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Ropers FG, Barratt A, Wilt TJ, Nicholls SG, Taylor-Phillips S, Kramer BS, Esserman LJ, Norris SL, Gibson LM, Harris RP, Carter SM, Jacklyn G, Jørgensen KJ. Health screening needs independent regular re-evaluation. BMJ 2021; 374:n2049. [PMID: 34580059 DOI: 10.1136/bmj.n2049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Fabienne G Ropers
- Department of General Paediatrics, Willem Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands
| | - Alexandra Barratt
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales
| | - Timothy J Wilt
- Minneapolis VA Center for Care Delivery and Outcomes Research and the University of Minnesota, Minneapolis, MN, USA
| | - Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Barnett S Kramer
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Laura J Esserman
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | | | - Lorna M Gibson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Russell P Harris
- School of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Stacy M Carter
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Wollongong, NSW, Australia
| | - Gemma Jacklyn
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Primary Drivers of Willingness to Continue to Participate in Community-Based Health Screening for Chronic Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091645. [PMID: 31083535 PMCID: PMC6539676 DOI: 10.3390/ijerph16091645] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/23/2019] [Accepted: 05/08/2019] [Indexed: 12/20/2022]
Abstract
Background: As the average age of the population continues to rise in the 21st century, chronic illnesses have become the most prominent threats to human health. Research has shown that early screenings for chronic diseases are an effective way of lowering incidence and mortality rates. However, low participation rates for health screening is one of the main challenges for preventive medicine. The objective of this study was to determine the primary drivers which: (1) first motivate people to participate in community-based health screening for chronic diseases; and (2) increase their willingness to continue to participate. Methods: A total of 440 individuals between 30 and 75 years of age were invited to undergo a health screening and then complete an interview questionnaire. Screenings and interviews were conducted in four regions in northern Taiwan. The questionnaire was separated into three sections, which explored sociodemographic differences, drivers of willingness to participate, and willingness to continue to participate respectively. Raw data was analyzed using the statistical software package SPSS (SPSS Inc., Chicago, IL, USA). Main Outcome Measures: Effects of sociodemographic factors on health screening participation rate, drivers of willingness to participate, and willingness to continue to participate. Results: Seventy-three percent of participants responded that they would be willing to continue to join in future health screenings. Notably, elderly people and married people were respectively more likely to participate in preventive health screening than were younger people and people who were single, divorced, separated, or widowed. Level of education was another key driver of willingness to participate in health screening for chronic diseases, as were the concern of relatives/friends and the provision of participation incentives. Discussion: Some of our findings, such as the key drivers of willingness to continue to participate in health screening that we identified, were different from findings of many previous studies conducted in other countries. The current study also found that a higher percentage of participants would be willing to join a similar health screening in the future if the service design is considered in advance and is well-implemented.
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Kingsley J, Karanth S, Revere FL, Agrawal D. Cost Effectiveness of Screening Colonoscopy Depends on Adequate Bowel Preparation Rates - A Modeling Study. PLoS One 2016; 11:e0167452. [PMID: 27936028 PMCID: PMC5147887 DOI: 10.1371/journal.pone.0167452] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/14/2016] [Indexed: 02/07/2023] Open
Abstract
Background Inadequate bowel preparation during screening colonoscopy necessitates repeating colonoscopy. Studies suggest inadequate bowel preparation rates of 20–60%. This increases the cost of colonoscopy for our society. Aim The aim of this study is to determine the impact of inadequate bowel preparation rate on the cost effectiveness of colonoscopy compared to other screening strategies for colorectal cancer (CRC). Methods A microsimulation model of CRC screening strategies for the general population at average risk for CRC. The strategies include fecal immunochemistry test (FIT) every year, colonoscopy every ten years, sigmoidoscopy every five years, or stool DNA test every 3 years. The screening could be performed at private practice offices, outpatient hospitals, and ambulatory surgical centers. Results At the current assumed inadequate bowel preparation rate of 25%, the cost of colonoscopy as a screening strategy is above society’s willingness to pay (<$50,000/QALY). Threshold analysis demonstrated that an inadequate bowel preparation rate of 13% or less is necessary before colonoscopy is considered more cost effective than FIT. At inadequate bowel preparation rates of 25%, colonoscopy is still more cost effective compared to sigmoidoscopy and stool DNA test. Sensitivity analysis of all inputs adjusted by ±10% showed incremental cost effectiveness ratio values were influenced most by the specificity, adherence, and sensitivity of FIT and colonoscopy. Conclusions Screening colonoscopy is not a cost effective strategy when compared with fecal immunochemical test, as long as the inadequate bowel preparation rate is greater than 13%.
