rubrica

Screening

  • Paolo Giorgi Rossi1

  1. Servizio interaziendale di epidemiologia, AUSL Reggio Emilia

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Screening • Paolo Giorgi Rossi1 1. Servizio interaziendale di epidemiologia, AUSL Reggio Emilia

Ricerca bibliografica periodo dal 1 luglio 2014 al 15 settembre 2014

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Stringa: ("mass screening"[MeSH Terms] OR cancer[Title/Abstract] AND screening[Title/Abstract] AND ("italy"[MeSH Terms] OR "italy"[All Fields]) AND ("2014/07/01"[PDAT] : "2014/09/15"[PDAT])

Breve commento a cura di P. Giorgi Rossi
Un’estate all’insegna dei pochi ma buoni. Sette lavori ma alcuni molto rilevanti: un lavoro uscito su Lancet sui risultati del follow up a 13 anni dello studio ERSPC, il trial europeo sullo screening del cancro della prostata con PSA: si abbassa ulteriormente il numero di cancri sovradagnosticati per morte evitata, ma rimane ancora un rapporto scoraggiante, 27 a 1. Sono usciti due studi sullo screening del cancro del colon retto: Rengucci presenta una validazione analitica di un test del DNA fecale e Zorzi descrive su Gut il primo report di screening di popolazione che testimonia un impatto sulla mortalità maggiore di quanto osservato nei trial. Ciò è dovuto probabilmente al fatto che i programmi italiani usano test immunochimico per il sangue occulto mentre i trial usarono test al Guaiaco.
Gli altri lavori sono tutti sullo screening mammografico: Paci con il gruppo Euroscreen ripropone il balance sheet dello screening, Ponti con un altro ampio gruppo di lavoro europeo passa in rassegna i diversi approcci terapeutici in uso in Europa per il caricnoma duttale in situ, Altobelli e Lattanzi presentano una review dell’implementazione dei programmi di screening in Europa, infine una lettera su BMI e screening (Montella).

1. Zorzi M(1), Fedeli U(2), Schievano E(2), Bovo E(1), Guzzinati S(1), Baracco S(1), Fedato C(1), Saugo M(2), Dei Tos AP(3). Impact on colorectal cancer mortality of screening programmes based on the faecal immunochemical test. Gut. 2014 Sep 1. pii: gutjnl-2014-307508. doi: 10.1136/gutjnl-2014-307508. [Epub ahead of print]
Author information: (1)Veneto Tumour Registry, Veneto Region, Padua, Italy. (2)SER-Epidemiological Department, Veneto Region, Padua, Italy. (3)Veneto Tumour Registry, Veneto Region, Padua, Italy Department of Pathology, Santa Maria di Ca' Foncello Hospital, Treviso, Italy.

Abstract
OBJECTIVE: Colorectal cancer (CRC) screening programmes based on the guaiac faecal occult blood test (gFOBT) reduce CRC-specific mortality. Several studies have shown higher sensitivity with the faecal immunochemical test (FIT) compared with gFOBT. We carried out an ecological study to evaluate the impact of FIT-based screening programmes on CRC mortality. DESIGN: In the Veneto Region (Italy), biennial FIT-based screening programmes that invited 50-69-year-old residents were introduced in different areas between 2002 and 2009. We compared CRC mortality rates from 1995 to 2011 between the areas where screening started in 2002-2004 (early screening areas (ESA)) and areas that introduced the screening in 2008-2009 (late screening areas (LSA)) using Poisson regression models. We also compared available data on CRC incidence rates (1995-2007) and surgical resection rates (2001-2012). RESULTS: Before the introduction of screening, CRC mortality and incidence rates in the two areas were similar. Compared with 1995-2000, 2006-2011 mortality rates were 22% lower in the ESA than in the LSA (rate ratio (RR)=0.78; 95% CI 0.68 to 0.89). The reduction was larger in women (RR=0.64; CI 0.51 to 0.80) than in men (RR=0.87; CI 0.73 to 1.04). In the ESA, incidence and surgery rates peaked during the introduction of the screening programme and then returned to the baseline (2006-2007 incidence) or dropped below initial values (surgery after 2007). CONCLUSIONS: FIT-based screening programmes were associated with a significant reduction in CRC mortality. This effect took place much earlier than reported by gFOBT-based trials and observational studies.

