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Steinberg J, Hughes S, Hui H, Allsop MJ, Egger S, David M, Caruana M, Coxeter P, Carle C, Onyeka T, Rewais I, Monroy Iglesias MJ, Vives N, Wei F, Abila DB, Carreras G, Santero M, O’Dowd EL, Lui G, Tolani MA, Mullooly M, Lee SF, Landy R, Hanley SJB, Binefa G, McShane CM, Gizaw M, Selvamuthu P, Boukheris H, Nakaganda A, Ergin I, Moraes FY, Timilshina N, Kumar A, Vale DB, Molina-Barceló A, Force LM, Campbell DJ, Wang Y, Wan F, Baker AL, Singh R, Salam RA, Yuill S, Shah R, Lansdorp-Vogelaar I, Yusuf A, Aggarwal A, Murillo R, Torode JS, Kliewer EV, Bray F, Chan KKW, Peacock S, Hanna TP, Ginsburg O, Hemelrijck MV, Sullivan R, Roitberg F, Ilbawi AM, Soerjomataram I, Canfell K. Risk of COVID-19 death for people with a pre-existing cancer diagnosis prior to COVID-19-vaccination: A systematic review and meta-analysis. Int J Cancer 2024; 154:1394-1412. [PMID: 38083979 PMCID: PMC10922788 DOI: 10.1002/ijc.34798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 10/04/2023] [Accepted: 10/20/2023] [Indexed: 02/12/2024]
Abstract
While previous reviews found a positive association between pre-existing cancer diagnosis and COVID-19-related death, most early studies did not distinguish long-term cancer survivors from those recently diagnosed/treated, nor adjust for important confounders including age. We aimed to consolidate higher-quality evidence on risk of COVID-19-related death for people with recent/active cancer (compared to people without) in the pre-COVID-19-vaccination period. We searched the WHO COVID-19 Global Research Database (20 December 2021), and Medline and Embase (10 May 2023). We included studies adjusting for age and sex, and providing details of cancer status. Risk-of-bias assessment was based on the Newcastle-Ottawa Scale. Pooled adjusted odds or risk ratios (aORs, aRRs) or hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated using generic inverse-variance random-effects models. Random-effects meta-regressions were used to assess associations between effect estimates and time since cancer diagnosis/treatment. Of 23 773 unique title/abstract records, 39 studies were eligible for inclusion (2 low, 17 moderate, 20 high risk of bias). Risk of COVID-19-related death was higher for people with active or recently diagnosed/treated cancer (general population: aOR = 1.48, 95% CI: 1.36-1.61, I2 = 0; people with COVID-19: aOR = 1.58, 95% CI: 1.41-1.77, I2 = 0.58; inpatients with COVID-19: aOR = 1.66, 95% CI: 1.34-2.06, I2 = 0.98). Risks were more elevated for lung (general population: aOR = 3.4, 95% CI: 2.4-4.7) and hematological cancers (general population: aOR = 2.13, 95% CI: 1.68-2.68, I2 = 0.43), and for metastatic cancers. Meta-regression suggested risk of COVID-19-related death decreased with time since diagnosis/treatment, for example, for any/solid cancers, fitted aOR = 1.55 (95% CI: 1.37-1.75) at 1 year and aOR = 0.98 (95% CI: 0.80-1.20) at 5 years post-cancer diagnosis/treatment. In conclusion, before COVID-19-vaccination, risk of COVID-19-related death was higher for people with recent cancer, with risk depending on cancer type and time since diagnosis/treatment.
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Affiliation(s)
- Julia Steinberg
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Suzanne Hughes
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Harriet Hui
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Matthew J Allsop
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Sam Egger
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Michael David
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Michael Caruana
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Peter Coxeter
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Chelsea Carle
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Tonia Onyeka
- Department of Anaesthesia/Pain & Palliative Care Unit, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
- IVAN Research Institute, Enugu, Enugu Stata, Nigeria
| | - Isabel Rewais
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Maria J Monroy Iglesias
- Translational Oncology and Urology Research (TOUR), Centre for Cancer, Society, and Public Health, School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Nuria Vives
- Cancer Screening Unit, Institut Català d’Oncologia (ICO), Early Detection of Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
- Ciber Salud Pública (CIBERESP), Instituto Salud Carlos III, Madrid, Spain
| | - Feixue Wei
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Giulia Carreras
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Marilina Santero
- Iberoamerican Cochrane Centre, IIB Sant Pau-Servei d’Epidemiologia Clínica i Salut Pública, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Emma L O’Dowd
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Gigi Lui
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | | | - Maeve Mullooly
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville MD, United States
| | - Sharon JB Hanley
- Department of Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Gemma Binefa
- Cancer Screening Unit,Cancer Prevention and Control Program, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
- Early Detection of Cancer Research Group, EPIBELL Programme, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Barcelona, Spain
| | - Charlene M McShane
- Centre for Public Health, Queen’s University Belfast, Institute of Clinical Sciences Block B, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Muluken Gizaw
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Ethiopia
- Institute for Medical Epidemiology, Biometrics and Informatics, Martin Luther University of Halle-Wittenberg, Germany
- NCD Working Group, School of Public Health, Addis Ababa University, Ethiopia
| | - Poongulali Selvamuthu
- Chennai Antiviral Research and Treatment Center and Clinical Research Site (CART CRS), Infectious Diseases Medical Center, Voluntary Health Services, Chennai, India
| | - Houda Boukheris
- University Abderrahmane Mira of Bejaia, School of Medicine, Algeria
- Departement of Epidemiology and Preventive Medicine, University Hospital of Bejaia, Algeria
| | - Annet Nakaganda
- Department of Cancer Epidemiology and Clinical Trials, Uganda Cancer Institute, Uganda
| | - Isil Ergin
- Department of Public Health, Faculty of Medicine, Ege University, Turkey
| | - Fabio Ynoe Moraes
- Department of Oncology, Queen’s University, Kingston, Ontario, Canada
| | - Nahari Timilshina
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Ashutosh Kumar
- Department of Anatomy, All India Institute of Medical Sciences-Patna, Patna, India
| | - Diama B Vale
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Brazil
| | - Ana Molina-Barceló
- Cancer and Public Health Research Unit, Biomedical Research Foundation FISABIO, Valencia, Spain
| | - Lisa M Force
- Department of Health Metrics Sciences and Department of Pediatrics, Division of Hematology/Oncology, University of Washington, United States
| | - Denise Joan Campbell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Yuqing Wang
- School of Public Health, University of Sydney, Sydney, Australia
| | - Fang Wan
- School of Public Health, University of Sydney, Sydney, Australia
| | - Anna-Lisa Baker
- School of Public Health, University of Sydney, Sydney, Australia
| | - Ramnik Singh
- School of Public Health, University of Sydney, Sydney, Australia
| | - Rehana Abdus Salam
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Susan Yuill
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- School of Public Health, University of Sydney, Sydney, Australia
| | - Richa Shah
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Aasim Yusuf
- Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore & Peshawar, Pakistan
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, School of Hygiene and Tropical Medicine, King’s College London, London, United Kingdom
- Department of Oncology, Guy’s & St Thomas NHS Trust, London, United Kingdom
| | - Raul Murillo
- Centro Javeriano De Oncologia - Hospital Universitario San Ignacio, Bogotá, Colombia
- Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Julie S Torode
- Institute of Cancer Policy, King’s College London, London, United Kingdom
- Research Oncology, Bermondsey Wing, Guy’s Hospital, SE1 9RT, London, United Kingdom
| | - Erich V Kliewer
- Department of Cancer Control Research, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Kelvin KW Chan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada
| | - Stuart Peacock
- Department of Cancer Control Research, BC Cancer Research Institute, Vancouver, British Columbia, Canada
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Timothy P Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen’s University, Kingston, Ontario, Canada
- Department of Oncology and Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Ophira Ginsburg
- Center for Global Health, National Cancer Institute, Maryland, United States
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), Centre for Cancer, Society, and Public Health, School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Richard Sullivan
- Institute of Cancer Policy, King’s College London, London, United Kingdom
| | - Felipe Roitberg
- Department of Non-Communicable Diseases, World Health Organisation, Geneva, Switzerland
- Hospital Sírio Libanês, São Paulo, Brazil
- Rede Ebserh, Rede Brasileira de Serviços Hospitalares, Brasília, Brazil
| | | | | | - Karen Canfell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
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Lycke KD, Kahlert J, Eriksen DO, Omann C, Pedersen LH, Sundtoft I, Landy R, Petersen LK, Hammer A. Preterm Birth Following Active Surveillance vs Loop Excision for Cervical Intraepithelial Neoplasia Grade 2. JAMA Netw Open 2024; 7:e242309. [PMID: 38483389 PMCID: PMC10940954 DOI: 10.1001/jamanetworkopen.2024.2309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/23/2024] [Indexed: 03/17/2024] Open
Abstract
Importance Active surveillance for cervical intraepithelial neoplasia grade 2 (CIN2) is being implemented in many high-income countries due to the association of excisional treatment with preterm birth. However, it is unknown whether active surveillance results in lower risk of preterm birth given that cervical dysplasia itself is associated with higher risk of preterm birth. Objective To compare the preterm birth risk between women with CIN2 undergoing active surveillance or immediate loop electrosurgical excision procedure (LEEP). Design, Setting, and Participants This historical population-based cohort study included women with a first-time diagnosis of CIN2 and a subsequent singleton birth from 1998 to 2018 in Denmark. Women with prior CIN grade 3 or greater or LEEP were excluded. Data were collected from 4 Danish health care registries. Analyses were conducted from October 2022 to June 2023. Exposure Women were categorized into active surveillance (cervical biopsy and/or cytology) or immediate LEEP based on their first cervical sample after CIN2 diagnosis. The active surveillance group was further subdivided based on whether a delayed LEEP was performed within 28 months from CIN2 diagnosis. Main Outcomes and Measures Risk of preterm birth (<37 + 0 weeks) was assessed and relative risks (RRs) were calculated using modified Poisson regression. Analyses used inverse probability treatment weighting of the propensity scores to adjust for age, parity, calendar year, index cytology, and smoking. Results A total of 10 537 women with CIN2 and a singleton birth were identified; 4430 (42%) underwent active surveillance and 6107 (58%) were treated with immediate LEEP. For both groups, most were aged 23 to 29 years at CIN2 diagnosis (3125 [70%] and 3907 [64%], respectively). Overall, 869 births (8.2%) were preterm. The risk of preterm birth was comparable between active surveillance and immediate LEEP (RR, 1.03; 95% CI, 0.90-1.18). However, for women undergoing delayed LEEP after active surveillance (1539 of the active surveillance group [35%]), the risk of preterm birth was higher than for women treated with immediate LEEP (RR, 1.29; 95% CI, 1.08-1.55). Conclusions and relevance In this cohort study of women with CIN2, the risk of preterm birth was comparable between active surveillance and immediate LEEP. However, delayed LEEP was associated with 30% higher risk of preterm birth than immediate LEEP. Thus, risk stratification at CIN2 diagnosis is important to identify women with increased risk of delayed LEEP.
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Affiliation(s)
- Kathrine Dyhr Lycke
- Department of Obstetrics and Gynecology, Gødstrup Hospital, Herning, Denmark
- NIDO, Centre for Research and Education, Gødstrup Hospital, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Johnny Kahlert
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Dina Overgaard Eriksen
- Department of Obstetrics and Gynecology, Gødstrup Hospital, Herning, Denmark
- NIDO, Centre for Research and Education, Gødstrup Hospital, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Camilla Omann
- Department of Obstetrics and Gynecology, Gødstrup Hospital, Herning, Denmark
- NIDO, Centre for Research and Education, Gødstrup Hospital, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Henning Pedersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Iben Sundtoft
- Department of Obstetrics and Gynecology, Gødstrup Hospital, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Lone Kjeld Petersen
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne Hammer
- Department of Obstetrics and Gynecology, Gødstrup Hospital, Herning, Denmark
- NIDO, Centre for Research and Education, Gødstrup Hospital, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Landy R, Cheung LC, Young CD, Chaturvedi AK, Katki HA. Absolute lung cancer risk increases among individuals with >15 quit-years: Analyses to inform the update of the American Cancer Society lung cancer screening guidelines. Cancer 2024; 130:201-215. [PMID: 37909885 PMCID: PMC10938406 DOI: 10.1002/cncr.34758] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 12/16/2022] [Accepted: 01/05/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND This report quantifies counteracting effects of quit-years and concomitant aging on lung cancer risk, especially on exceeding 15 quit-years, when the US Preventive Services Task Force (USPSTF) recommends curtailing lung-cancer screening. METHODS Cox models were fitted to estimate absolute lung cancer risk among Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) and National Lung Screening Trial (NLST) participants who ever smoked. Absolute lung cancer risk and gainable years of life from screening for individuals aged 50 to 80 in the US-representative National Health Interview Survey (NHIS) 2015-2018 who ever smoked were projected. Relaxing USPSTF recommendations to 20/25/30 quit-years versus augmenting USPSTF criteria with individuals whose estimated gain in life expectancy from screening exceeded 16.2 days according to the Life Years From Screening-CT (LYFS-CT) prediction model was compared. RESULTS Absolute lung cancer risk increased by 8.7%/year (95% CI, 7.7%-9.7%; p < .001) as individuals aged beyond 15 quit-years in the PLCO, with similar results in NHIS and NLST. For example, mean 5-year lung cancer risk for those aged 65 years with 15 quit-years = 1.47% (95% CI, 1.35%-1.59%) versus 1.76% (95% CI, 1.62%-1.90%) for those aged 70 years with 20 quit-years in the PLCO. Removing the quit-year criterion would make 4.9 million more people eligible and increase the proportion of preventable lung cancer deaths prevented (sensitivity) from 63.7% to 74.2%. Alternatively, augmentation using LYFS-CT would make 1.7 million more people eligible while increasing the lung cancer death sensitivity to 74.0%. CONCLUSIONS Because of aging, absolute lung cancer risk increases beyond 15 quit-years, which does not support exemption from screening or curtailing screening once it has been initiated. Compared with relaxing the USPSTF quit-year criterion, augmentation using LYFS-CT could prevent most of the deaths at substantially superior efficiency, while also preventing deaths among individuals who currently smoke with low intensity or long duration.
