JOURNAL OF MEDICAL SCREENING

Response to the letter: "Ethics of screening promotion: A slippery slope to forced marketing?"
Nicholson SL, Douglas H, Halcrow S and Whelehan P
Ethics of screening promotion: A slippery slope to forced marketing?
Braillon A
Primary human papillomavirus testing by clinician- versus self-collection: Awareness and acceptance among cervical cancer screening-eligible women
MacLaughlin KL, Jenkins GD, St Sauver J, Fan C, Miller NE, Meyer AF, Jacobson RM and Finney Rutten LJ
Primary human papillomavirus (HPV) testing by clinician-collection is endorsed by U.S. guideline organizations for cervical cancer screening, but uptake remains low and insights into patients' understanding are limited. This study aims to primarily address patient awareness of primary HPV screening by clinician-collection and acceptance of primary HPV screening by clinician- and self-collection, and secondarily assess factors associated with awareness and acceptance.
Factors associated with private or public breast cancer screening attendance in Queensland, Australia: A retrospective cross-sectional study
Li T, Marinovich ML, Ormiston-Smith N, Nickel B, Findlay A and Houssami N
This study aimed to estimate participation in private breast screening in Queensland, Australia, where public-funded screening is implemented, and to identify factors associated with the screening setting, using an online survey (999 female respondents aged 40-74). Screening-specific and socio-demographic factors were collected. Multivariable logistic regression was used to identify factors associated with screening setting (public vs private) and screening recency (<2 vs ≥2 years). Participation estimates were 53.2% (95% confidence interval, CI: 50.0%-56.3%) and 10.9% (9.0%-13.0%) for national screening program and private screening, respectively. In the screening setting model, participation in private screening was significantly associated with longer time since last screening (>4 versus <2 years, odds ratio (OR) = 7.3, 95%CI: 4.1-12.9,  < 0.001), having symptoms (OR = 9.5, 5.8-15.5,  < 0.001), younger age (40-49 versus 50-74 years, OR = 1.8, 1.1-3.0,  = 0.018) and having children <18 years in household (OR = 2.4, 1.5-3.9,  < 0.001). In the screening recency model, only screening setting was statistically significant and private screening was associated with screening recency ≥2 years (OR = 4.0, 2.8-5.7,  < 0.001). Around one in nine women screen outside of the BreastScreen Queensland program. Clinical and socio-demographic factors associated with participation in private screening were identified, providing knowledge relevant to the program's endeavours to improve screening participation.
Skin cancer screening recommendations by U.S. cancer centers: Inconsistency with national guidelines
Lee J, Han LK, Morris LGT, Korenstein D and Marti JL
The incidence of melanoma has increased dramatically over the past four decades, while overall mortality has remained stable. This increase in incidence without a change in overall mortality may be due to overdiagnosis through skin cancer screening. Despite the USPSTF citing insufficient evidence for or against professional skin cancer screening in average-risk adults, U.S. skin cancer screening practices may be leading to overdiagnosis of skin cancers.
Flow-charting to improve clarity in describing screening protocols
Wald NJ
Attitudes towards being offered a choice of self-sampling or clinician sampling for cervical screening: A cross-sectional survey of women taking part in a clinical validation of HPV self-collection devices
Marlow L, Drysdale H and Waller J
Primary human papillomavirus (HPV) testing in cervical screening offers the opportunity for women to be given a choice between HPV self-sampling and traditional clinician screening. This study assessed attitudes towards a choice and anticipated future preference among women who had collected a vaginal self-sample alongside their usual cervical screen.
Newborn screening for biliary atresia using direct bilirubin: An implementation science study
Rabbani T and Shah J
Biliary atresia (BA) is a liver disease of infancy characterized by obstruction of the biliary tree. Infants with BA have the best outcomes when identified early and the Kasai portoenterostomy is performed before 45 days of life (DoL). In our hospital system, the average age at Kasai was 60 DoL. To address the problem of late presentation, we implemented a two-stage BA screening strategy utilizing direct bilirubin (DB).
Percentage mammographic density or absolute breast density for risk stratification in breast screening: Possible implications for socioeconomic health disparity
Hudson S, Kamangari N and Wilkinson LS
Obesity levels and mortality from breast cancer are higher in more deprived areas of the UK, despite lower breast cancer incidence. Supplemental imaging for women with dense breasts has been proposed as a potential improvement to screening, but it is not clear how stratification by percentage mammographic density (%MD) would be reflected across socioeconomic groups. This study aims to clarify the associations between breast composition (dense and fatty tissue) and socioeconomic status in a multi-ethnic screening population.
Breast cancer mortality during the COVID-19 pandemic
Mattiuzzi C and Lippi G
Several lines of evidence suggest that breast cancer screening and treatment may have been compromised during the early phase of the COVID-19 pandemic. Using data from the US Centers for Disease Control and Prevention (CDC) WONDER database, we estimated the age-adjusted mortality rates for female breast cancer between 2018 and 2023. We found that the age-adjusted death rate for breast cancer decreased gradually from 2018 to 2019 and 2020. This downward trend reversed in 2021, with an increase in breast cancer mortality, which then declined further in 2022 and 2023. These findings indicate that breast cancer mortality may have increased slightly in 2021, possibly as a result of limited access to screening and timely treatment during the first phase of the COVID-19 pandemic, although the age-adjusted mortality rate continued to decline in the following two years.
