rubrica

Screening

  • Paolo Giorgi Rossi1

  1. Servizio interaziendale di epidemiologia, AUSL Reggio Emilia

  • Se sei abbonato scarica il PDF nella colonna in alto a destra
  • Se non sei abbonato ti invitiamo ad abbonarti online cliccando qui
  • Se vuoi acquistare solo questo articolo scrivi a: abbonamenti@inferenze.it (20 euro)


Ricerca bibliografica periodo dal 16 aprile 2014 al 30 giugno 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 ("2014/04/16"[PDAT] : "2014/06/30"[PDAT])

Breve commento a cura di P. Giorgi Rossi
In questo bimestre sono stati pubblicati nove lavori sugli screening da gruppi di ricerca Italiani. Ben 5 riguardano lo screening della cervice uterina (Cristiani, Giorgi Rossi, De Vito, Visioli, Barbadoro), uno il colon retto (Zorzi), uno la mammografia (Houssami), uno l’uso dei miRNA nella diagnosi precoce in generale (Lauria), infine uno studio parte dalle TAC spirale per lo screening del polmone per proporre una diagnosi precoce delle calcificazioni delle coronarie (Arcadi). Cristiani presenta i risultati di un vasto programma di quality assurance della colposcopia nei programmi di screening dell’Emilia-Romagna. Fra tutte le fasi dello screening cervicale, la colposcopia è sempre stata quella meno soggetta a controlli di qualità sistematici, sia per motivi intrinseci alla tecnica (non era possibile fare diagnosi a distanza come del caso della citologia e istologia dove si possono far circolare vetrini), sia per una minore standardizzazione delle classificazioni diagnostiche. Il lavoro presentato ha dunque un valore culturale che va molto oltre i risultati presentati: una delle tante eredità che ci lascia Mario Sideri, scomparso lo scorso giugno in un incidente stradale; ancora per molto tempo coglieremo i frutti degli studi che aveva impostato e del profondo cambiamento culturale che cercava di portare avanti nella ginecologia oncologica in Italia e nel mondo. Inevitabilmente il pensiero corre subito a Stefano Ciatto, ultimo nome del lavoro di Houssami sul confronto fra tomosintesi e mammografia bidimensionale, un confronto intelligente che cerca soluzioni per rendere sostenibile un’eventuale introduzione della tomosintesi nei programmi di screening di massa. Nelle conclusioni si ricorda però che ancora abbiamo bisogno di studi che confermino se la maggiore accuratezza della tomosintesi si traduca in una maggiore efficacia nel ridurre l’incidenza di cancri in stadio avanzato. Non c’è traccia, nei due lavori che propongono nuovi screening (Lauria e Arcadi), di questa prudenza nel non interpretare l’accuratezza nella diagnosi come un automatico miglioramento della prognosi.