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Affiliation(s)
- James Kingsley
- Department of Internal Medicine, Texas Health Presbyterian Hospital, Dallas, Texas, United States of America
| | - Siddharth Karanth
- School of Public Health, University of Texas Health Science Center, Houston, Texas, United States of America
| | - Frances Lee Revere
- School of Public Health, University of Texas Health Science Center, Houston, Texas, United States of America
| | - Deepak Agrawal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- * E-mail:
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Parker LM, Carter SM. The Role of Socially Embedded Concepts in Breast Cancer Screening: An Empirical Study with Australian Experts. Public Health Ethics 2016. [DOI: 10.1093/phe/phw012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Wong MCS, Wong SH, Ng SC, Wu JCY, Chan FKL, Sung JJY. Targeted screening for colorectal cancer in high-risk individuals. Best Pract Res Clin Gastroenterol 2015; 29:941-51. [PMID: 26651255 DOI: 10.1016/j.bpg.2015.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/02/2015] [Indexed: 01/31/2023]
Abstract
The idea of targeted screening for colorectal cancer based on risk profiles originates from its benefits to improve detection yield and optimize screening efficiency. Clinically, it allows individuals to be more aware of their own risk and make informed decisions on screening choice. From a public health perspective, the implementation of risk stratification strategies may better justify utilization of colonoscopic resources, and facilitate resource-planning in the formulation of population-based screening programmes. There are several at-risk groups who should receive earlier screening, and colonoscopy is more preferred. This review summarizes the currently recommended CRC screening strategies among subjects with different risk factors, and introduces existing risk scoring systems. Additional genetic, epidemiological, and clinical parameters may be needed to enhance their performance to risk-stratify screening participants. Future research studies should refine these scoring systems, and explore the adaptability, feasibility, acceptability, and user-friendliness of their use in clinical practice among different population groups.
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Affiliation(s)
- Martin C S Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong, China; JC School of Public Health and Primary Care, Chinese University of Hong Kong, 4/F, School of Public Health and Primary Care Building, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
| | - Sunny H Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Siew C Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Justin C Y Wu
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Francis K L Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Joseph J Y Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
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Informed choice vs. no choice in colorectal cancer screening tests: a prospective cohort study in real-life screening practice. Am J Gastroenterol 2014; 109:1072-9. [PMID: 24935273 DOI: 10.1038/ajg.2014.136] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 04/25/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The objective of this study was to compare the level of adherence to colorectal cancer (CRC) screening programs among screening participants offered vs. not offered informed choices on screening modality. METHODS We recruited 10,606 screening participants aged 50-70 years, including 6,397 subjects who were offered a choice of yearly fecal immunochemical test (FIT) for up to 3 years vs. one colonoscopy, and 4,209 subjects who were offered either FIT or colonoscopy without choice. They were prospectively followed up for 3 years. The proportion of screening participants who returned their specimens in all subsequent years (FIT group) and the attendance rate of scheduled endoscopy appointment (colonoscopy group) were compared between those with vs. without choice. RESULTS The adherence rate with FIT was 97.6%, 84.1%, and 72.6% in the first 3 years of follow-up, respectively, among those who were offered a choice. The adherence rate with FIT was 97.5%, 78.4%, and 62.8%, respectively, among those without choices. The proportion of subjects attending colonoscopy was 95.7% (choice offered) and 90.6% (no choice). From binary logistic regression analysis, participants who were offered informed choice were significantly more likely to adhere to the program when compared with those without test choices (odds ratio (OR)=2.54, 95% confidence interval (CI): 2.30-2.82, P<0.001). The respective adjusted OR for the FIT and colonoscopy groups was 1.60 (95% CI: 1.42-1.80, P<0.001) and 2.53 (95% CI: 1.94-3.31, P<0.001). CONCLUSIONS This study found that patients who were offered an informed choice for screening had higher adherence rates than patients who were not offered a choice in real-life practices, suggesting that providing screening test options for CRC screening is preferred.
