rubrica

Screening

  • Paolo Giorgi Rossi1

  1. Laziosanità, Agenzia di sanità pubblica, Roma
Paolo Giorgi Rossi -

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Ricerca bibliografica periodo 2 aprile 2011 – 1 giugno 2011

Per leggere le caratteristiche di questa ROUTINE di ricerca clicca qui

Database: Pubmed/MEDline
Stringa:
Database:Ovid MEDLINE(R) <1996 to June Week 5 2010> Strategie di ricerca: (exp Mass Screening [MeSH Terms] AND ( Italy [termine libero] OR Italy [MeSH Terms])
Database: Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations Strategia di ricerca: (cancer AND screening) nel campo “title” AND italy nel campo “ Institution”
Limiti: pubblicati da 1gennaio 2010 al 26 ottobre 2010
Esclusi: commentari, editoriali e review narrative; studi multicentrici con PI/primo nome non affiliato in Italia.
Definizione di screening adottata: screening di popolazione a finalità preventive

Commento generale a cura di Paolo Giorgi Rossi
Solo 6 lavori epidemiologici sugli screening negli ultimi due mesi. La ricerca in PubMed ha prodotto circa la metà dei risultati della volta precedente, ma anche la selezione degli abstract ha ridotto maggiormente: risultato da venti a sei lavori. Tre di questi sono dedicati a tumori correlati all’HPV, due sulla cervice e uno sui tumori orali, due al colon retto, una analisi di costo efficacia e un report de risultati del round di prevalenza a Ferrara, e infine uno sull’impatto sulle diseguaglianze dello screening mammografico a Firenze.
Ancora una volta di dimostra come i dati routinari raccolti a scopo di monitoraggio dai programmi di screening siano in grado di sostenere la ricerca epidemiologica ad ogni livello: dall’eziologia, all’economia sanitaria.
Lo studio fiorentino, di Puliti et al, fornisce una convincente evidenza su come l’implementazione del programma di screening organizzato abbia azzerato le differenze di sopravvivenza a dieci anni dei casi di carcinoma mammario che esistevano fra livelli di stato socio-economico nel periodo pre-screening; l’inferenza causale è resa ancora più plausibile dal fatto che la differenza in sopravvivenza è rimasta invece invariata anche nel periodo post-screening fra le donne più giovani, fuori dalla fascia di età del programma organizzato.
Nel paese del conflitto d’interessi, rispetto la tradizione e mi dilungo ora nel commentare un lavoro di cui sono coautore. Una revisione sistematica degli studi sul test HPV come test di screening delle lesioni neoplastiche della cervice uterina (Giorgi Rossi, Ronco, Franceschi) dimostra come vi sia una relazione inversa fra prevalenza del virus e specificità, mentre la relazione fra valore predittivo positivo e prevalenza è molto debole. Questa osservazione va in senso del tutto contrario a quanto osservato e teorizzato per molti altri test diagnostici, per i quali il valore predittivo positivo diminuisce al diminuire della prevalenza. Nel lavoro suggeriamo un modello interpretativo che spiega questa relazione inversa fra prevalenza e specificità che si applica a tutti quei test che hanno come target un fattore di rischio della malattia e non una conseguenza (sintomo o segno) della malattia stessa, quando vengono utilizzati per individuare malati, ad esempio i test genetici per mutazioni a penetranza incompleta. Che ci tocchi rivedere qualche lezione dei corsi di epidemiologia di base?