1. Zorzi M(1), Giorgi Rossi P(2), Cogo C(3), Falcini F(4), Giorgi D(5), Grazzini G(6), Mariotti L(7), Matarese V(8), Soppelsa F(9), Senore C(10), Ferro A(11); PARC Working Group. A comparison of different strategies used to invite subjects with a positive faecal occult blood test to a colonoscopy assessment. A randomised controlled trial in population-based screening programmes. Prev Med. 2014 Aug;65:70-6. doi: 10.1016/j.ypmed.2014.04.022. Epub 2014 May 6.
Collaborators: Mel R, Tison A, Di Camillo S, Germanà B, Bisello M, Lazzaro S, Antoniello LM, Bertazzo S, Gennaro M, Trevisani L, Cifalà V, Degl'Innocenti C, Migliori M, Ciacci R, Colamartini A, Giuliani O, Vattiato R, Palumbo M, Barca A, Baiocchi D, Quadrino F, Bellardini P, Picchi A, Finucci G, Coccioli S, Passamonti BU, Malaspina M, Tintori B, D'Angelo V, Silvani M, Fiorina G, Capuano A, Segnan N. Author information: (1)Registro Tumori del Veneto, Passaggio Gaudenzio 1, Padova, Italy. Electronic address: manuel.zorzi@ioveneto.it. (2)Servizio Interaziendale Epidemiologia, Azienda Sanitaria Locale di Reggio Emilia, via Amendola 2, Reggio Emilia, Italy. Electronic address: Paolo.GiorgiRossi@ausl.re.it. (3)Registro Tumori del Veneto, Passaggio Gaudenzio 1, Padova, Italy. Electronic address: crr.screening@ioveneto.it. (4)Unità Operativa di Prevenzione Oncologica, Ospedale Civile G.B. Morgagni L. Pierantoni, AUSL di Forlì, via Forlanini 34, Forlì, Italy. Electronic address: f.falcini@ausl.fo.it. (5)S.C. Epidemiologia e Screening, Azienda Sanitaria Locale 2 di Lucca, via per Sant'Alessio - Monte San Quirico, Lucca, Italy. Electronic address: d.giorgi@usl2.toscana.it. (6)Screening Unit Cancer Prevention and Research Institute ISPO, via Cosimo il Vecchio 2, Firenze, Italy. Electronic address: g.grazzini@ispo.toscana.it. (7)Laboratorio Unico di Screening, Azienda Sanitaria Locale 2 di Perugia, via XIV settembre 75, Perugia, Italy. Electronic address: lmariotti@ausl2.umbria.it. (8)Unità Operativa di Gastroenterologia, Azienda Ospedaliero-Universitaria S. Anna, Cona-Ferrara, via Moro 8, Cona,FE, Italy. Electronic address: mtv@unife.it. (9)Dipartimento di Prevenzione, Azienda Sanitaria Locale 1 di Belluno, via S. Andrea 8, Belluno, Italy. Electronic address: fabio.soppelsa@ulss.belluno.it. (10)Centro per la Prevenzione Oncologica (CPO), via San Francesco da Paola 31, Torino, Italy. Electronic address: carlo.senore@cpo.it. (11)Dipartimento di Prevenzione, Azienda Sanitaria Locale 17 di Este Monselice, via Francesconi 2, Este,PD, Italy. Electronic address: antonio.ferro@ulss17.it.

Abstract
OBJECTIVE: The purpose of this parallel randomised controlled trial was to compare compliance with different modalities used to invite patients with a positive immunochemical faecal occult blood test (FIT+) for a total colonoscopy (TC). METHOD: FIT+ patients from nine Italian colorectal cancer screening programmes were randomised to be invited for a TC initially by mail or by phone and, for non-compliers, to be recalled by mail, for counselling with a general practitioner, or to meet with a specialist screening practitioner (nurse or healthcare assistant). RESULTS: In all, 3777 patients were randomised to different invitation strategies. Compliance with an initial invitation by mail and by phone was similar (86.0% vs. 84.0%, relative risk - RR: 1.02; 95%CI 0.97-1.08). Among non-responders to the initial invitation, compliance with a recall by appointment with a specialist practitioner was 50.4%, significantly higher than with a mail recall (38.1%; RR:1.33; 95%CI 1.01-1.76) or with a face-to-face counselling with the GP (30.8%; RR:1.45;95%CI 1.14-1.87). CONCLUSION: Compliance with an initial invitation for a TC by mail and by phone was similar. A personal meeting with a specialist screening practitioner was associated with the highest compliance among non-compliers with initial invitations, while the involvement of GPs in this particular activity seemed less effective.

2. Houssami N(1), Macaskill P(2), Bernardi D(3), Caumo F(4), Pellegrini M(3), Brunelli S(4), Tuttobene P(3), Bricolo P(4), Fantò C(3), Valentini M(3), Ciatto S(5). Breast screening using 2D-mammography or integrating digital breast tomosynthesis (3D-mammography) for single-reading or double-reading--evidence to guide future screening strategies. Eur J Cancer. 2014 Jul;50(10):1799-807. doi: 10.1016/j.ejca.2014.03.017. Epub 2014 Apr 17.
Author information: (1)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. (2)Screening and Test Evaluation Program (STEP), School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia. (3)U.O. Senologia Clinica e Screening Mammografico, Department of Diagnostics, Azienda Provinciale Servizi Sanitari (APSS), Trento, Italy. (4)Centro di Prevenzione Senologica, Marzana, Verona, Italy. (5)U.O. Senologia Clinica e Screening Mammografico, Department of Diagnostics, Azienda Provinciale Servizi Sanitari (APSS), Trento, Italy; Centro di Prevenzione Senologica, Marzana, Verona, Italy.