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Groothuis-Oudshoorn CGM, Fermont JM, van Til JA, Ijzerman MJ. Public stated preferences and predicted uptake for genome-based colorectal cancer screening. BMC Med Inform Decis Mak 2014; 14:18. [PMID: 24642027 PMCID: PMC4000055 DOI: 10.1186/1472-6947-14-18] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 03/11/2014] [Indexed: 02/06/2023] Open
Abstract
Background Emerging developments in nanomedicine allow the development of genome-based technologies for non-invasive and individualised screening for diseases such as colorectal cancer. The main objective of this study was to measure user preferences for colorectal cancer screening using a nanopill. Methods A discrete choice experiment was used to estimate the preferences for five competing diagnostic techniques including the nanopill and iFOBT. Alternative screening scenarios were described using five attributes namely: preparation involved, sensitivity, specificity, complication rate and testing frequency. Fourteen random and two fixed choice tasks, each consisting of three alternatives, were offered to 2225 individuals. Data were analysed using the McFadden conditional logit model. Results Thirteen hundred and fifty-six respondents completed the questionnaire. The most important attributes (and preferred levels) were the screening technique (nanopill), sensitivity (100%) and preparation (no preparation). Stated screening uptake for the nanopill was 79%, compared to 76% for iFOBT. In the case of screening with the nanopill, the percentage of people preferring not to be screened would be reduced from 19.2% (iFOBT) to 16.7%. Conclusions Although the expected benefits of nanotechnology based colorectal cancer screening are improved screening uptake, assuming more accurate test results and less preparation involved, the relative preference of the nanopill is only slightly higher than the iFOBT. Estimating user preferences during the development of diagnostic technologies could be used to identify relative performance, including perceived benefits and harms compared to competitors allowing for significant changes to be made throughout the process of development.
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Affiliation(s)
- Catharina G M Groothuis-Oudshoorn
- Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology & Technical Medicine, University of Twente, P,O, box 217, 7500 AE, Enschede, The Netherlands.
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Smith SK, Simpson JM, Trevena LJ, McCaffery KJ. Factors Associated with Informed Decisions and Participation in Bowel Cancer Screening among Adults with Lower Education and Literacy. Med Decis Making 2014; 34:756-72. [DOI: 10.1177/0272989x13518976] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 12/06/2013] [Indexed: 11/17/2022]
Abstract
Background. Making informed decisions about cancer screening involves understanding the benefits and harms in conjunction with personal values. There is little research examining factors associated with informed decision making or participation in screening in the context of a decision aid trial. Objectives. To identify factors associated with informed choice and participation in fecal occult blood testing (FOBT) among lower education populations. Design. Randomized controlled trial of an FOBT decision aid conducted between July and November 2008. Setting. Socioeconomically disadvantaged areas in New South Wales, Australia. Participants. Included 572 adults aged 55 to 64 years with lower education. Measurements. Sociodemographic variables, perceived health literacy, and involvement preferences in decision making were examined to identify predictors of informed choice (knowledge, attitudes, and behavior). Results. Multivariate analysis identified independent predictors of making an informed choice as having higher education (relative risk [RR], 1.49; 95% confidence interval [CI], 1.13–1.95; P = 0.001), receiving the decision aid (RR, 2.88; 95% CI, 1.87–4.44; P < 0.001), and being male (RR, 1.48; 95% CI, 1.11–1.97; P = 0.009). Participants with no confidence in completing forms and poorer self-reported health were less likely to make an informed choice (RR, 0.74; 95% CI, 0.53–1.03; P = 0.05 and RR, 0.57; 95% CI, 0.36–0.89; P = 0.007, respectively). Independent predictors of completing the FOBT were positive screening attitudes, receiving the standard information, preference for making the decision alone, and knowing that screening may lead to false-positive/negative results. Limitations. We did not objectively measure health literacy. Conclusions. Participants with the lowest levels of education had greater difficulties making an informed choice about participation in bowel screening. Alternative methods are needed to support informed decision making among lower education populations.
