rubrica

Screening

  • Paolo Giorgi Rossi1

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

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Ricerca bibliografica periodo 2 giugno 2011 – 2 agosto 2011

Per leggere le caratteristiche di questa ROUTINE di ricerca clicca qui

Database: Pubmed/MEDline
Stringa:
(exp Mass Screening [MESH] or (cancer AND screening) (titolo/abstract) and italy (tutti i campi).

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
Fra giugno e luglio sono usciti solo 5 lavori e due lettere sugli screening prodotti da gruppi italiani.
Un lavoro (Argenziano, J Am Acad Dermatol) riguarda lo screening dei tumori della pelle attraverso l’esame completo della cute, in soggetti con sintomi focalizzati. Lo screening dei tumori della pelle è una pratica molto diffusa, con raccomandazioni poco condivise e relativamente poco studiata dal punto di vista della sanità pubblica. Il lavoro si concentra su pazienti sintomatici e tenta di valutare detection rate, sensibilità e number need to screen, seguendo un protocollo definito di accertamenti.
Un lavoro (Vismasa Fugini, Urologia) sul carcinoma prostatico screen detected non trova nessun buon marcatore prognostico che permetta di distinguere i tumori non clinicamente significativi da quelli che avranno una progressione, confermando che non ci sono soluzioni facili in vista per ridurre il sovra trattamento indotto dallo screening con PSA.
Due lavori riguardano lo screening mammografico. Un trial multicentrico (Giordano, Eur J Public Health) valuta differenti modalità d’invito per aumentare l’adesione delle donne più giovani (40-45 anni), una classe di età per la quale al momento non è raccomandata l’estensione dei programmi di screening; risultati non differiscono da ciò che si è visto per le donne di 50-69 anni: l’appuntamento prefissato è la strategia migliore, mentre il materiale informativo e l’offerta di un counselling hanno effetti poco rilevanti. Il secondo (Pellegrini, Radiol Med) valuta la sensibilità del programma di screening di Trento attraverso la ricerca e l’analisi dei cancri intervallo. Una buona pratica di valutazione, più o meno routinaria, che si sta diffondendo in molti programmi di screening del centro nord.
Infine un lavoro (Parente, Am J Gastroenterol) presenta un’analisi interessante dei sistemi informativi correnti per valutare l’impatto dell’implementazione del programma di screening colo rettale sulle colonscopie e sugli esami per il sangue occulto fecale sia all’interno del programma, sia effettuate spontaneamente.
Le due lettere (Lisi, Grattagliano entrambe su Dig Liver Dis), infine, riguardano entrambe i metodi per aumentare la partecipazione allo screening del colon-retto, un argomento caro agli epidemiologi italiani e che necessita, e forse sempre necessiterà, di ricerca ben condotta, ma contestualizzata nelle singole realtà.

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

1. Vismara Fugini A, Antonelli A, Giovanessi L, Gardini VC, Abuhilal M, Zambolin T, Tardanico R, Simeone C, Cosciani Cunico S.
[Insignificant prostate cancer: charateristics and predictive factors.]
Urologia. 2011 Jul 20. pii: 872B50EF-CB23-4BBC-8C56-C410656D2560. doi: 10.5301/RU.2011.8541. [Epub ahead of print]
Cattedra di Urologia, Università degli Studi di Brescia - Italy.

Abstract
Introduction. The widespread screening for PSA has contributed to the increased incidence of prostate cancer (PCa), mostly identifying disease at earlier stages. Many of these patients will probably not require treatment because of the indolent course of the disease. The European Randomized Study of Screening for Prostate Cancer (ERSPC) has showed that 1410 men needed to be screened and 48 prostatectomies performed to prevent death. The aim of this study was to evaluate predictive factors of insignificant PCa in our experience.
Materials and Methods. We analyzed various preoperative clinical and biopsy findings of 225 consecutive patients who underwent prostatectomy from October 2007 to June 2010. The indication for biopsy was placed in presence of an abnormal rectal examination and/or suspected transrectal ultrasound and/or PSA >4 ng/ml. We consider insignificant a tumor with a volume ≤5% of the entire gland with a Gleason score ≤ 6, with no grades 4 or 5 and organ confined.
Results. The prevalence of potentially insignificant PCa in our experience was 12%. The preoperative findings of patients with insignificant PCa were significantly more favorable than the remaining cases with PCa not insignificant. Multivariate analysis did not reveal any independent predictors.
Conclusions: In our experience, in a population not screened for PCa, we have not identified any factors that can predict with certainty the insignificant nature of a tumor and, therefore, useful to start a patient on an active surveillance program.

