rubrica

Screening

  • Paolo Giorgi Rossi1

  1. Servizio interaziendale di epidemiologia, AUSL Reggio Emilia

Ricerca bibliografica periodo dal 16 gennaio 2013 al 31 marzo 2013

Per leggere le caratteristiche di questa ROUTINE di ricerca clicca qui

Stringa: ("mass screening"[MeSH Terms] OR cancer[Title/Abstract] AND screening[Title/Abstract] AND ("italy"[MeSH Terms] OR "italy"[All Fields]) AND ("2013/01/16"[PDAT] : "2013/03/31"[PDAT])

Di ogni articolo è disponibile l'abstract. Per visualizzarlo basta cliccare sul titolo.

Breve commento a cura di P. Giorgi Rossi riferito all'intera sezione
Rispetto alle precedenti questa ricerca presenta solo 9 lavori sugli screening pubblicati da gruppi italiani, incluse due lettere. Due articoli e una lettera riguardano lo screening del colon retto (Di Lena, Sali, Scaringi), due la cervice uterina (Lukic, Giambi), due il polmone (Ulivi, Rampinelli), uno la mammella (Foca) e, infine, una lettera lancia la proposta di uno screening delle malattie cardiache negli atleti agonisti (Thiene). Da segnalare l’analisi dei dati dello studio IMPATTO effettuata da Foca e colleghi che ha mostrato una riduzione d’incidenza dei tumori della mammella diagnosticati in stadi avanzati a partire già dal terzo anno di attivazione del programma di screening. Ciò a fronte di un modesto aumento d’incidenza globale, che include sia l’anticipazione diagnostica, sia l’eventuale sovradiagnosi. Sali e colleghi illustrano il disegno di un trial a tre bracci, non ancora partito, che confronterà l’efficacia dello screening con 1) colonscopia virtuale, 2) colonscopia ottica, entrambe una volta nella vita, e 3) FOBT biennale per tre round. Il confronto con il FOBT anziché con l’assenza di screening è l’unico ormai accettabile per valutare una nuova tecnologia nella diagnosi precoce del colon retto e questo studio ha il disegno giusto; certo rimangono dei dubbi sull’adeguatezza della dimensione campionaria. Infine salutiamo la pubblicazione dei risultati dell’indagine sulla prevalenza di infezioni da HPV per tipo virale nelle donne giovani, lo studio PREGIO (Giambi).

Di ogni articolo è disponibile l'abstract. Per visualizzarlo basta cliccare sul titolo.

1. Di Lena M, Travaglio E, Altomare DF. New strategies for colorectal cancer screening. World J Gastroenterol. 2013 Mar 28;19(12):1855-60. doi: 10.3748/wjg.v19.i12.1855.
Maria Di Lena, Elisabetta Travaglio, Donato F Altomare, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, 11-70124 Bari, Italy.

Abstract
Colorectal cancer (CRC) is still one of the leading causes of cancer-related death in Western countries, despite major improvements in its treatment. The dramatically high social and economic impact of CRC on human health makes the identification of a reliable screening tool of paramount importance. Current screening methods, such as the fecal occult blood test and colonoscopy do not adequately meet the ideal requisites of a screening test because, even if they are effective, they are limited first by too low specificity and sensitivity, or second by high invasiveness, costs and risk. Nowadays extended efforts are made by researchers to look for more reliable and effective screening tests based on a systems biology approach, using biological samples easily available, such as urine, breath, serum and feces. The effectiveness and reliability of several new attempts to screen these patients by non-invasive analysis of their biological samples using genomic (genetic and epigenetic alteration), transcriptomic (miRNA), proteomic (cancer-related antigens, new antibodies against tumor-associated antigens, mutated proteins) and metabolomic (volatile organic metabolites) methods are discussed in this review. Among the most interesting new screening tools, fecal fluorescent long-DNA, fecal miRNA and metabolomic evaluation in breath and/or serum seem to be most promising.

2. Foca F, Mancini S, Bucchi L, Puliti D, Zappa M, Naldoni C, Falcini F, Gambino ML, Piffer S, Sanoja Gonzalez ME, Stracci F, Zorzi M, Paci E; the IMPACT Working Group. Decreasing incidence of late-stage breast cancer after the introduction of organized mammography screening in Italy. Cancer. 2013 Mar 15. doi: 10.1002/cncr.28014. [Epub ahead of print]
Romagna Cancer Registry, Romagna Cancer Institute, Meldola, Forli, Italy.