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Affiliation(s)
- Sian K. Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine University of New South Wales, NSW, Australia (SKS)
- Sydney School of Public Health, University of Sydney, NSW, Australia (JMS)
- Screening and Test Evaluation Program, Sydney School of Public Health, University of Sydney, NSW, Australia (LJT, KJM)
- Centre for Medical Psychology and Evidence-Based Decision-Making, University of Sydney, NSW, Australia (LJT, KJM)
| | - Judy M. Simpson
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine University of New South Wales, NSW, Australia (SKS)
- Sydney School of Public Health, University of Sydney, NSW, Australia (JMS)
- Screening and Test Evaluation Program, Sydney School of Public Health, University of Sydney, NSW, Australia (LJT, KJM)
- Centre for Medical Psychology and Evidence-Based Decision-Making, University of Sydney, NSW, Australia (LJT, KJM)
| | - Lyndal J. Trevena
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine University of New South Wales, NSW, Australia (SKS)
- Sydney School of Public Health, University of Sydney, NSW, Australia (JMS)
- Screening and Test Evaluation Program, Sydney School of Public Health, University of Sydney, NSW, Australia (LJT, KJM)
- Centre for Medical Psychology and Evidence-Based Decision-Making, University of Sydney, NSW, Australia (LJT, KJM)
| | - Kirsten J. McCaffery
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine University of New South Wales, NSW, Australia (SKS)
- Sydney School of Public Health, University of Sydney, NSW, Australia (JMS)
- Screening and Test Evaluation Program, Sydney School of Public Health, University of Sydney, NSW, Australia (LJT, KJM)
- Centre for Medical Psychology and Evidence-Based Decision-Making, University of Sydney, NSW, Australia (LJT, KJM)
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Jeong KE, Cairns JA. Review of economic evidence in the prevention and early detection of colorectal cancer. HEALTH ECONOMICS REVIEW 2013; 3:20. [PMID: 24229442 PMCID: PMC3847082 DOI: 10.1186/2191-1991-3-20] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 08/23/2013] [Indexed: 05/20/2023]
Abstract
This paper aims to systematically review the cost-effectiveness evidence, and to provide a critical appraisal of the methods used in the model-based economic evaluation of CRC screening and subsequent surveillance. A search strategy was developed to capture relevant evidence published 1999-November 2012. Databases searched were MEDLINE, EMBASE, National Health Service Economic Evaluation (NHS EED), EconLit, and HTA. Full economic evaluations that considered costs and health outcomes of relevant intervention were included. Sixty-eight studies which used either cohort simulation or individual-level simulation were included. Follow-up strategies were mostly embedded in the screening model. Approximately 195 comparisons were made across different modalities; however, strategies modelled were often simplified due to insufficient evidence and comparators chosen insufficiently reflected current practice/recommendations. Studies used up-to-date evidence on the diagnostic test performance combined with outdated information on CRC treatments. Quality of life relating to follow-up surveillance is rare. Quality of life relating to CRC disease states was largely taken from a single study. Some studies omitted to say how identified adenomas or CRC were managed. Besides deterministic sensitivity analysis, probabilistic sensitivity analysis (PSA) was undertaken in some studies, but the distributions used for PSA were rarely reported or justified. The cost-effectiveness of follow-up strategies among people with confirmed adenomas are warranted in aiding evidence-informed decision making in response to the rapidly evolving technologies and rising expectations.
