rubrica

Screening

  • Paolo Giorgi Rossi1

  1. Reggio Emilia
Paolo Giorgi Rossi -

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Ricerca bibliografica periodo 16 marzo 2012 – 31 maggio 2012

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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 ("2012/03/16"[PDAT] : "2012/05/31"[PDAT])

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Breve commento a cura di Paolo Giorgi Rossi
Sono stati trovati undici lavori usciti su PubMed in questi due mesi abbondanti (16 marzo 2012 -31 maggio 2012). Lo spettro delle malattie candidate allo screening si allarga: oltre a colon retto (Recipi, Hassan, Senore), polmone (Mascalchi, Carreras, Pastorino), mammella (Musolino, Biganzoli), cervice (Paba), compare anche la tiroide (Rossi). Molti i lavori degni di nota: riprende la ricerca sui modelli organizzativi del colon retto sia con studi economici (Hassan) sia d’impatto sulla copertura (Senore Gut); la caratterizzazione dello stato recettoriale nei cancri intervallo (Musolino) sembra confermare l’ipotesi che questi siano più aggressivi rispetto ai cancri screen-detected, cosa non sorprendente vista la diagnosi anticipata in questi ultimi, ma anche dei casi identificati clinicamente, punto su cui molti studi precedenti avevano trovato risultati differenti (Caumo F et al., Tumori. 2010 Mar-Apr;96(2):198-201). È uscito anche un lavoro sul MILD trial per la CT nello screening del polmone che riporta risultati negativi per la riduzione di mortalità causa specifica, in contrasto con i risultati pubblicati l’agosto scorso sul NEJM (National Lung Screening Trial Research Team. N Engl J Med. 2011 Aug 4;365(5):395-409). Sono state pubblicate su Lancet Oncology, da un gruppo comprendente diversi autori italiani, anche le linee guida SIOG (società internazionale di oncologia geriatrica) ed EUSOMA sul cancro della mammella nell’anziana. Infine, il fatto che si cominci ad associare la parola “screening” al cancro della tiroide forse ci obbligherà a ragionare, insieme alla comunità dei clinici, sull’enorme aumento di diagnosi di tumori tiroidei che si è verificato in Italia negli ultimi anni. Questa epidemia, con il suo conseguente carico di tiroidectomie, sebbene abbia cause non del tutto chiarite, è senza dubbio in larga parte conseguenza di un’attività spontanea di diagnostica precoce e di case finding (Lise M et al 2012 Thyroid: 22(1):27-34; Dal maso L et al. Annals of Oncology 2010,22:957-63; Davies L et al. JAMA 2006 may 10;295(18):2164-67)) le cui conseguenze non sono state ancora valutate da un punto di vista d’impatto sulla salute della popolazione. Diversi lavori presentano risultati di studi innestati sui programmi di screening, ma il cui oggetto di ricerca non è lo screening stesso, bensì i programmi organizzati sono utilizzati come un’infrastruttura permanente per la ricerca: sulla storia naturale della malattia (Musolino), innestare interventi di prevenzione primaria (Senore Front Oncol, Carreras), diagnosi di enfisema (Mascalchi).

1 Repici A, Laterra MA, Cisaro F, Pellicano R, Fini L, Ishaq S. Unveiling cancer in IBD: screening colonoscopy or chromoendoscopy. Curr Drug Targets. 2012 May 28. [Epub ahead of print]
Digestive Endoscopy Unit, IRRCS Isituto Clinico Humanitas, Milano, Italy. alessandro.repici@humanitas.it.
Abstract
The risk of developing colorectal cancer (CRC) is increased in patients with inflammatory bowel disease (IBD), particularly if the disease is extensive and its duration long-standing. Endoscopic guidelines have been developed with the goal of detecting early neoplastic changes prior to development of advanced malignancy. The current surveillance strategy of surveillance colonoscopy, with multiple random biopsies, most likely reduces morbidity and mortality associated with IBD-related CRC. Unfortunately, standard surveillance colonoscopy also has limitations, including high cost and sampling error at time of biopsy. The main issue is that colitis associated neoplasms often occur in flat mucosa of normal appearance, and are detected on taking random biopsies rather than by direct identification of these lesions via endoscopic imaging. Advances in endoscopic imaging techniques, such as vital or optical chromoendoscopy, that can enhance mucosal characteristics, may potentially aid in increasing dysplasia detection rate, and may reduce the workload of standard random biopsies. The aim of this review was to describe and summarize outcomes of more advanced endoscopic imaging techniques, including chromoendoscopy and magnification endoscopy.
