rubrica

Screening

  • Paolo Giorgi Rossi1

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

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Ricerca bibliografica periodo dal 16 ottobre 2011 al 27 dicembre 2011

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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 ("2011/10/16"[PDAT] : "2011/12/27"[PDAT])

Breve commento a cura di P. Giorgi Rossi
Per il periodo ottobre dicembre vi proponiamo 10 lavori prodotti da gruppi italiani sugli screening. Quattro lavori sullo screening del colon retto, due sullo screening del polmone, uno sullo screening genetico per la mammella, uno sulla diagnosi istologica nel carcinoma della mammella, e due sulla prevalenza di HPV nella popolazione. È interessante notare come alcuni degli studi riportati in questa selezione (Carozzi Eur J Cancer; Cassinotti Int J Cancer; Lauriola J Clin Psychol Med Settings), non siano ricerche sullo screening, bensì siano ricerche di epidemiologia eziologica che hanno utilizzato i programmi di screening come un’efficiente fonte di reclutamento di soggetti sani o di casi dalla popolazione generale.

1. Mussetto A, Triossi O, Gasperoni S, Casetti T. Colon capsule endoscopy may represent an effective tool for colorectal cancer screening: A single-centre series. Dig Liver Dis. 2011 Dec 9. [Epub ahead of print]
Department of Gastroenterology, S. Maria delle Croci Hospital, Ravenna, Italy.

Abstract
Non disponibile

2. Simone B, De Feo E, Nicolotti N, Ricciardi W, Boccia S. Quality evaluation of guidelines on genetic screening, surveillance and management of hereditary colorectal cancer. Eur J Public Health. 2011 Dec 2. [Epub ahead of print]
1 Institute of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy.

Abstract
BACKGROUND: We examined the methodological quality of guidelines on colorectal cancer genetic susceptibility syndromes.
METHODS: PubMed, EMBASE, and Google were searched up to July 2010. Adjourned guidelines in English were included. The Appraisal of Guidelines, Research and Evaluation (AGREE) instrument was used to assess their quality, and the reported evidence base of the guidelines was evaluated.
RESULTS: The search yielded 17 eligible guidelines: 11 were developed by independent associations, while 6 had national\state endorsement. Only three guidelines performed satisfactorily, achieving a score >50% in all 6 AGREE domains. Mean standardized scores for the 6 AGREE domains were: 'scope and purpose', 83.9±22.5%; 'stakeholder involvement', 35.6±24.9%; 'rigour of development', 48.6±25.3%; 'clarity and presentation', 71.6±19.3%; 'applicability', 33.8±30.1%; 'editorial independence', 42.2±39.7%. Guidelines with national endorsement performed better in all the domains, with a statistically significant difference in three domains. Fifteen guidelines out of 17 were found to be based on research evidence.
CONCLUSIONS: There is scope, in many areas, for improving the guidelines analysed, among which are the involvement of various professional figures and patients' representatives, and policies for their application. The AGREE instrument is a useful tool and could also be used profitably by guideline developers to improve the quality of recommendations.

3. Sverzellati N, Cademartiri F, Bravi F, Martini C, Gira FA, Maffei E, Marchianò A, La Vecchia C, De Filippo M, Kuhnigk JM, Rossi C, Pastorino U. Relationship and Prognostic Value of Modified Coronary Artery Calcium Score, FEV1, and Emphysema in Lung Cancer Screening Population: The MILD Trial. Radiology. 2011 Nov 23. [Epub ahead of print]
Department of Clinical Sciences, Section of Diagnostic Imaging, University of Parma, Padiglione Barbieri, University Hospital of Parma, V. Gramsci 14, 43100 Parma, Italy; Department of Radiology, Azienda Ospedaliero-Universitaria di Parma, Italy; Department of Epidemiology and Occupational Health, Mario Negri Institute, University of Milan, Italy; Division of Radiology and Division of Thoracic Surgery, National Cancer Institute of Milan, Italy.