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Affiliation(s)
- Kim E Jeong
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - John A Cairns
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
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COST-EFFECTIVENESS OF AN ADVANCE NOTIFICATION LETTER TO INCREASE COLORECTAL CANCER SCREENING. Int J Technol Assess Health Care 2013; 29:261-8. [DOI: 10.1017/s0266462313000226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objectives:The aim of this study is to evaluate the cost-effectiveness of a patient-direct mailed advance notification letter on participants of a National Bowel Cancer Screening Program (NBCSP) in Australia, which was launched in August 2006 and offers free fecal occult blood testing to all Australians turning 50, 55, or 65 years of age in any given year.Methods:This study followed a hypothetical cohort of 50-year-old, 55-year-old, and 65-year-old patients undergoing fecal occult blood test (FOBT) screening through a decision analytic Markov model. The intervention compared two strategies: (i) advance letter, NBCSP, and FOBT compared with (ii) NBCSP and FOBT. The main outcome measures were life-years gained (LYG), quality-adjusted life-years (QALYs) gained and incremental cost-effectiveness ratio.Results:An advance notification screening letter would yield an additional 54 per 100,000 colorectal cancer deaths avoided compared with no letter. The estimated cost-effectiveness was $3,976 per LYG and $6,976 per QALY gained.Conclusions:An advance notification letter in the NBCSP may have a significant impact on LYG and cancer deaths avoided. It is cost-effective and offers a feasible strategy that could be rolled out across other screening program at an acceptable cost.
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van Dam L, Kuipers EJ, Steyerberg EW, van Leerdam ME, de Beaufort ID. The price of autonomy: should we offer individuals a choice of colorectal cancer screening strategies? Lancet Oncol 2013; 14:e38-46. [DOI: 10.1016/s1470-2045(12)70455-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Flitcroft KL, Irwig LM, Carter SM, Salkeld GP, Gillespie JA. Colorectal cancer screening: why immunochemical fecal occult blood tests may be the best option. BMC Gastroenterol 2012; 12:183. [PMID: 23272939 PMCID: PMC3548714 DOI: 10.1186/1471-230x-12-183] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 12/14/2012] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There are many test options available for colorectal cancer screening. The choice of test relates to the objectives of those offering or considering screening. DISCUSSION While all screening programs aim to detect disease early in order to improve the length and/or quality of life for the individual, some organizations and individuals prefer screening tests that offer the opportunity for cancer prevention. Others favor maximizing participation or the opportunity for shared decision-making, including discussion of information on test quality and availability. We propose three additional objectives for screening: minimizing harms, optimizing economic efficiency and maximizing equity of access to screening. SUMMARY Applying these objectives to colorectal cancer screening, we advocate the use of immunochemical FOBTs as the preferred screening strategy, as it satisfies all three of these important objectives.
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Affiliation(s)
- Kathy L Flitcroft
- Sydney School of Public Health, Edward Ford Building, A28 University of Sydney, 2006, Sydney, NSW, Australia
| | - Les M Irwig
- Sydney School of Public Health, Edward Ford Building, A28 University of Sydney, 2006, Sydney, NSW, Australia
| | - Stacy M Carter
- Sydney School of Public Health, Edward Ford Building, A28 University of Sydney, 2006, Sydney, NSW, Australia
| | - Glenn P Salkeld
- Sydney School of Public Health, Edward Ford Building, A28 University of Sydney, 2006, Sydney, NSW, Australia
| | - James A Gillespie
- Sydney School of Public Health, Edward Ford Building, A28 University of Sydney, 2006, Sydney, NSW, Australia
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Howard K. The cost-effectiveness of screening for anal cancer in men who have sex with men: a systematic review. Sex Health 2012; 9:610-9. [DOI: 10.1071/sh12017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 04/03/2012] [Indexed: 11/23/2022]
Abstract
Anal cancer is a relatively rare neoplasm, related to human papillomavirus (HPV), with an incidence that does not warrant general screening. However, as many cases occur in identifiable high-risk populations, targeting these groups may be cost-effective. Screening for anal cancer in men who have sex with men (MSM) may be appropriate, given their elevated risk of anal cancer. Examining existing cost-effectiveness analyses can help inform the design and conduct of future clinical and economic studies.