Abstract
BACKGROUND: After the introduction of a mammography screening program, the incidence of late-stage breast cancer is expected to decrease. The objective of the current study was to evaluate variations in the total incidence of breast cancer and in the incidence of breast cancers with a pathologic tumor (pT) classification of pT2 through pT4 after the introduction of mammography screening in 6 Italian administrative regions. METHODS: The study area included 700 municipalities, with a total population of 692,824 women ages 55 to 74 years, that were targeted by organized mammography screening between 1991 and 2005. The year screening started at the municipal level (year 1) was identified. The years of screening were numbered from 1 to 8. The ratio of the observed 2-year, age-standardized (Europe) incidence rate to the expected rate (the incidence rate ratio [IRR]) was calculated. Expected rates were estimated assuming that the incidence of breast cancer was stable and was equivalent to that in the last 3 years before year 1. RESULTS: The study was based on a total of 14,447 incident breast cancers, including 4036 pT2 through pT4 breast cancers. The total IRR was 1.35 (95% confidence interval, 1.03-1.41) in years 1 and 2, 1.16 (95% confidence interval, 1.10-1.21) in years 3 and 4, 1.14 (95% confidence interval, 1.08-1.20) in years 5 and 6, and 1.14 (95% confidence interval, 1.08-1.21) in years 7 and 8. The IRR for pT2 through pT4 breast cancers was 0.97 (95% confidence interval, 0.90-1.04) in years 1 and 2, 0.81 (95% confidence interval, 0.75-0.88) in years 3 and 4, 0.79 (95% confidence interval, 0.73-0.87) in years 5 and 6, and 0.71 (95% confidence interval, 0.64-0.79) in years 7 and 8. CONCLUSIONS: A significant and stable decrease in the incidence of late-stage breast cancer was observed from the third year of screening onward, when the IRR varied between 0.81 and 0.71.

3. Sali L, Grazzini G, Carozzi F, Castiglione G, Falchini M, Mallardi B, Mantellini P, Ventura L, Regge D, Zappa M, Mascalchi M, Milani S. Screening for colorectal cancer with FOBT, virtual colonoscopy and optical colonoscopy: study protocol for a randomized controlled trial in the Florence district (SAVE study). Trials. 2013 Mar 15;14:74. doi: 10.1186/1745-6215-14-74.
Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Viale G, Pieraccini 6, 50139 Florence, Italy. m.mascalchi@dfc.unifi.it.

Abstract
BACKGROUND: Colorectal cancer (CRC) is the most frequent cancer in Europe. Randomized clinical trials demonstrated that screening with fecal occult blood test (FOBT) reduces mortality from CRC. Accordingly, the European Community currently recommends population-based screening with FOBT. Other screening tests, such as computed tomography colonography (CTC) and optical colonoscopy (OC), are highly accurate for examining the entire colon for adenomas and CRC. Acceptability represents a critical determinant of the impact of a screening program. We designed a randomized controlled trial to compare participation rate and diagnostic yield of FOBT, CTC with computer-aided diagnosis, and OC as primary tests for population-based screening. METHODS/DESIGN: A total of 14,000 subjects aged 55 to 64 years, living in the Florence district and never screened for CRC, will be randomized in three arms: group 1 (5,000 persons) invited to undergo CTC (divided into: subgroup 1A with reduced cathartic preparation and subgroup 1B with standard bowel preparation); group 2 (8,000 persons) invited to undergo a biannual FOBT for three rounds; and group 3 (1,000 persons) invited to undergo OC. Subjects of each group will be invited by mail to undergo the selected test. All subjects with a positive FOBT or CTC test (that is, mass or at least one polyp ≥6 mm) will be invited to undergo a second-level OC. Primary objectives of the study are to compare the participation rate to FOBT, CTC and OC; to compare the detection rate for cancer or advanced adenomas of CTC versus three rounds of biannual FOBT; to evaluate referral rate for OC induced by primary CTC versus three rounds of FOBT; and to estimate costs of the three screening strategies. A secondary objective of the study is to create a biological bank of blood and stool specimens from subjects undergoing CTC and OC. DISCUSSION: This study will provide information about participation/acceptability, diagnostic yield and costs of screening with CTC in comparison with the recommended test (FOBT) and OC.