2. Altobelli E(1), Lattanzi A(2). Breast cancer in European Union: An update of screening programmes as of March 2014 (Review). Int J Oncol. 2014 Nov;45(5):1785-92. doi: 10.3892/ijo.2014.2632. Epub 2014 Sep 1.
Author information: (1)Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy. (2)Epidemiologic and Social Marketing Unit, AUSL 4 Teramo, Italy.

Abstract
Breast cancer, a major cause of female morbidity and mortality, is a global health problem; 2008 data show an incidence of ~450,000 new cases and 140,000 deaths (mean incidence rate 70.7 and mortality rate 16.7, world age-standardized rate per 100,000 women) in European Union Member States. Incidence rates in Western Europe are among the highest in the world. We review the situation of BC screening programmes in European Union. Up to date information on active BC screening programmes was obtained by reviewing the literature and searching national health ministries and cancer service websites. Although BC screening programmes are in place in nearly all European Union countries there are still considerable differences in target population coverage and age and in the techniques deployed. Screening is a mainstay of early BC detection whose main weakness is the rate of participation of the target population. National policies and healthcare planning should aim at maximizing participation in controlled organized screening programmes by identifying and lowering any barriers to adhesion, also with a view to reducing healthcare costs.

3. Montella M(1), Grimaldi M(1), Rinaldo M(2), Capasso I(2), D' Aiuto M(2), D'Aiuto G(2), Ciliberto G(3), Crispo A(4) Breast cancer screening, body mass index and prognosis benefit. J Med Screen. 2014 Sep;21(3):165-6. doi: 10.1177/0969141314547968.
Author information: (1)Epidemiology Unit, National Cancer Institute of Naples "G. Pascale Foundation" - Italy. (2)Breast Unit, National Cancer Institute of Naples "G. Pascale Foundation" - Italy. (3)Scientific Director, National Cancer Institute of Naples "G. Pascale Foundation" - Italy. (4)Epidemiology Unit, National Cancer Institute of Naples "G. Pascale Foundation" - Italy anna.crispo@tin.it.
4. Ponti A(1), Lynge E(2), James T(3), Májek O(4), von Euler-Chelpin M(2), Anttila A(5), Fitzpatrick P(6), Mano MP(7), Kawai M(8), Scharpantgen A(9), Fracheboud J(10), Hofvind S(11), Vidal C(12), Ascunce N(13), Salas D(14), Bulliard JL(15), Segnan N(7), Kerlikowske K(16), Taplin S(17); ICSN DCIS Working group International variation in management of screen-detected ductal carcinoma in situ of the breast. Eur J Cancer. 2014 Oct;50(15):2695-704. doi: 10.1016/j.ejca.2014.07.019. Epub 2014 Aug 19.
Author information: (1)CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy. Electronic address: antonio.ponti@cpo.it. (2)Department of Public Health, University of Copenhagen, Copenhagen, Denmark. (3)Department of Surgery, University of Vermont, Burlington, VT, USA. (4)Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic. (5)Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland. (6)National Cancer Screening Service, Dublin, Ireland. (7)CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy. (8)Department of Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan. (9)Programme Mammographie, Direction de la Santé, Luxembourg. (10)Erasmus Medical Centre, Rotterdam, The Netherlands. (11)The Cancer Registry of Norway, Oslo, Norway. (12)Cancer Detection and Control Programme, Catalan Institute of Oncology, Barcelona, Spain. (13)Breast Cancer Screening Programme, Instituto de Salud Pública, Navarra, Spain. (14)General Directorate Research and Public Health and Centre for Public Health Research, Valencia, Spain. (15)Lausanne University Hospital, Lausanne, Switzerland. (16)Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA. (17)Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.