A review of the literature was performed using three databases to identify studies that assessed the cost-effectiveness of anal cancer screening in MSM. Five analyses were identified: four modelled the cost-effectiveness of cytological screening over a patient’s lifetime, and estimated final health outcomes as survival or quality adjusted survival. The fifth presented a decision analysis with intermediate health outcomes only and did not extrapolate to longer-term health outcomes.
Several factors influenced the incremental cost-effectiveness ratios. These factors were related to a paucity of primary data and included: availability of longer-term epidemiological and natural history data; availability of utility-based quality of life data from an appropriate respondent population; appropriate resource use information; and availability of information on screening adherence.
There is considerable uncertainty in model results: analyses from the United States suggest screening is almost always cost-effective; analyses from the United Kingdom suggest that screening is unlikely to be cost-effective. Uncertainty is primarily driven by data paucity; by summarising key uncertainties in existing models, this review can inform the design and conduct of future studies.
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Flitcroft KL, St John DJB, Howard K, Carter SM, Pignone MP, Salkeld GP, Trevena LJ. A comparative case study of bowel cancer screening in the UK and Australia: evidence lost in translation? J Med Screen 2011; 18:193-203. [PMID: 22106435 DOI: 10.1258/jms.2011.011066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES (i) To document the current state of the English, Scottish, Welsh, Northern Irish and Australian bowel cancer screening programmes, according to seven key characteristics, and (ii) to explore the policy trade-offs resulting from inadequate funding. SETTING United Kingdom and Australia. METHODS A comparative case study design using document and key informant interview analysis. Data were collated for each national jurisdiction on seven key programme characteristics: screening frequency, population coverage, quality of test, programme model, quality of follow-up, quality of colonoscopy and quality of data collection. A list of optimal features for each of the seven characteristics was compiled, based on the FOBT screening literature and our detailed examination of each programme. RESULTS Each country made different implementation choices or trade-offs intended to conserve costs and/or manage limited and expensive resources. The overall outcome of these trade-offs was probable lower programme effectiveness as a result of compromises such as reduced screening frequency, restricted target age range, the use of less accurate tests, the deliberate setting of low programme positivity rates or increased inconvenience to participants from re-testing. CONCLUSIONS Insufficient funding has forced programme administrators to make trade-offs that may undermine the potential net population benefits achieved in randomized controlled trials. Such policy compromise contravenes the principle of evidence-based practice which is dependent on adequate funding being made available.
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Affiliation(s)
- K L Flitcroft
- Health Policy, Screening and Test Evaluation Program, Sydney School of Public Health, Edward Ford Building, A27, University of Sydney, NSW 2006, Australia.