2 Senore C, Giordano L, Bellisario C, Di Stefano F, Segnan N. Population based cancer screening programmes as a teachable moment for primary prevention interventions. A review of the literature. Front Oncol. 2012;2:45. Epub 2012 May 8.
Epidemiologia dei Tumori II, AOU S Giovanni Battista - CPO Piemonte Torino, Italy.
Abstract
BACKGROUND AND AIM Unhealthy diet, physical inactivity, and smoking are key risk factors for the major non-communicable diseases such as cancer, cardiovascular diseases, and diabetes. The screening procedure may represent an ideal setting for promoting healthy lifestyles as it represents a time when subjects are probably more inclined to consider a relationship between their own habits and their effects on health. The aim of this study is to review available evidence concerning interventions combining screening and primary prevention interventions, aimed at promoting the adoption of healthy lifestyles. METHODS We searched the MEDLINE and Cochrane library electronic databases for intervention studies of primary prevention interventions implemented in the context of established screening programmes, or of pilot screening projects, where the study design included a comparison group. RESULTS Comprehensive interventions are acceptable for asymptomatic subjects targeted for cancer screening, can result in improvements and may be cost-effective. A positive impact of these interventions in favoring the adoption of cancer protective dietary behaviors was observed in all studies. Conflicting results were instead reported with respect to physical activity, while no impact could be observed for interventions aimed to favor smoking cessation. CONCLUSIONS The retrieved studies suggest that the screening setting may offer valuable opportunities to provide credible, potentially persuasive life style advice, reaching a wide audience. A multiple risk factor approach may maximize the benefit of behavioral change, as the same health related habits are associated not only with cancers targeted by screening interventions, but also with other cancers, coronary artery disease, and other chronic conditions, while unhealthy behaviors may be mutually reinforcing. In order to cover a maximum number of possibilities, health education programmes should include multiple strategies, integrating and combining models of individual, social, and environmental change.
3 Musolino A, Michiara M, Conti GM, Boggiani D, Zatelli M, Palleschi D, Bella MA, Sgargi P, Di Blasio B, Ardizzoni A. Human Epidermal Growth Factor Receptor 2 Status and Interval Breast Cancer in a Population-Based Cancer Registry Study. J Clin Oncol. 2012 May 14. [Epub ahead of print]
Antonino Musolino, Maria Michiara, Daniela Boggiani, Dario Palleschi, Maria Angela Bella, Paolo Sgargi, Beatrice Di Blasio, and Andrea Ardizzoni, University Hospital of Parma; and Giovanni Maria Conti and Marella Zatelli, Azienda Sanitaria Locale, Parma, Italy.
Abstract
PURPOSE To determine whether human epidermal growth factor receptor 2 (HER2) -positive status is associated with risk of breast cancer diagnosis in the interval between mammographic screening, we estimated the distribution of features of aggressive tumor behavior in a general population with newly diagnosed breast cancer and known screening status. PATIENTS AND METHODS We evaluated all invasive breast cancers (N = 641) that were systematically collected by the Parma Province Cancer Registry and diagnosed in women age 50 to 69 years from 2004 to 2007. From this population, 292 screen-detected cancers and 48 interval cases with negative screening mammograms on expert rereading (true interval cancers) were selected for study purposes. Unconditional logistic regression adjusted for age and tumor size was used to determine whether interval cancers were associated with selected clinicobiologic characteristics. RESULTS Tumors with a high histologic grade (odds ratio [OR], 1.8; 95% CI, 1.2 to 3.8), high proliferative rate (OR, 2.4; 95% CI, 1.2 to 4.5), negative estrogen receptor status (OR, 1.6; 95% CI, 1.1 to 3.1), or HER2-positive status (OR, 3.4; 95% CI, 1.7 to 7.1) were more likely to be diagnosed in the interval between screening. Women age less than 60 years with HER2-positive breast cancer were four times more likely to be diagnosed in the interval between screening compared with only a two-fold increased risk for older women. CONCLUSION This population-based cancer registry study demonstrated that HER2-positive tumors account for a substantial proportion of mammographic screening failure. The distribution of biologic characteristics in screen-detected cancers differs from that observed in interval cancers and may account in part for the more aggressive behavior of interval-detected cases.