Abstract
BACKGROUND: Ductal carcinoma in situ (DCIS) incidence has grown with the implementation of screening and its detection varies across International Cancer Screening Network (ICSN) countries. The aim of this survey is to describe the management of screen-detected DCIS in ICSN countries and to evaluate the potential for treatment related morbidity. METHODS: We sought screen-detected DCIS data from the ICSN countries identified during 2004-2008. We adopted standardised data collection forms and analysis and explored DCIS diagnosis and treatment processes ranging from pre-operative diagnosis to type of surgery and radiotherapy. RESULTS: Twelve countries contributed data from a total of 15 screening programmes, all from Europe except the United States of America and Japan. Among women aged 50-69years, 7,176,050 screening tests and 5324 screen-detected DCIS were reported. From 21% to 93% of DCIS had a pre-operative diagnosis (PO); 67-90% of DCIS received breast conservation surgery (BCS), and in 41-100% of the cases this was followed by radiotherapy; 6.4-59% received sentinel lymph node biopsy (SLNB) only and 0.8-49% axillary dissection (ALND) with 0.6% (range by programmes 0-8.1%) being node positive. Among BCS patients 35% received SLNB only and 4.8% received ALND. Starting in 2006, PO and SLNB use increased while ALND remained stable. SLNB and ALND were associated with larger size and higher grade DCIS lesions. CONCLUSIONS: Variation in DCIS management among screened women is wide and includes lymph node surgery beyond what is currently recommended. This indicates the presence of varying levels of overtreatment and the potential for its reduction.

5. Rengucci C(1), Maio GD(1), Menghi M(2), Scarpi E(3), Guglielmo S(4), Fusaroli P(4), Caletti G(4), Saragoni L(5), Gardini AC(6), Zoli W(1), Falcini F(7), Amadori D(6), Calistri D(8). Improved Stool DNA Integrity Method for Early Colorectal Cancer Diagnosis. Cancer Epidemiol Biomarkers Prev. 2014 Aug 15. [Epub ahead of print]
Author information: (1)Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy. (2)Diatech Pharmacogenetics, Jesi, Italy. (3)Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy. (4)Gastroenterology Unit, University of Bologna, Imola Hospital, Imola, Italy. (5)Pathology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy. (6)Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy. (7)Epidemiology Unit and Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy. (8)Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy. daniele.calistri@irst.emr.it.

Abstract
BACKGROUND: DNA integrity analysis could represent an alternative approach to the early detection of colorectal cancer. Previously, fluorescence long DNA (FL-DNA) in stools was extracted using a manual approach and analyzed by capillary electrophoresis assay (CE FL-DNA). We aimed to improve diagnostic accuracy using a simpler and more standardized method [Real Time PCR FL-DNA (RT FL-DNA)] for the detection of early malignant lesions in a population undergoing colorectal cancer screening. METHODS: From 241 stool samples, DNA was extracted using manual and semiautomatic extraction systems and analyzed using FL-DNA tests by CE and RT assays. The RT FL-DNA approach showed slightly higher sensitivity and specificity compared with the CE FL-DNA method. Furthermore, we compared the RT FL-DNA approach with the iFOBT report. RESULTS: Nonparametric ranking statistics were used to analyze the relationship between the median values of RT FL-DNA and the clinicohistopathologic characteristics. The median values of both variables were significantly higher in patients with cancer than in patients with noncancerous lesions. According to the Fagan nomogram results, the iFOBT and FL-DNA methods provided more accurate diagnostic information and were able to identify subgroups at varying risks of cancer. CONCLUSIONS: The combination of the semiautomatic extraction system and RT FL-DNA analysis improved the quality of DNA extracted from stool samples. IMPACT: RT FL-DNA shows great potential for colorectal cancer diagnosis as it is a reliable and relatively easy analysis to perform on routinely processed stool samples in combination with iFOBT.

