rubrica

Screening

  • Paolo Giorgi Rossi1

  1. Servizio interaziendale di epidemiologia, AUSL Reggio Emilia

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Ricerca bibliografica periodo dal 1 febbraio 2014 al 15 aprile 2014

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 ("2014/02/01"[PDAT] : "2014/04/15"[PDAT])

 

Breve commento a cura di P. Giorgi Rossi
Due mesi intensi per la comunità scientifica degli screening in Italia con 6 articoli sulla cervice uterina, 5 sul colonretto, 2 sulla mammella e 1 sullo screening dei cirrotici per l’epatocarcinoma. Per la cervice facciamo notare un botta e risposta su Lancet (Sideri, Ronco) quasi tutto italiano sui risultati dei trial europei sull’HPV pubblicati a gennaio sempre su Lancet. Sono usciti anche tre lavori a cavallo fra aspetti molecolari e differenze socioeconomiche nell’epidemiologia e nella prevenzione del cervicocarcinoma (Tornesello migranti e infezioni, Giorgi Rossi differenze socioeconomiche e screening con HPV test, Guzzetta interazione vaccino e screening). Infine un lavoro più classico di concordaza della diagnosi istologica nello screening cone e senza biomarker (Pacchiarotti) che suona un po’ come una bocciatura dell’uso a tappeto della p16 in istologia. Per il colon retto troviamo due valutazioni della colon virtuale, una per l’uso della lettura computer assistita (CAD) (Iussich) e il disegno di un trial di efficacia colon virtuale vs. sigmoidoscopia (Regge). Maffei propone un test moleoclare per la diagnosi precoce del cancro del colon retto, mentre Fraser propone un’analisi delle variazioni di positività del test immunochimico del sangue occulto per età, dimostrando al contempo che l’impatto di questi rsultati sulle pratiche di screening è nullo. Infine una review sull’epidemiologia, i programmi di screening e la ricerca sulla prevenzioen del cancro del colonretto in europa (Altobelli) che aggiorna il lavoro di von Karsa del 2007. Per la mammella Cedolini presenta un’analisi sulla sopravvivenza di casi screen detected e non, che però non risolve tutti i problemi di lead-time bias e di lenght-time bias di questi studi, mentre Bernardi presenta un altro bello studio sulla tomosintesi che sostiene la lettura integrata 3D e 2D anziché la sola 3D almeno per l’impatto sulla variabilità fra letori (un altro lavoro che ci fa sentire il vuoto lasciato da Stefano Ciatto quando lo leggiamo fra gli autori). Dal Poggio presenta un’interssante analisi della sorveglianza ecografica in cirrotici con un end point di efficacia abbastanza solido, sebbene non sia la mortalità, cioè l’incidenza di casi di epatocarcinoma in stadio avazato. Le conclusioni indicano che una sorveglianza semestrale è più efficace nel ridurre gli stadi avanzati di una annuale, ma viene da chiedersi con un lead time così breve quanto siamo in grado effettivamente di fare la differenza in termini di miglioramento della prognosi in questo screening.