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Affiliation(s)
- Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Li C. Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Corey D. Young
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Anil K. Chaturvedi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Hormuzd A. Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
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Landy R, Killcoyne S, Tang C, Juniat S, O’Donovan M, Goel N, Gehrung M, Fitzgerald RC. Real-world implementation of non-endoscopic triage testing for Barrett's oesophagus during COVID-19. QJM 2023; 116:659-666. [PMID: 37220898 PMCID: PMC10497181 DOI: 10.1093/qjmed/hcad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/27/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND The Coronavirus pandemic (COVID-19) curtailed endoscopy services, adding to diagnostic backlogs. Building on trial evidence for a non-endoscopic oesophageal cell collection device coupled with biomarkers (Cytosponge), an implementation pilot was launched for patients on waiting lists for reflux and Barrett's oesophagus surveillance. AIMS (i) To review reflux referral patterns and Barrett's surveillance practices. (ii) To evaluate the range of Cytosponge findings and impact on endoscopy services. DESIGN AND METHODS Cytosponge data from centralized laboratory processing (trefoil factor 3 (TFF3) for intestinal metaplasia (IM), haematoxylin & eosin for cellular atypia and p53 for dysplasia) over a 2-year period were included. RESULTS A total of 10 577 procedures were performed in 61 hospitals in England and Scotland, of which 92.5% (N = 9784/10 577) were sufficient for analysis. In the reflux cohort (N = 4074 with gastro-oesophageal junction sampling), 14.7% had one or more positive biomarkers (TFF3: 13.6% (N = 550/4056), p53: 0.5% (21/3974), atypia: 1.5% (N = 63/4071)), requiring endoscopy. Among samples from individuals undergoing Barrett's surveillance (N = 5710 with sufficient gland groups), TFF3-positivity increased with segment length (odds ratio = 1.37 per cm (95% confidence interval: 1.33-1.41, P < 0.001)). Some surveillance referrals (21.5%, N = 1175/5471) had ≤1 cm segment length, of which 65.9% (707/1073) were TFF3 negative. Of all surveillance procedures, 8.3% had dysplastic biomarkers (4.0% (N = 225/5630) for p53 and 7.6% (N = 430/5694) for atypia), increasing to 11.8% (N = 420/3552) in TFF3+ cases with confirmed IM and 19.7% (N = 58/294) in ultra-long segments. CONCLUSIONS Cytosponge-biomarker tests enabled targeting of endoscopy services to higher-risk individuals, whereas those with TFF3 negative ultra-short segments could be reconsidered regarding their Barrett's oesophagus status and surveillance requirements. Long-term follow-up will be important in these cohorts.
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Affiliation(s)
- R Landy
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - S Killcoyne
- Cyted Ltd, 22 Station Road, Cambridge CB1 2JD, UK
| | - C Tang
- Cyted Ltd, 22 Station Road, Cambridge CB1 2JD, UK
| | - S Juniat
- Cyted Ltd, 22 Station Road, Cambridge CB1 2JD, UK
| | - M O’Donovan
- Cyted Ltd, 22 Station Road, Cambridge CB1 2JD, UK
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - N Goel
- Cyted Ltd, 22 Station Road, Cambridge CB1 2JD, UK
| | - M Gehrung
- Cyted Ltd, 22 Station Road, Cambridge CB1 2JD, UK
| | - R C Fitzgerald
- Department of Oncology, Early Cancer Institute, University of Cambridge, Cambridge CB2 0XZ, UK
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Landy R, Gomez I, Caverly TJ, Kawamoto K, Rivera MP, Robbins HA, Young CD, Chaturvedi AK, Cheung LC, Katki HA. Methods for Using Race and Ethnicity in Prediction Models for Lung Cancer Screening Eligibility. JAMA Netw Open 2023; 6:e2331155. [PMID: 37721755 PMCID: PMC10507484 DOI: 10.1001/jamanetworkopen.2023.31155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/20/2023] [Indexed: 09/19/2023] Open
Abstract
Importance Using race and ethnicity in clinical prediction models can reduce or inadvertently increase racial and ethnic disparities in medical decisions. Objective To compare eligibility for lung cancer screening in a contemporary representative US population by refitting the life-years gained from screening-computed tomography (LYFS-CT) model to exclude race and ethnicity vs a counterfactual eligibility approach that recalculates life expectancy for racial and ethnic minority individuals using the same covariates but substitutes White race and uses the higher predicted life expectancy, ensuring that historically underserved groups are not penalized. Design, Setting, and Participants The 2 submodels composing LYFS-CT NoRace were refit and externally validated without race and ethnicity: the lung cancer death submodel in participants of a large clinical trial (recruited 1993-2001; followed up until December 31, 2009) who ever smoked (n = 39 180) and the all-cause mortality submodel in the National Health Interview Survey (NHIS) 1997-2001 participants aged 40 to 80 years who ever smoked (n = 74 842, followed up until December 31, 2006). Screening eligibility was examined in NHIS 2015-2018 participants aged 50 to 80 years who ever smoked. Data were analyzed from June 2021 to September 2022. Exposure Including and removing race and ethnicity (African American, Asian American, Hispanic American, White) in each LYFS-CT submodel. Main Outcomes and Measures By race and ethnicity: calibration of the LYFS-CT NoRace model and the counterfactual approach (ratio of expected to observed [E/O] outcomes), US individuals eligible for screening, predicted days of life gained from screening by LYFS-CT. Results The NHIS 2015-2018 included 25 601 individuals aged 50 to 80 years who ever smoked (2769 African American, 649 Asian American, 1855 Hispanic American, and 20 328 White individuals). Removing race and ethnicity from the submodels underestimated lung cancer death risk (expected/observed [E/O], 0.72; 95% CI, 0.52-1.00) and all-cause mortality (E/O, 0.90; 95% CI, 0.86-0.94) in African American individuals. It also overestimated mortality in Hispanic American (E/O, 1.08, 95% CI, 1.00-1.16) and Asian American individuals (E/O, 1.14, 95% CI, 1.01-1.30). Consequently, the LYFS-CT NoRace model increased Hispanic American and Asian American eligibility by 108% and 73%, respectively, while reducing African American eligibility by 39%. Using LYFS-CT with the counterfactual all-cause mortality model better maintained calibration across groups and increased African American eligibility by 13% without reducing eligibility for Hispanic American and Asian American individuals. Conclusions and Relevance In this study, removing race and ethnicity miscalibrated LYFS-CT submodels and substantially reduced African American eligibility for lung cancer screening. Under counterfactual eligibility, no one became ineligible, and African American eligibility increased, demonstrating the potential for maintaining model accuracy while reducing disparities.
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Affiliation(s)
- Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Isabel Gomez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
- Biostatistics Department, University of Michigan, Ann Arbor
| | - Tanner J. Caverly
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City
| | - M. Patricia Rivera
- Division of Pulmonary and Critical Care Medicine and Wilmot Cancer Institute, University of Rochester, Rochester, New York
| | - Hilary A. Robbins
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Corey D. Young
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, Georgia
| | - Anil K. Chaturvedi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Li C. Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Hormuzd A. Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
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Landy R, Wang VL, Baldwin DR, Pinsky PF, Cheung LC, Castle PE, Skarzynski M, Robbins HA, Katki HA. Recalibration of a Deep Learning Model for Low-Dose Computed Tomographic Images to Inform Lung Cancer Screening Intervals. JAMA Netw Open 2023; 6:e233273. [PMID: 36929398 PMCID: PMC10020880 DOI: 10.1001/jamanetworkopen.2023.3273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 01/31/2023] [Indexed: 03/18/2023] Open
Abstract
Importance Annual low-dose computed tomographic (LDCT) screening reduces lung cancer mortality, but harms could be reduced and cost-effectiveness improved by reusing the LDCT image in conjunction with deep learning or statistical models to identify low-risk individuals for biennial screening. Objective To identify low-risk individuals in the National Lung Screening Trial (NLST) and estimate, had they been assigned a biennial screening, how many lung cancers would have been delayed 1 year in diagnosis. Design, Setting, and Participants This diagnostic study included participants with a presumed nonmalignant lung nodule in the NLST between January 1, 2002, and December 31, 2004, with follow-up completed on December 31, 2009. Data were analyzed for this study from September 11, 2019, to March 15, 2022. Exposures An externally validated deep learning algorithm that predicts malignancy in current lung nodules using LDCT images (Lung Cancer Prediction Convolutional Neural Network [LCP-CNN]; Optellum Ltd) was recalibrated to predict 1-year lung cancer detection by LDCT for presumed nonmalignant nodules. Individuals with presumed nonmalignant lung nodules were hypothetically assigned annual vs biennial screening based on the recalibrated LCP-CNN model, Lung Cancer Risk Assessment Tool (LCRAT + CT [a statistical model combining individual risk factors and LDCT image features]), and the American College of Radiology recommendations for lung nodules, version 1.1 (Lung-RADS). Main Outcomes and Measures Primary outcomes included model prediction performance, the absolute risk of a 1-year delay in cancer diagnosis, and the proportion of people without lung cancer assigned a biennial screening interval vs the proportion of cancer diagnoses delayed. Results The study included 10 831 LDCT images from patients with presumed nonmalignant lung nodules (58.7% men; mean [SD] age, 61.9 [5.0] years), of whom 195 were diagnosed with lung cancer from the subsequent screen. The recalibrated LCP-CNN had substantially higher area under the curve (0.87) than LCRAT + CT (0.79) or Lung-RADS (0.69) to predict 1-year lung cancer risk (P < .001). If 66% of screens with nodules were assigned to biennial screening, the absolute risk of a 1-year delay in cancer diagnosis would have been lower for recalibrated LCP-CNN (0.28%) than LCRAT + CT (0.60%; P = .001) or Lung-RADS (0.97%; P < .001). To delay only 10% of cancer diagnoses at 1 year, more people would have been safely assigned biennial screening under LCP-CNN than LCRAT + CT (66.4% vs 40.3%; P < .001). Conclusions and Relevance In this diagnostic study evaluating models of lung cancer risk, a recalibrated deep learning algorithm was most predictive of 1-year lung cancer risk and had least risk of 1-year delay in cancer diagnosis among people assigned biennial screening. Deep learning algorithms could prioritize people for workup of suspicious nodules and decrease screening intensity for people with low-risk nodules, which may be vital for implementation in health care systems.
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Affiliation(s)
- Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Vivian L. Wang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - David R. Baldwin
- School of Medicine, Nottingham University Hospitals and the University of Nottingham, Nottingham, United Kingdom
| | - Paul F. Pinsky
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Li C. Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Philip E. Castle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Martin Skarzynski
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Hilary A. Robbins
- Genomic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Hormuzd A. Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
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Landy R, Haber G, Graubard BI, Campos NG, Sy S, Kim JJ, Burger EA, Cheung LC, Katki HA, Gillison ML, Chaturvedi AK. Upper age-limits for US male HPV-vaccination for oropharyngeal cancer prevention: A microsimulation-based modeling study. J Natl Cancer Inst 2023; 115:429-436. [PMID: 36655795 PMCID: PMC10086634 DOI: 10.1093/jnci/djad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/29/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND HPV-positive oropharyngeal cancer is the most common HPV-associated cancer in the United States. The age at acquisition of oral HPV infections that cause oropharyngeal cancer (causal infections) is unknown; consequently, the benefit of vaccination of US men aged 27-45 remains uncertain. METHODS We developed a microsimulation-based, individual-level, state-transition model of oral HPV16 and HPV16-positive oropharyngeal cancer among heterosexual US men aged 15-84 years, calibrated to population-level data. We estimated the benefit of vaccination of men aged 27-45 for prevention of oropharyngeal cancer, while accounting for direct- and indirect/herd-effects of male and female vaccination. RESULTS In the absence of vaccination, most (70%) causal oral HPV16 infections are acquired by age 26, and 29% are acquired between ages 27-45. Among men aged 15-45 in 2021 (1976-2006 birth cohorts), status-quo vaccination of men through age 26 is estimated to prevent 95% of 153,450 vaccine-preventable cancers. Assuming 100% vaccination in 2021, extending the upper age-limit to 30, 35, 40, or 45 for men aged 27-45 (1976-1994 cohorts) is estimated to yield small benefit (3.0%, 4.2%, 5.1%, and 5.6% additional cancers prevented, respectively). Importantly, status-quo vaccination of men through age 26 is predicted to result in notable declines in HPV16-positive oropharyngeal cancer incidence in young men by 2035 (51% and 24% declines at ages 40-44 and 45-49, respectively) and noticeable declines (12%) overall by 2045. CONCLUSION Most causal oral HPV16 infections in US men are acquired by age 26, underscoring limited benefit from vaccination of men aged 27-45 for prevention of HPV16-positive oropharyngeal cancers.
