rubrica

Screening

  • Paolo Giorgi Rossi1

  1. ASPLazio, Roma
Paolo Giorgi Rossi -

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Ricerca bibliografica periodo dal 1gennaio 2012 al 15 marzo 2012

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 ("2012/01/01"[PDAT] : "2012/03/15"[PDAT])

Breve commento a cura di P. Giorgi Rossi
Sono stati identificati 10 lavori inerenti allo screening in questi 75 giorni: 3 rigurdano lo screening mammografico (Puliti et al., Bernardi et al., Ciatto et al.), due il colon retto (Giuliani et al., Crotta et al.), uno il polmone (Larici et al.), uno il melanoma (Seidenari et al.) e uno l’identificazione di famiglie ad alto rischio per tumore del pankreas (Leonardi et al.); infine un lavoro analizza i dati della multiscopo 2004-05 sulla copertura dello screening mammografico e citologico (Damiani et al.). Ben tre lavori riguardano valutazioni di nuove tecnologie in radiologia: uno sulla tomosintesi per lo screening della mammella e due valutano softwere per l’interpretazione delle immagini uno per l’identificazione di lesioni sospette nelle TAC spirali del polmone e uno per la densità mammografica. Il lavoro di Puliti propone una limpida quantificazione dei benefici, in termini di riduzione di mortalità, e dei danni, in termini di sovradagnosi, dello screening mammografico utilizzando un approccio di coorte e seguendo donne aderenti e non aderenti al programma di screening per quasi 20 anni. Lo studio qantifica la riduzione della mortalità causa specifica in circa il 50% e la sovradiagnosi nel 10% del totale dei casi diagnosticati, con un rapporto di 0.6-1 caso sovradiagnosticato ogni morte evitata. Lo studio onestamente conclude che un residuo self selection bias può ancora influenzare i risultati. Mi chiedo però quale può essere l’ entità di questo bias: la consistenza di tutti i risultati basati su approccio di coorte nella stima della sovradiagnosi, nonchè la conoscenza dei principali fattori di rischio per l’insorgenza del ca mammario, rendono questa stima estremamente plausibile. È interessante il tentativo di calcolare indicatori quantitativi di processo per l’Euromelanoma day da parte di Seidenari e collaboratori. Dai risultati del lavoro stesso emergono le difficoltà intrinseche nel vautare queste iniziative. Interessante il carico di diagnosi di altre patologie neoplastiche che comporta la ricerca di melanomi nella popolazione sana; ciò porta gli autori stessi a raccomandare iniziative mirate nella prevenzione del melanoma. Infine, lo studio di Damiani e collaboratori conferma, con i dati della multiscopo, l’effetto dei programmi organizzati di screening nel ridurre le diseguaglianze di accesso alla prevenzione individuale osservati da studi ad hoc e dalle analisi dello studio PASSI.

1. Giuliani J, Marzola M, Indelli M, Frassoldati A. [Oncological quality indicators and Colorectal Cancer Program: data from 2009-2010 of University Hospital in Ferrara, Italy]. , Recenti Prog Med. 2012 Feb;103(2):56-61. doi: 10.1701/1045.11386.

Abstract
The aim of this study is to analyse the oncological quality indicators on our Colorectal Cancer Program, that are reflective of the scope of care, feasible to implement and supported by evidence. We compared two different populations during the same period: patients referring to our Clinical Oncology Unit coming from Regional Colorectal Cancer Screening Program and the other population that was not in any Colorectal Cancer Program. On the basis of our experience, we concluded for high-quality care for both population. Any critical point should be carefully analysed in order to implement quality of care.

2. Crotta S, Segnan N, Paganin S, Dagnes B, Rosset R, Senore C. High Rate of Advanced Adenoma Detection in 4 Rounds of Colorectal Cancer Screening with the Fecal Immunochemical Test. Clin Gastroenterol Hepatol. 2012 Mar 14. [Epub ahead of print]
Gastroenterology and Gastrointestinal Endoscopy Unit, Beauregard Hospital, Aosta, Italy.