Abstract
PURPOSE: We compared detection measures for breast screening strategies comprising single-reading or double-reading using standard 2D-mammography or 2D/3D-mammography, based on the 'screening with tomosynthesis or standard mammography' (STORM) trial. METHODS: STORM prospectively examined screen-reading in two sequential phases, 2D-mammography alone and integrated 2D/3D-mammography, in asymptomatic women participating in Trento and Verona (Northern Italy) population-based screening services. Outcomes were ascertained from assessment and/or excision histology or follow-up. For each screen-reading strategy we calculated the number of detected and non-detected (including interval) cancers, cancer detection rates (CDRs), false positive recall (FPR) measures and incremental CDR relative to a comparator strategy. We estimated the false:true positive (FP:TP) ratio and sensitivity of each mammography screening strategy. Paired binary data were compared using McNemar's test. RESULTS: Amongst 7292 screening participants, there were 65 (including six interval) breast cancers; estimated first-year interval cancer rate was 0.82/1000 screens (95% confidence interval (CI): 0.30-1.79/1000). For single-reading, 35 cancers were detected at both 2D and 2D/3D-mammography, 20 cancers were detected only with 2D/3D-mammography compared with none at 2D-mammography alone (p<0.001) and 10 cancers were not detected. For double-reading, 39 cancers were detected at 2D-mammography and 2D/3D-mammography, 20 were detected only with 2D/3D-mammography compared with none detected at 2D-mammography alone (p<0.001) and six cancers were not detected. The incremental CDR attributable to 2D/3D-mammography (versus 2D-mammography) of 2.7/1000 screens (95% CI: 1.6-4.2) was evident for single and for double-reading. Incremental CDR attributable to double-reading (versus single-reading) of 0.55/1000 screens (95% CI: -0.02-1.4) was evident for 2D-mammography and for 2D/3D-mammography. Estimated FP:TP ratios showed that 2D/3D-mammography screening strategies had more favourable FP to TP trade-off and higher sensitivity, applying single-reading or double-reading, relative to 2D-mammography screening. CONCLUSION: The evidence we report warrants rethinking of breast screening strategies and should be used to inform future evaluations of 2D/3D-mammography that assess whether or not the estimated incremental detection translates into improved screening outcomes such as a reduction in interval cancer rates.

3. Arcadi T, Maffei E, Sverzellati N, Mantini C, Guaricci AI, Tedeschi C, Martini C, La Grutta L, Cademartiri F. Coronary artery calcium score on low-dose computed tomography for lung cancer screening. World J Radiol. 2014 Jun 28;6(6):381-7. doi: 10.4329/wjr.v6.i6.381.
Author information: Teresa Arcadi, Department of Radiology, SDN Foundation, IRCCS, 80131 Naples, Italy.

