Journal of medical screening
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Current United States recommendations for low-dose computed tomography (LDCT) lung cancer screening limit eligibility to ever-smokers with 30+ pack-years, with former smokers eligible only within 15 years of quitting. The 15 year limit is partly based on perceived decreases in lung cancer risk as years since quitting (YSQ) increase. We examine the relationship between lung cancer risk and YSQ among 30+ pack-year former smokers. ⋯ Lung cancer risk decreases gradually with YSQ in 30+ pack year former smokers. A range of upper limits on YSQ may be supportable for LDCT screening.
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Comparative Study
Cost-effectiveness of annual versus biennial screening mammography for women with high mammographic breast density.
The sensitivity of screening mammography is much lower among women who have dense breast tissue, compared with women who have largely fatty breasts, and they are also at much higher risk of developing the disease. Increasing mammography screening frequency from biennially to annually has been suggested as a policy option to address the elevated risk in this population. The purpose of this study was to assess the cost-effectiveness of annual versus biennial screening mammography among women aged 50-79 with dense breast tissue. ⋯ There is considerable uncertainty about the incremental cost-effectiveness of annual mammography. Further research on the comparative effectiveness of screening strategies for women with high mammographic breast density is warranted, particularly as digital mammography and density measurement become more widespread, before cost-effectiveness can be reevaluated.
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Review Meta Analysis
Screening and primary prevention of colorectal cancer: a review of sex-specific and site-specific differences.
Colorectal cancer (CRC) is the second commonest cancer in England. Incidence rates for colorectal adenomas and advanced colorectal neoplasia are higher in men than in women of all age groups. The male-to-female ratio for CRC incidence rates differs for different parts of the large bowel. ⋯ We encourage researchers of CRC screening and prevention to publish their results by sex where possible. Pilot studies should be undertaken before implementation of quantitative FIT in a national screening programme to establish the appropriate threshold. Finally, individual risk assessment for CRC and non-CRC events, will be necessary to make an informed decision on whether a patient should receive aspirin chemoprevention.
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Randomized Controlled Trial Multicenter Study
Efficacy versus effectiveness study design within the European screening trial for prostate cancer: consequences for cancer incidence, overall mortality and cancer-specific mortality.
To assess the impact of different study designs on outcome data within the European Randomized Study of Screening for Prostate Cancer (ERSPC). ⋯ Our results suggest that an efficacy trial with informed consent prior to randomization may have introduced a 'healthy screenee bias'. Therefore, an effectiveness trial with consent after randomization may more accurately estimate the PC-specific mortality reduction if population-based screening is introduced.
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The National Lung Screening Trial (NLST) demonstrated a 20% reduction in lung cancer mortality for screening with low-dose computed tomography versus chest radiography. The major NLST eligibility criteria were age 55-74, a 30 + pack year smoking history and current smoking status or having quit in the last 15 years. We utilized data from SEER (Surveillance, Epidemiology and End Results), the United States (US) Census and the National Health Interview Survey, as well as two statistical models of lung cancer risk, to estimate the proportion of the total US population and of those currently diagnosed with lung cancer that would be covered by the NLST and other suggested eligibility criteria. ⋯ A criterion of ever smokers aged 50-79 would cover 68% of the cancers while screening 30% of the (over 40) population. To extend recommended screening beyond the NLST eligibility criteria, two questions are key. First, can the 20% mortality reduction observed in NLST be extrapolated to populations at moderately lower risk? Second, given that such an extrapolation is valid, what background incidence rate is high enough for the balance between the benefits and harms of screening to be favourable? Further research on these questions is needed.