Abstract
Purpose: To assess the relationship between a modified coronary artery calcium (mCAC) score and both forced expiratory volume in 1 second (FEV(1)) and pulmonary emphysema and the associations of such factors with all-cause mortality and cardiovascular events (CVEs) in a lung cancer computed tomographic (CT) screening trial.
Materials and Methods: In this institutional review board-approved study, both clinical and low-dose CT data were evaluated in a cohort of heavy smokers consecutively recruited by the Multicentric Italian Lung Detection, or MILD, trial. Low-dose CT images were analyzed by using software that allowed quantification of mCAC, mean lung attenuation (MLA), and total extent of emphysema. The correlations between mCAC, percentage predicted FEV(1), MLA, and emphysema extent were tested by using the Pearson correlation coefficient. Adjusted multiple logistic regression models were applied to assess the relationships between mCAC, FEV(1), MLA, and emphysema extent and all-cause mortality and CVEs.
Results: The final study cohort consisted of 1159 smokers. There were no significant correlations between mCAC score and FEV(1) (r = -0.03, P = .4), MLA (r = -0.01, P = .7), or emphysema extent (r = 0.02, P = .6). An mCAC score greater than 400 was the only factor that was independently associated with both all-cause mortality (odds ratio [OR]: 3.73; 95% confidence interval [CI]: 1.05, 13.32; P = .04) and CVEs (OR: 2.87; 95% CI: 1.13, 7.27; P = .03).
Conclusion: mCAC is a better predictor of CVE and all-cause mortality than FEV(1) and emphysema extent and may contribute to the identification of high-risk individuals in a lung cancer screening setting.© RSNA, 2011Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11110364/-/DC1.

4. Carozzi F, Ronco G, Gillio-Tos A, Marco LD, Mistro AD, Girlando S, Franceschi S, Plummer M, Vaccarella S; For the New Technologies for Cervical Cancer screening (NTCC) Working Group. Concurrent infections with multiple human papillomavirus (HPV) types in the New Technologies for Cervical Cancer (NTCC) screening study. Eur J Cancer. 2011 Nov 14. [Epub ahead of print]
Centre for Cancer Study and Prevention, Via Cosimo il Vecchio 2, 50139 Florence, Italy.

Abstract
INTRODUCTION: We investigated clustering patterns of human papillomavirus (HPV) in a large study, the New Technologies in Cervical Cancer (NTCC) screening study.
MATERIALS AND METHODS: Women aged 25-60years who attended cervical screening in eight different areas in Northern and Central Italy were tested for HPV infection with Hybrid Capture 2 (HC2). Genotyping of the HC2-positive samples was performed for 13 HPV types targeted by GP5+/GP6+ PCR, followed by Reverse Line Blot. Logistic regression was used to model type-specific HPV positivity, adjusted for age, study area, and specific HPV type prevalence. Subject-level random effects were added to represent unobservable risk factors common to all HPV types.
RESULTS: A total of 36,877 women were included. Of 2833 HC2-positive women, 2108 were confirmed to be positive for any of the 13 specific HPV infections using the PCR assay, and amongst them 430 (20.4% of all PCR-positive women) were infected with multiple types. The observed-to-expected ratio for infection with ⩾2 HPV types was 1.21 (95% Credible Interval: 1.13-1.30). Amongst the 78 combinations of specific HPV types, none of the pairs reached the chosen level of significance, p-value <0.01.
CONCLUSIONS: Multiple HPV infections occurred more frequently than predicted by chance. The excess of multiple infections was small, though not completely absent, after controlling for all sources of common correlation between HPV types. The present analysis of the NTCC screening study showed no evidence that specific HPV types have the tendency to be found more or less often than others in coinfections.

5. Piras F, Piga M, De Montis A, Zannou AR, Minerba L, Perra MT, Murtas D, Atzori M, Pittau M, Maxia C, Sirigu P. Prevalence of human papillomavirus infection in women in Benin, West Africa. Virol J. 2011 Nov 10;8:514.
Department of Cytomorphology, University of Cagliari, Cagliari, Italy. fpiras@unica.it.