4 Mascalchi M, Sverzellati N, Falchini M, Favilli G, Lombardo S, Macconi L, Paci E, Pegna AL, Falaschi F, Zompatori M, Diciotti S. Changes in Volume-corrected Whole-lung Density in Smokers and Former Smokers During the ITALUNG Screening Trial. J Thorac Imaging. 2012 May 8. [Epub ahead of print]
*Sezione di Radiodiagnostica, Dipartimento di Fisiopatologia Clinica, Università di Firenze ‡Istituto di Studio e Prevenzione Oncologica §Dipartimento di Pneumologia, Azienda Ospedaliera-Universitaria di Careggi, Firenze †Dipartimento di Radiologia, Università di Parma, Parma ∥Dipartimento di Radiologia, Ospedale Cisanello, Azienda Ospedaliera Pisana, Pisa ¶Dipartimento di Radiologia, Ospedale S. Orsola Malpighi, Università di Bologna, Bologna, Italy.
Abstract
PURPOSE To evaluate with a volume-corrected whole-lung approach changes in lung density over 2 years consistent with progression of pulmonary emphysema in smokers and former smokers enrolled in the ITALUNG trial of lung cancer screening using low-dose computed tomography (LDCT). MATERIALS AND METHODS A total of 103 subjects (mean age 63±4 y with a pack-year history of at least 20) underwent 2 whole-lung LDCT examinations 2 years apart. Visual assessment was made independently by 2 experienced observers on the initial LDCT examination with a 0 to 4 grading system for each of 6 regions (right and left upper, mid, and lower lung). The whole-lung 15th percentile of attenuation coefficient and relative area (RA) at -910 HU, both corrected to the individual lung volume (Perc15v and RA910v), were measured on the 2 LDCT examinations. The intrasubject variability of Perc15v and RA910v was previously determined in 32 other subjects of the trial examined using the same scanner and technique twice over a 3-month interval for suspicious nodules. RESULTS The 2 operators agreed on the presence of mild to severe emphysema (visual score ≥1 in at least 1 region) at initial LDCT examination in 24 (23%) of the 103 subjects. Fifteen subjects (15%) showed a Perc15v change between the 2 examinations exceeding the lower 95% limit of agreement, indicating progression of emphysema with a mean difference in lung density of -14.7%±2.6%. Ten of the 15 were identified as showing emphysema progression by RA910v as well. No association was observed between progression of emphysema and visual evidence of emphysema at initial LDCT examination, smoking status, or pack-years at baseline, or intervening changes in smoking habits. CONCLUSION Once variations in inspiratory lung volumes are taken into account, changes in lung density over 2 years consistent with progression of pulmonary emphysema in elderly smokers and former smokers are uncommon.
5 Rossi M, Buratto M, Bruni S, Filieri C, Tagliati F, Trasforini G, Rossi R, Beccati MD, Degli Uberti EC, Zatelli MC. Role of Ultrasonographic/Clinical Profile, Cytology, and BRAF V600E Mutation Evaluation in Thyroid Nodule Screening for Malignancy: A Prospective Study. J Clin Endocrinol Metab. 2012 Apr 24. [Epub ahead of print]
Section of Endocrinology (M.R., C.F., F.T., E.C.d.U., M.C.Z.), Department of Biomedical Sciences and Advanced Therapies, University of Ferrara, and Azienda Ospedaliero Universitaria di Ferrara (S.B., G.T., R.R.), 44121 Ferrara, Italy; Section of Pathology (M.D.B.), Azienda Ospedaliero Universitaria di Ferrara, 44121 Ferrara, Italy; and Laboratorio in rete del Tecnopolo "Tecnologie delle terapie avanzate" (E.C.d.U., M.C.Z.), University of Ferrara, 44121 Ferrara, Italy.
Abstract
CONTEXT Ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) is the most reliable nonsurgical test for distinguishing benign from malignant thyroid nodules. However, there is no consensus on which nodules should undergo FNAB. AIMSThe aims of this study were to evaluate the utility of US-guided FNAB in the diagnostic assessment of nodules with or without clinical/US features suggestive for malignancy and to investigate the additional contribution of BRAF V600E mutation analysis in the detection of differentiated thyroid cancer. DESIGN AND METHODS Thyroid cytoaspirates from 2421 nodules at least 4 mm in diameter were performed in 1856 patients who underwent cytological evaluation and biomolecular analysis. RESULTS Cytology showed high positive predictive value and specificity for the diagnosis of malignant lesions. BRAF V600E mutation was found in 115 samples, 80 of which were also cytologically diagnosed as papillary thyroid cancer. BRAF mutation analysis significantly enhanced the diagnostic value of cytology, increasing FNAB diagnostic sensitivity for malignant nodules by approximately 28%. Micro PTC (63% of diagnosed papillary thyroid carcinoma) showed a high prevalence of multifocality, extrathyroidal extension, and lymph node metastases, underlining the malignant potential of thyroid microcarcinomas. Each investigated US/clinical characteristic of suspected malignancy correlated with the presence of a thyroid cancer in thyroid nodules with diameter of at least 4 mm. CONCLUSIONS These data indicate that nodules of at least 4 mm may underlie a thyroid cancer independently of US/clinical characteristics of suspected malignancy, suggesting the need to perform FNAB. The diagnostic sensitivity for thyroid cancer is significantly increased by BRAF V600E mutation analysis, indicating that the screening for BRAF mutation in FNAB samples has a relevant diagnostic potential.