1. Ronco G(1), Meijer CJ(2), Segnan N(3), Kitchener H(4), Giorgi-Rossi P(5), Peto J(6), Dillner J(7). HPV-based screening for prevention of invasive cervical cancer - Authors' reply. Lancet. 2014 Apr 12;383(9925):1295. doi: 10.1016/S0140-6736(14)60645-0.
Author information: (1)Unit of Cancer Epidemiology, Center for Cancer Epidemiology and Prevention, AO City of Health and Science, 10123 Torino, Italy. Electronic address: guglielmo.ronco@cpo.it. (2)VU University Medical Centre, Amsterdam, Netherlands. (3)Unit of Cancer Epidemiology, Center for Cancer Epidemiology and Prevention, AO City of Health and Science, 10123 Torino, Italy. (4)University of Manchester, Manchester, UK. (5)Azienda Sanitaria Locale, Reggio Emilia, Italy. (6)London School of Hygiene & Tropical Medicine, London, UK. (7)Karolinska Institutet, Stockholm, Sweden. Comment on Lancet. 2014 Apr 12;383(9925):1294-5. Lancet. 2014 Apr 12;383(9925):1294. Lancet. 2014 Feb 8;383(9916):524-32.
2. Sideri M(1), Igidbashian S(2). HPV-based screening for prevention of invasive cervical cancer. Lancet. 2014 Apr 12;383(9925):1294. doi: 10.1016/S0140-6736(14)60643-7.
Author information: (1)Preventive Gynaecology Unit, European Institute of Oncology, 20141 Milano, Italy. (2)Preventive Gynaecology Unit, European Institute of Oncology, 20141 Milano, Italy. Electronic address: sarah.igidbashian@ieo.it. Comment in Lancet. 2014 Apr 12;383(9925):1295. Comment on Lancet. 2014 Feb 8;383(9916):524-32.
3. Cedolini C(1), Bertozzi S(2), Londero AP(3), Bernardi S(4), Seriau L(2), Concina S(2), Cattin F(2), Risaliti A(2). Type of Breast Cancer Diagnosis, Screening, and Survival. Clin Breast Cancer. 2014 Feb 20. pii: S1526-8209(14)00029-9. doi: 10.1016/j.clbc.2014.02.004. [Epub ahead of print]
Author information: (1)Clinic of Surgery, University of Udine, Udine, Italy. Electronic address: sere_d.estate@libero.it. (2)Clinic of Surgery, University of Udine, Udine, Italy. (3)Clinic of Obstetrics and Gynecology, University of Udine, Udine, Italy. (4)Department of Surgery, Ospedale Civile di Latisana, Udine, Italy; Department of Surgery, AOU "Santa Maria della Misericordia," Udine, Italy.

Abstract
INTRODUCTION: Breast cancer screening is known to reduce mortality. In the present study, we analyzed the prevalence of breast cancers detected through screening, before and after introduction of an organized screening, and we evaluated the overall survival of these patients in comparison with women with an extrascreening imaging-detected breast cancer or those with palpable breast cancers. MATERIALS AND METHODS: We collected data about all women who underwent a breast operation for cancer in our department between 2001 and 2008, focusing on type of tumor diagnosis, tumor characteristics, therapies administered, and patient outcome in terms of overall survival, and recurrences. Data was analyzed by R (version 2.15.2), and P < .05 was considered significant. RESULTS: Among the 2070 cases of invasive breast cancer we considered, 157 were detected by regional mammographic screening (group A), 843 by extrascreening breast imaging (group B: 507 by mammography and 336 by ultrasound), and 1070 by extrascreening breast objective examination (group C). The 5-year overall survival in groups A, B, and C were, respectively, 99% (95% CI, 98%-100%), 98% (95% CI, 97%-99%), and 91% (95% CI, 90%-93%), with a significant difference between the first 2 groups and the third (P < .05) and a trend between groups A and B (P = .081). CONCLUSION: The diagnosis of invasive breast cancer with screening in our population resulted in a survival gain at 5 years from the diagnosis, but a longer follow-up is necessary to confirm this data.

4. Regge D, Iussich G, Senore C, Correale L(1), Hassan C, Bert A, Montemezzi S, Segnan N. Population screening for colorectal cancer by flexible sigmoidoscopy or CT colonography: study protocol for a multicenter randomized trial. Trials. 2014 Mar 28;15(1):97. doi: 10.1186/1745-6215-15-97.
Author information: (1)im3D SpA, Turin, Italy. loredana.correale@i-m3d.com.