Abstract
BACKGROUND: Cervical cancer ranks as the first most frequent cancer among women in Benin. The major cause of cervical cancer now recognized is persistent infection of Human Papillomavirus (HPV). In Benin there is a lack of screening programs for prevention of cervical cancer and little information exists regarding HPV genotype distribution. METHODS: Cervical cells from 725 women were examined for the presence of viral DNA by means of a polymerase chain reaction (PCR) multiplex-based assay with the amplification of a fragment of L1 region and of E6/E7 region of the HPV genome, and of abnormal cytology by Papanicolaou method. The association between HPV status and Pap test reports was evaluated. Socio-demographic and reproductive characteristics were also related. RESULTS: A total of 18 different HPV types were identified, with a prevalence of 33.2% overall, and 52% and 26.7% among women with and without cervical lesions, respectively. Multiple HPV infections were observed in 40.2% of HPV-infected women. In the HPV-testing group, the odds ratio for the detection of abnormal cytology was 2.98 (95% CI, 1.83-4.84) for HPV positive in comparison to HPV negative women. High risk types were involved in 88% of infections, most notably HPV-59, HPV-35, HPV-16, HPV-18, HPV-58 and HPV-45. In multiple infections of women with cytological abnormalities HPV-45 predominated. CONCLUSIONS: This study provides the first estimates of the prevalence of HPV and type-specific distribution among women from Benin and demonstrates that the epidemiology of HPV infection in Benin is different from that of other world regions. Specific area vaccinations may be needed to prevent cervical cancer and the other HPV-related diseases.

6. Pilato B, De Summa S, Danza K, Papadimitriou S, Zaccagna P, Paradiso A, Tommasi S DHPLC/SURVEYOR Nuclease: A Sensitive, Rapid and Affordable Method to Analyze BRCA1 and BRCA2 Mutations in Breast Cancer Families. Mol Biotechnol. 2011 Nov 10. [Epub ahead of print]
National Cancer Centre "Giovanni Paolo II", Molecular Genetics Laboratory, v. Orazio Flacco 65, 70124, Bari, Italy.

Abstract
Hereditary breast cancer accounts for about 10% of all breast cancers and BRCA1 and BRCA2 genes have been identified as validated susceptibility genes for this pathology. Testing for BRCA gene mutations is usually based on a pre-screening approach, such as the partial denaturation DHPLC method, and capillary direct sequencing. However, this approach is time consuming due to the large size of BRCA1 and BRCA2 genes. Recently, a new low cost and time saving DHPLC protocol has been developed to analyze gene mutations by using SURVEYOR(®) Nuclease digestion and DHPLC analysis. A subset of 90 patients, enrolled in the Genetic Counseling Program of the National Cancer Centre of Bari (Italy), was performed to validate this approach. Previous retrospective analysis showed that 9/90 patients (10%) were mutated in BRCA1 and BRCA2 genes and these data were confirmed by the present approach. DNA samples underwent touchdown PCR and, subsequently, SURVEYOR(®) nuclease digestion. BRCA1 and BRCA2 amplicons were divided into groups depending on amplicon size to allow multiamplicon digestion. The product of this reaction were analyzed on Transgenomic WAVE Nucleic Acid High Sensitivity Fragment Analysis System. The operator who performed the DHPLC surveyor approach did not know the sequencing results at that time. The SURVEYOR(®) Nuclease DHPLC approach was able to detect all alterations with a sensitivity of 95%. Furthermore, in order to save time and reagents, a multiamplicon setting preparation was validated.

7. Cassinotti E, Melson J, Liggett T, Melnikov A, Yi Q, Replogle C, Mobarhan S, Boni L, Segato S, Levenson V. DNA methylation patterns in blood of patients with colorectal cancer and adenomatous colorectal polyps. Int J Cancer. 2011 Oct 23. doi: 10.1002/ijc.26484. [Epub ahead of print]
Department of Surgical Sciences, Minimally Invasive Surgery Research Center, University of Insubria, Varese, Italy.