Anxiety and disease awareness in individuals with heredity for abdominal aortic aneurysm
Fattahi N, Nilsson O, Svensjö S, Roy J, Linné A and Hultgren R
The psychological consequences of being aware of an increased risk of developing abdominal aortic aneurysm as a first-degree relative of a person with abdominal aortic aneurysm are hitherto unexplored. This study investigates the awareness of heritability and anxiety in male and female adult offspring of abdominal aortic aneurysm patients compared to controls. Health-related quality of life among participants with aortic pathology was compared to participants with normal aortic diameters.
Women's experience of the information provided along with invitation to participate in BreastScreen Norway
Moshina N, Bergan MB, Holen ÅS, Mangerud G and Hofvind S
To explore how women aged 50-69 invited to BreastScreen Norway perceived the information provided along with the invitation letter, as well as time spent on reading this information.
Improving access to cervical cancer screening: The impact of a Saturday pap smear clinic
Strelow B, Stevens J, Fink S, Cole K and O'Laughlin D
The implementation of cervical cancer screening and human papillomavirus (HPV) vaccination has significantly reduced cervical cancer rates. However, it remains the fourth most common cancer among women globally. Barriers to screening include personal, health system, and insurance factors.
Risk stratification in medical screening
Wald NJ, Duffy SW and Hackshaw A
Identifying optimum implementation for human papillomavirus self-sampling in underserved communities: A systematic review
Mackay O, Lifford KJ, Kalra A and Williams D
To review the existing evidence to identify the optimum methods for implementing human papillomavirus self-sampling to increase screening uptake for underserved groups.
Simulated arbitration of discordance between radiologists and artificial intelligence interpretation of breast cancer screening mammograms
Marinovich ML, Lotter W, Waddell A and Houssami N
Artificial intelligence (AI) algorithms have been retrospectively evaluated as replacement for one radiologist in screening mammography double-reading; however, methods for resolving discordance between radiologists and AI in the absence of 'real-world' arbitration may underestimate cancer detection rate (CDR) and recall. In 108,970 consecutive screens from a population screening program (BreastScreen WA, Western Australia), 20,120 were radiologist/AI discordant without real-world arbitration. Recall probabilities were randomly assigned for these screens in 1000 simulations. Recall thresholds for screen-detected and interval cancers (sensitivity) and no cancer (false-positive proportion, FPP) were varied to calculate mean CDR and recall rate for the entire cohort. Assuming 100% sensitivity, the maximum CDR was 7.30 per 1000 screens. To achieve >95% probability that the mean CDR exceeded the screening program CDR (6.97 per 1000), interval cancer sensitivities ≥63% (at 100% screen-detected sensitivity) and ≥91% (at 80% screen-detected sensitivity) were required. Mean recall rate was relatively constant across sensitivity assumptions, but varied by FPP. FPP > 6.5% resulted in recall rates that exceeded the program estimate (3.38%). CDR improvements depend on a majority of interval cancers being detected in radiologist/AI discordant screens. Such improvements are likely to increase recall, requiring careful monitoring where AI is deployed for screen-reading.
The Risk-Screening Converter: Use of multiple risk factors
Wald NJ
Barriers and facilitators of abdominal aortic aneurysm screening in London: A cross-sectional survey
McKay E, Wong J, Ward S, Ruwende J and Kerrison R
The aim of this research was to identify patient barriers and facilitators of abdominal aortic aneurysm (AAA) screening in London.
Examining breast cancer screening recommendations in Canada: The projected resource impact of screening among women aged 40-49
Basmadjian RB, Ruan Y, Hutchinson JM, Warkentin MT, Alagoz O, Coldman A and Brenner DR
To quantify the resource use of revising breast cancer screening guidelines to include average-risk women aged 40-49 years across Canada from 2024 to 2043 using a validated microsimulation model.
HPV self-sampling in organized cervical cancer screening program: A randomized pilot study in Estonia in 2021
Hallik R, Innos K, Jänes J, Jõers K, Ratnik K and Veerus P
Cervical cancer incidence in Estonia ranks among the highest in Europe, but screening attendance has remained low. This randomized study aimed to evaluate the impact of opt-in and opt-out human papillomavirus (HPV) self-sampling options on participation in organized screening.
Introduction of one-view tomosynthesis in population-based mammography screening: Impact on detection rate, interval cancer rate and false-positive rate
Vilmun BM, Napolitano G, Lillholm M, Winkel RR, Lynge E, Nielsen M, Nielsen MB, Carlsen JF, von Euler-Chelpin M and Vejborg I
To assess performance endpoints of a combination of digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) compared with FFDM only in breast cancer screening.