Abstract
BACKGROUND: Colorectal cancer (CRC) is the second most prevalent type of cancer in Europe. A single flexible sigmoidoscopy (FS) screening at around the age of 60 years prevents about one-third of CRC cases. However, FS screens only the distal colon, and thus mortality from proximal CRC is unaffected. Computed tomography colonography (CTC) is a highly accurate examination that allows assessment of the entire colon. However, the benefit of CTC testing as a CRC screening test is uncertain. We designed a randomized trial to compare participation rate, detection rates, and costs between CTC (with computer-aided detection) and FS as primary tests for population-based screening. METHODS/DESIGN: An invitation letter to participate in a randomized screening trial comparing CTC versus FS will be mailed to a sample of 20,000 people aged 58 or 60 years, living in the Piedmont region and the Verona district of Italy. Individuals with a history of CRC, adenomas, inflammatory bowel disease, or recent colonoscopy, or with two first-degree relatives with CRC will be excluded from the study by their general practitioners. Individuals responding positively to the invitation letter will be then randomized to the intervention group (CTC) or control group (FS), and scheduled for the screening procedure. The primary outcome parameter of this part of the trial is the difference in advanced neoplasia detection between the two screening tests. Secondary outcomes are cost-effectiveness analysis, referral rates for colonoscopy induced by CTC versus FS, and the expected and perceived burden of the procedures. To compare participation rates for CTC versus FS, 2,000 additional eligible subjects will be randomly assigned to receive an invitation for screening with CTC or FS. In the CTC arm, non-responders will be offered fecal occult blood test (FOBT) as alternative screening test, while in the FS arm, non-responders will receive an invitation letter to undergo screening with either FOBT or CTC. Data on reasons for participation and non-participation will also be collected. DISCUSSION: This study will provide reliable information concerning benefits and risks of the adoption of CTC as a mass screening intervention in comparison with FS. The trial will also evaluate the role of computer-aided detection in a screening setting. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01739608.

5. Maffei F(1), Zolezzi Moraga JM, Angelini S, Zenesini C, Musti M, Festi D, Cantelli-Forti G, Hrelia P. Micronucleus frequency in human peripheral blood lymphocytes as a biomarker for the early detection of colorectal cancer risk. Mutagenesis. 2014 May;29(3):221-5. doi: 10.1093/mutage/geu007. Epub 2014 Mar 25.
Author information: (1)Department for Life Quality Studies, University of Bologna, Corso d'Augusto 237, 47921 Rimini, Italy.

Abstract
The early detection of colorectal cancer (CRC) can significantly improve the prognosis of affected patients. The loss of genomic stability and the resulting gene alteration play an important role in the molecular pathological steps that occur early in tumorigenesis of CRC. Thus, the identification of non-invasive biomarkers, whose function may provide useful insights into critical early events in the CRC process, is of great interest. In this regard, micronucleus (MN) frequency in peripheral blood lymphocytes (PBL) has become one of the most established biomarkers for studying DNA damage in the human population. This study investigated the MN frequency in the PBL of 82 subjects (30 females and 52 males; aged 50-70 years) who were participating in a screening programme for CRC prevention. All 82 patients were positive in fecal occult blood tests and they were subsequently classified, according to colonoscopy and histological findings, as patients with CRC, patients with colon polyps or subjects without intestinal lesion, referred to as study controls. This study also examined the relationship between the plasma clastogenic activity and the frequency of micronuclei of the study population. The MN frequency was significantly higher in CRC patients than in both colon polyp patients (16.82±6.56 versus 12.23±1.88; P = 0.002) and controls (16.82±6.56 versus 8.00±1.77; P < 0.001). An increased MN frequency was detected in the lymphocytes of the polyp group in comparison to the control group, although this was lower than that observed in CRC patients (12.23±1.88 versus 8.00±1.77; P < 0.001). In the overall study population, the increase of MN frequency, which was observed in the lymphocytes of the subjects involved, was significantly associated with the clastogenic activity detected in their plasma (r = 0.594, P < 0.001). Overall, the results suggest that the MN test can become a promising biomarker for the early detection of CRC.