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Smith SK, Trevena L, Simpson JM, Barratt A, Nutbeam D, McCaffery KJ. A decision aid to support informed choices about bowel cancer screening among adults with low education: randomised controlled trial. BMJ 2010; 341:c5370. [PMID: 20978060 PMCID: PMC2965151 DOI: 10.1136/bmj.c5370] [Citation(s) in RCA: 175] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2010] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine whether a decision aid designed for adults with low education and literacy can support informed choice and involvement in decisions about screening for bowel cancer. DESIGN Randomised controlled trial. SETTING Areas in New South Wales, Australia identified as socioeconomically disadvantaged (low education attainment, high unemployment, and unskilled occupations). PARTICIPANTS 572 adults aged between 55 and 64 with low educational attainment, eligible for bowel cancer screening. INTERVENTION Patient decision aid comprising a paper based interactive booklet (with and without a question prompt list) and a DVD, presenting quantitative risk information on the possible outcomes of screening using faecal occult blood testing compared with no testing. The control group received standard information developed for the Australian national bowel screening programme. All materials and a faecal occult blood test kit were posted directly to people's homes. MAIN OUTCOME MEASURES Informed choice (adequate knowledge and consistency between attitudes and screening behaviour) and preferences for involvement in screening decisions. RESULTS Participants who received the decision aid showed higher levels of knowledge than the controls; the mean score (maximum score 12) for the decision aid group was 6.50 (95% confidence interval 6.15 to 6.84) and for the control group was 4.10 (3.85 to 4.36; P<0.001). Attitudes towards screening were less positive in the decision aid group, with 51% of the participants expressing favourable attitudes compared with 65% of participants in the control group (14% difference, 95% confidence interval 5% to 23%; P=0.002). The participation rate for screening was reduced in the decision aid group: completion of faecal occult blood testing was 59% v 75% in the control group (16% difference, 8% to 24%; P=0.001). The decision aid increased the proportion of participants who made an informed choice, from 12% in the control group to 34% in the decision aid group (22% difference, 15% to 29%; P<0.001). More participants in the decision aid group had no decisional conflict about the screening decision compared with the controls (51% v 38%; P=0.02). The groups did not differ for general anxiety or worry about bowel cancer. CONCLUSIONS Tailored decision support information can be effective in supporting informed choices and greater involvement in decisions about faecal occult blood testing among adults with low levels of education, without increasing anxiety or worry about developing bowel cancer. Using a decision aid to make an informed choice may, however, lead to lower uptake of screening. Trial registration ClinicalTrials.gov NCT00765869 and Australian New Zealand Clinical Trials Registry 12608000011381.
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Affiliation(s)
- Sian K Smith
- Screening and Test Evaluation Program, Centre for Medical Psychology and Evidence-Based Decision-Making, Sydney School of Public Health, University of Sydney, NSW 2006, Australia.
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Shuhaibar M, Walsh C, Lindsay F, Lee N, Walsh P, O’Gorman P, Boran G, McLoughlin R, Qasim A, Breslin N, Ryan B, O’Connor H, O’Morain C. A comparative study of faecal occult blood kits in a colorectal cancer screening program in a cohort of healthy construction workers. Ir J Med Sci 2010; 180:103-8. [DOI: 10.1007/s11845-010-0605-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 09/30/2010] [Indexed: 12/22/2022]
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Janda M, Hughes KL, Auster JF, Leggett BA, Newman BM. Repeat participation in colorectal cancer screening utilizing fecal occult blood testing: a community-based project in a rural setting. J Gastroenterol Hepatol 2010; 25:1661-7. [PMID: 20880176 DOI: 10.1111/j.1440-1746.2010.06405.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIM To investigate participation in a second round of colorectal cancer screening using a fecal occult blood test (FOBT) in an Australian rural community, and to assess the demographic characteristics and individual perspectives associated with repeat screening. METHODS Potential participants from round 1 (50-74 years of age) were sent an intervention package and asked to return a completed FOBT (n = 3406). Doctors of participants testing positive referred to colonoscopy as appropriate. Following screening, 119 participants completed qualitative telephone interviews. Multivariable logistic regression models evaluated the association between round-2 participation and other variables. RESULTS Round-2 participation was 34.7%; the strongest predictor was participation in round 1. Repeat participants were more likely to be female; inconsistent screeners were more likely to be younger (aged 50-59 years). The proportion of positive FOBT was 12.7%, that of colonoscopy compliance was 98.6%, and the positive predictive value for cancer or adenoma of advanced pathology was 23.9%. Reasons for participation included testing as a precautionary measure or having family history/friends with colorectal cancer; reasons for non-participation included apathy or doctors' advice against screening. CONCLUSION Participation was relatively low and consistent across rounds. Unless suitable strategies are identified to overcome behavioral trends and/or to screen out ineligible participants, little change in overall participation rates can be expected across rounds.
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Affiliation(s)
- Monika Janda
- School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia.