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Affiliation(s)
- Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Gregory Haber
- Information Technology Laboratory, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Barry I Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | | | - Stephen Sy
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Jane J Kim
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Emily A Burger
- Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Department of Health Management and Health Economics, University of Oslo, Norway
| | - Li C Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | | | - Anil K Chaturvedi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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Ghimire B, Landy R, Maroni R, Smith SG, Debiram-Beecham I, Sasieni PD, Fitzgerald RC, Rubin G, Walter FM, Waller J, Offman J. Predictors of the experience of a Cytosponge test: analysis of patient survey data from the BEST3 trial. BMC Gastroenterol 2023; 23:7. [PMID: 36627580 PMCID: PMC9832657 DOI: 10.1186/s12876-022-02630-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The Cytosponge is a cell-collection device, which, coupled with a test for trefoil factor 3 (TFF3), can be used to diagnose Barrett's oesophagus, a precursor condition to oesophageal adenocarcinoma. BEST3, a large pragmatic, randomised, controlled trial, investigated whether offering the Cytosponge-TFF3 test would increase detection of Barrett's. Overall, participants reported mostly positive experiences. This study reports the factors associated with the least positive experience. METHODS Patient experience was assessed using the Inventory to Assess Patient Satisfaction (IAPS), a 22-item questionnaire, completed 7-14 days after the Cytosponge test. STUDY COHORT All BEST3 participants who answered ≥ 15 items of the IAPS (N = 1458). STATISTICAL ANALYSIS A mean IAPS score between 1 and 5 (5 indicates most negative experience) was calculated for each individual. 'Least positive' experience was defined according to the 90th percentile. 167 (11.4%) individuals with a mean IAPS score of ≥ 2.32 were included in the 'least positive' category and compared with the rest of the cohort. Eleven patient characteristics and one procedure-specific factor were assessed as potential predictors of the least positive experience. Multivariable logistic regression analysis using backwards selection was conducted to identify factors independently associated with the least positive experience and with failed swallow at first attempt, one of the strongest predictors of least positive experience. RESULTS The majority of responders had a positive experience, with an overall median IAPS score of 1.7 (IQR 1.5-2.1). High (OR = 3.01, 95% CI 2.03-4.46, p < 0.001) or very high (OR = 4.56, 95% CI 2.71-7.66, p < 0.001) anxiety (relative to low/normal anxiety) and a failed swallow at the first attempt (OR = 3.37, 95% CI 2.14-5.30, p < 0.001) were highly significant predictors of the least positive patient experience in multivariable analyses. Additionally, sex (p = 0.036), height (p = 0.032), alcohol intake (p = 0.011) and education level (p = 0.036) were identified as statistically significant predictors. CONCLUSION We have identified factors which predict patient experience. Identifying anxiety ahead of the procedure and discussing particular concerns with patients or giving them tips to help with swallowing the capsule might help improve their experience. Trial registration ISRCTN68382401.
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Affiliation(s)
- Bhagabati Ghimire
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University London, London, UK
| | - Rebecca Landy
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Roberta Maroni
- Cancer Research UK and King's College London Cancer Prevention Trials Unit, Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Samuel G Smith
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Irene Debiram-Beecham
- Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Peter D Sasieni
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Rebecca C Fitzgerald
- Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Greg Rubin
- Population Health Sciences Institute, Newcastle University, 5th Floor, Ridley 1, Newcastle Upon Tyne, UK
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Jo Waller
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Judith Offman
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
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Egemen D, Katki HA, Chaturvedi AK, Landy R, Cheung LC. Variation in Human Papillomavirus Vaccination Effectiveness in the US by Age at Vaccination. JAMA Netw Open 2022; 5:e2238041. [PMID: 36269357 PMCID: PMC9587484 DOI: 10.1001/jamanetworkopen.2022.38041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This survey study assesses the status and timing of HPV vaccination as self-reported by female participants in the National Health and Nutrition Examination Survey from 2011 to 2018.
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Affiliation(s)
- Didem Egemen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | - Hormuzd A. Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | - Anil K. Chaturvedi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | - Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | - Li C. Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
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Harvey SV, Pfeiffer RM, Landy R, Wentzensen N, Clarke MA. Trends and predictors of hysterectomy prevalence among women in the United States. Am J Obstet Gynecol 2022; 227:611.e1-611.e12. [PMID: 35764133 PMCID: PMC9529796 DOI: 10.1016/j.ajog.2022.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/17/2022] [Accepted: 06/21/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hysterectomy is the most common nonobstetrical medical procedure performed in US women. Evaluating hysterectomy prevalence trends and determinants is important for estimating gynecologic cancer rates and management of uterine conditions. OBJECTIVE This study aimed to assess hysterectomy prevalence trends and determinants using the Behavioral Risk Factor Surveillance System (2006-2016). STUDY DESIGN We estimated crude hysterectomy prevalences and multivariable-adjusted odds ratios and 95% confidence intervals for associations of race or ethnicity, age group (5-year), body mass index (categorical), smoking status, education, insurance, income, and US region with hysterectomy. Missing data were imputed. The number of women in each survey year ranged from 220,302 in 2006 to 275,631 in 2016. RESULTS Although overall hysterectomy prevalence changed little between 2006 and 2016 (21.4% and 21.1%, respectively), hysterectomy prevalence was lower in 2016 than in 2006 among women aged ≥40 years, particularly among non-Hispanic Black and Hispanic women. Current smoking (odds ratio, 1.38; 95% confidence interval, 1.35-1.41), increasing age (odds ratio, 1.40; 95% confidence interval, 1.39-1.40), living in the South compared with the Midwest (odds ratio, 1.36; 95% confidence interval, 1.34-1.39), higher body mass index (odds ratio, 1.26; 95% confidence interval, 1.25-1.27), Black race compared with White (odds ratio, 1.10; 95% confidence interval, 1.07-1.13), and having insurance compared with being uninsured (odds ratio, 1.26; 95% confidence interval, 1.22-1.30) were most strongly associated with increased prevalence. Hispanic ethnicity and living in the Northeast were most strongly associated with decreased prevalence (odds ratio, 0.73; 95% confidence interval, 0.70-0.76; odds ratio, 0.67; 95% confidence interval, 0.65-0.69). CONCLUSION Nationwide hysterectomy prevalence decreased among women aged ≥40 years from 2006 to 2016, particularly among non-Hispanic Black and Hispanic women. Age, non-Hispanic Black race, having insurance, current smoking, and living in the South were associated with increased odds of hysterectomy, even after accounting for possible explanatory factors. Further research is needed to better understand associations of race and ethnicity and region with hysterectomy prevalence.
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Affiliation(s)
- Summer V Harvey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD.
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Megan A Clarke
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
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Robbins HA, Zahed H, Lebrett MB, Balata H, Johansson M, Sharman A, Evans DG, Crosbie EJ, Booton R, Landy R, Crosbie PAJ. Explaining differences in the frequency of lung cancer detection between the National Lung Screening Trial and community-based screening in Manchester, UK. Lung Cancer 2022; 171:61-64. [PMID: 35917648 PMCID: PMC9790152 DOI: 10.1016/j.lungcan.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/21/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND The frequency of lung cancer detection in the Manchester Lung Health Checks (MLHCs), a community-based screening service, was higher than in the National Lung Screening Trial (NLST) over two screening rounds. We aimed to identify the potential reasons for this difference. METHODS We analyzed individual-level data from NLST and MLHCs, restricting to MLHCs participants who met NLST eligibility criteria. We calculated 'detection ratios' comparing the frequency of lung cancer detection in MLHCs vs NLST, first after excluding NLST participants ineligible by MLHC eligibility criteria (6-year lung cancer risk ≥ 1.51 %), and then after standardization to remove the influence of different distributions of baseline lung cancer risk. RESULTS Among the 1,079 MLHCs participants who met NLST eligibility criteria, 4.7% were diagnosed with lung cancer over two screening rounds compared with 1.7% in NLST, giving an initial detection ratio of 2.6 (95%CI 2.2-3.0). This was reduced to 2.2 (95%CI 1.3-2.3) after imposing the MLHCs eligibility criterion on NLST, and further to 1.6 (95%CI 1.2-2.1) after removing the influence of different risk distributions. In stratified analyses, the standardized detection ratio was particularly elevated in individuals who were older, living in areas of high socioeconomic disadvantage, or had an FEV/FVC ratio less than 60. CONCLUSIONS The 2.6-fold higher lung cancer detection in the community-based MLHCs vs NLST is partly explained by differences in eligibility criteria and baseline risk distributions. The residual 60% increase may relate to higher detection in certain risk groups, including older participants, those with more obstructive lung disease, and those living in areas of socioeconomic disadvantage.
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Affiliation(s)
- Hilary A Robbins
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France.
| | - Hana Zahed
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Mikey B Lebrett
- Prevention and Early Detection Theme, NIHR Manchester Biomedical Research Centre, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Haval Balata
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK; Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Mattias Johansson
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Anna Sharman
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - D Gareth Evans
- Prevention and Early Detection Theme, NIHR Manchester Biomedical Research Centre, Manchester, UK; Division of Evolution and Genomic Sciences, University of Manchester, Manchester, UK
| | - Emma J Crosbie
- Prevention and Early Detection Theme, NIHR Manchester Biomedical Research Centre, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Richard Booton
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Philip A J Crosbie
- Prevention and Early Detection Theme, NIHR Manchester Biomedical Research Centre, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
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Landy R, Hollingworth T, Waller J, Marlow LA, Rigney J, Round T, Sasieni PD, Lim AW. Non-speculum clinician-taken samples for human papillomavirus testing: a cross-sectional study in older women. Br J Gen Pract 2022; 72:e538-e545. [PMID: 35667684 PMCID: PMC9183459 DOI: 10.3399/bjgp.2021.0708] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/28/2022] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Cervical cancer incidence and mortality are high in women aged ≥65 years, despite the disease being preventable by screening. Speculum-based screening can become more uncomfortable after the menopause. AIM To examine test performance and acceptability of human papillomavirus (HPV) testing on clinician-collected vaginal samples without a speculum (non-speculum). DESIGN AND SETTING Cross-sectional study in 11 GP practices and four colposcopy clinics in London, UK, between August 2017 and January 2019. METHOD Non-speculum and conventional (speculum) samples were collected from women aged ≥50 years attending for a colposcopy (following a speculum HPV-positive screening result) or women aged ≥35 years (with confirmed cervical intraepithelial neoplasia (CIN) 2+), and women aged 50-64 years attending routine screening. Sensitivity to CIN2+ was assessed among women with confirmed CIN2+ (colposcopy). Specificity to HPV relative to speculum sampling and overall concordance was assessed among women with negative cytology (routine screening). RESULTS The sensitivity of non-speculum sampling for detecting CIN2+ was 83.3% (95% confidence interval [CI] = 60.8 to 94.2) (n = 15/18). There was complete concordance among women with positive CIN2+ who had a speculum sample ≤91 days prior to the non-speculum sample (n = 12). Among 204 women with negative cytology, the specificity to HPV was 96.4% (95% CI = 92.7 to 98.5), with 96.6% concordant results (κ 72.4%). Seventy-one percent (n = 120/170) of women preferred a non-speculum sample for their next screen. CONCLUSION HPV testing on non-speculum clinician-taken samples is a viable approach that warrants further exploration in larger studies. Overall test performance was broadly comparable with that of self-sampling.