6. Fraser CG, Rubeca T, Rapi S, Chen LS, Chen HH. Faecal haemoglobin concentrations vary with sex and age, but data are not transferable across geography for colorectal cancer screening. Clin Chem Lab Med. 2014 Mar 15. pii: /j/cclm-ahead-of-print/cclm-2014-0115/cclm-2014-0115.xml. doi: 10.1515/cclm-2014-0115. [Epub ahead of print]
Abstract
Abstract Background: Faecal immunochemical tests (FIT) are becoming widely used in colorectal cancer (CRC) screening. Availability of data on faecal haemoglobin concentrations (f-Hb) in three countries prompted an observational study on sex and age and the transferability of data across geography. Methods: Single estimates of f-Hb in large groups were made in Scotland, Taiwan and Italy using quantitative automated immunoturbidimetry on the Eiken OC-Sensor. Distributions were examined for men and women overall and in four different age groups. Results: The distributions of f-Hb were not Gaussian and had kurtosis and positive skewness. The distributions were different in the three countries: f-Hb varies with sex and age in all countries, being higher in men and the elderly, but the degree of variation is inconsistent across countries, f-Hb being higher in Scotland than in Taiwan than in Italy, possibly due to different lifestyles. At any cut-off concentration, more men are declared positive than women and more older people are declared positive than younger individuals. Conclusions: Our analysis supports the view that setting and using a single f-Hb cut-off in any CRC screening programme is far from ideal. We suggest that individualisation is the optimum approach with f-Hb, alone or with other important factors such as sex and age, used to determine important personal issues such as need for colonoscopy, screening interval between tests and risk of future CRC. Whether there is merit in monitoring f-Hb in individuals over time remains an interesting research question for the future.
7. Guzzetta G(1), Faustini L(2), Panatto D(3), Gasparini R(3), Manfredi P(4). The impact of HPV female immunization in Italy: model based predictions. PLoS One. 2014 Mar 11;9(3):e91698. doi: 10.1371/journal.pone.0091698. eCollection 2014.
Author information: (1)Trento Rise, Trento, Italy; Fondazione Bruno Kessler, Trento, Italy. (2)Istat Toscana, Florence, Italy. (3)Dipartimento di Scienze della Salute, Università di Genova, Genoa, Italy. (4)Dipartimento di Economia e Management, Università di Pisa, Pisa, Italy.

Abstract
The Human Papillomavirus (HPV) is a sexually transmitted virus that causes cervical cancer. Since 2008 a vaccination program targeting 12-year-old girls has been initiated in Italy, backing up the cervical screening program already active since 1996. We propose a mathematical model of HPV transmission dynamics with the aim of evaluating the impact of these prevention strategies. The model considers heterosexual transmission of HPV types 16 and 18, structured by sex, age and sexual activity level, where transition to sexual activity is explicitly modeled from recent survey data. The epidemiological structure is a hybrid SIS/SIR, where a fraction of individuals recovering from infection develops permanent immunity against reinfection. Infections may progress to cervical lesions and cancer and heal spontaneously or upon treatment. Women undergoing hysterectomy (either after treatment of HPV lesions or by other causes) also transmit HPV infection. The model fits well both the age-specific prevalence of HPV infections and the incidence of cervical cancers in Italy, and accurately reproduces the decreasing trend in cancer incidence due to the introduction of the screening program. The model predicts that if the screening coverage is maintained at current levels, even in the absence of vaccination, such trend will continue in the next few decades, eventually plateauing at 25% below the current level. The additional initiation of routine vaccination targeting 12-year-old girls will further reduce cervical cancer incidence by two thirds at equilibrium, under realistic assumptions of 70% coverage and a duration of protective immunity of 50 years. If catch-up immunization of 25-year-old women at first cervical screening is also introduced, about 3,000 cervical cancer cases overall can be averted, corresponding to 9.6% of all cases expected in the scenario without catch-up. We conclude that HPV vaccination in addition to cervical screening will significantly reduce the burden of cervical cancer in Italy.

8. Tornesello ML(1), Giorgi Rossi P(2), Buonaguro L(1), Buonaguro FM(1); HPV Prevalence Italian Working Group. Human Papillomavirus Infection and Cervical Neoplasia among Migrant Women Living in Italy Front Oncol. 2014 Feb 20;4:31. doi: 10.3389/fonc.2014.00031. eCollection 2014.
Author information: (1)Molecular Biology and Viral Oncology Unit, Istituto Nazionale Tumori "Fondazione G Pascale" - IRCCS , Naples , Italy. (2)Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale and IRCCS, Arcispedale Santa Maria Nuova , Reggio Emilia , Italy.