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

1 Hassan C, Benamouzig R, Spada C, Ponchon T, Zullo A, Saurin JC, Costamagna G. Cost-effectiveness and projected national impact of colorectal cancer screening in France. Endoscopy. 2011 May 27. [Epub ahead of print]
Digestive Endoscopy Unit, Catholic University, Rome, Italy.
Abstract
BACKGROUND: Colorectal cancer (CRC) is a major cause of morbidity and mortality in France. Only scanty data on cost-effectiveness of CRC screening in Europe are available, generating uncertainty over its efficiency. Although immunochemical fecal tests (FIT) and guaiac-based fecal occult blood tests (g-FOBT) have been shown to be cost-effective in France, cost-effectiveness of endoscopic screening has not yet been addressed.
METHODS
: Cost-effectiveness of screening strategies using colonoscopy, flexible sigmoidoscopy, second-generation colon capsule endoscopy (CCE), FIT and g-FOBT were compared using a Markov model. A 40 % adherence rate was assumed for all strategies. Colonoscopy costs included anesthesiologist assistance. Incremental cost-effectiveness ratios (ICERs) were calculated. Probabilistic and value-of-information analyses were used to estimate the expected benefit of future research. A third-payer perspective was adopted.
RESULTS: In the reference case analysis, FIT repeated every year was the most cost-effective strategy, with an ICER of euros 48 165 per life-year gained vs. FIT every 2 years, which was the next most cost-effective strategy. Although CCE every 5 years was as effective as FIT 1-year, it was not a cost-effective alternative. Colonoscopy repeated every 10 years was substantially more costly, and slightly less effective than FIT 1-year. When projecting the model outputs onto the French population, the least (g-FOBT 2-years) and most (FIT 1-year) effective strategies reduced the absolute number of annual CRC deaths from 16 037 to 12 916 and 11 217, respectively, resulting in an annual additional cost of 26 million euros and  347 million euros, respectively. Probabilistic sensitivity analysis demonstrated that FIT 1-year was the optimal choice in 20 % of the simulated scenarios, whereas sigmoidoscopy 5-years, colonoscopy, and FIT 2-years were the optimal choices in 40 %, 26 %, and 14 %, respectively.
CONCLUSIONS: A screening program based on FIT 1-year appeared to be the most cost-effective approach for CRC screening in France. However, a substantial uncertainty over this choice is still present.
2 Giorgi-Rossi P, Franceschi S, Ronco G. Human papillomavirus (HPV) prevalence and accuracy of HPV testing to detect high-grade cervical intraepithelial neoplasia. Int J Cancer. 2011 Apr 25. doi: 10.1002/ijc.26147. [Epub ahead of print]
Agency for Public Health, Lazio Region, Rome, Italy.
Abstract
Concern was raised on using testing for high-risk (HR) human papillomavirus (HPV) in cervical cancer screening in populations where HPV prevalence is high. The impact of HR HPV prevalence on the efficiency of HPV test-based screening has never been directly evaluated. A meta-regression of the relationship between HR HPV prevalence and the specificity and positive predictive value (PPV) of HPV DNA testing for the presence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was performed. Only studies that used Hybrid Capture 2 (HC2) were included. Country income (low-medium vs. high) was used as a proxy of previous screening. Twenty-six populations from 20 studies were included. For a 10% increase in HR HPV prevalence HC2 specificity decreased by 8.41% (95% confidence interval (CI): 8.02-8.81%) whereas PPV increased by 4.74% (95% CI: 2.45-7.03%). HR HPV prevalence explained 98% of the variability in HC2 specificity and 38% of the variability in PPV. Country income did not affect specificity but low-medium income was associated with higher PPV (3.81%; 95% CI: 1.53-6.10%) after adjustment for HR HPV prevalence. When HR HPV prevalence is high, the specificity of HPV testing for CIN2+ decreases, but PPV does not decrease and it is high in inadequately screened populations. The number of HPV-positive women needing further assessment or treatment per CIN2+ case detected will therefore decrease and screening efficiency will improve. This is explained by the fact that HR HPV causes CIN2+: an increase in HR HPV prevalence is inevitably accompanied by an increase in CIN2+.
3 Puliti D, Miccinesi G, Manneschi G, Buzzoni C, Crocetti E, Paci E, Zappa M. Does an organised screening programme reduce the inequalities in breast cancer survival? Ann Oncol. 2011 Apr 22. [Epub ahead of print]
"Clinical and Descriptive Epidemiology Unit, ISPO-Cancer Prevention and Research Institute, Florence, Italy "
Abstract
BACKGROUND: The aim of the present study was to examine whether the implementation of an organised mammographic screening programme in Florence has been successful in reducing socioeconomic inequalities in breast cancer survival.
PATIENTS AND METHODS
: All invasive breast cancer cases diagnosed in women resident in the city of Florence in a prescreening period and in the first 10 years of the screening programme were selected. Their socioeconomic status (SES) was determined by using the national census 2001 data. All breast cancers were followed up to 10 years after the diagnosis.
RESULTS