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Affiliation(s)
- Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, US
| | | | - Jo Waller
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Laura Av Marlow
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Jane Rigney
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Thomas Round
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Peter D Sasieni
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Anita Ww Lim
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
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Affiliation(s)
- Hilary A Robbins
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Jasjit S Ahluwalia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
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Young CD, Cheung LC, Berg CD, Rivera P, Robbins HA, Chaturvedi AK, Katki HA, Landy R. Abstract PR-13: Potential effect on racial/ethnic disparities of removing racial/ethnic variables from risk models: The example of lung-cancer screening. Cancer Epidemiol Biomarkers Prev 2022. [DOI: 10.1158/1538-7755.disp21-pr-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Some uses of “race correction” in clinical algorithms and prediction models unfairly reduce access to care, resulting in calls to remove racial/ethnic variables from all models and algorithms. However, for models that are based on unbiased, high-quality, and plentiful data, removing racial/ethnic variables may reduce prediction accuracy for minorities. We model racial/ethnic disparities in screening eligibility from augmenting USPSTF-2021 guidelines (ages 50-80, ≥20 pack-years, ≤15 quit-years) to also include individuals selected by an NCCN-recommended risk model that includes race (PLCOM2012) versus the same model with race/ethnicity removed (PLCOM2012_NoRace). Methods: We used previously published methodology to model the performance of lung cancer screening using 6915 ever-smokers ages 50-80 from the US-representative 2015 National Health Interview Survey (NHIS). Individuals were considered eligible for screening if they are eligible by USPSTF-2021 guidelines or by PLCOM2012 (“USPSTF+PLCOM2012”), versus being eligible by USPSTF-2021 or PLCOM2012_NoRace (“USPSTF+PLCOM2012_NoRace”). Both models used the NCCN-recommended ≥1.3% 6-year risk-threshold for eligibility. We evaluated model accuracy (average percent over/under-estimation) by race/ethnicity, estimated the proportion of life-years gainable achieved by each eligible cohort (LYG), and evaluated the LYG disparity (difference in LYG between whites and each minority). Results: USPSTF+PLCOM2012 and USPSTF+PLCOM2012_NoRace identified similar numbers of minorities as eligible for screening (~2.7 million). However, USPSTF+PLCOM2012_NoRace selected 125% more Hispanic-Americans and 31% less African-Americans. LYG disparities decreased using USPSTF+PLCOM2012_NoRace versus USPSTF+PLCOM2012 for Hispanic Americans (LYG: 33% to 29%). However, LYG disparities for African Americans increased (LYG: 16% to 18%). PLCOM2012 underestimated lung cancer risk by 49% for Hispanic-Americans, whereas PLCOM2012_NoRace performed well (4% overestimation). However, PLCOM2012underestimated risk in African-Americans by only 6%, PLCOM2012_NoRace underestimated risk in African-Americans by 36%. Conclusion: The model that was most accurate for a minority group was projected to reduce disparities the most for that group. Removing race from the PLCOM2012 model substantially underestimated risk for African-Americans and may increase disparities. Inexplicably, PLCOM2012 substantially underestimated risk in Hispanic-Americans despite including race/ethnicity, which was alleviated by removing race/ethnicity. Great care must be taken when removing racial/ethnic variables from models, because this will assign minorities risk estimates that may be largely, or entirely, based on the majority population.
Citation Format: Corey D. Young, Li C. Cheung, Christine D. Berg, Patricia Rivera, Hilary A. Robbins, Anil K. Chaturvedi, Hormuzd A. Katki, Rebecca Landy. Potential effect on racial/ethnic disparities of removing racial/ethnic variables from risk models: The example of lung-cancer screening [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PR-13.
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Affiliation(s)
| | - Li C. Cheung
- 2Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD,
| | - Christine D. Berg
- 2Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD,
| | - Patricia Rivera
- 3Division of Pulmonary and Critical Care Medicine University of North Carolina at Chapel Hill, Chapel Hill, NC,
| | | | - Anil K. Chaturvedi
- 2Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD,
| | - Hormuzd A. Katki
- 2Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD,
| | - Rebecca Landy
- 2Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD,
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Landy R, Hollingworth T, Waller J, Marlow LA, Rigney J, Round T, Sasieni PD, Lim AW. Non-speculum sampling approaches for cervical screening in older women: randomised controlled trial. Br J Gen Pract 2022; 72:e26-e33. [PMID: 34972808 PMCID: PMC8714504 DOI: 10.3399/bjgp.2021.0350] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/25/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Cervical cancer disproportionately affects women ≥65 years, especially those not screened regularly. Speculum use is a key barrier. AIM To assess if offering non-speculum clinician-taken sampling and self-sampling increases uptake for lapsed attenders aged 50-64 years. DESIGN AND SETTING Pragmatic randomised control trial conducted at 10 general practices in East London, UK. METHOD Participants were 784 women aged 50-64 years, last screened 6-15 years before randomisation. Intervention participants received a letter offering the choice of non-speculum clinician- or self-sampling. Control participants received usual care. The main outcome measure was uptake within 4 months. RESULTS Screening uptake 4 months after randomisation was significantly higher in the intervention arm: 20.4% (n = 80/393) versus 4.9% in the control arm (n = 19/391, absolute difference 15.5%, 95% confidence interval [CI] = 11.0% to 20.0%, P<0.001). This was maintained at 12 months: intervention 30.5% (n = 120/393) versus control 13.6% (n = 53/391) (absolute difference 17.0%, 95% CI = 11.3% to 22.7%, P<0.001). Conventional screening attendance within 12 months was very similar for both intervention 12.7% (n = 50/393) and control 13.6% (n = 53/391) arms. Ethnic differences were seen in screening modality preference. More White women opted for self-sampling (50.7%, n = 38/75), whereas most Asian and Black women and those from other ethnic backgrounds opted for conventional screening. CONCLUSION Offering non-speculum clinician-taken sampling and self-sampling substantially increases uptake in older lapsed attendee women. Non-speculum clinician sampling appeals to women who dislike the speculum but still prefer a clinician to take their sample. Providing a choice of screening modality may be important for optimising cervical screening uptake.
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Affiliation(s)
- Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, US
| | | | - Jo Waller
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Laura Av Marlow
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Jane Rigney
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Thomas Round
- School of Population Health and Environmental Sciences, King's College London, London and National Cancer Analysis and Registration Service, Public Health England
| | - Peter D Sasieni
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Anita Ww Lim
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
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Landy R, Mathews C, Robertson M, Wiggins CL, McDonald YJ, Goldberg DW, Scarinci IC, Cuzick J, Sasieni PD, Wheeler CM. Corrigendum to 'A state-wide population-based evaluation of cervical cancers arising during opportunistic screening in the United States' [Gynecologic Oncology 159 (2020) 344-353]. Gynecol Oncol 2021; 163:614. [PMID: 34602285 DOI: 10.1016/j.ygyno.2021.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rebecca Landy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
| | - Christopher Mathews
- School of Cancer & Pharmaceutical Sciences, King's College London, London SE1 9RT, United Kingdom
| | - Michael Robertson
- University of New Mexico Comprehensive Cancer Center, The Center for HPV Prevention, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Charles L Wiggins
- University of New Mexico Comprehensive Cancer Center, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Yolanda J McDonald
- Department of Human and Organizational Development, Vanderbilt University, Nashville, TN, USA
| | - Daniel W Goldberg
- Department of Geography, Texas A&M University, College Station, TX, USA
| | - Isabel C Scarinci
- Division of Preventive Medicine, University of Alabama at Birmingham, AL, USA
| | - Jack Cuzick
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Peter D Sasieni
- School of Cancer & Pharmaceutical Sciences, King's College London, London SE1 9RT, United Kingdom
| | - Cosette M Wheeler
- Departments of Pathology and Obstetrics & Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Landy R, Young CD, Skarzynski M, Cheung LC, Berg CD, Rivera MP, Robbins HA, Chaturvedi AK, Katki HA. Using Prediction Models to Reduce Persistent Racial and Ethnic Disparities in the Draft 2020 USPSTF Lung Cancer Screening Guidelines. J Natl Cancer Inst 2021; 113:1590-1594. [PMID: 33399825 PMCID: PMC8562965 DOI: 10.1093/jnci/djaa211] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/20/2020] [Accepted: 10/29/2020] [Indexed: 01/04/2023] Open
Abstract
We examined whether draft 2020 United States Preventive Services Task Force (USPSTF) lung cancer screening recommendations "partially ameliorate racial disparities in screening eligibility" compared with the 2013 guidelines, as claimed. Using data from the 2015 National Health Interview Survey, USPSTF-2020 increased eligibility by similar proportions for minorities (97.1%) and Whites (78.3%). Contrary to the intent of USPSTF-2020, the relative disparity (differences in percentages of model-estimated gainable life-years from National Lung Screening Trial-like screening by eligible Whites vs minorities) actually increased from USPSTF-2013 to USPSTF-2020 (African Americans: 48.3%-33.4% = 15.0% to 64.5%-48.5% = 16.0%; Asian Americans: 48.3%-35.6% = 12.7% to 64.5%-45.2% = 19.3%; Hispanic Americans: 48.3%-24.8% = 23.5% to 64.5%-37.0% = 27.5%). However, augmenting USPSTF-2020 with high-benefit individuals selected by the Life-Years From Screening with Computed Tomography (LYFS-CT) model nearly eliminated disparities for African Americans (76.8%-75.5% = 1.2%) and improved screening efficiency for Asian and Hispanic Americans, although disparities were reduced only slightly (Hispanic Americans) or unchanged (Asian Americans). The draft USPSTF-2020 guidelines increased the number of eligible minorities vs USPSTF-2013 but may inadvertently increase racial and ethnic disparities. LYFS-CT could reduce disparities in screening eligibility by identifying ineligible people with high predicted benefit regardless of race and ethnicity.
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Affiliation(s)
- Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Corey D Young
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Martin Skarzynski
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Li C Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Christine D Berg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - M Patricia Rivera
- Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Anil K Chaturvedi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
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Robbins HA, Alcala K, Swerdlow AJ, Schoemaker MJ, Wareham N, Travis RC, Crosbie PAJ, Callister M, Baldwin DR, Landy R, Johansson M. Correction: Comparative performance of lung cancer risk models to define lung screening eligibility in the United Kingdom. Br J Cancer 2021; 125:305. [PMID: 34002041 PMCID: PMC8292451 DOI: 10.1038/s41416-021-01436-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Karine Alcala
- International Agency for Research on Cancer, Lyon, France
| | | | | | | | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | - David R Baldwin
- Nottingham University Hospitals and University of Nottingham, Nottingham, UK
| | - Rebecca Landy
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Landy R, Mathews C, Robertson M, Wiggins CL, McDonald YJ, Goldberg DW, Scarinci IC, Cuzick J, Sasieni PD, Wheeler CM. Erratum to 'A state-wide population-based evaluation of cervical cancers arising during opportunistic screening in the United States' [Gynecologic Oncology 159 (2020) 344-353]. Gynecol Oncol 2021; 161:913. [PMID: 33867145 PMCID: PMC8486679 DOI: 10.1016/j.ygyno.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Rebecca Landy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
| | - Christopher Mathews
- School of Cancer & Pharmaceutical Sciences, King's College London, London SE1 9RT, United Kingdom
| | - Michael Robertson
- University of New Mexico Comprehensive Cancer Center, The Center for HPV Prevention, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Charles L Wiggins
- University of New Mexico Comprehensive Cancer Center, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Yolanda J McDonald
- Department of Human and Organizational Development, Vanderbilt University, Nashville, TN, USA
| | - Daniel W Goldberg
- Department of Geography, Texas A&M University, College Station, TX, USA
| | - Isabel C Scarinci
- Division of Preventive Medicine, University of Alabama at Birmingham, AL, USA
| | - Jack Cuzick
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Peter D Sasieni
- School of Cancer & Pharmaceutical Sciences, King's College London, London SE1 9RT, United Kingdom
| | - Cosette M Wheeler
- Departments of Pathology and Obstetrics & Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Robbins HA, Alcala K, Swerdlow AJ, Schoemaker MJ, Wareham N, Travis RC, Crosbie PAJ, Callister M, Baldwin DR, Landy R, Johansson M. Comparative performance of lung cancer risk models to define lung screening eligibility in the United Kingdom. Br J Cancer 2021; 124:2026-2034. [PMID: 33846525 PMCID: PMC8184952 DOI: 10.1038/s41416-021-01278-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/04/2021] [Accepted: 01/13/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The National Health Service England (NHS) classifies individuals as eligible for lung cancer screening using two risk prediction models, PLCOm2012 and Liverpool Lung Project-v2 (LLPv2). However, no study has compared the performance of lung cancer risk models in the UK. METHODS We analysed current and former smokers aged 40-80 years in the UK Biobank (N = 217,199), EPIC-UK (N = 30,813), and Generations Study (N = 25,777). We quantified model calibration (ratio of expected to observed cases, E/O) and discrimination (AUC). RESULTS Risk discrimination in UK Biobank was best for the Lung Cancer Death Risk Assessment Tool (LCDRAT, AUC = 0.82, 95% CI = 0.81-0.84), followed by the LCRAT (AUC = 0.81, 95% CI = 0.79-0.82) and the Bach model (AUC = 0.80, 95% CI = 0.79-0.81). Results were similar in EPIC-UK and the Generations Study. All models overestimated risk in all cohorts, with E/O in UK Biobank ranging from 1.20 for LLPv3 (95% CI = 1.14-1.27) to 2.16 for LLPv2 (95% CI = 2.05-2.28). Overestimation increased with area-level socioeconomic status. In the combined cohorts, USPSTF 2013 criteria classified 50.7% of future cases as screening eligible. The LCDRAT and LCRAT identified 60.9%, followed by PLCOm2012 (58.3%), Bach (58.0%), LLPv3 (56.6%), and LLPv2 (53.7%). CONCLUSION In UK cohorts, the ability of risk prediction models to classify future lung cancer cases as eligible for screening was best for LCDRAT/LCRAT, very good for PLCOm2012, and lowest for LLPv2. Our results highlight the importance of validating prediction tools in specific countries.