Abstract
Human papillomavirus (HPV) infection is highly prevalent in women migrating from countries where cervical screening is not implemented. The variety of HPV genotypes, their prevalence and the association with cervical abnormalities has been investigated by several groups in women moving mainly from Eastern Europe, Africa, and Southern Asia to Italy. All studies are concordant on the elevated rate of HPV infection among immigrants, which is four times higher than that observed among age-matched Italian women. The HPV prevalence among short-term migrants and characterization of viral variants showed that the high prevalence of HPV reflects either individual lifestyle or high prevalence of HPV in the country of origin. The high burden of HPV infection correlates very well with the high incidence of cervical cancer in migrant women. In fact, during the years 2000-2004 the cervical cancer incidence in women from Central and Eastern Europe and living in Central Italy was 38.3 per 100,000, which is statistically significant higher than that of native Italian women (6 per 100,000). In this study, we pooled together the results of three independent studies originally designed to assess the distribution and the prevalence of HPV genotypes among 499 immigrant women living in Southern Italy. A total of 39 mucosal HPV genotypes were identified. The 12 genotypes (HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59) classified as carcinogenic to humans (group 1) accounted for >80% of all infections. HPV16 was the most common viral type in all groups with frequency rates ranging from 15.4% in Africa to 51.1% in Eastern and Southern European HPV-positive women. The high prevalence of oncogenic HPVs and cervical cancer risk among migrant women, together with the lower participation in screening programs, demands for an urgent implementation of preventive strategies to increase screening and vaccine coverage and viral monitoring of uncommon HPV genotypes potential spreading in settled population.

9. Del Poggio P(1), Olmi S(2), Ciccarese F(2), Di Marco M(3), Rapaccini GL(4), Benvegnù L(5), Borzio F(6), Farinati F(7), Zoli M(8), Giannini EG(9), Caturelli E(10), Chiaramonte M(11), Trevisani F(12); Italian Liver Cancer (ITA.LI.CA) group. Factors That Affect Efficacy Of Ultrasound Surveillance For Early-Stage Hepatocellular Carcinoma In Patients With Cirrhosis. Clin Gastroenterol Hepatol. 2014 Feb 26. pii: S1542-3565(14)00310-3. doi: 10.1016/j.cgh.2014.02.025. [Epub ahead of print]
Author information: (1)Unità di Epatologia, Policlinico S. Marco, Zingonia (Bergamo). Electronic address: paolo.delpoggio@fastwebnet.it. (2)Unità di Epatologia, Policlinico S. Marco, Zingonia (Bergamo). (3)Divisione di Medicina, Azienda Ospedaliera Bolognini, Seriate. (4)Medicina Interna e Gastroenterologia, Università Cattolica, Rome. (5)Medicina Clinica e Sperimentale, Università di Padova, Padova. (6)Medicina Interna ed Epatologia, Ospedale Fatebenefratelli, Milano. (7)Scienze Chirurgiche e Gastroenterologiche, Università di Padova, Padova. (8)Dipartimento di Scienze Mediche e Chirugiche, Medicina Interna, Alma Mater Studiorum -Università di Bologna, Bologna. (9)Gastroenterologia, Università di Genova, Genova. (10)Gastroenterologia, Ospedale Belcolle, Viterbo. (11)Gastroenterologia, Ospedale Negrar, Verona. (12)Dipartimento di Scienze Mediche e Chirugiche, Semeiotica Medica, Alma Mater Studiorum - Università di Bologna, Bologna; Italy.

Abstract
BACKGROUND & AIMS: Ultrasound surveillance does not detect early-stage hepatocellular carcinomas (HCCs) in some patients with cirrhosis, although the reasons for this have not been well studied. We assessed the rate at which ultrasound fails to detect early-stage HCCs and factors that affect its performance. METHODS: We collected information on 1170 consecutive patients included in the Italian Liver Cancer (ITA.LI.CA ) database who had Child-Pugh A or B cirrhosis and were diagnosed with HCC during semi-annual or annual ultrasound surveillance, from January 1987 through December 2008. Etiologies included: hepatitis C virus infection (59.3%), alcohol abuse (11.3%), hepatitis B virus infection (9%), a combination of factors (15.6%), and other factors (4.7%). Surveillance was considered to be a failure when patients were diagnosed with HCC at a stage beyond the Milan criteria (1 nodule ≤5 cm or ≤3 nodules each ≤3 cm). RESULTS: Ultrasound surveillance failed to detect HCC in 34.3 % of patients and more often in the annual program than in the semiannual one. (41.3% vs 32.2 % ; P<0.01). Nearly half of surveillance failures were associated with at least one indicator of aggressive HCC (levels of AFP >1000 ng/ml, infiltrating tumors, or vascular invasion and metastases). Semi-annual surveillance, female sex, Child-Pugh class A, and AFP levels ≤ 200 ng/ml were independently associated with successful ultrasound screening for HCC. CONCLUSION: Based on analysis of surveillance for HCC in patients with cirrhosis , the efficacy of ultrasound-based screening is acceptable. Ultrasound is least effective in identifying aggressive HCC, and at surveillance intervals >6 months.