6 Hassan C, Rex DK, Cooper GS, Benamouzig R. Endoscopist-directed propofol administration versus anesthesiologist assistance for colorectal cancer screening: a cost-effectiveness analysis. Endoscopy. 2012 May;44(5):456-64. Epub 2012 Apr 24.
Gastroenterology Department, Nuovo Regina Margherita Hospital, Rome, Italy. cesareh@hotmail.com
Abstract
Comment in Endoscopy. 2012 May;44(5):453-5.
BACKGROUND Propofol for colonoscopy is largely administered by anesthesiologists or anesthesiology nurses in the United States (US) and Europe. Endoscopist-directed administration of propofol (EDP) by nonanesthesiologists has recently been proposed, with potential savings of anesthetist reimbursement costs. We aimed to assess potential EDP-related benefit in a screening setting. METHODS In a Markov model the total number of screening and follow-up colonoscopies in a cohort of 100 000 US subjects were estimated. Anesthetist-assisted colonoscopy was compared with an EDP strategy. Model outputs were projected onto the 50 - 80-year-old US population, assuming 27 % as the current uptake for colonoscopy screening. Anesthetist costs were estimated using the mean reimbursement for the corresponding Medicare code (≥ 65-year-olds) and from commercial insurance information (50 - 64-year-olds). The proportion of colonoscopies with anesthesiologist assistance was estimated from the Medicare database. Mean nurse salary was used to estimate the cost of a 2-week EDP training. The absolute number of US endoscopists was estimated by inflating by 33 % the number of board-certified gastroenterologists. No EDP mortality was assumed in the reference scenario, and 0.0008 % mortality in the sensitivity analysis. US census data were adopted. Analogous inputs were used for France to assess EDP-related benefit in a European country. RESULTS EDP training for 17 166 nurses (one for each US endoscopist) showed a cost of $ 47 million. Cost estimates for anesthesiologist assistance for colonoscopy were $ 95 (Medicare) and $ 450 (non-Medicare commercial insurance), with 34.8 % of colonoscopies requiring anesthesiologist assistance. US implementation of an EDP policy showed a 10-year saving of $ 3.2 billion (Monte Carlo analysis 5 - 95 % percentiles $ 2.7 - $ 11.9 billion). In the sensitivity analysis, assuming 50 % of colonoscopies were anesthetist-assisted showed an EDP benefit of $ 4.6 billion. Assuming a 0.0008 % mortality rate, the incremental cost - effectiveness of anesthetist-assisted colonoscopy versus an EDP policy was $ 1.5 million per life-year gained, supporting EDP as the optimal choice. A 31-fold increase of EDP-related mortality or a 17-fold cost reduction for anesthetist-assisted colonoscopy was required for EDP to become not cost-effective in this scenario. Implementation of an EDP policy in France, within a guaiac-fecal occult blood test (g-FOBT) screening program, was estimated to save € 0.8 billion in 10 years. CONCLUSIONS The absolute economic benefit of EDP implementation in a screening setting is probably substantial with 10-year savings of $3.2 billion in the US and €0.8 billion in France. The impact of an eventual EDP-related mortality on EDP cost - effectiveness seems marginal. The huge economic and medical resources entailed by anesthetist-assisted colonoscopy could be more efficiently invested in other clinical fields.
7 Carreras G, Gorini G, Paci E. Can a national lung cancer screening program in combination with smoking cessation policies cause an early decrease in tobacco deaths in Italy? Cancer Prev Res (Phila). 2012 Jun;5(6):874-82. Epub 2012 Apr 23.
Environmental and Occupational Epidemiology Unit, ISPO Cancer Prevention and Research Institute, Ponte Nuovo - via delle Oblate, 1 - 50141 Florence, Italy. g.gorini@ispo.toscana.it.