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Affiliation(s)
| | - Karine Alcala
- International Agency for Research on Cancer, Lyon, France
| | | | | | | | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | - David R Baldwin
- Nottingham University Hospitals and University of Nottingham, Nottingham, UK
| | - Rebecca Landy
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Robbins H, Alcala K, Swerdlow A, Schoemaker M, Wareham N, Key T, Travis R, Brennan P, Crosbie P, Callister M, Baldwin D, Landy R, Johansson M. P42.07 Comparative Performance of Lung Cancer Risk Models to Define Lung Screening Eligibility in the United Kingdom. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Landy R, Young C, Skarzynski M, Cheung L, Berg C, Rivera M, Robbins H, Chaturvedi A, Katki H. MA05.10 Performance of Draft 2020 USPSTF Lung-Cancer Screening Guidelines and Potential for use of Risk Models to Reduce Racial/Ethnic Disparities. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Landy R, Chaturvedi AK. HPV16 E6 seropositivity and oropharyngeal cancer: Marker of exposure, risk, or disease? EBioMedicine 2021; 63:103190. [PMID: 33418506 PMCID: PMC7804595 DOI: 10.1016/j.ebiom.2020.103190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Rebecca Landy
- Clinical Epidemiology Unit, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rm. 6-E238, Rockville, MD 20850, United States
| | - Anil K Chaturvedi
- Clinical Epidemiology Unit, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rm. 6-E238, Rockville, MD 20850, United States.
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Katki HA, Cheung LC, Landy R. Basing Eligibility for Lung Cancer Screening on Individualized Risk Calculators Should Save More Lives, but Life Expectancy Matters. J Natl Cancer Inst 2020; 112:429-430. [PMID: 31566223 DOI: 10.1093/jnci/djz165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 12/17/2022] Open
Affiliation(s)
- Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Li C Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
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Landy R, Young CD, Skarzynski M, Cheung LC, Berg CD, Rivera MP, Robbins HA, Chaturvedi AK, Katki HA. Abstract PO-247: Use of prediction models to reduce racial/ethnic disparities in eligibility for lung-cancer screening. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: For the same age and smoking history as whites, minorities have substantially different lung-cancer risk. However, current US Preventive Services Task Force (USPSTF) lung-cancer screening recommendations make no allowance for race/ethnicity and may induce health disparities. Incorporating individualized prediction-models into USPSTF guidelines may reduce racial/ethnic disparities in lung-cancer screening eligibility. We examine whether expanding current USPSTF lung cancer screening eligibility to include ever-smokers whose risk (calculated by an individualized prediction model) exceeded a threshold would reduce racial/ethnic disparities induced by current USPSTF guidelines. Methods: We used the US- representative 2015 National Health Interview Survey to examine screening eligibility. We identified the thresholds for each of 5 models: lung-cancer risk (Bach, PLCOM2012 and LCRAT models), lung-cancer death risk (LCDRAT model), and life- years gained by attending screening (LYFS-CT model), which select the same number of ever-smokers aged 50-80yrs as USPSTF guidelines. We defined 5 cohorts of ever- smokers as eligible for screening if they were eligible by each screening model or USPSTF guidelines. Among each race/ethnicity, we calculated the number eligible for screening, proportion of preventable lung-cancer deaths prevented (LCD sensitivity), proportion of gainable life-years gained (LYG sensitivity) and screening effectiveness (the number needed to screen to prevent one lung-cancer death). Results: USPSTF criteria performed best for whites (20% eligible, preventing 55% of preventable lung- cancer deaths). Asian-Americans had the least effective screening (NNS=419), only 13% of African-Americans were eligible despite having the most effective screening (NNS=135), and Hispanic-Americans had the lowest percentages eligible (9%) and deaths preventable (30%). Augmenting USPSTF criteria with LCDRAT or LYFS-CT prediction-models nearly equalized the performance of screening for African- Americans with that of whites, doubling the number of African-Americans eligible and increasing the number of preventable deaths and life-years gained by nearly 80%, although at a 25% loss in effectiveness. Prediction-models improved all screening metrics for Asian-Americans and Hispanic-Americans. However models estimated risk more accurately for whites than minorities. Conclusions: Augmenting USPSTF criteria with the LCDRAT or LYFS-CT prediction-models nearly eliminated the white/African-American disparity. All screening metrics were substantially improved for Asian/Hispanic-Americans.
Citation Format: Rebecca Landy, Corey D. Young, Martin Skarzynski, Li C. Cheung, Christine D. Berg, M. Patricia Rivera, Hilary A. Robbins, Anil K. Chaturvedi, Hormuzd A. Katki. Use of prediction models to reduce racial/ethnic disparities in eligibility for lung-cancer screening [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-247.
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Landy R, Mathews C, Robertson M, Wiggins CL, McDonald YJ, Goldberg DW, Scarinci IC, Cuzick J, Sasieni PD, Wheeler CM. A state-wide population-based evaluation of cervical cancers arising during opportunistic screening in the United States. Gynecol Oncol 2020; 159:344-353. [PMID: 32977987 PMCID: PMC7594931 DOI: 10.1016/j.ygyno.2020.08.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/27/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Despite widespread cervical screening, an estimated 13,800 women will be diagnosed with cervical cancer in the United States in 2020. To inform improvements, the screening histories of women diagnosed with cervical cancer in New Mexico were assessed. METHODS Data were collected on all cervical screening, diagnostic tests and treatment procedures for all women diagnosed with cervical cancer aged 25-64 yrs. in New Mexico from 2006 to 2016. Women were categorized by their screening attendance in the 5-40 months (screening interval) and 1-4 months (peri-diagnostic interval) prior to cancer diagnosis. RESULTS Of the 504 women diagnosed between May 2009-December 2016, 64% were not screened or had only inadequate screening tests in the 5-40 months prior to diagnosis, and 90 of 182 screened women (49%) had only negative screens in this period. Only 32% (N = 162) of cervical cancers were screen-detected. Women with adenocarcinomas were more likely to have had a recent negative screen (41/57 = 722%) than women with squamous cancers (50/112 = 45%). Both older women (aged 45-64 years) and women with more advanced cancers were less likely to have been screened, and if screened, were more likely to have a false-negative outcome. Only 9% of cancers were diagnosed in women who did not attend biopsy or treatment after positive tests requiring clinical management. Screening currently prevents 35% of cancers, whereas full screening coverage could prevent 61% of cervical cancers. CONCLUSION Improved screening coverage has the largest potential for reducing cervical cancer incidence, though there is also a role for improved recall procedures and screening sensitivity.
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Affiliation(s)
- Rebecca Landy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
| | - Christopher Mathews
- School of Cancer & Pharmaceutical Sciences, King's College London, London SE1 9RT, United Kingdom
| | - Michael Robertson
- University of New Mexico Comprehensive Cancer Center, The Center for HPV Prevention, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Charles L Wiggins
- University of New Mexico Comprehensive Cancer Center, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Yolanda J McDonald
- Department of Human and Organizational Development, Vanderbilt University, Nashville, TN, USA
| | - Daniel W Goldberg
- Department of Geography, Texas A&M University, College Station, TX, USA
| | - Isabel C Scarinci
- Division of Preventive Medicine, University of Alabama at Birmingham, AL, USA
| | - Jack Cuzick
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Peter D Sasieni
- School of Cancer & Pharmaceutical Sciences, King's College London, London SE1 9RT, United Kingdom
| | - Cosette M Wheeler
- Departments of Pathology and Obstetrics & Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Landy R, Sasieni PD, Mathews C, Wiggins CL, Robertson M, McDonald YJ, Goldberg DW, Scarinci IC, Cuzick J, Wheeler CM. Impact of screening on cervical cancer incidence: A population-based case-control study in the United States. Int J Cancer 2020; 147:887-896. [PMID: 31837006 PMCID: PMC7282928 DOI: 10.1002/ijc.32826] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/14/2019] [Accepted: 11/25/2019] [Indexed: 12/03/2022]
Abstract
Cervical cancer is widely preventable through screening, but little is known about the duration of protection offered by a negative screen in North America. A case-control study was conducted with records from population-based registries in New Mexico. Cases were women diagnosed with cervical cancer in 2006-2016, obtained from the Tumor Registry. Five controls per case from the New Mexico HPV Pap Registry were matched to cases by sex, age and place of residence. Dates and results of all cervical screening and diagnostic tests since 2006 were identified from the pap registry. We estimated the odds ratio of nonlocalized (Stage II+) and localized (Stage I) cervical cancer associated with attending screening in the 3 years prior to case-diagnosis compared to women not screened in 5 years. Of 876 cases, 527 were aged 25-64 years with ≥3 years of potential screening data. Only 38% of cases and 61% of controls attended screening in a 3-year period. Women screened in the 3 years prior to diagnosis had 83% lower risk of nonlocalized cancer (odds ratio [OR] = 0.17, 95% CI: 0.12-0.24) and 48% lower odds of localized cancer (OR = 0.52, 95% CI: 0.38-0.72), compared to women not screened in the 5 years prior to diagnosis. Women remained at low risk of nonlocalized cancer for 3.5-5 years after a negative screen compared to women with no negative screens in the 5 years prior to diagnosis. Routine cervical screening is effective at preventing localized and nonlocalized cervical cancers; 3 yearly screening prevents 83% of nonlocalized cancers, with no additional benefit of more frequent screening. Increasing screening coverage remains essential to further reduce cervical cancer incidence.
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Affiliation(s)
- Rebecca Landy
- Wolfson Institute of Preventive MedicineQueen Mary University of LondonLondonUnited Kingdom
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human ServicesBethesdaMD
| | - Peter D. Sasieni
- School of Cancer & Pharmaceutical SciencesKing's College LondonLondonUnited Kingdom
| | - Christopher Mathews
- School of Cancer & Pharmaceutical SciencesKing's College LondonLondonUnited Kingdom
| | - Charles L. Wiggins
- Department of Internal MedicineUniversity of New Mexico Comprehensive Cancer Center and University of New Mexico Health Sciences CenterAlbuquerqueNM
| | - Michael Robertson
- The Center for HPV PreventionUniversity of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences CenterAlbuquerqueNM
| | - Yolanda J. McDonald
- Department of Human and Organizational DevelopmentVanderbilt UniversityNashvilleTN
| | | | - Isabel C. Scarinci
- Division of Preventive MedicineUniversity of Alabama at BirminghamBirminghamAL
| | - Jack Cuzick
- Wolfson Institute of Preventive MedicineQueen Mary University of LondonLondonUnited Kingdom
| | - Cosette M. Wheeler
- Department of Pathology and Obstetrics & GynecologyUniversity of New Mexico Health Sciences CenterAlbuquerqueNM
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Clarke MA, Cheung LC, Lorey T, Hare B, Landy R, Tokugawa D, Gage JC, Darragh TM, Castle PE, Wentzensen N. 5-Year Prospective Evaluation of Cytology, Human Papillomavirus Testing, and Biomarkers for Detection of Anal Precancer in Human Immunodeficiency Virus-Positive Men Who Have Sex With Men. Clin Infect Dis 2020; 69:631-638. [PMID: 30418518 DOI: 10.1093/cid/ciy970] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/08/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV)-related biomarkers have shown good cross-sectional performance for anal precancer detection in human immunodeficiency virus-positive (HIV+) men who have sex with men (MSM). However, the long-term performance and risk stratification of these biomarkers are unknown. Here, we prospectively evaluated high-risk (HR) HPV DNA, HPV16/18 genotyping, HPV E6/E7 messenger RNA (mRNA), and p16/Ki-67 dual stain in a population of HIV+ MSM. METHODS We enrolled 363 HIV+ MSM between 2009-2010, with passive follow-up through 2015. All had anal cytology and a high-resolution anoscopy at baseline. For each biomarker, we calculated the baseline sensitivity and specificity for a combined endpoint of high-grade squamous intraepithelial lesion (HSIL) and anal intraepithelial neoplasia grade 2 or more severe diagnoses (HSIL/AIN2+), and we estimated the 2- and 5-year cumulative risks of HSIL/AIN2+ using logistic and Cox regression models. RESULTS There were 129 men diagnosed with HSIL/AIN2+ during the study. HR-HPV testing had the highest positivity and sensitivity of all assays, but the lowest specificity. HPV16/18 and HPV E6/E7 mRNA had high specificity, but lower sensitivity. The 2- and 5-year risks of HSIL/AIN2+ were highest for those testing HPV16/18- or HPV E6/E7 mRNA-positive, followed by those testing dual stain-positive. Those testing HR-HPV- or dual stain-negative had the lowest 2- and 5-year risks of HSIL/AIN2+. CONCLUSIONS HPV-related biomarkers provide long-term risk stratification for anal precancers. HR-HPV- and dual stain-negativity indicate a low risk of HSIL/AIN2+ for at least 2 years, compared with negative anal cytology; however, the high positivity of HR-HPV in HIV+ MSM may limit its utility for surveillance and management in this population.