Abstract
BACKGROUND & AIMS: Few data have been published on the performance of colorectal cancer (CRC) screens that use multiple rounds of the fecal immunochemical test (FIT). We evaluated outcomes of 4 screening rounds in 7 years in an Italian population based program. METHODS: We conducted a prospective cohort study of 2,959 average-risk subjects, 50-74 years old, who were invited for the first screening round in 2001. We assessed the participation rate, the yield of advanced adenomas and CRC detected in the screening examinations and we collected information about interval CRCs, with a follow-up of 8 ½-year period. RESULTS: Participation in each round varied from 56% to 63%; 48.1% of eligible subjects attended all 4 invitations. The positive predictive value of the FIT for advanced neoplasia (CRC or advanced adenoma) was 40% at the first round, and approximately 33% in the subsequent rounds. This decrease was mainly attributable to a decrease in the detection of CRC, while a high rate of advanced adenomas (range 0.8%-1.7%) was observed over all rounds. To find 1 advanced neoplasia in the study period the number of people that needed to be screened was 28 and the number of tests needed was 74. CONCLUSIONS: About 60% of invited individuals participated in every single round of FIT screening for CRC, but less than 50% attended all 4 tests. A high detection rate of advanced adenomas in all rounds indicates that FIT screening could have a higher impact on incidence of CRC than the guaiac fecal occult blood test.

3. Larici AR, Amato M, Ordóñez P, Maggi F, Menchini L, Caulo A, Calandriello L,Vallati G, Giunta S, Crecco M, Bonomo L. Detection of noncalcified pulmonary nodules on low-dose MDCT: comparison of the sensitivity of two CAD systems by using a double reference standard. Radiol Med. 2012 Feb 10. [Epub ahead of print]
Dipartimento di Bioimmagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Largo A. Gemelli 8, 00168, Roma, Italy, anna.larici@rm.unicatt.it.

Abstract
PURPOSE: This study compared the sensitivity of two commercial computer-aided detection (CAD) systems in identifying noncalcified pulmonary nodules on low-dose multidetector computed tomography (MDCT) scans by using a double reference standard. MATERIALS AND METHODS: Three chest low-dose MDCT scans of patients who had undergone lung cancer screening were retrospectively analysed using two distinct commercial CAD systems: LungCAD VC10A, Siemens Medical Solutions (CAD1) and LungVCAR, GE Healthcare (CAD2). The exact location of each finding suggested by each system was recorded by an independent reader according to spatial coordinates (x, y, z). Two panels of experienced thoracic radiologists from two different institutions independently established two reference standards (RS1, RS2) by identifying the true positive findings with spatial coordinates without using CAD. Sensitivity of the two CAD systems, defined by lesionlevel analysis, was tested and sensitivities compared. RESULTS: RS1 identified 34 noncalcified pulmonary nodules, whereas RS2 identified 54. The total number of findings detected by the two CAD systems was 684. CAD1 correctly identified 13/34 nodules (sensitivity 38%) for RS1 and 17/54 (sensitivity 30%) for RS2, whereas CAD2 correctly identified 11/34 nodules (sensitivity 35%) for RS1 and 13/54 (sensitivity 23%) for RS2. Comparison between the two CAD systems did not show a statistically significant difference in terms of sensitivity (p<0.05) for both RS1 (p=0.42) and RS2 (p=0.33). CONCLUSIONS: The two commercial CAD systems had similar sensitivity in detecting noncalcified pulmonary nodules on low-dose MDCT of the chest.

4. Damiani G, Federico B, Basso D, Ronconi A, Bianchi CB, Anzellotti GM, Nasi G, Sassi F, Ricciardi W. Socioeconomic disparities in the uptake of breast and cervical cancer screening in Italy: a cross sectional study. BMC Public Health. 2012 Feb 3;12(1):99. [Epub ahead of print]

Abstract
BACKGROUND: Breast and cervical cancer screening are widely recognized as effective preventive procedures in reducing cancer mortality. The aim of this study was to evaluate the impact of socioeconomic disparities in the uptake of female screening in Italy, with a specific focus on different types of screening programs. METHODS: A cross-sectional study was conducted using data from the 2004-2005 national health interview survey. A sample of 15,486 women aged 50- 69 years for mammography and one of 35,349 women aged 25-64 years for Pap smear were analysed. Logistic regression models were used to estimate the association between socioeconomic factors and female screening utilization. RESULTS: Education and occupation were positively associated with attendance to both screening. Women with higher levels of education were more likely to have a mammogram than those with a lower level (OR = 1.28; 95% CI = 1.10-1.49). Women of intermediate and high occupational classes were more likely to use breast cancer screening (OR = 1.77; 95% CI = 1.55-2.03, OR = 1.63; 95% CI = 1.40-1.91) compared to unemployed women. Women in the highest occupational class had a higher likelihood of cervical cancer screening compared to those in the lowest class (OR = 1.91; 95% CI = 1.72-2.13). Among women who attended screening, those with lower levels of education and lower occupational classes were more likely than more advantaged women to attend organized screening programs rather than being screened on the basis of their own initiative. CONCLUSIONS: Inequalities in the uptake of female screening widely exist in Italy. Organized screening programs may have an important role in increasing screening attendance and tackling inequalities.