4. Lukic A, Iannaccio S, Heyn R, Villani S, Nobili F, Giarnieri E, Mancini R, Moscarini M, Giovagnoli MR. Satisfactory sampling in cytological cervical diagnosis: comparison between a conventional and a new sampling device. Anticancer Res. 2013 Mar;33(3):917-22.
Via Michele Amari 47, 00179 Roma, Italy. luki.anki@tin.it.

Abstract
Aim: Inadequate cervical sampling is the most frequent cause of misdiagnosis in cervical cancer screening. The aim of this study was to test the ability of PapCone® versus the conventional sampling method (Ayre's spatula plus cytobrush) to collect ectocervical and glandular cells.MATERIALS AND METHODS: In 18 healthy women, two ecto-endocervical samples, obtained by two different methods, were obtained at a three-month interval. Qualitative and quantitative parameters were evaluated. Ultrastructure features of sampling devices were analyzed by scanning electron microscopy (SEM) before and after sampling. RESULTS: The χ test revealed a statistically significant difference between the two methods: PapCone® caused less cell overlap and sampled less white blood cells (p<0.05) and more metaplastic cells (p<0.01). SEM evaluation highlighted the porous and spongy structure of PapCone® that was responsible for the large number of glandular cells on its surface. CONCLUSION: Cervical smears performed by PapCone® were adequate and generally easier to screen than conventionally performed ones.

5. Scaringi S, Di Martino C, Zambonin D. About the Colorectal Cancer Screening and Surveillance in Crohn's Colitis. J Crohns Colitis. 2013 Mar 7. pii: S1873-9946(13)00073-1. doi: 10.1016/j.crohns.2013.02.008. [Epub ahead of print]
Digestive Surgery Unit, Careggi University Hospital, Florence, Italy. Electronic address: stefano.scaringi@unifi.it.
6. Ulivi P, Mercatali L, Casoni GL, Scarpi E, Bucchi L, Silvestrini R, Sanna S, Monteverde M, Amadori D, Poletti V, Zoli W. Multiple Marker Detection in Peripheral Blood for NSCLC Diagnosis. PLoS One. 2013;8(2):e57401. doi: 10.1371/journal.pone.0057401. Epub 2013 Feb 26.
Biosciences Laboratory, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy.

Abstract
BACKGROUND: Non-invasive early detection of lung cancer could reduce the number of patients diagnosed with advanced disease, which is associated with a poor prognosis. We analyzed the diagnostic accuracy of a panel of peripheral blood markers in detecting non small cell lung cancer (NSCLC). METHODS: 100 healthy donors and 100 patients with NSCLC were enrolled onto this study. Free circulating DNA, circulating mRNA expression of peptidylarginine deiminase type 4 (PAD4/PADI4), pro-platelet basic protein (PPBP) and haptoglobin were evaluated using a Real-Time PCR-based method. RESULTS: Free circulating DNA, PADI4, PPBP and haptoglobin levels were significantly higher in NSCLC patients than in healthy donors (p<0.0001, p<0.0001, p = 0.0002 and p = 0.0001, respectively). The fitted logistic regression model demonstrated a significant direct association between marker expression and lung cancer risk. The odds ratios of individual markers were 6.93 (95% CI 4.15-11.58; p<0.0001) for free DNA, 6.99 (95% CI 3.75-13.03; p<0.0001) for PADI4, 2.85 (95% CI 1.71-4.75; p<0.0001) for PPBP and 1.16 (95% CI 1.01-1.33; p = 0.031) for haptoglobin. Free DNA in combination with PPBP and PADI4 gave an area under the ROC curve of 0.93, 95% CI = 0.90-0.97, with sensitivity and specificity over 90%. CONCLUSIONS: Free circulating DNA analysis combined with PPBP and PADI4 expression determination appears to accurately discriminate between healthy donors and NSCLC patients. This non-invasive multimarker approach warrants further research to assess its potential role in the diagnostic or screening workup of subjects with suspected lung cancer.