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Affiliation(s)
- Megan A Clarke
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Li C Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Thomas Lorey
- Kaiser Permanente The Permanente Medical Group Regional Laboratory, Berkeley
| | - Brad Hare
- The Permanente Medical Group, San Francisco
| | - Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Diane Tokugawa
- Kaiser Permanente The Permanente Medical Group Regional Laboratory, Berkeley
| | - Julia C Gage
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | | | | | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
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Katki H, Skarzynski M, Cheung L, Berg C, Chaturvedi A, Landy R, Young C. Abstract A110: Could use of individualized risk models mitigate health disparities in eligibility for lung cancer screening? Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-a110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Current US Preventive Services Task Force (USPSTF) lung cancer screening guidelines recommend screening ever-smokers aged 55-80 years with ≥30 pack-years who currently smoke or have quit in the last 15 years. However, USPSTF guidelines could exacerbate health disparities, since they do not account for race/ethnicity, gender or socioeconomic status. In particular, African-Americans have a higher risk of developing lung cancer despite smoking less than their white counterparts, suggesting that current guidelines may eliminate many African Americans from screening despite having equivalent risk to whites. Validated lung cancer risk models, some of which include race/ethnicity, have been proposed for determining screening eligibility, although it is unknown whether these would mitigate any potential disparities. Methods: Using data from the US-representative 2015 National Health Interview Survey, we calculated those eligible for screening (overall and by subpopulations) under USPSTF guidelines, and three prominent validated lung cancer risk models (Bach, PLCOM2012 and LCRAT) at a range of risk thresholds. The PLCOM2012 and LCRAT models include race/ethnicity, and the Bach and LCRAT models include gender. We also calculated the distributions of pack-years, cigarettes per day (cpd) and years smoked by race/ethnicity. Results: Using a 2.3% 6-year lung cancer risk threshold for each model, a higher proportion of those selected by risk models are African-American (PLCOM2012: 10%, LCRAT: 12%, Bach: 9%) compared to USPSTF guidelines (7%). In contrast, a lower proportion of those selected by risk models are Asian-American (PLCOM2012: 1.6%, LCRAT: 1.4%, Bach: 2.1%) compared to USPSTF guidelines (2.7%). The models disagree on the proportion selected who are Hispanic (PLCOM2012: 1.5%, Bach: 5.1%, LCRAT: 2.6%), although the proportion selected by USPSTF guidelines (3.9%) is within their range. Some of the differences between models may occur as a result of how each model assigns risk to smokers with <30 pack-years, which occurs more frequently in racial/ethnic minorities: 82% of African-American ever-smokers aged 50-80, 84% of Hispanic and 80% of Asians had smoked <30 pack-years, compared to 67% of whites. Conclusions: Substantially higher proportions of those selected for lung screening by risk models were African-American than by USPSTF guidelines. However, risk models might select smaller proportions of Asian-Americans than USPSTF guidelines and disagree on the proportion selected who are Hispanic. Given historical lack of equal access to healthcare among minorities, the use of risk models to determine screening eligibility requires careful thought.
Citation Format: Hormuzd Katki, Martin Skarzynski, Li Cheung, Christine Berg, Anil Chaturvedi, Rebecca Landy, Corey Young. Could use of individualized risk models mitigate health disparities in eligibility for lung cancer screening? [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A110.
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Affiliation(s)
| | | | | | | | | | | | - Corey Young
- 2Morehouse School of Medicine, Atlanta, GA, USA
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Hofmann JN, Landgren O, Landy R, Kemp TJ, Santo L, McShane CM, Shearer JJ, Lan Q, Rothman N, Pinto LA, Pfeiffer RM, Hildesheim A, Katki HA, Purdue MP. A Prospective Study of Circulating Chemokines and Angiogenesis Markers and Risk of Multiple Myeloma and Its Precursor. JNCI Cancer Spectr 2020; 4:pkz104. [PMID: 33336146 PMCID: PMC7083234 DOI: 10.1093/jncics/pkz104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/08/2019] [Accepted: 12/12/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Experimental and clinical studies have implicated certain chemokines and angiogenic cytokines in multiple myeloma (MM) pathogenesis. To investigate whether systemic concentrations of these markers are associated with future MM risk and progression from its precursor, monoclonal gammopathy of undetermined significance (MGUS), we conducted a prospective study within the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. METHODS We measured concentrations of 45 immunologic and pro-angiogenic markers in sera from 241 MM case patients, 441 participants with nonprogressing MGUS, and 258 MGUS-free control participants using Luminex-based multiplex assays and enzyme-linked immunosorbent assays. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression. We also evaluated absolute risk of progression using weighted Kaplan-Meier estimates. All statistical tests were two-sided. RESULTS Prediagnostic levels of six markers were statistically significantly elevated among MM case patients compared with MGUS-free control participants using a false discovery rate of 10% (EGF, HGF, Ang-2, CXCL12, CCL8, and BMP-9). Of these, three angiogenesis markers were associated with future progression from MGUS to MM: EGF (fourth vs first quartile: OR = 3.01, 95% CI = 1.61 to 5.63, P trend = .00028), HGF (OR = 2.59, 95% CI = 1.33 to 5.03, P trend = .015), and Ang-2 (OR = 2.14, 95% CI = 1.15 to 3.98, P trend = .07). A composite angiogenesis biomarker score substantially stratified risk of MGUS progression to MM beyond established risk factors for progression, particularly during the first 5 years of follow-up (areas under the curve of 0.71 and 0.64 with and without the angiogenesis marker score, respectively). CONCLUSIONS Our prospective findings provide new insights into mechanisms involved in MM development and suggest that systemic angiogenesis markers could potentially improve risk stratification models for MGUS patients.
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Affiliation(s)
- Jonathan N Hofmann
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Ola Landgren
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Troy J Kemp
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc., Frederick, MD, USA
| | - Loredana Santo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Charlene M McShane
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen’s University, Belfast, Northern Ireland, UK
| | - Joseph J Shearer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Qing Lan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Ligia A Pinto
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc., Frederick, MD, USA
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Allan Hildesheim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Mark P Purdue
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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Landy R, Schiffman M, Sasieni PD, Cheung LC, Katki HA, Rydzak G, Wentzensen N, Poitras NE, Lorey T, Kinney WK, Castle PE. Absolute risks of cervical precancer among women who fulfill exiting guidelines based on HPV and cytology cotesting. Int J Cancer 2020; 146:617-626. [PMID: 30861114 PMCID: PMC6742586 DOI: 10.1002/ijc.32268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/05/2019] [Accepted: 02/25/2019] [Indexed: 01/05/2023]
Abstract
US guidelines recommend that most women older than 65 years cease cervical screening after two consecutive negative cotests (concurrent HPV and cytology tests) in the previous 10 years, with one in the last 5 years. However, this recommendation was based on expert opinion and modeling rather than empirical data on cancer risk. We therefore estimated the 5-year risks of cervical precancer (cervical intraepithelial neoplasia grade 3 or adenocarcinoma in situ [CIN3]) after one, two and three negative cotests among 346,760 women aged 55-64 years undergoing routine cotesting at Kaiser Permanente Northern California (2003-2015). Women with a history of excisional treatment or CIN2+ were excluded. No woman with one or more negative cotests was diagnosed with cancer during follow-up. Five-year risks of CIN3 after one, two, and three consecutive negative cotests were 0.034% (95% CI: 0.023%-0.046%), 0.041% (95% CI: 0.007%-0.076%) and 0.016% (95% CI: 0.000%-0.052%), respectively (ptrend < 0.001). These risks did not appreciably differ by a positive cotest result prior to the one, two or three negative cotest(s). Since CIN3 risks after one or more negative cotests were significantly below a proposed 0.12% CIN3+ risk threshold for a 5-year screening interval, a longer screening interval in these women is justified. However, the choice of how many negative cotests provide sufficient safety against invasive cancer over a woman's remaining life represents a value judgment based on the harms versus benefits of continued screening. Ideally, this guideline should be informed by longer-term follow-up given that exiting is a long-term decision.
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Affiliation(s)
- Rebecca Landy
- Centre for Cancer PreventionWolfson Institute of Preventive Medicine, Queen Mary University of LondonLondonUnited Kingdom
- Division of Cancer Epidemiology and GeneticsNational Cancer Institute, National Institutes of Health, DHHSBethesdaMDUSA
| | - Mark Schiffman
- Division of Cancer Epidemiology and GeneticsNational Cancer Institute, National Institutes of Health, DHHSBethesdaMDUSA
| | - Peter D. Sasieni
- Faculty of Life Sciences & MedicineSchool of Cancer & Pharmaceutical Sciences, Guys Cancer Centre, Guys Hospital, King's College LondonLondonSE1 9RTUnited Kingdom
| | - Li C. Cheung
- Division of Cancer Epidemiology and GeneticsNational Cancer Institute, National Institutes of Health, DHHSBethesdaMDUSA
| | - Hormuzd A. Katki
- Division of Cancer Epidemiology and GeneticsNational Cancer Institute, National Institutes of Health, DHHSBethesdaMDUSA
| | - Greg Rydzak
- Information Management Services Inc.CalvertonMDUSA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and GeneticsNational Cancer Institute, National Institutes of Health, DHHSBethesdaMDUSA
| | - Nancy E. Poitras
- Regional LaboratoryKaiser Permanente Northern CaliforniaBerkeleyCAUSA
| | - Thomas Lorey
- Regional LaboratoryKaiser Permanente Northern CaliforniaBerkeleyCAUSA
| | - Walter K. Kinney
- Division of Gynaecologic OncologyKaiser Permanente Medical Care ProgramOaklandCAUSA
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Landy R, Houghton LC, Berg CD, Grubb RL, Katki HA, Black A. Risk of Prostate Cancer-related Death Following a Low PSA Level in the PLCO Trial. Cancer Prev Res (Phila) 2020; 13:367-376. [PMID: 31996370 DOI: 10.1158/1940-6207.capr-19-0397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/23/2019] [Accepted: 01/23/2020] [Indexed: 01/25/2023]
Abstract
Longer-than-annual screening intervals have been suggested to improve the balance of benefits and harms in prostate cancer screening. Many researchers, societies, and guideline committees have suggested that screening intervals could depend on the prostate-specific antigen (PSA) result. We analyzed data from men (N = 33,897) ages 55-74 years with a baseline PSA test in the intervention arm of the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial (United States, 1993-2001). We estimated 5- and 10-year risks of aggressive cancer (Gleason ≥8 and/or stage III/IV) and 15-year risks of prostate cancer-related mortality for men with baseline PSA ≤ 0.5 ng/mL (N = 4,862), ≤1 ng/mL (N = 15,110), and 1.01-2.5 ng/mL (N = 12,422). A total of 217 men died from prostate cancer through 15 years, although no men with PSA ≤ 1 ng/mL died from prostate cancer within 5 years [95% confidence interval (CI), 0.00%-0.03%]. The 5-year incidence of aggressive disease was low (0.08%; 95% CI, 0.03%-0.12%) for men with PSA ≤ 1 ng/mL, and higher for men with baseline PSA 1.01-2.5 ng/mL (0.51%; 95% CI, 0.38%-0.74%). No men aged ≥65 years with PSA ≤ 0.5 ng/mL died from prostate cancer within 15 years (95% CI, 0.00%-0.32%), and their 10-year incidence of aggressive disease was low (0.25%; 95% CI, 0.00%-0.53%). Compared with white men, black men with PSA ≤ 1 ng/mL had higher 10-year rates of aggressive disease (1.6% vs. 0.4%; P < 0.01). Five-year screening intervals may be appropriate for the 45% of men with PSA ≤ 1 ng/mL. Men ages ≥65 years with PSA ≤ 0.5 ng/mL could consider stopping screening. Substantial risk disparities suggest appropriate screening intervals could depend on race/ethnicity.
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Affiliation(s)
- Rebecca Landy
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland.
| | - Lauren C Houghton
- Mailman School of Public Health, Columbia University, New York, New York
| | - Christine D Berg
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Robert L Grubb
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
| | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Amanda Black
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland.
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Landy R, Cheung LC, Berg CD, Chaturvedi AK, Robbins HA, Katki HA. Contemporary Implications of U.S. Preventive Services Task Force and Risk-Based Guidelines for Lung Cancer Screening Eligibility in the United States. Ann Intern Med 2019; 171:384-386. [PMID: 31158854 PMCID: PMC6822170 DOI: 10.7326/m18-3617] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Rebecca Landy
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland (R.L., L.C.C., C.D.B., A.K.C., H.A.K.)
| | - Li C Cheung
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland (R.L., L.C.C., C.D.B., A.K.C., H.A.K.)
| | - Christine D Berg
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland (R.L., L.C.C., C.D.B., A.K.C., H.A.K.)
| | - Anil K Chaturvedi
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland (R.L., L.C.C., C.D.B., A.K.C., H.A.K.)
| | - Hilary A Robbins
- International Agency for Research on Cancer, Lyon, France (H.A.R.)
| | - Hormuzd A Katki
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland (R.L., L.C.C., C.D.B., A.K.C., H.A.K.)