Abstract
Objective is to predict smoking attributable deaths (SAD) for lung cancer and all causes in Italy, 2015 to 2040, assuming a yet unimplemented tobacco control policies (TCP) and a national, low-dose, lung cancer, computed tomography (CT) annual screening program (CT screen). A dynamic model describing the evolution of smoking habits was developed to estimate quit rates, 1986 to 2009, and to predict SAD under different scenarios: keeping the status quo; raising cigarette taxes by 20%; implementing cessation treatment policies (funding treatment, setting up an active quitline, promoting counseling among health professionals); introducing a three-round annual CT screen for current and former heavy smokers aged 55 to 74, 70% compliance, 20% lung cancer mortality reduction; combining all the above-mentioned measures. The CT screen brought a 3.0% constant annual reduction in lung cancer SAD and decreased or postponed all-cause SAD by 1.7% annually (a half due to respiratory diseases), relative to the status quo scenario. The effect was noticeable after few years from its introduction. TCP showed a steadily strengthening effect starting from 5 to 10 years after implementation. The lung cancer and all-cause SAD under cessation treatment policies, for instance, were reduced by 8.4% and 12.0% in 2030, respectively, and by 16.1% and 20.0% in 2040. TCP gave a greater effect than CT screen in reducing all-cause SAD because cessation brought about a reduction in smoking-related SAD other than lung cancer and respiratory diseases. Combining TCP and CT screen could bring about an early decrease in lung cancer and respiratory disease SAD due to CT screen, followed by a more substantial drop in all-cause SAD in subsequent decades due to TCP. Cancer Prev Res; 5(6); 874-82. ©2012 AACR.
8 Paba P, Ascone C, Criscuolo AA, Marcuccilli F, Ciccozzi M, Sesti F, Piccione E, Perno CF, Ciotti M. Human papillomavirus molecular testing in women with low grade cervical lesions: experience from an Italian hospital. Anticancer Res. 2012 Apr;32(4):1253-7.
Laboratory of Molecular Virology, Department of Surgical Sciences, Tor Vergata University Hospital, Rome, Italy.
Abstract
BACKGROUND In recent years, efforts have been made to identify molecular markers as potential screening tools in the early detection of cervical cancer precursors. PATIENTS AND METHODS One-hundred-eighty-two women admitted to the Colposcopy Unit of Tor Vergata University Hospital were enrolled in this study. The inclusion criteria were: i) Pap test with atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL); ii) normal cytology but human papillomavirus (HPV) DNA test positive for at least one of the most frequently detected five high-risk HPV types (16, 18, 31, 33 and 45). HPV DNA was detected with the HPV Sign kit and the type was assigned by pyrosequencing using the PyroMark ID System. E6/E7 transcripts of the high-risk HPV types 16, 18, 31, 33 and 45 were detected by the NucliSense EasyQ HPV kit. RESULTS Overall, 90 (49.5%) patients were HPV-DNA negative, whereas 92 (50.5%) were HPV-DNA positive. Single infections were detected in 55 women: HPV 16 ranked first (56.4%), followed by HPV 18 (21.8%), HPV 31 (9%), HPV 33 (7.3%), and HPV 45 (5.5%). Co-infections were detected in 37/92 (40.2%) positive cases; HPV 16 was detected most frequently (27/37), followed by HPV 18 and 31. All patients underwent HPV RNA testing: 47/182 (25.8%) tested positively while 135/182 (74.2%) were negative. HPV 16 E6/E7 transcripts was the most frequently detected. CONCLUSION Detection of HPV E6/E7 oncogenic transcripts may be used as a molecular biomarker in women with ASCUS or LSIL to help identify women at risk of disease progression.
9 Biganzoli L, Wildiers H, Oakman C, Marotti L, Loibl S, Kunkler I, Reed M, Ciatto S, Voogd AC, Brain E, Cutuli B, Terret C, Gosney M, Aapro M, Audisio R. Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). Lancet Oncol. 2012 Apr;13(4):e148-60. Epub 2012 Mar 30.