7. Thiene G, Corrado D, Schiavon M, Basso C. Screening of competitive athletes to prevent sudden death: implement programmes now. Heart. 2013 Mar;99(5):304-6. doi: 10.1136/heartjnl-2012-302411.
Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Via A. Gabelli, 61, Padua 35121, Italy. gaetano.thiene@unipd.it Comment in Heart. 2013 Mar;99(5):306-7.
8. Rampinelli C, Origgi D, Bellomi M. Low-dose CT: technique, reading methods and image interpretation. Cancer Imaging. 2013 Feb 8;12:548-56. doi: 10.1102/1470-7330.2012.0049.
Department of Radiology, European Institute of Oncology, Milan, Italy. cristiano.rampinelli@ieo.it

Abstract
The National Lung Cancer Screening Trial has recently demonstrated that screening of high-risk populations with the use of low-dose computed tomography (LDCT) reduces lung cancer mortality. Based on this encouraging result, the National Comprehensive Cancer Network guidelines recommended LDCT for selected patients at high risk of lung cancer. This suggests that an increasing number of CT screening examinations will be performed. The LDCT technique is relatively simple but some CT parameters are important and should be accurately defined in order to achieve good diagnostic quality and minimize the delivered dose. In addition, LDCT examinations are not as easy to read as they may initially appear; different approaches and tools are available for nodule detection and measurement. Moreover, the management of positive results can be a complex process and can differ significantly from routine clinical practice. Therefore this paper deals with the LDCT technique, reading methods and interpretation in lung cancer screening, particularly for those radiologists who have little experience of the technique.

9. Giambi C, Donati S, Carozzi F, Salmaso S, Declich S, Atti ML, Ronco G, Alibrandi MP, Brezzi S, Collina N, Franchi D, Lattanzi A, Minna MC, Nannini R, Barretta E, Burroni E, Gillio-Tos A, Macallini V, Pierotti P, Bella A. A cross-sectional study to estimate high-risk human papillomavirus prevalence and type distribution in Italian women aged 18-26 years. BMC Infect Dis. 2013 Feb 7;13:74. doi: 10.1186/1471-2334-13-74.
Communicable Disease Epidemiology Unit, National Centre for Epidemiology, Surveillance and Health Promotion; Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy. cristina.giambi@iss.it.

Abstract
BACKGROUND: Pre-vaccination information on HPV type-specific prevalence in target populations is essential for designing and monitoring immunization strategies for cervical cancer (CC) prevention. Data on HPV prevalence in Italy are available for women over the age of 24 years, target of the population-based CC screening programmes; while data of HPV prevalence in younger ages are very limited. The present study enrolled Italian women aged 18-26 years in order to assess the prevalence and distribution of high-risk (HR) HPV types. Risk-factors correlated with HR-HPV positivity were also described. METHODS: A sample of 2,289 women was randomly selected from the resident population lists of ten Local Health Units (LHUs) located in six Italian Regions scattered across the country; both rural and urban LHUs were involved. Women aged between 18 and 26 years and living in the selected LHUs were included in the study; pregnant women and women who did not speak Italian were excluded. A total of 1,102 women met the inclusion criteria and agreed to participate. Participants were offered pap test and Hybrid-Capture 2 (HC2) test for HR-HPV types and genotyping was performed on positive smears. RESULTS: Out of 1,094 valid samples, 205 (18.7%) were HR-HPV positive. Women with 2-4 (ORadj = 4.15, 95%CI: 2.56-6.72) and ≥5 lifetime partners (ORadj = 10.63, 95%CI: 6.16-18.36) and women who have used any contraceptive in the last six months (ORadj = 1.67, 95%CI: 1.09-2.54) had a higher risk to be infected; women living with their partner had a lower risk (ORadj = 0.56, 95%CI: 0.34-0.92) to acquire infection than women living with parents/friends/alone. Among HC2 positive women, HPV16 was the most prevalent type (30.9%), followed by 31 (19.6%), 66 (12.9%), 51 (11.3%), 18 (8.8%), 56 (8.8%). Co-infections of HR-HC2 targeted types were found in 20.4% of positive samples. The HR-HPV prevalence in women with abnormal cytology (52.4%) was significantly higher than in women with normal cytology (14.6%); however 33.0% of HR-HPV infected women had an abnormal cytology. CONCLUSION: HR-HPV prevalence in Italian women aged 18-26 years was 19%, higher than what detected for older women, by other studies using the same molecular method and laboratory network; this result supports the choice of electing girls before the sexual debut as the primary target of HPV vaccination. The HPV type distribution found in this study may represent a baseline picture; an accurate post-vaccine surveillance is necessary to early detect a possible genotype replacement. The high prevalence of viral types other than vaccine-HPV types supports the necessity to guarantee the progression of CC screening programmes in vaccinated women.

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