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Robbins HA, Katki HA, Cheung LC, Landy R, Berg CD. Insights for Management of Ground-Glass Opacities From the National Lung Screening Trial. J Thorac Oncol 2019; 14:1662-1665. [PMID: 31125735 PMCID: PMC6909540 DOI: 10.1016/j.jtho.2019.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/12/2019] [Accepted: 05/11/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND In the National Lung Screening Trial (NLST), screen-detected cancers that would not have been identified by the Lung Computed Tomographic Screening Reporting and Data System (Lung-RADS) nodule management guidelines were frequently ground-glass opacities (GGOs). Lung-RADS suggests that GGOs with diameter less than 20 mm return for annual screening, and GGOs greater than or equal to 20 mm receive 6-month follow-up. We examined whether this 20-mm threshold gives consistent management of GGOs compared with solid nodules. METHODS First, we calculated diameter-specific malignancy probabilities for GGOs and solid nodules in the NLST. Using the solid-nodule malignancy risks as benchmarks, we suggested risk-based management categories for GGOs based on their probability of malignancy. Second, we compared lung-cancer mortality between GGOs and solid nodules in the same risk-based category. RESULTS Using the Lung-RADS v1.0 classifications, malignancy probability is higher for GGOs than solid nodules within the same category. A risk-based classification of GGOs would assign annual screening for GGOs 4 to 5 mm (0.4% malignancy risk); 6-month follow-up for GGOs 6 to 7 mm (1.1%), 8 to 14 mm (3.0%), and 15 to 19 mm (5.2%); and 3-month follow-up for greater than or equal to 20 mm (10.9%). This reclassification would have assigned similarly fatal cancers to 3-month follow-up (hazard ratio = 2.0 for lung-cancer death in GGOs versus solid-nodule cancers, 95% confidence interval: 0.4-8.7), but for 6-month follow-up, mortality was lower in GGO cancers (hazard ratio = 0.18, 95% confidence interval: 0.05-0.67). CONCLUSIONS If Lung-RADS categories for GGOs were based on malignancy probability, then 6- to 19-mm GGOs would receive 6-month follow-up and greater than or equal to 20-mm GGOs would receive 3-month follow-up. Such risk-based management for GGOs could improve the sensitivity of Lung-RADS, especially for large GGO cancers. However, small GGO cancers were less aggressive than their solid-nodule counterparts.
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Affiliation(s)
| | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Li C Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Christine D Berg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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Iftner T, Neis KJ, Castanon A, Landy R, Holz B, Woll-Herrmann A, Iftner A, Staebler A, Wallwiener D, Hann von Weyhern C, Neis F, Haedicke-Jarboui J, Martus P, Brucker S, Henes M, Sasieni P. Longitudinal Clinical Performance of the RNA-Based Aptima Human Papillomavirus (AHPV) Assay in Comparison to the DNA-Based Hybrid Capture 2 HPV Test in Two Consecutive Screening Rounds with a 6-Year Interval in Germany. J Clin Microbiol 2019; 57:e01177-18. [PMID: 30355760 PMCID: PMC6322477 DOI: 10.1128/jcm.01177-18] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/08/2018] [Indexed: 11/20/2022] Open
Abstract
Longitudinal data on the E6/E7 mRNA-based Aptima human papillomavirus (AHPV) assay exceeding three years in comparison to the gold standard Digene Hybrid Capture 2 (HC2) test are not available. We previously reported the cross-sectional data of the German AHPV Screening Trial (GAST) in which 10,040 women were recruited and tested by liquid-based cytology, the HC2 assay, and the AHPV assay. Four hundred eleven test-positive women were followed for up to six years. In addition, 3,295 triple-negative women were screened after a median time of six years. Overall, 28 high-grade cervical intraepithelial neoplasia (CIN3) cases were detected. The absolute risk of developing high-risk HPV-positive CIN3+ over six years among those women that tested negative at baseline was 2.2 (95% confidence interval [95% CI], 1.0 to 4.9) and 3.1 (95% CI, 1.7 to 5.7) per 1,000 women screened by the HC2 and the AHPV tests; the additional risk for those with AHPV-negative compared with HC2-negative results was 0.9 (95% CI, -0.2 to 2.1) per 1,000. In comparison, the absolute risk following a negative LBC test was 9.3 (95% CI, 2.9 to 30.2). The relative sensitivity of AHPV compared to HC2 was 91.5% for CIN3+, and the negative predictive values were 99.8% (95% CI, 99.5 to 99.9%) for HC2 and 99.7% (95% CI, 99.4 to 99.8%) for AHPV. Our data show that the longitudinal performance of the AHPV test over six years is comparable to the performance of the HC2 test and that the absolute risk of CIN3+ over six years following a negative AHPV result in a screening population is low. (This study is registered at ClinicalTrials.gov under registration number NCT02634190.).
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Affiliation(s)
- Thomas Iftner
- Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital Tübingen, Tübingen, Germany
| | | | - Alejandra Castanon
- Centre for Cancer Prevention, Queen Mary University of London, London, United Kingdom
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Rebecca Landy
- Centre for Cancer Prevention, Queen Mary University of London, London, United Kingdom
| | - Barbara Holz
- Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital Tübingen, Tübingen, Germany
| | | | - Angelika Iftner
- Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Annette Staebler
- Department of Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Diethelm Wallwiener
- Department of Gynaecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | - Claus Hann von Weyhern
- Department of Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Felix Neis
- Department of Gynaecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | - Juliane Haedicke-Jarboui
- Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Peter Martus
- Medical Faculty Tübingen, Institute for Clinical Epidemiology and Applied Biometry, Tübingen, Germany
| | - Sara Brucker
- Department of Gynaecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | - Melanie Henes
- Department of Gynaecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | - Peter Sasieni
- Centre for Cancer Prevention, Queen Mary University of London, London, United Kingdom
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
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Hanson S, Gilbert D, Landy R, Okoli G, Guell C. Cancer risk in socially marginalised women: An exploratory study. Soc Sci Med 2019; 220:150-158. [PMID: 30445340 PMCID: PMC6323356 DOI: 10.1016/j.socscimed.2018.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/13/2018] [Accepted: 11/05/2018] [Indexed: 12/02/2022]
Abstract
BACKGROUND Cancer is a leading cause of premature death in women worldwide, and is associated with socio-economic disadvantage. Yet many interventions designed to reduce risk and improve health fail to reach the most marginalised with the greatest needs. Our study focused on socially marginalised women at two women's centres that provide support and training to women in the judicial system or who have experienced domestic abuse. METHODS This qualitative study was framed within a sociological rather than behavioural perspective involving thirty participants in individual interviews and focus groups. It sought to understand perceptions of, and vulnerability to, cancer; decision making (including screening); cancer symptom awareness; and views on health promoting activities within the context of the women's social circumstances. FINDINGS Women's experiences of social adversity profoundly shaped their practices, aspirations and attitudes towards risk, health and healthcare. We found that behaviours such as unhealthy eating and smoking need to be understood in the context of inherently risky lives. They were a coping mechanism whilst living in extreme adverse circumstances, navigating complex everyday lives and structural failings. Long term experiences of neglect, harm and violence, often by people they should be able to trust, led to low self-esteem and influenced their perceptions of risk and self-care. This was reinforced by negative experiences of navigating state services and a lack of control and agency over their own lives. CONCLUSION Women in this study were at high risk of cancer, but it would be better to understand these risk factors as markers of distress and duress. Without appreciating the wider determinants of health and systemic disadvantage of marginalised groups, and addressing these with a structural rather than an individual response, we risk increasing cancer inequities by failing those who are in the greatest need.
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Affiliation(s)
- Sarah Hanson
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK.
| | | | | | | | - Cornelia Guell
- European Centre for Environment and Human Health, University of Exeter Medical School, UK
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Gravitt PE, Landy R, Schiffman M. How confident can we be in the current guidelines for exiting cervical screening? Prev Med 2018; 114:188-192. [PMID: 29981791 DOI: 10.1016/j.ypmed.2018.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 06/15/2018] [Accepted: 07/04/2018] [Indexed: 01/08/2023]
Abstract
Current US guidelines recommend against cervical screening beyond age 65 in women who have had adequate negative screening. In anticipation of the next round of evidence review and guideline updates, we provide a critical review of the evidence supporting the exiting recommendation in the US, highlighting both practice changes and new insights into the epidemiology and natural history of HPV and cervical cancer. Current recommendations are based, by necessity, on cytology alone, and will be limited in generalizability to evolving screening strategies with co-testing and primary HPV testing. The lack of empirical data to define what constitutes 'adequate recent screening with negative results' is compounded by difficulties in predicting future risk without consideration of concepts of HPV latency and cohort effects of changing sexual behaviour in US women over time. We urge caution in extrapolating past risk experience in post-menopausal women to today's population, and suggest study designs to strengthen the evidence base in well-screened older women. We further recommend building the qualitative evidence base to better define the harms and benefits of screening among older women. Extending the lifetime of screening is a matter of finding the appropriate balance of benefits of cancer reduction and limitation of harms and costs of 'overscreening'. This will require moving beyond current emphasis on number of colposcopies as the metric of harm. Our commentary is meant to stimulate intellectual debate regarding the certainty of our existing knowledge base and set clear research priorities for the future.
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Affiliation(s)
- Patti E Gravitt
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
| | - Rebecca Landy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
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Landy R, Cheung LC, Schiffman M, Gage JC, Hyun N, Wentzensen N, Kinney WK, Castle PE, Fetterman B, Poitras NE, Lorey T, Sasieni PD, Katki HA. Challenges in risk estimation using routinely collected clinical data: The example of estimating cervical cancer risks from electronic health-records. Prev Med 2018; 111:429-435. [PMID: 29222045 PMCID: PMC5930038 DOI: 10.1016/j.ypmed.2017.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/27/2017] [Accepted: 12/04/2017] [Indexed: 11/28/2022]
Abstract
Electronic health-records (EHR) are increasingly used by epidemiologists studying disease following surveillance testing to provide evidence for screening intervals and referral guidelines. Although cost-effective, undiagnosed prevalent disease and interval censoring (in which asymptomatic disease is only observed at the time of testing) raise substantial analytic issues when estimating risk that cannot be addressed using Kaplan-Meier methods. Based on our experience analysing EHR from cervical cancer screening, we previously proposed the logistic-Weibull model to address these issues. Here we demonstrate how the choice of statistical method can impact risk estimates. We use observed data on 41,067 women in the cervical cancer screening program at Kaiser Permanente Northern California, 2003-2013, as well as simulations to evaluate the ability of different methods (Kaplan-Meier, Turnbull, Weibull and logistic-Weibull) to accurately estimate risk within a screening program. Cumulative risk estimates from the statistical methods varied considerably, with the largest differences occurring for prevalent disease risk when baseline disease ascertainment was random but incomplete. Kaplan-Meier underestimated risk at earlier times and overestimated risk at later times in the presence of interval censoring or undiagnosed prevalent disease. Turnbull performed well, though was inefficient and not smooth. The logistic-Weibull model performed well, except when event times didn't follow a Weibull distribution. We have demonstrated that methods for right-censored data, such as Kaplan-Meier, result in biased estimates of disease risks when applied to interval-censored data, such as screening programs using EHR data. The logistic-Weibull model is attractive, but the model fit must be checked against Turnbull non-parametric risk estimates.
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Affiliation(s)
- Rebecca Landy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, Charterhouse Square, London EC1M 6BQ, UK.
| | - Li C Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Julia C Gage
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Noorie Hyun
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Walter K Kinney
- Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA, USA
| | | | - Barbara Fetterman
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, USA
| | - Nancy E Poitras
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, USA
| | - Thomas Lorey
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, USA
| | - Peter D Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
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Landy R, Windridge P, Gillman MS, Sasieni PD. What cervical screening is appropriate for women who have been vaccinated against high risk HPV? A simulation study. Int J Cancer 2018; 142:709-718. [PMID: 29023748 PMCID: PMC5765470 DOI: 10.1002/ijc.31094] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/14/2017] [Accepted: 10/02/2017] [Indexed: 11/06/2022]
Abstract
Women vaccinated against HPV16/18 are approaching the age for cervical screening; however, an updated screening algorithm has not been agreed. We use a microsimulation model calibrated to real published data to determine the appropriate screening intensity for vaccinated women. Natural histories in the absence of vaccination were simulated for 300,000 women using 10,000 sets of transition probabilities. Vaccination with (i) 100% efficacy against HPV16/18, (ii) 15% cross-protection, (iii) 22% cross-protection, (iv) waning vaccine efficacy and (v) 100% efficacy against HPV16/18/31/33/45/52/58 was added, as were a range of screening scenarios appropriate to the UK. To benchmark cost-benefits of screening for vaccinated women, we evaluated the proportion of cancers prevented per additional screen (incremental benefit) of current cytology and likely HPV screening scenarios in unvaccinated women. Slightly more cancers are prevented through vaccination with no screening (70.3%, 95% CR: 65.1-75.5) than realistic compliance to the current UK screening programme in the absence of vaccination (64.3%, 95% CR: 61.3-66.8). In unvaccinated women, when switching to HPV primary testing, there is no loss in effectiveness when doubling the screening interval. Benchmarking supports screening scenarios with incremental benefits of ≥2.0%, and rejects scenarios with incremental benefits ≤0.9%. In HPV16/18-vaccinated women, the incremental benefit of offering a third lifetime screen was at most 3.3% (95% CR: 2.2-4.5), with an incremental benefit of 1.3% (-0.3-2.8) for a fourth screen. For HPV16/18/31/33/45/52/58-vaccinated women, two lifetime screens are supported. It is important to know women's vaccination status; in these simulations, HPV16/18-vaccinated women require three lifetime screens, HPV16/18/31/33/45/52/58-vaccinated women require two lifetime screens, yet unvaccinated women require seven lifetime screens.