Sandro Pitigliani Medical Oncology Unit, Istituto Toscano Tumori, Hospital of Prato, Prato, Italy. lbiganzoli@usl4.toscana.it
Abstract
As the mean age of the global population increases, breast cancer in older individuals will be increasingly encountered in clinical practice. Management decisions should not be based on age alone. Establishing recommendations for management of older individuals with breast cancer is challenging because of very limited level 1 evidence in this heterogeneous population. In 2007, the International Society of Geriatric Oncology (SIOG) created a task force to provide evidence-based recommendations for the management of breast cancer in elderly individuals. In 2010, a multidisciplinary SIOG and European Society of Breast Cancer Specialists (EUSOMA) task force gathered to expand and update the 2007 recommendations. The recommendations were expanded to include geriatric assessment, competing causes of mortality, ductal carcinoma in situ, drug safety and compliance, patient preferences, barriers to treatment, and male breast cancer. Recommendations were updated for screening, primary endocrine therapy, surgery, radiotherapy, neoadjuvant and adjuvant systemic therapy, and metastatic breast cancer.
10 Pastorino U, Rossi M, Rosato V, Marchianò A, Sverzellati N, Morosi C, Fabbri A, Galeone C, Negri E, Sozzi G, Pelosi G, La Vecchia C. Annual or biennial CT screening versus observation in heavy smokers: 5-year results of the MILD trial. Eur J Cancer Prev. 2012 May;21(3):308-15.
Unit of Thoracic Surgery, Foundation IRCCS National Cancer Institute of Milan, Via Venezian 1, Milan, Italy. ugo.pastorino@istitutotumori.mi.it
Abstract
The efficacy and cost-effectiveness of low-dose spiral computed tomography (LDCT) screening in heavy smokers is currently under evaluation worldwide. Our screening program started with a pilot study on 1035 volunteers in Milan in 2000 and was followed up in 2005 by a randomized trial comparing annual or biennial LDCT with observation, named Multicentric Italian Lung Detection. This included 4099 participants, 1723 randomized to the control group, 1186 to biennial LDCT screening, and 1190 to annual LDCT screening. Follow-up was stopped in November 2011, with 9901 person-years for the pilot study and 17 621 person-years for Multicentric Italian Lung Detection. Forty-nine lung cancers were detected by LDCT (20 in biennial and 29 in the annual arm), of which 17 were identified at baseline examination; 63% were of stage I and 84% were surgically resectable. Stage distribution and resection rates were similar in the two LDCT arms. The cumulative 5-year lung cancer incidence rate was 311/100 000 in the control group, 457 in the biennial, and 620 in the annual LDCT group (P=0.036); lung cancer mortality rates were 109, 109, and 216/100 000 (P=0.21), and total mortality rates were 310, 363, and 558/100 000, respectively (P=0.13). Total mortality in the pilot study was similar to that observed in the annual LDCT arm at 5 years. There was no evidence of a protective effect of annual or biennial LDCT screening. Furthermore, a meta-analysis of the four published randomized trials showed similar overall mortality in the LDCT arms compared with the control arm.
11 Senore C, Ederle A, Benazzato L, Arrigoni A, Silvani M, Fantin A, Fracchia M, Armaroli P, Segnan N. Offering people a choice for colorectal cancer screening. Gut. 2012 Mar 22. [Epub ahead of print]
Turin, Italy.
Abstract
OBJECTIVES To assess the population coverage and diagnostic yield of offering an immunochemical faecal occult blood test (FIT) to non-responders to a flexible sigmoidoscopy (FS) invitation. DESIGN A cohort study conducted in a population-based colorectal cancer (CRC) screening programme. In this programme, eligible men and women aged 58 (Turin; 43 748 subjects) or 60 (Verona; 19 970 subjects) are invited, with a personal letter signed by their general practitioner, to undergo an FS. Bowel preparation is limited to a single enema self-administered at home. Subjects in whom one distal polyp >5 mm (≥10 mm in Turin) or at least one adenoma (one advanced adenoma or more than two adenomas in Turin) is detected at FS are referred for colonoscopy. People who do not respond to the invitation to undergo an FS are invited to have an FIT (OC-Sensor; Eiken, Tokyo, Japan; single sample, cut-off 100 ng/ml). Attendance rate and neoplasia yield were analysed in four consecutive birth cohorts. RESULTS Overall participation rate for the FS invitation was 39.3% in Verona and 29.9% in Turin. Of the eligible non-responders to the FS invitation, 19.3% (95% CI 18.9% to 19.7%) underwent an FIT. As a result, the proportion of people undergoing screening by FS or FIT was 55.2% in Verona and 39.3% in Turin, with no gender differences in either centre. FIT detected 8.3% of all advanced adenomas and 20.4% of all CRCs diagnosed at screening. CONCLUSIONS A strategy involving the sequential offer of FS and FIT is a feasible and efficient approach. FIT in people not attending for FS increases screening uptake and detection of advanced adenomas and CRCs.

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