5. Ciatto S, Bernardi D, Calabrese M, Durando M, Gentilini MA, Mariscotti G, Monetti F, Moriconi E, Pesce B, Roselli A, Stevanin C, Tapparelli M, Houssami N. A first evaluation of breast radiological density assessment by QUANTRA software as compared to visual classification. Breast. 2012 Jan 27. [Epub ahead of print]
U.O. Senologia Clinica e Screening Mammografico, Dipartimento di Radiodiagnostica, APSS, Trento, Italy.

Abstract
Breast radiological density is a determinant of breast cancer risk and of mammography sensitivity and may be used to personalize screening approach. We first analyzed the reproducibility of visual density assessment by eleven experienced radiologists classifying a set of 418 digital mammograms: reproducibility was satisfactory on a four (BI-RADS D1-2-3-4: weighted kappa = 0.694-0.844) and on a two grade (D1-2 vs D3-4: kappa = 0.620-0.851), but subjects classified as with dense breast would range between 25.1 and 50.5% depending on the classifying reader. Breast density was then assessed by computer using the QUANTRA software which provided systematically lower density percentage values as compared to visual classification. In order to predict visual classification results in discriminating dense and non-dense breast subjects on a two grade scale (D3-4 vs, D1-2) the best fitting cut off value observed for QUANTRA was ≤ 22.0%, which correctly predicted 88.6% of D1-2, 89.8% of D3-4, and 89.0% of total cases. Computer assessed breast density is absolutely reproducible, and thus to be preferred to visual classification. Thus far few studies have addressed the issue of adjusting computer assessed density to reproduce visual classification, and more similar comparative studies are needed.

6. Leonardi G, Marchi S, Falconi M, Zerbi A, Ussia V, de Bortoli N, Mosca F, Presciuttini S, Del Chiaro M. "PancPro" as a tool for selecting families eligible for pancreatic cancer screening: An Italian study of incident cases. Dig Liver Dis. 2012 Jan 24. [Epub ahead of print]
Gastroenterology Unit, Pisa University Hospital, Italy.

Abstract
BACKGROUND: PancPRO is a computer program that estimates the risk of pancreatic cancer for asymptomatic individuals based on a genetic model of susceptibility and the familial incidence of cancer. AIM: To evaluate the distribution of the familial risk in a series of incident cases of pancreatic adenocarcinoma. MATERIALS AND METHODS: The lifetime risk of pancreatic cancer was calculated by PancPro for a hypothetical 40-year-old son of 570 consecutive probands with pancreatic cancer. RESULTS: The 570 risk values were included between 1% and 13%. The distribution was bimodal, with the antimode located at risk=7.5%. Considering a 10-fold risk over the general population as a threshold for including a subject in a surveillance program, 19 families (3.3%) would be selected, totalling 92 first- degree relatives with age >40 years. CONCLUSIONS: PancPro is a valid instrument to rank families based on risk of pancreatic cancer.

7. Bernardi D, Ciatto S, Pellegrini M, Tuttobene P, Fanto' C, Valentini M, Michele SD, Peterlongo P, Houssami N. Prospective study of breast tomosynthesis as a triage to assessment in screening. Breast Cancer Res Treat. 2012 Jan 22. [Epub ahead of print]
U.O. Senologia Clinica e Screening Mammografico, Dipartimento di Radiodiagnostica, APSS, Via Degasperi, 79, 38100, Trento, Italy.