10. Bernardi D(1), Caumo F(2), Macaskill P(3), Ciatto S(4), Pellegrini M(1), Brunelli S(2), Tuttobene P(1), Bricolo P(2), Fantò C(1), Valentini M(1), Montemezzi S(2), Houssami N(5). Effect of integrating 3D-mammography (digital breast tomosynthesis) with 2D-mammography on radiologists' true-positive and false-positive detection in a population breast screening trial. Eur J Cancer. 2014 May;50(7):1232-8. doi: 10.1016/j.ejca.2014.02.004. Epub 2014 Feb 28.
Author information: (1)U.O. Senologia Clinica e Screening Mammografico, Department of Diagnostics, Azienda Provinciale Servizi Sanitari (APSS), Trento, Italy. (2)Centro di Prevenzione Senologica, Marzana, Verona, Italy. (3)Screening and Test Evaluation Program (STEP), School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia. (4)U.O. Senologia Clinica e Screening Mammografico, Department of Diagnostics, Azienda Provinciale Servizi Sanitari (APSS), Trento, Italy; Centro di Prevenzione Senologica, Marzana, Verona, Italy. (5)Screening and Test Evaluation Program (STEP), School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia. Electronic address: nehmath@med.usyd.edu.au.

Abstract
OBJECTIVE: We investigated the effect of integrating three-dimensional (3D)-mammography with 2D-mammography on radiologists' detection measures in the 'screening with tomosynthesis or standard mammography' (STORM) trial. METHODS: STORM, a prospective population-based trial (Trento and Verona breast screening services) compared sequential screen-reading: 2D-mammography alone and integrated 2D/3D-mammography. Radiologist-specific detection measures were calculated for each screen-reading phase for eight radiologists: number of detected cancers, proportion of true-positive (TP) detection, and number and rate of false-positive (FP) recalls (FPR). We estimated the incremental cancer detection rate (CDR). RESULTS: There were 59 cancers and 395 false recalls amongst 7292 screening participants. At 2D-mammography screening, radiologist-specific TP detection ranged between 38% and 83% (median 63%; mean 60% and sd 15.4%); at integrated 2D/3D-mammography, TP detection ranged between 78% and 93% (median 87%; mean 87% and sd 5.2%). For all but one radiologist, 2D/3D-mammography improved breast cancer detection (relative to 2D-mammography) ranging between 0% and 54% (median 29%; mean 27% and sd 16.2%) increase in the proportion of detected cancers. Incremental CDR attributable to integrating 3D-mammography in screening varied between 0/1000 and 5.3/1000 screens (median 1.8/1000; mean 2.3/1000 and sd 1.6/1000). Radiologist-specific FPR for 2D-mammography ranged between 1.5% and 4.2% (median 3.1%; mean 2.9% and sd 0.87%), and FPR based on the integrated 2D/3D-mammography read ranged between 1.0% and 3.3% (median 2.4%; mean 2.2% and sd 0.72%). Integrated 2D/3D-mammography screening, relative to 2D-mammography, had the effect of reducing FP and increasing TP detection for most radiologists. CONCLUSION: There was broad variability in radiologist-specific TP detection at 2D-mammography and hence in the additional TP detection and incremental CDR attributable to integrated 2D/3D-mammography; more consistent (less variable) TP-detection estimates were observed for the integrated screen-read. Integrating 3D-mammography with 2D-mammography improves radiologists' screen-reading through improved cancer detection and/or reduced FPR, with most readers achieving both using integrated 2D/3D mammography.