Abstract
AIM: To evaluate the feasibility of coronary artery calcium score (CACS) on low-dose non-gated chest CT (ngCCT). METHODS: Sixty consecutive individuals (30 males; 73 ± 7 years) scheduled for risk stratification by means of unenhanced ECG-triggered cardiac computed tomography (gCCT) underwent additional unenhanced ngCCT. All CT scans were performed on a 64-slice CT scanner (Somatom Sensation 64 Cardiac, Siemens, Germany). CACS was calculated using conventional methods/scores (Volume, Mass, Agatston) as previously described in literature. The CACS value obtained were compared. The Mayo Clinic classification was used to stratify cardiovascular risk based on Agatston CACS. Differences and correlations between the two methods were compared. A P-value < 0.05 was considered significant. RESULTS: Mean CACS values were significantly higher for gCCT as compared to ngCCT (Volume: 418 ± 747 vs 332 ± 597; Mass: 89 ± 151 vs 78 ± 141; Agatston: 481 ± 854 vs 428 ± 776; P < 0.05). The correlation between the two values was always very high (Volume: r = 0.95; Mass: r = 0.97; Agatston: r = 0.98). Of the 6 patients with 0 Agatston score on gCCT, 2 (33%) showed an Agatston score > 0 in the ngCCT. Of the 3 patients with 1-10 Agatston score on gCCT, 1 (33%) showed an Agatston score of 0 in the ngCCT. Overall, 23 (38%) patients were reclassified in a different cardiovascular risk category, mostly (18/23; 78%) shifting to a lower risk in the ngCCT. The estimated radiation dose was significantly higher for gCCT (DLP 115.8 ± 50.7 vs 83.8 ± 16.3; Effective dose 1.6 ± 0.7 mSv vs 1.2 ± 0.2 mSv; P < 0.01). CONCLUSION: CACS assessment is feasible on ngCCT; the variability of CACS values and the associated re-stratification of patients in cardiovascular risk groups should be taken into account.

4. Barbadoro P(1), Ricciardi A, Di Tondo E, Vallorani S, Mazzarini G, Prospero E. Utilization patterns of cervical cancer screening in Italy. Eur J Cancer Prev. 2014 Jun 27. [Epub ahead of print]
Author information: (1)Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy.

Abstract
The aim of this study is to identify the use of cervical cancer screening and sociodemographic determinants associated with proper screening, overscreening, and underscreening in the Italian target population. Cross-sectional data from the national last available survey 'Health and use of health care in Italy,' conducted between December 2004 and September 2005, were analyzed. Multiple logistic regression was used to evaluate the risk factors associated independently with Pap test utilization. Our final sample included 36 161 women aged 25-64 years. Among women who reported having a Pap smear at least once, 20 920 (81.6%) repeated the Pap smear after the first one: 15 454 (74.3%) more than once every 3 years ('OVER' screening) and 2599 (12.4%) less than once every 3 years ('UNDER' screening). Among the independent risk factors associated with 'OVER' screening were higher social class [odds ratio (OR)=1.26, 95% confidence interval (CI) 1.15-1.39], being a former smoker (OR=1.16, 95% CI 1.05-1.28), and having had two or more pregnancies in the last 5 years (OR=1.43, 95% CI 1.20-1.70), whereas 'UNDER' screening was associated with the age group of 55-64 years (OR=2.11, 95% CI 1.76-2.53) and being divorced (OR=1.32, 95% CI 1.02-1.71). Improving Pap test compliance according to the proper timing is important for future reduction in cervical cancer mortality.

5. Visioli CB(1), Crocetti E, Zappa M, Iossa A, Andersson KL, Bulgaresi P, Alfieri A, Amunni G. Participation and Risk of High Grade Cytological Lesions Among Immigrants and Italian-Born Women in an Organized Cervical Cancer Screening Program in Central J Immigr Minor Health. 2014 Jun 11. [Epub ahead of print]
Author information: (1)Clinical and Descriptive Epidemiology Unit, ISPO - Istituto per lo Studio e la Prevenzione Oncologica, Via delle Oblate 2, 50144, Florence, Italy, latorre.visioli2@teletu.it.

Abstract
Few studies analyzed the risk for high-grade squamous intraepithelial lesions or worse (HSIL+) among immigrants and natives attending organized cervical cancer (CC) screening programs (SP). We evaluated participation and diagnosis of HSIL+ by country of birth with logistic models. Overall 540,779 invitation letters were delivered to target women of Florence SP in three screening rounds (years 2000-2002, 2003-2005, 2006-2008). The probability of attending screening was lower for immigrants than natives, but the difference decreased from 35 % (1st round) to 20 % (2nd-3rd round) for women born in high migration pressure (HMP) countries. The risk of HSIL+ was double than natives for HMP-born women from countries with high prevalence of human papillomavirus, even adjusting for age and previous history of Pap test. This is an important public health problem due to an increasing proportion over time of immigrant women with a lower attendance and greater risk for CC.