Abstract
Colorectal cancer (CRC) screening rates are currently suboptimal. Blood-based screening could improve rates of earlier detection for CRC and adenomatous colorectal polyps. In this study, we evaluated the feasibility of plasma-based detection of early CRC and adenomatous polyps using array-mediated analysis methylation profiling of 56 genes implicated in carcinogenesis. Methylation of 56 genes in patients with Stages I and II CRC (N = 30) and those with adenomatous polyps (N = 30) were compared with individuals who underwent colonoscopy and were found to have neither adenomatous changes nor CRC. Composite biomarkers were developed for adenomatous polyps and CRC, and their sensitivity and specificity was estimated using five-fold cross validation. Six promoters (CYCD2, HIC1, PAX 5, RASSF1A, RB1 and SRBC) were selected for the biomarker, which differentiated CRC patients and controls with 84% sensitivity and 68% specificity. Three promoters (HIC1, MDG1 and RASSF1A) were selected for the biomarker, which differentiated patients with adenomatous polyps and controls with sensitivity of 55% and specificity of 65%. Methylation profiling of plasma DNA can detect early CRC with significant accuracy and shows promise as a methodology to develop biomarkers for CRC screening.

8. Diciotti S, Sverzellati N, Kauczor HU, Lombardo S, Falchini M, Favilli G, Macconi L, Kuhnigk JM, Marchianò A, Pastorino U, Zompatori M, Mascalchi M. Defining the intra-subject variability of whole-lung CT densitometry in two lung cancer screening trials. Acad Radiol. 2011 Nov;18(11):1403-11.
Computational Biomedical Imaging Laboratory, Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Florence, Italy.

Abstract
RATIONALE AND OBJECTIVES: To define a statistically based variation of individual whole-lung densitometry above which a real increase of pulmonary extent can be suspected in lung cancer screening trials.
MATERIALS AND METHODS: Baseline and 3-month follow-up low-dose computed tomography (LDCT) examinations of 131 smokers or former smokers recruited in the ITALUNG (32 subjects) and MILD (99 subjects) trials were compared using for each data set two different image processing tools for whole-lung densitometry. Both trials were approved by institutional review boards, and written informed consent was obtained from all participants. Assuming that no change of emphysema extent can occur in a 3-month interval, the Bland and Altman method was used to assess the agreement between baseline and follow-up LDCT examinations for lung volume, 15th percentile (Perc15) of lung density and Perc15 corrected for lung volume by application of a linear detrend on log-transformed data.
RESULTS: Similar results were obtained in each data set using two different image processing tools. In the ITALUNG cohort the 95% limits of agreement (LoA) interval of volume corrected Perc15 was -9.7 to 10.7% using image processing method 1 and -10.3 to 11.5% using image processing method 2. In the MILD cohort, the 95% LoA interval of volume corrected Perc15 was -14.7 to 17.3% with both image processing methods.
CONCLUSION: In the two considered lung cancer screening settings a range of 9.7-14.7% decrease of volume corrected Perc15 represents a statistically defined threshold to suspect a real increase of emphysema extent in serial LDCT examinations.

9. Lauriola M, Panno A, Tomai M, Ricciardi V, Potenza AE. Is alexithymia related to colon cancer? A survey of patients undergoing a screening colonoscopy examination. J Clin Psychol Med Settings. 2011 Dec;18(4):410-5.
Department of Social and Developmental Psychology, University of Rome "Sapienza", Rome, Italy.

Abstract
The current study examined whether alexithymia is involved in colon cancer as has been found in breast and uterine cancer research. The TAS-20 was administered before examination to patients who underwent colon cancer screening. Histological data were obtained from the biopsies. Gender, age, education, smoking and drinking habits, and personal and family histories of neoplastic colonic disease were controlled for in the analysis. Both adenoma and adenocarcinoma patients had higher TAS-20 scores than negative cases, and both high and intermediate levels of alexithymia were implicated. Difficulty identifying feelings and externally oriented thinking were the most prominent facets related to the disease process.

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