11. Giorgi Rossi P(1), Baldacchini F(1), Ronco G(2). The Possible Effects on Socio-Economic Inequalities of Introducing HPV Testing as Primary Test in Cervical Cancer Screening Programs. Front Oncol. 2014 Feb 10;4:20. eCollection 2014.
Author information: (1)Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale di Reggio Emilia , Reggio Emilia , Italy. (2)Unit of Cancer Epidemiology II, Center for Cancer Epidemiology and Prevention (CPO) , Turin , Italy.

Abstract
Background: Screening with HPV is more effective than Pap test in preventing cervical cancer. HPV as primary test will imply longer intervals and a triage test for HPV positive women. It will also permit the development of self-sampling devices. These innovations may affect population coverage, participation, and compliance to protocols, and likely in a different way for less educated, poorer, and disadvantaged women. Aim: To describe the impact on inequalities, actual or presumed, of the introduction of HPV-based screening. Methods: The putative HPV-based screening algorithm has been analyzed to identify critical points for inequalities. A systematic review of the literature has been conducted searching PubMed on HPV screening coverage, participation, and compliance. Results were summarized in a narrative synthesis. Results: Knowledge about HPV and cervical cancer was lower in women with low socio-economic status and in disadvantaged groups. A correct communication can reduce differences. Longer intervals will make it easier to achieve high-population coverage, but higher cost of the test in private providers could reduce the use of opportunistic screening by disadvantaged women. There are some evidences that inviting for HPV test instead of Pap increases participation, but there are no data on social differences. Self-sampling devices are effective in increasing participation and coverage. Some studies showed that the acceptability of self-sampling is higher in more educated women, but there is also an effect on hard-to-reach women. Communication of HPV positivity may increase anxiety and impact on sexual behaviors, the effect is stronger in low educated and disadvantaged women. Finally, many studies found indirect evidence that unvaccinated women are or will be more probably under-screened. Conclusion: The introduction of HPV test may increase population coverage, but non-compliance to protocols and interaction with opportunistic screening can increase the existing inequalities.

12. Altobelli E(1), Lattanzi A(2), Paduano R(3), Varassi G(4), di Orio F(5). Colorectal cancer prevention in Europe: Burden of disease and status of screening programs. Prev Med. 2014 May;62C:132-141. doi: 10.1016/j.ypmed.2014.02.010. Epub 2014 Feb 14.
Author information: (1)Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy; Epidemiologic and Social Marketing Unit, AUSL 4 Teramo, Italy. Electronic address: emma.altobelli@cc.univaq.it. (2)Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy. Electronic address: amedeo.lattanzi@aslteramo.it. (3)Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy. Electronic address: riccardo.paduano@gmail.com. (4)AUSL 4, Teramo, Italy. Electronic address: giuvarr@gmail.com. (5)Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy. Electronic address: ferdinando.diorio@cc.univaq.it.

Abstract
Colorectal cancer is a major public health challenge worldwide. In Europe it is the first malignancy in terms of incidence and the second in terms of mortality in both genders. Despite evidence indicating that removal of premalignant and early-stage cancer lesion scan greatly reduce mortality, remarkable differences are still found among countries both in terms of organized screening programs and of the tests used. In 2003 the European Council recommended that priority be given to activation of organized cancer screening programs, and various states have been making significant efforts to adopt effective prevention programs with international quality standards and centralizing screening organization and result evaluation. After a 2008 European Union report on the state of screening program, activation highlighted that little more than 50% (12/22) of Member States had colorectal cancer screening programs, Screening programs have been adopted or earlier pilot projects have been extended nationwide. This paper examines the state of activation and the screening strategies of colorectal cancer screening programs in EU States as of July 2013.

13. Pacchiarotti A(1), Galeotti S, Bellardini P, Chini F, Collina G, Dalla Palma P, Ghiringhello B, Maccallini V, Musolino F, Negri G, Pisa R, Sabatucci I, Giorgi Rossi P. Impact of p16(INK4a) immunohistochemistry staining on interobserver agreement on the diagnosis of cervical intraepithelial neoplasia. Am J Clin Pathol. 2014 Mar;141(3):367-73. doi: 10.1309/AJCPCYWVL61SVKFU.
Author information: (1)Servizio Interaziendale di Epidemiologia, AUSL Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy; paolo.giorgirossi@ausl.re.it.