Abstract
There is limited evidence on the role of 3D mammography with tomosynthesis in breast screening, although early studies suggest that it may improve specificity. We prospectively evaluated the effect of integrating 3D mammography as a triage to assessment in 158 consecutive recalls to assessment (recalled in standard 2D- mammographic screening) in asymptomatic subjects. Radiologists provided 3D mammography-based opinion as to whether recall/assessment was warranted or unnecessary, and all subjects proceeded to assessment. 3D triage was positive (confirmed the need for assessment) in all 21 subjects with breast cancer (there were no false negatives), and would have avoided recall in 102 of 137 (74.4%) subjects with a negative/benign final outcome in whom 3D triage did not recommend recall. Proportion of true negative 3D triage (as a proxy for potential reduction in recalls) was slightly higher in dense than non-dense breasts, did not differ across age- groups, but was significantly associated with the type of lesion seen on imaging (being highest for distortions, asymmetric densities, and lesions with ill-defined margins). While the simulation design may have over-estimated the potential for 3D mammography triage to reduce recalls, this study clearly demonstrates its capability to improve breast screening specificity and to reduce recall rates. Future studies of 3D mammography should further assess its role as a recall-reducing strategy in screening practice and should include formal cost-analysis.

8. Puliti D, Miccinesi G, Zappa M, Manneschi G, Crocetti E, Paci E. Balancing harms and benefits of service mammography screening programs: a cohort study. Breast Cancer Res. 2012 Jan 9;14(1):R9. [Epub ahead of print]
Clinical and Descriptive Epidemiology Unit, ISPO - Cancer Prevention and Research Institute, via San Salvi 12, 50135 Florence, Italy. e.paci@ispo.toscana.it.

Abstract
INTRODUCTION: The use of screening mammography is still under debate within the medical community. The aim of this study is to define a balance sheet of benefits (breast cancer mortality reduction) and harms (overdiagnosis) for mammography screening programs. METHODS: We compared breast cancer incidence and mortality in two cohorts of women, defined as 'attenders' or 'non-attenders' on the basis of the individual attitudes towards screening, who were invited to the first round of the Florentine screening program. The effects of screening exposure on breast cancer incidence and mortality were evaluated by fitting Poisson regression models adjusted for age at entry, marital status and deprivation index. We performed a sensitivity analysis excluding 34 women not responding to the invitation with a breast cancer diagnosis in the following six months. RESULTS: In total, we included 51,096 women aged 50 to 69 years invited at the first screening round (1991 to 1993) and followed-up for breast cancer incidence and mortality until 31 December 2007 and 31 December 2008, respectively The estimate of mortality reduction varies from 45% among 50 to 59 year-old women up to 51% among 60 to 69 year-old women. The estimate of overdiagnosis, according to the cumulative-incidence method, is an additional 10% of all breast cancer cases among 60 to 69 year-old women screened. CONCLUSIONS: Comparing the breast cancer mortality and breast cancer incidence between attenders and non-attenders, we have determined that the overall cost to save one life corresponds to no more than one over-diagnosed tumor (from 0.6 to 1 depending on the selection criteria of the cohort), even if a residual self-selection bias cannot be excluded.

9. Seidenari S, Benati E, Ponti G, Borsari S, Ferrari C, Albertini G, Altomare G, Arcangeli F, Aste N, Bernengo MG, Bongiorno MR, Borroni G, Calvieri S, Chimenti S, Cusano F, Fracchiolla C, Gaddoni G, Girolomoni G, Guarneri B, Lanzoni A, Lombardi M, Lotti T, Mariotti A, Marsili F, Micali G, Parodi A, Peris K, Peserico A, Quaglino P, Santini M, Schiavon S, Tonino C, Trevisan G, Tribuzi P, Valentini P, Vena GA, Virgili A. Italian Euromelanoma Day Screening Campaign (2005-2007) and the planning of melanoma screening strategies. Eur J Cancer Prev. 2012 Jan;21(1):89-95.
Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.

Abstract
Although no study has definitively shown that unfocused screening of skin cancer is effective, many campaigns have been organized with the aim of increasing awareness on melanoma risk factors. The objective of this study was to analyse the results of the Skin Cancer Screening Day in Italy during the period 2005-2007, to determine the priorities for melanoma control plans in a Mediterranean country. A total of 5002 patients were screened by dermatologists in 31 cities. Individuals who considered themselves to have many naevi and those with a family history of melanoma showed a higher number of common and atypical naevi. Ten melanomas, 20 basal cell carcinomas and two squamous cell carcinomas were histopathologically confirmed. Our observations provide the following suggestions for melanoma prevention strategies: (a) an unfocused campaign is suitable to inform the public about the importance of self-examination of the skin, but is not useful to identify a larger number of melanomas; and (b) melanoma screening campaigns should focus on a selected population, which meets rigorous risk criteria to maintain higher cost-effectiveness. The financial support to effective melanoma screening programmes could be increased, especially in southern populations where lower levels of self-surveillance and socioeconomic conditions represent risk factors for late identification of melanoma.

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