2. Argenziano G, Zalaudek I, Hofmann-Wellenhof R, Bakos RM, Bergman W, Blum A, Broganelli P, Cabo H, Caltagirone F, Catricalà C, Coppini M, Dewes L, Francia MG, Garrone A, Turk BG, Ghigliotti G, Giacomel J, Gourhant JY, Hlavin G, Kukutsch N, Lipari D, Melchionda G, Ozdemir F, Pellacani G, Pellicano R, Puig S, Scalvenzi M, Sortino-Rachou AM, Virgili AR, Kittler H.
Total body skin examination for skin cancer screening in patients with focused symptoms J Am Acad Dermatol. 2011 Jul 12. [Epub ahead of print]
Department of Dermatology, Second University of Naples, Naples, Italy

Abstract
BACKGROUND: The value of total body skin examination (TBSE) for skin cancer screening is controversial.
OBJECTIVE: We sought to determine whether TBSE could be helpful in patients with focused skin symptoms who would not otherwise have undergone TBSE.
METHODS: In a prospective, multicenter, cross-sectional study consecutive adult patients were recruited during a period of 18 months. Physicians first inspected problem areas and uncovered areas and then performed TBSE. Equivocal lesions detected in both steps were excised or biopsied. Primary outcomes were the absolute and relative risks of missing skin cancer and the number of patients needed to examine to detect melanoma or another malignancy. A secondary outcome was the proportion of false-positive results obtained by TBSE.
RESULTS: We examined 14,381 patients and detected 40 (0.3%) patients with melanoma and 299 (2.1%) with at least one nonmelanoma skin cancer by TBSE. In 195 (1.3%) patients equivocal lesions found by TBSE turned out to be benign. We calculated that 47 patients need to be examined by TBSE to find one skin malignancy and 400 patients to detect one melanoma. The risk of missing one malignancy if not performing TBSE was 2.17% (95% confidence interval 1.25-3.74). Factors significantly increasing the chance to find a skin cancer were age, male gender, previous nonmelanoma skin cancer, fair skin type, skin tumor as the reason for consultation, and presence of an equivocal lesion on problem/uncovered areas.
LIMITATIONS: The impact of TBSE on skin cancer mortality was not evaluated.

CONCLUSIONS:
TBSE improves skin cancer detection in patients with focused skin symptoms and shows a low rate of false-positive results.

3. Lisi D, Hassan C, Crespi M.
Author's reply: More data are needed on General Practitioners in colorectal cancer screening. Gastroenterology and Digestive Endoscopy Unit, "Nuovo Regina Margherita" Hospital, Rome, Italy.
4. Giordano L, Stefanini V, Senore C, Frigerio A, Castagno R, Marra V, Dalmasso M, Del Turco MR, Paci E, Segnan N. The impact of different communication and organizational strategies on mammography screening uptake in women aged 40-45 years.
Eur J Public Health. 2011 Jul 11. [Epub ahead of print]
Unit of Epidemiology - CPO Piemonte, Center for Cancer Prevention, Turin, Italy.

Abstract
BACKGROUND: Several factors can influence access to population breast cancer screening. The aim of the study was to evaluate the impact of different information approaches, women's socio-demographic characteristics and organizational factors on mammography screening uptake.
METHODS: We selected 5744 women aged 40-45 years who were randomly assigned to be given letters with: (i) a pre-fixed appointment plus standard leaflet (Group 1); (ii) a pre-fixed appointment plus a more comprehensive booklet (Group 2); (iii) point (ii) plus the offer of a counselling session (Group 3); and (iv) an invitation to contact the centre to get information and arrange participation (Group 4).
RESULTS: Ninety-five women were excluded before the invitation and 5649 were randomized. After excluding undelivered letters (n = 41) and women reporting an exclusion criterion following our invitation (n = 248), the final eligible population was 5360 women. Participation rates following the first contact were 36.5, 39.9, 35.8 and 16.5% for Groups 1-4, respectively. The rates increased to 40.9, 43.6, 40.1 and 35.1% after the reminder letters. Women receiving more complete information had a higher uptake (Group 2), although not statistically significant. Differences among the four groups were maintained by controlling the effect of socio-demographic and attendance determinants. Regardless of intervention, participation was higher among married, higher educated, white-collared women, those born in northern Italy, living closer to the screening unit and with a female-collaborative doctor.
CONCLUSIONS: Invitation letters with a fixed appointment correlate with a higher attendance rate. Providing women with more information on procedures, risks and benefits of mammography screening does not modify their participation.

5. Pellegrini M, Bernardi D, Di Michele S, Tuttobene P, Fantò C, Valentini M, Peterlongo P, Caumo F, Frigerio A, Ciatto S. Analysis of proportional incidence and review of interval cancer cases observed within the mammography screening programme in Trento province, Italy. Radiol Med. 2011 Jul 9. [Epub ahead of print]
U.O. Senologia Clinica e Screening Mammografico, Dipartimento di Radiodiagnostica, APSS, Trento, Italy.

