younger women, low body mass index., Limitations: Confounding by variation in patient-level characteristics and outcomes across registries and regions may have been present. Some factors, such as numbers of first- and second-degree relatives with breast cancer and diagnoses associated with previous benign biopsy results, were not examined., Conclusion: False-positive mammography results and additional imaging are common, particularly for younger women and those with risk factors, whereas biopsies occur less often. Rates of false-negative results are low., Primary Funding Source: Agency for Healthcare Research and Quality and National Cancer Institute.

Objective: The objective of our study was to develop an automated calculation method to provide organ dose assessment for a large cohort of pediatric and adult patients undergoing CT examinations., Materials and Methods: We adopted two dose libraries that were previously published: the volume CT dose index-normalized organ dose library and the tube current-exposure time product (100 mAs)-normalized weighted CT dose index library. We developed an algorithm to calculate organ doses using the two dose libraries and the CT parameters available from DICOM data. We calculated organ doses for pediatric (n = 2499) and adult (n = 2043) CT examinations randomly selected from four health care systems in the United States and compared the adult organ doses with the values calculated from the ImPACT calculator., Results: The median brain dose was 20 mGy (pediatric) and 24 mGy (adult), and the brain dose was greater than 40 mGy for 11% (pediatric) and 18% (adult) of the head CT studies. Both the National Cancer Institute (NCI) and ImPACT methods provided similar organ doses (median discrepancy < 20%) for all organs except the organs located close to the scanning boundaries. The visual comparisons of scanning coverage and phantom anatomies revealed that the NCI method, which is based on realistic computational phantoms, provides more accurate organ doses than the ImPACT method., Conclusion: The automated organ dose calculation method developed in this study reduces the time needed to calculate doses for a large number of patients. We have successfully used this method for a variety of CT-related studies including retrospective epidemiologic studies and CT dose trend analysis studies.

Objective: The objective of our study was to conduct a randomized controlled trial of educational interventions that were created to improve performance of screening mammography interpretation., Materials and Methods: We randomly assigned physicians who interpret mammography to one of three groups: self-paced DVD, live expert-led educational seminar, or control. The DVD and seminar interventions used mammography cases of varying difficulty and provided associated teaching points. Interpretive performance was compared using a pretest-posttest design. Sensitivity, specificity, and positive predictive value (PPV) were calculated relative to two outcomes: cancer status and consensus of three experts about recall. The performance measures for each group were compared using logistic regression adjusting for pretest performance., Results: One hundred two radiologists completed all aspects of the trial. After adjustment for preintervention performance, the odds of improved sensitivity for correctly identifying a lesion relative to expert recall were 1.34 times higher for DVD participants than for control subjects (95% CI, 1.00-1.81; p = 0.050). The odds of an improved PPV for correctly identifying a lesion relative to both expert recall (odds ratio [OR] = 1.94; 95% CI, 1.24-3.05; p = 0.004) and cancer status (OR = 1.81; 95% CI, 1.01-3.23; p = 0.045) were significantly improved for DVD participants compared with control subjects, with no significant change in specificity. For the seminar group, specificity was significantly lower than the control group (OR relative to expert recall = 0.80; 95% CI, 0.64-1.00; p = 0.048; OR relative to cancer status = 0.79; 95% CI, 0.65-0.95; p = 0.015)., Conclusion: In this randomized controlled trial, the DVD educational intervention resulted in a significant improvement in screening mammography interpretive performance on a test set, which could translate into improved interpretative performance in clinical practice.

Latent class regression (LCR) is a popular method for analyzing multiple categorical outcomes. While nonresponse to the manifest items is a common complication, inferences of LCR can be evaluated using maximum likelihood, multiple imputation, and two-stage multiple imputation. Under similar missing data assumptions, the estimates and variances from all three procedures are quite close. However, multiple imputation and two-stage multiple imputation can provide additional information: estimates for the rates of missing information. The methodology is illustrated using an example from a study on racial and ethnic disparities in breast cancer severity., (© 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)