: In the prescreening period, the survival of deprived women was 12 percentage points lower than the reference class, both in the younger age class (<50 years old) and in the age class target of the screening programme (50-69 years old). This difference progressively decreases until disappearing completely during the first 10 years of the screening programme for the age class invited to screening, whereas it remains stable in the younger age class. Participation in breast cancer screening and diagnostic accuracy were similar by SES.
CONCLUSION: The organised breast cancer screening implemented in the Florentine area achieved the goal of reducing inequalities in breast cancer survival.
4 Matarese VG, Feo CV, Lanza G, Fusetti N, Carpanelli MC, Cataldo S, Cifalà V, Ferretti S, Gafà R, Marzola M, Montanari E, Palmonari C, Simone L, Trevisani L, Stockbrugger R, Gullini S. The first 2 years of colorectal cancer screening in Ferrara, Italy. Eur J Cancer Prev. 2011 May;20(3):166-8.
Unit of Gastroenterology, Departments of General Surgery, S Anna University Hospital of Ferrara, Lagosanto, Ferrara, Italy.
Abstract
We report on the first screening round in the District of Ferrara, a region of Emilia-Romagna, carried out between March 2005 and March 2007 to illustrate the effort of colorectal cancer (CRC) screening from administration and information to therapy and follow-up. After invitation of 38 344 persons aged 50-69 years (28.5%), 19 480 (50.8%) accepted the immunological faecal occult blood test, with 1 149 (6%) resulting positive. One thousand and one individuals (88.2%) who tested positive for immunological faecal occult blood test accepted examination by either colonoscopy (99.5%) or barium enema (0.5%). Out of 996 screenees having a colonoscopy, 231 had low-risk adenomas (23.2%) and 239 had high-risk adenomas (24%), and were treated endoscopically (96%) or surgically (4%). Ninety-one cancers were diagnosed in 9.1% of colonoscopies (Dukes stadia: A, 58.2%; B, 19.8%; C, 18.7%; D, 3.3%). Fourteen cancers (all in polyps) were treated endoscopically, and the remaining 77 were treated by surgery. One Dukes B patient and 13 of 17 Dukes C patients received adjuvant chemotherapy. Three Dukes D patients had chemotherapy only. During the 2-year study period, 87 screenees had a follow-up colonoscopy: no neoplasia was found in 35 patients initially diagnosed with cancer; low-risk adenomas were found in 31 of 52 patients with initial high-risk adenomas. In conclusion, the first CRC screening round in Ferrara was easy to organize, had a high acceptance, and detected 91 cancers (78% of which were in Dukes stages A and B, compared with only 40% in sporadic CRC in the same background population). Chemotherapy was necessary in 17 cases. This report may motivate other health authorities to initiate CRC screening campaigns.
5 Piazza C. Is narrow band imaging the ideal screening tool for mucosal head and neck cancer? Oral Oncol. 2011 May;47(5):313. Epub 2011 Mar 21.
"Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Spedali Civili of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy."
Abstract
No abstract available.
6 Benevolo M, Vocaturo A, Caraceni D, French D, Rosini S, Zappacosta R, Terrenato I, Ciccocioppo L, Frega A, Giorgi Rossi P. Sensitivity, specificity and clinical value of HPV E6/E7 mRNA assay as a triage test for cervical cytology and HPV DNA test. J Clin Microbiol. 2011 Apr 27. [Epub ahead of print]
Pathology Department, Regina Elena Cancer Institute, Rome, Italy.
Abstract
There is evidence that testing for HPV E6/E7 mRNA is more specific than testing for HPV DNA. A retrospective study was carried out to evaluate the performance of the PreTect HPV-Proofer E6/E7 mRNA assay (Norchip) as a triage test for cytology and HPV DNA testing. This study analyzed 1201 women, of who 688 had a colposcopy follow up and 195 had histology-confirmed high-grade intraepithelial neoplasia or worse (CIN2+). Proportion of positive results and sensitivity and specificity for CIN2+ were determined for HPV mRNA in comparison with HPV DNA and cytology. All data were adjusted for follow-up completeness. Stratified by cytological grades, HPV mRNA sensitivity was 83% (95%CI 63-94%) in ASC-US (Atypical Squamous Cells of Undetermined Significance), 62% (95%CI 47-75%) in L-SIL (Low-grade Squamous Intraepithelial Lesion), and 67% (95%CI 57-76%) in H-SIL (High-grade Squamous Intraepithelial Lesion). The corresponding figures were 99%, 91%, and 96%, respectively, for HPV DNA. The specificities were 82%, 76%, and 45%, respectively, for HPV mRNA and 29%, 13% and 4%, respectively, for HPV DNA. Used as a triage test for ASC-US and L-SIL, mRNA reduced colposcopies by 79% (95%CI 74-83%) and 69% (95%CI 65-74%) respectively, while HPV DNA reduced colposcopies by 38% (95%CI 32-44%) and by 15% (95%CI 12-19%), respectively. As a HPV DNA positivity triage test, mRNA reduced colposcopies by 63% (95%CI 60-66%), having 68% sensitivity (95%CI 61-75%), whereas cytology at the ASC-US+ threshold reduced colposcopies by 23% (95%CI 20-26%), showing 92% sensitivity (95%CI 87-95%). In conclusion, PreTect HPV-Proofer mRNA can serve as a better triage test than HPV DNA to reduce colposcopy referral in both ASC-US and L-SIL. It is also more efficient than cytology for the triage of HPV DNA positive women. Nevertheless, its low sensitivity demands a strict follow up of HPV DNA positive-mRNA negative cases.

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