Abstract
PURPOSE: The aim of this study was to assess the performance of the mammography screening programme in Trento Province, Italy, by analysing the interval cancers (IC) observed from 2001 to 2008.
:
MATERIAL AND METHODS: IC were identified by linking screening archives with local cancer registry and pathology archives as well as with hospital discharge records. Proportional incidence was determined according to breast cancers expected in the absence of screening, estimated on the basis of patients/year at risk and age-specific incidence. The review of screening mammograms preceding ICs was performed by an external (three radiologists) and an internal (five radiologists) panel and aimed at assessing the proportion of IC reviewed as screening errors. Results were compared with European Community (EC) recommended standards.
RESULTS: IC proportional incidence was 15.90% for the first year (EC standard <30%) and 25.77% for the second year (EC standard <50%) of the interval. At external review, 18.4% of cases were reviewed as screening errors (identified by at least two of three reviewers), whereas at internal review (identified by at least three of five reviewers) it was 17.4% (EC standard <20%). No significant difference was observed between external and internal review (mean recall rate 8.3% vs. 9.0%; mean identification rate 19.7% vs 19.6%).
CONCLUSIONS: The study confirms good performance of the mammography screening programme in Trento Province, Italy. Comparable results of external and internal reviews suggest that the latter, no doubt easier to be implemented, might be adopted as a routine procedure to assess this early efficacy indicator.

6. Grattagliano I, Tosetti C, Ubaldi E, Cricelli C.
Comments to "The intelligent, painless, "germ-free" colonoscopy: A Columbus' egg for increasing population adherence to colorectal cancer screening?"
Dig Liver Dis. 2011 Jun 23. [Epub ahead of print]
Gastroenterological Area of the Italian Society of General Medicine, Italy.

7. Parente F, Marino B, Ardizzoia A, Ucci G, Ilardo A, Limonta F, Villani P, Moretti R, Zucchi A, Cremaschini M, Pirola ME.
Impact of a Population-Based Colorectal Cancer Screening Program on Local Health Services Demand in Italy: A 7-Year Survey in a Northern Province.
Am J Gastroenterol. 2011 Jun 14. doi: 10.1038/ajg.2011.185.
Gastroenterology Unit, Alessandro Manzoni Hospital, Lecco, Italy.

Abstract
OBJECTIVES: In 2005, the National Health Service recommended a population-based colorectal cancer (CRC) screening program using biennial fecal occult blood testing (FOBT), followed by total colonoscopy in positive patients. So far, no studies have been performed to evaluate the impact of a mass-screening CRC campaign on the health system services at the community level in Italy. We have therefore assessed the workload generated by the first two biennial rounds of screening program on the activity of hospital services involved in CRC diagnosis in the Lecco province.
METHODS: Routine data from all hospital services of our province were collected on activity levels related to CRC diagnosis from January 2003 to December 2009. This time span covered the 2 years prior to, as well as the two biennial rounds of the CRC screening program. In particular, we focused on the volume of outpatient FOBTs and colonoscopies (both diagnostic and interventional) performed among subjects outside the screening program. Joinpoint models were used to test whether an apparent change in trend of examination over time was statistically significant in different age cohorts of the population (<50 years, 50-69 years, and ≥70 years).
RESULTS: The volume of "extra-screening" per-patient/FOBTs and colonoscopies increased significantly over the evaluated periods in all ages, until year 2008, when a steady trend was beginning; the AAPCs (average of the annual percent changes) values were 5.7, 3.1, and 8.4 for FOBT and 14.6, 13.4, and 16.7 for colonoscopy in the three age cohorts, respectively. However, the increase in both FOBT and colonoscopy demand was maximal in the cohort ≥70 years, where three statistically significant annual percent changes (APCs) were identified (in 2003-2005, 2005-2006, and 2006-2007 APCs were 12.3, 14.9, and 15.9 for FOBT, and 18.7, 36.8, and 25.4 for colonoscopy, respectively)
CONCLUSIONS: After the implementation of a FOBT-based mass-screening program for CRC, careful consideration must be given to the significant increase in the workload of hospital services involved in CRC diagnosis, outside the screening campaign. The extra-work mainly involves gastroenterologists performing colonoscopy, whose activity increased over the 5-year period by 118%, as well as laboratory services, where the demand of FOBTs rose by 40%. This phenomenon, mainly attributable to a profound change in the attitude toward CRC screening by those age cohorts outside the program, covers a time span of two full rounds of screening, whereupon a steady trend for colonoscopy is apparent.

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