6. Schröder FH(1), Hugosson J(2), Roobol MJ(3), Tammela TL(4), Zappa M(5), Nelen V(6), Kwiatkowski M(7), Lujan M(8), Määttänen L(9), Lilja H(10), Denis LJ(11), Recker F(12), Paez A(13), Bangma CH(3), Carlsson S(14), Puliti D(5), Villers A(15), Rebillard X(16), Hakama M(17), Stenman UH(18), Kujala P(19), Taari K(20), Aus G(21), Huber A(22), van der Kwast TH(23), van Schaik RH(24), de Koning HJ(25), Moss SM(26), Auvinen A(27); for the ERSPC Investigators. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet. 2014 Aug 6. pii: S0140-6736(14)60525-0. doi: 10.1016/S0140-6736(14)60525-0. [Epub ahead of print]
Author information: (1)Department of Urology, Erasmus University Medical Center, Rotterdam, Netherlands. Electronic address: secr.schroder@erasmusmc.nl. (2)Department of Urology, Sahlgrenska Academy at Goteborg University, Goteborg, Sweden. (3)Department of Urology, Erasmus University Medical Center, Rotterdam, Netherlands. (4)Department of Urology, Tampere University Hospital, Tampere, Finland; School of Medicine, University of Tampere, Tampere, Finland. (5)Unit of Clinical and Descriptive Epidemiology, ISPO, Florence, Italy. (6)Provinciaal Instituut voor Hygiene, Antwerp, Belgium. (7)Department of Urology, Kantonsspital Aarau, Aarau, Switzerland; Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany. (8)Department of Urology, Hospital Infanta Cristina, Parla, Madrid, Spain; Department of Urology, Hospital Universitario de Getafe, Getafe, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain. (9)Finnish Cancer Registry, Helsinki, Finland. (10)Department of Surgery (Urology), Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Departments of Laboratory Medicine and Medicine (GU-Oncology), Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Department of Laboratory Medicine, Lund University, Malmö, Sweden; Institute of Biomedical Technology, University of Tampere, Tampere, Finland. (11)Oncology Centre Antwerp, Antwerp, Belgium. (12)Department of Urology, Kantonsspital Aarau, Aarau, Switzerland. (13)Department of Urology, Hospital Universitario de Fuenlabrada, Madrid, Spain; Department of Urology, Hospital Universitario de Getafe, Getafe, Madrid, Spain; Universidad Rey Juan Carlos, Madrid, Spain. (14)Department of Urology, Sahlgrenska Academy at Goteborg University, Goteborg, Sweden; Department of Surgery (Urology), Memorial Sloan-Kettering Cancer Center, New York, NY, USA. (15)Department of Urology, CHU Lille, Univ Lille Nord de France, Lille, France. (16)Service d'Urologie, Clinique BeauSoleil, Montpellier, France. (17)Finnish Cancer Registry, Helsinki, Finland; School of Health Sciences, University of Tampere, Tampere, Finland. (18)Department of Clinical Chemistry, Helsinki University Central Hospital Laboratory Division (HUSLAB), Helsinki, Finland. (19)FIMLAB, Department of Pathology, Tampere, Finland. (20)Department of Urology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland. (21)Department of Urology, Carlanderska Sjukhuset Göteborg, Sweden. (22)Centre of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland. (23)Department of Pathology, Erasmus University Medical Center, Rotterdam, Netherlands. (24)Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, Netherlands. (25)Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands. (26)Centre for Cancer Prevention, Queen Mary University of London, London, UK. (27)School of Health Sciences, University of Tampere, Tampere, Finland.