7. Cristiani P(1), Costa S, Schincaglia P, Garutti P, de Bianchi PS, Naldoni C, Sideri M, Bucchi L. An Online Quality Assurance Program for Colposcopy in a Population-Based Cervical Screening Setting in Italy: Results on Colposcopic Impression. J Low Genit Tract Dis. 2014 May 30. [Epub ahead of print]
Author information: (1)1Cervical Cancer Screening Unit, Bologna Health Care District, Bologna; 2Department of Obstetrics and Gynaecology, St. Orsola Hospital, Bologna; 3Cancer Prevention Center, Ravenna Health Care District, Ravenna; 4Department of Obstetrics and Gynaecology, University Hospital, Ferrara; 5Department of Health, Regione Emilia-Romagna, Bologna; 6Preventive Gynaecology Unit, European Institute of Oncology, Milan; and 7Romagna Cancer Registry, Romagna Cancer Institute (IRST), Meldola, Forlì, Italy.

Abstract
OBJECTIVE: To report the results of an Internet-based colposcopy quality assurance program from a population-based cervical screening service in a large region of northern Italy. METHODS: In 2010 to 2011, a Web application was made accessible on the Web site of the regional administration. Fifty-nine colposcopists of the registered 65 participated. They logged-in, viewed a posted set of 50 high-quality digital colpophotographs selected by an expert committee, and rated them for colposcopic impression using a 4-tier classification (Negative; abnormal, grade 1 [G1]; abnormal, grade 2 [G2]; suspected invasive cancer [Cancer]) derived from the International Federation for Cervical Pathology and Colposcopy 2002 classification. kappa (κ) coefficients for intercolposcopist agreement and colposcopist-committee agreement were calculated. RESULTS: Colposcopist-committee agreement was greater than intercolposcopist agreement (overall κ 0.69 vs 0.60, p < .001). The κ values for colposcopist-committee agreement were 0.83 on Negative, 0.53 on G1, 0.66 on G2, and 0.80 on Cancer (all p values for pairwise comparisons <.001, except for Negative vs Cancer [p = .078]). There was no systematic tendency for colposcopists to underestimate or overestimate the colposcopic findings (2-tailed sign test, p = .13). Overall colposcopist-committee agreement was greater among patients 35 years or older (p < .001) and for colposcopists with previous quality assurance experiences (p < .01). Only 0.2% of Negative impressions were formulated for a cervical intraepithelial neoplasia grade 2 or worse. As a parallel finding, the impression of Cancer predicted cervical intraepithelial neoplasia grade 2 or less in 0.5% of cases. The histologic substrates of G1 were dispersed over a large spectrum. CONCLUSIONS: The reproducibility of colposcopic impression, when classified by trained colposcopists examining high-quality images, is higher than is generally thought.

8. Giorgi Rossi P(1), Caroli S, Mancini S, Sassoli De' Bianchi P, Finarelli AC, Naldoni C, Bucchi L, Falcini F; the Emilia-Romagna cervical cancer screening and pathology registry group. Screening history of cervical cancers in Emilia-Romagna, Italy: defining priorities to improve cervical cancer screening. Eur J Cancer Prev. 2014 Apr 30. [Epub ahead of print]
Author information: (1)aInterinstitutional Epidemiology Unit, Local Health Authority and IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia bRomagna Cancer Registry, Romagna Cancer Research and Care Institute (IRST) s.r.l., IRCCS, Meldola (FC) cPublic Health Unit, Health Regional Authority, Emilia-Romagna Region, Bologna, Italy.