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The health and economic impact of cervical cancer screening and human papillomavirus vaccination in kidney transplant recipients. Transplantation 2009; 87:1078-91. [PMID: 19352131 DOI: 10.1097/tp.0b013e31819d32eb] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The risk of cervical cancer in women who are kidney transplant recipients is increased, but little is known about the effectiveness of screening and human papillomavirus (HPV) vaccination in this group of women. We sought to determine the cost effectiveness of annual screening for cervical cancers using conventional cytology, liquid-based cytology (LBC), and pretransplant HPV vaccination in kidney transplant recipients. METHODS Three deterministic Markov models were developed to compare the costs and health outcomes in a cohort of women (n=1000) with kidney transplants aged 18 to 69 who underwent annual screening using conventional cytology, LBC, and HPV vaccination in HPV naïve women. RESULTS After a screening period of 50 years, the incremental benefits of screening using conventional cytology compared with no screening were 0.05 life years saved (LYS) (18.2 days of lives saved), the incremental costs were $608, giving an incremental cost-effectiveness ratio of $12,160 per LYS. Compared with conventional cytology alone, the incremental cost-effectiveness ratios of annual screening using LBC and HPV vaccination before transplantation (assuming nonwaning efficacy) were $127,000 and $152,333 per LYS, respectively. CONCLUSION The recommended policy of annual screening using conventional cytology is cost effective. The replacement of conventional cytology with LBC is likely to provide minimal survival benefits but considerable costs. Assuming the reported trial-based vaccine efficacy in HPV naïve women, a program of HPV vaccination before kidney transplantation is unlikely to be cost effective. Additional data about the long-term efficacy and safety of HPV vaccination is required before it should be included as standard care of renal transplant recipients.
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Cost-effectiveness of colorectal cancer screening in renal transplant recipients. Transplantation 2008; 85:532-41. [PMID: 18347531 DOI: 10.1097/tp.0b013e3181639d35] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Colorectal cancer screening is now standard practice in most developed countries. The aim of this study was to determine the cost-effectiveness of colorectal cancer screening, with annual fecal occult blood testing, in renal transplant recipients. METHOD A Markov model was developed to compare the effects of annual fecal occult blood testing (FOBT) as screening for colorectal cancer in a cohort of renal transplant recipients ages 50-70 years, versus no screening. Data on cancer risk and survival were obtained from the ANZDATA Registry. Accuracy of FOBT, cancer stage distribution of the screened and unscreened arms, and adverse effects of colonoscopy were extrapolated from general population data because of unavailability of equivalent data in renal transplant recipients. RESULTS When the participation rate was 50%, the average cost for annual FOBT was $5076. The estimated incremental cost-effectiveness ratio was $22,309 per life year saved. Using a series of sensitivity analyses, the choice of screening strategy was most sensitive to the prevalence of disease, test specificities, and participation rate. When the base-case analyses were tested over the worst and best-case scenarios, the incremental cost-effectiveness ratio varied from $32,863 to $95,668 per life year saved. CONCLUSION Under the most favorable conditions, immunochemical FOBT screening in renal transplant recipients appears good value for money. Uncertainties, however, exist in the model's influential estimates. Primary research into these uncertainties is necessary to confirm whether population colorectal cancer screening is cost-effective in renal transplant population.
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Salkeld GP, Young JM, Solomon MJ. Consumer choice and the National Bowel Cancer Screening Program. Med J Aust 2006; 184:541-2. [PMID: 16768656 DOI: 10.5694/j.1326-5377.2006.tb00374.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2006] [Accepted: 04/30/2006] [Indexed: 11/17/2022]
Abstract
The opportunity for informed choice in screening is limited.
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Abstract
Evaluation of screening should reflect consumer priorities. We need to make more effort to find out what they really are
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Affiliation(s)
- Les Irwig
- Screening and Test Evaluation Program, School of Public Health, Edward Ford Building, A27, University of Sydney, NSW 2006, Australia.
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