Abstract
OBJECTIVES: This study aimed to compare the interobserver Cohen κ on H&E staining and on H&E plus p16(INK4a) staining of all cervical biopsy specimens in a population-based screening program. METHODS: All the colposcopy-guided biopsies generated by the routine screening of 23,258 women aged 25 to 64 years were stained with H&E and H&E plus p16. Biopsy specimens were reviewed by six external experts. RESULTS: The four diagnoses were available in 441 cases. The interobserver κ values were 0.52 (95% confidence interval [CI], 0.45-0.58) and 0.48 (95% CI, 0.42-0.56) with H&E and H&E + p16, respectively, when using a five-group classification (normal, CIN 1, CIN 2, CIN 3, and cancer); adopting a two-group classification (≤CIN 1 and ≥CIN 2), the values were 0.75 (95% CI, 0.66-0.82) and 0.70 (95% CI, 0.61-0.79), respectively. CONCLUSIONS: The use of p16 on all cervical biopsy specimens in a screening program showed virtually no effect on reproducibility of the histologic diagnosis.

14. Iussich G(1), Correale L, Senore C, Hassan C, Segnan N, Campanella D, Bert A, Galatola G, Laudi C, Regge D. Computer-aided detection for computed tomographic colonography screening: a prospective comparison of a double-reading paradigm with first-reader computer-aided detection against second-reader computer-aided detection. Invest Radiol. 2014 Mar;49(3):173-82. doi: 10.1097/RLI.0000000000000009.
Author information: (1)From the *Radiology Unit, Institute for Cancer Research and Treatment, Candiolo; †im3D S.p.A., Torino; ‡AOU S Giovanni Battista, Torino; §Gastroenterology and Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome; and ∥Gastroenterology and Endoscopy Unit, Institute for Cancer Research and Treatment, Candiolo, Italy.

Abstract
OBJECTIVES: The objective of this study was to prospectively compare diagnostic performance and time efficiency of a double-reading paradigm in which a first-reader computer-aided detection (CAD) is followed by a fast 2-dimensional review (DR FR-CAD) with those of a double reading with second-reader CAD (SR CAD). MATERIALS AND METHODS: The local ethical committee approved this study. Consecutive immunological patients who have positive results for fecal immunological test who were scheduled for colonoscopy were enrolled for a 10-month period. Computed tomographic colonography studies were read with CAD (CAD COLON-1.20; im3D, Turin, Italy) by using both SR CAD (applied after unassisted interpretation primary 2-dimensional) and DR FR-CAD (CAD-prompts evaluation followed by a fast 2-dimensional review) in randomized order with the radiologist for each reading paradigm masked to the other reader's results.Per-patient sensitivity and specificity of unassisted and CAD-assisted readings for detecting 6-mm adenomas or larger were calculated by using unblinding colonoscopy as reference standard. Reporting times were also calculated. Pairwise comparisons were performed. RESULTS: A total of 182 participants (median age, 65 years; range, 58-76) were included in the final analysis. Of these, 93 (51%) had at least 1 cancer or a 6-mm adenoma or larger. At the 6-mm threshold, sensitivity of unassisted reading (79.6%; 95% confidence interval [CI], 69.9-87.2) increased significantly with the use of both SR CAD (86.0%; 95% CI, 77.3%-92.3%) and DR FR-CAD (89.2%; 95% CI, 81.1%-94.7%), without differences between CAD readings (P = 0.500). No significant differences in specificity among the 3 paradigms were observed. Double reading with first-reader CAD required less reading time than that for SR CAD (378 vs 496; Δ118 seconds; P < 0.001) and was 59 seconds longer than the unassisted reading (P = 0.058). CONCLUSIONS: When compared with unassisted reading, a double-reading paradigm in which first-reader CAD is followed by a fast 2-dimensional review improves the adenoma detection rate to the same level achieved by a second-reader CAD while decreasing reporting times.

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