Abstract
Most invasive cervical cancers in industrialized countries are due to the lack of Pap test coverage, very few are due to screening failures. This study aimed at quantifying the proportion of invasive cancers occurring in nonscreened or underscreened women and that in women with a previous negative screening, that is, screening failure, during the first two screening rounds (1996-2002) and in the following rounds (2003-2008) in the Emilia-Romagna region. All cases of invasive cancers registered in the regional cancer registry between 1996 and 2008 were classified according to screening history through a record linkage with the screening programme registry. The incidence significantly decreased from 11.6/100 000 to 8.7/100 000; this decrease is due to a reduction in squamous cell cancers (annual percentage change -6.2; confidence interval: -7.8, -4.6) and advanced cancers (annual percentage change -6.6; confidence interval: -8.8, -4.3), whereas adenocarcinomas and microinvasive cancers were essentially stable. The proportion of cancers among women not yet invited and among nonresponders decreased over the two periods, from 45.5 to 33.3%. In contrast, the proportion of women with a previous negative Pap test less than 5 years and 5 years or more before cancer incidence increased from 5.7 to 13.3% and from 0.3 to 5.5%, respectively. Although nonattendance of the screening programme remains the main barrier to cervical cancer control, the introduction of a more sensitive test, such as the human papillomavirus DNA test, could significantly reduce the burden of disease.

9. Lauria M. Rank-Based miRNA Signatures for Early Cancer Detection. Biomed Res Int. 2014;2014:192646. doi: 10.1155/2014/192646. Epub 2014 Jun 18.
Author information: The Microsoft Research - University of Trento Centre for Computational and Systems Biology, Piazza Manifattura 1, 38068 Rovereto, Italy.

Abstract
We describe a new signature definition and analysis method to be used as biomarker for early cancer detection. Our new approach is based on the construction of a reference map of transcriptional signatures of both healthy and cancer affected individuals using circulating miRNA from a large number of subjects. Once such a map is available, the diagnosis for a new patient can be performed by observing the relative position on the map of his/her transcriptional signature. To demonstrate its efficacy for this specific application we report the results of the application of our method to published datasets of circulating miRNA, and we quantify its performance compared to current state-of-the-art methods. A number of additional features make this method an ideal candidate for large-scale use, for example, as a mass screening tool for early cancer detection or for at-home diagnostics. Specifically, our method is minimally invasive (because it works well with circulating miRNA), it is robust with respect to lab-to-lab protocol variability and batch effects (it requires that only the relative ranking of expression value of miRNA in a profile be accurate not their absolute values), and it is scalable to a large number of subjects. Finally we discuss the need for HPC capability in a widespread application of our or similar methods.

10. De Vito C(1), Angeloni C(2), De Feo E(3), Marzuillo C(1), Lattanzi A(2), Ricciardi W(3), Villari P(1), Boccia S(4). A large cross-sectional survey investigating the knowledge of cervical cancer risk aetiology and the predictors of the adherence to cervical cancer screening related to mass media campaign. Biomed Res Int. 2014;2014:304602. doi: 10.1155/2014/304602. Epub 2014 Jun 12.
Author information: (1)Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy. (2)Local Health Unit Teramo, Abruzzo Region, Circ.ne Ragusa 1, 64100 Teramo, Italy. (3)Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy. (4)Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy ; IRCCS San Raffaele Pisana, Via della Pisana 235, 00163 Rome, Italy.

Abstract
Objectives. The aims of this study were to compare the characteristics of women who got a Pap-test during the mass media campaign, carried out in an Italian region by broadcasts advertising, and two years later and to identify the determinants of knowledge of cervical cancer etiology and of the adherence to the mass media campaign. Methods. A cross-sectional survey was carried out through a self-administered questionnaire. Results. A total of 8570 randomly selected women were surveyed, 823 of these had a Pap-test during the mass media campaign period and 7747 two years later. Higher educational level, being not married, and living in urban areas were the main independent characteristics associated with a higher level of knowledge of cervical cancer etiology, although a previous treatment following a Pap smear abnormality was the strongest predictor (OR = 2.88; 95% CI: 2.43-3.41). During the campaign period women had the Pap-test more frequently as a consequence of the mass media campaign (OR = 8.28; 95% CI; 5.51-12.45). Conclusions. Mass media campaign is a useful tool to foster cervical screening compliance; however, its short-term effect suggests repeating it regularly.

Inserisci il tuo commento

L'indirizzo mail è privato e non verrà mostrato pubblicamente.
Refresh Type the characters you see in this picture. Type the characters you see in the picture; if you can't read them, submit the form and a new image will be generated. Not case sensitive.  Switch to audio verification.