Abstract
BACKGROUND: The European Randomised study of Screening for Prostate Cancer (ERSPC) has shown significant reductions in prostate cancer mortality after 9 years and 11 years of follow-up, but screening is controversial because of adverse events such as overdiagnosis. We provide updated results of mortality from prostate cancer with follow-up to 2010, with analyses truncated at 9, 11, and 13 years. METHODS: ERSPC is a multicentre, randomised trial with a predefined centralised database, analysis plan, and core age group (55-69 years), which assesses prostate-specific antigen (PSA) testing in eight European countries. Eligible men aged 50-74 years were identified from population registries and randomly assigned by computer generated random numbers to screening or no intervention (control). Investigators were masked to group allocation. The primary outcome was prostate cancer mortality in the core age group. Analysis was by intention to treat. We did a secondary analysis that corrected for selection bias due to non-participation. Only incidence and no mortality data at 9 years' follow-up are reported for the French centres. This study is registered with Current Controlled Trials, number ISRCTN49127736. FINDINGS: With data truncated at 13 years of follow-up, 7408 prostate cancer cases were diagnosed in the intervention group and 6107 cases in the control group. The rate ratio of prostate cancer incidence between the intervention and control groups was 1•91 (95% CI 1•83-1•99) after 9 years (1•64 [1•58-1•69] including France), 1•66 (1•60-1•73) after 11 years, and 1•57 (1•51-1•62) after 13 years. The rate ratio of prostate cancer mortality was 0•85 (0•70-1•03) after 9 years, 0•78 (0•66-0•91) after 11 years, and 0•79 (0•69-0•91) at 13 years. The absolute risk reduction of death from prostate cancer at 13 years was 0•11 per 1000 person-years or 1•28 per 1000 men randomised, which is equivalent to one prostate cancer death averted per 781 (95% CI 490-1929) men invited for screening or one per 27 (17-66) additional prostate cancer detected. After adjustment for non-participation, the rate ratio of prostate cancer mortality in men screened was 0•73 (95% CI 0•61-0•88). INTERPRETATION: In this update the ERSPC confirms a substantial reduction in prostate cancer mortality attributable to testing of PSA, with a substantially increased absolute effect at 13 years compared with findings after 9 and 11 years. Despite our findings, further quantification of harms and their reduction are still considered a prerequisite for the introduction of populated-based screening. FUNDING: Each centre had its own funding responsibility.

7. Paci E(1), Broeders M(2), Hofvind S(3), Puliti D(4), Duffy SW(5); EUROSCREEN Working Group. European breast cancer service screening outcomes: a first balance sheet of the benefits and harms. Cancer Epidemiol Biomarkers Prev. 2014 Jul;23(7):1159-63. doi: 10.1158/1055-9965.EPI-13-0320.
Author information: (1)Authors' Affiliations: ISPO Cancer Prevention and Research Institute, Florence, Italy; e.paci@ispo.toscana.it. (2)Radboud University Nijmegen Medical Centre and National Expert and Training Centre for Breast Cancer Screening, Nijmegen, the Netherlands; (3)Cancer Registry of Norway, Research Department and Oslo and Akershus University College of Applied Science, Oslo, Norway; and. (4)Authors' Affiliations: ISPO Cancer Prevention and Research Institute, Florence, Italy; (5)Wolfson Institute of Preventive Medicine, Queen Mary University, London, United Kingdom.

Abstract
A recent comprehensive review has been carried out to quantify the benefits and harms of the European population-based mammographic screening programs. Five literature reviews were conducted on the basis of the observational published studies evaluating breast cancer mortality reduction, breast cancer overdiagnosis, and false-positive results. On the basis of the studies reviewed, the authors present a first estimate of the benefit and harm balance sheet. For every 1,000 women screened biennially from ages 50 to 51 years until ages 68 to 69 years and followed up until age 79 years, an estimated seven to nine breast cancer deaths are avoided, four cases are overdiagnosed, 170 women have at least one recall followed by noninvasive assessment with a negative result, and 30 women have at least one recall followed by invasive procedures yielding a negative result. The chance of a breast cancer death being avoided by population-based mammography screening of appropriate quality is more than that of overdiagnosis by screening. These outcomes should be communicated to women offered service screening in Europe.

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