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Affiliation(s)
- Rebecca Landy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of MedicineQueen Mary University of London, Charterhouse SquareLondonEC1M 6BQUK
| | - Peter Windridge
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of MedicineQueen Mary University of London, Charterhouse SquareLondonEC1M 6BQUK
| | - Matthew S. Gillman
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of MedicineQueen Mary University of London, Charterhouse SquareLondonEC1M 6BQUK
| | - Peter D. Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of MedicineQueen Mary University of London, Charterhouse SquareLondonEC1M 6BQUK
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Castanon A, Landy R, Pesola F, Windridge P, Sasieni P. Prediction of cervical cancer incidence in England, UK, up to 2040, under four scenarios: a modelling study. Lancet Public Health 2018; 3:e34-e43. [PMID: 29307386 PMCID: PMC5765529 DOI: 10.1016/s2468-2667(17)30222-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND In the next 25 years, the epidemiology of cervical cancer in England, UK, will change: human papillomavirus (HPV) screening will be the primary test for cervical cancer. Additionally, the proportion of women screened regularly is decreasing and women who received the HPV vaccine are due to attend screening for the first time. Therefore, we aimed to estimate how vaccination against HPV, changes to the screening test, and falling screening coverage will affect cervical cancer incidence in England up to 2040. METHODS We did a data modelling study that combined results from population modelling of incidence trends, observable data from the individual level with use of a generalised linear model, and microsimulation of unobservable disease states. We estimated age-specific absolute risks of cervical cancer in the absence of screening (derived from individual level data). We used an age period cohort model to estimate birth cohort effects. We multiplied the absolute risks by the age cohort effects to provide absolute risks of cervical cancer for unscreened women in different birth cohorts. We obtained relative risks (RRs) of cervical cancer by screening history (never screened, regularly screened, or lapsed attender) using data from a population-based case-control study for unvaccinated women, and using a microsimulation model for vaccinated women. RRs of primary HPV screening were relative to cytology. We used the proportion of women in each 5-year age group (25-29 years to 75-79 years) and 5-year period (2016-20 to 2036-40) who have a combination of screening and vaccination history, and weighted to estimate the population incidence. The primary outcome was the number of cases and rates per 100 000 women under four scenarios: no changes to current screening coverage or vaccine uptake and HPV primary testing from 2019 (status quo), changing the year in which HPV primary testing is introduced, introduction of the nine-valent vaccine, and changes to cervical screening coverage. FINDINGS The status quo scenario estimated that the peak age of cancer diagnosis will shift from the ages of 25-29 years in 2011-15 to 55-59 years in 2036-40. Unvaccinated women born between 1975 and 1990 were predicted to have a relatively high risk of cervical cancer throughout their lives. Introduction of primary HPV screening from 2019 could reduce age-standardised rates of cervical cancer at ages 25-64 years by 19%, from 15·1 in 2016 to 12·2 per 100 000 women as soon as 2028. Vaccination against HPV types 16 and 18 (HPV 16/18) could see cervical cancer rates in women aged 25-29 years decrease by 55% (from 20·9 in 2011-15 to 9·5 per 100 000 women by 2036-40), and introduction of nine-valent vaccination from 2019 compared with continuing vaccination against HPV 16/18 will reduce rates by a further 36% (from 9·5 to 6·1 per 100 000 women) by 2036-40. Women born before 1991 will not benefit directly from vaccination; therefore, despite vaccination and primary HPV screening with current screening coverage, European age-standardised rates of cervical cancer at ages 25-79 years will decrease by only 10% (from 12·8 in 2011-15 to 11·5 per 100 000 women in 2036-40). If screening coverage fell to 50%, European age-standardised rates could increase by 27% (from 12·8 to 16·3 per 100 000 by 2036-40). INTERPRETATION Going forward, focus should be placed on scenarios that offer less intensive screening for vaccinated women and more on increasing coverage and incorporation of new technologies to enhance current cervical screening among unvaccinated women. FUNDING Jo's Cervical Cancer Trust and Cancer Research UK.
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Affiliation(s)
- Alejandra Castanon
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
| | - Rebecca Landy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Francesca Pesola
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Peter Windridge
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Peter Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK; Bermondsey Wing, Guy's and St Thomas', Kings College London, London, UK
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Castanon A, Landy R, Michalopoulos D, Bhudia R, Leaver H, Qiao YL, Zhao F, Sasieni P. Systematic Review and Meta-Analysis of Individual Patient Data to Assess the Sensitivity of Cervical Cytology for Diagnosis of Cervical Cancer in Low- and Middle-Income Countries. J Glob Oncol 2017; 3:524-538. [PMID: 29094092 PMCID: PMC5646897 DOI: 10.1200/jgo.2016.008011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To assess the sensitivity of cervical cytology to cancer by pooling individual patient cytology results from cancers diagnosed in studies that assessed cervical screening in low- and middle-income countries. METHODS Two authors reviewed studies identified through PubMed and Embase databases. We included studies that reported cervical cytology in which at least one woman was diagnosed with cervical cancer and in which abnormal cytology results were investigated at colposcopy and through a histologic sample (if appropriate). When cytology results were not reported in the manuscript, authors were contacted. Stratified analyses and meta-regression were performed to assess sources of heterogeneity between studies. RESULTS We included 717 cancers from 23 studies. The pooled sensitivity of cytology to cancer at a cutoff of a high-grade squamous intraepithelial lesion (HSIL) or worse was 79.4% (95% CI, 67.7% to 86.0%). Results from stratified analyses did not differ significantly, except among studies that recruited symptomatic women or women referred because of abnormal cytology, when the sensitivity of cytology was much higher (95.9%; 95% CI, 86.5% to 99.9%). The cutoff of an HSIL or worse detected 85% of the cancers that would have been detected at a cutoff of atypical squamous cells of undetermined significance or worse (relative sensitivity, 85.2%; 95% CI, 80.7% to 89.7%). CONCLUSION Cytology at a high cutoff could be an excellent tool for targeted screening of populations at high risk of cervical cancer with a view to diagnose cancer at an earlier stage.
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Affiliation(s)
- Alejandra Castanon
- AlejandraCastanon,Rebecca Landy, Dimitrios Michalopoulos, Roshni Bhudia, Hannah Leaver, and Peter Sasieni, Wolfson Institute of Preventive Medicine, London, United Kingdom; and You Lin Qiao and Fanghui Zhao, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Rebecca Landy
- AlejandraCastanon,Rebecca Landy, Dimitrios Michalopoulos, Roshni Bhudia, Hannah Leaver, and Peter Sasieni, Wolfson Institute of Preventive Medicine, London, United Kingdom; and You Lin Qiao and Fanghui Zhao, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Dimitrios Michalopoulos
- AlejandraCastanon,Rebecca Landy, Dimitrios Michalopoulos, Roshni Bhudia, Hannah Leaver, and Peter Sasieni, Wolfson Institute of Preventive Medicine, London, United Kingdom; and You Lin Qiao and Fanghui Zhao, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Roshni Bhudia
- AlejandraCastanon,Rebecca Landy, Dimitrios Michalopoulos, Roshni Bhudia, Hannah Leaver, and Peter Sasieni, Wolfson Institute of Preventive Medicine, London, United Kingdom; and You Lin Qiao and Fanghui Zhao, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hannah Leaver
- AlejandraCastanon,Rebecca Landy, Dimitrios Michalopoulos, Roshni Bhudia, Hannah Leaver, and Peter Sasieni, Wolfson Institute of Preventive Medicine, London, United Kingdom; and You Lin Qiao and Fanghui Zhao, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - You Lin Qiao
- AlejandraCastanon,Rebecca Landy, Dimitrios Michalopoulos, Roshni Bhudia, Hannah Leaver, and Peter Sasieni, Wolfson Institute of Preventive Medicine, London, United Kingdom; and You Lin Qiao and Fanghui Zhao, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Fanghui Zhao
- AlejandraCastanon,Rebecca Landy, Dimitrios Michalopoulos, Roshni Bhudia, Hannah Leaver, and Peter Sasieni, Wolfson Institute of Preventive Medicine, London, United Kingdom; and You Lin Qiao and Fanghui Zhao, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Peter Sasieni
- AlejandraCastanon,Rebecca Landy, Dimitrios Michalopoulos, Roshni Bhudia, Hannah Leaver, and Peter Sasieni, Wolfson Institute of Preventive Medicine, London, United Kingdom; and You Lin Qiao and Fanghui Zhao, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Landy R, Head J, Richards M, Hardy R. The effect of life course socioeconomic position on crystallised cognitive ability in two large UK cohort studies: a structured modelling approach. BMJ Open 2017; 7:e014461. [PMID: 28576891 PMCID: PMC5541359 DOI: 10.1136/bmjopen-2016-014461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study systematically compared accumulation, sensitive period, critical period and social mobility models relating life course socioeconomic position (SEP) and adult crystallised cognitive ability, which has not been comprehensively investigated. DESIGN Two prospective cohort studies. PARTICIPANTS Five thousand three hundred and sixty-two participants in the Medical Research Council National Survey of Health and Development (NSHD) Birth Cohort Study and 10 308 participants in the Whitehall II Occupational Cohort Study. MEASURES Childhood SEP was measured by father's occupational SEP, early adulthood SEP by educational qualifications and adult SEP by own occupational SEP. Each life course model was compared with a saturated model. RESULTS Using multiple imputation to account for missing data, the sensitive period model, which contained childhood, early adulthood and adult SEP terms, with different coefficients, provided the best fit for both men and women in the NSHD and Whitehall II cohorts. Early adulthood SEP had the largest coefficient in NSHD women, whereas for NSHD men early adulthood and adult SEP had similar coefficients. In Whitehall II adult SEP had the largest effect size for both men and women. CONCLUSIONS Sensitive period with all three time periods was the most appropriate life course models for adult crystallised cognitive ability in both cohorts, including an effect of childhood SEP. It is important to directly compare the life course models to determine which is the most appropriate.
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Affiliation(s)
- Rebecca Landy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University of London, London, UK
| | - Jenny Head
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Rebecca Hardy
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
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Castanon A, Landy R, Sasieni P. By how much could screening by primary human papillomavirus testing reduce cervical cancer incidence in England? J Med Screen 2017; 24:110-112. [PMID: 27363972 PMCID: PMC5490776 DOI: 10.1177/0969141316654197] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 05/20/2016] [Indexed: 11/29/2022]
Abstract
Objective The replacement of cytology with human papillomavirus testing as the primary cervical screening test in England is imminent. In light of newly available evidence, we revised our previous estimates of the likely impact of primary human papillomavirus testing on incidence of cervical cancer. Method and results Using screening data on women aged 25-64 diagnosed with cervical cancer in England between 1988 and 2012, we previously reported that 38.8% had a negative test six months to six years prior to diagnosis. However, not all of these cancers would be prevented by human papillomavirus testing: for 1.0% the human papillomavirus positive test would come too late (within 18 months of diagnosis) to make a difference; 7.6% will have a negative human papillomavirus test (based on 79.9% sensitivity of human papillomavirus testing in cytology negative women); and 2.0% will develop cancer despite a positive human papillomavirus test. Additionally, we estimate that some women (equivalent to 4.3% of current incidence) whose cancers are currently prevented by cytology-based screening will have a false-negative human papillomavirus test. Conclusion Overall, we estimate that 23.9% (95% CI: 19.3-27.6%) of current cases in women invited for screening could be prevented. Based on 2013 cancer incidence statistics, absolute numbers could be reduced by 487 (95% CI 394 to 563) or 3.4 (95% CI 2.8 to 4.0) per 100,000 women per year.
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Affiliation(s)
- Alejandra Castanon
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Rebecca Landy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Peter Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
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Speedie JMM, Mansour D, Landy R, Clement KM. Authors' response to 'Cervical grasping and stabilising forceps'. J Fam Plann Reprod Health Care 2016; 43:77-78. [PMID: 28007825 DOI: 10.1136/jfprhc-2016-101683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lim AW, Landy R, Castanon A, Hollingworth A, Hamilton W, Dudding N, Sasieni P. Cytology in the diagnosis of cervical cancer in symptomatic young women: a retrospective review. Br J Gen Pract 2016; 66:e871-e879. [PMID: 27777232 PMCID: PMC5198672 DOI: 10.3399/bjgp16x687937] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/27/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cervical cancer in young women presents a diagnostic challenge because gynaecological symptoms are common but underlying disease is rare. AIM To explore the potential for using cytology as a diagnostic aid for cervical cancer in young women. DESIGN AND SETTING Retrospective review of primary care records and cytology data from the national cervical screening database and national audit of cervical cancers. METHOD Four datasets of women aged 20-29 years in England were examined: primary care records and national screening data from an in-depth study of cervical cancers; cytology from the national audit of cervical cancers; whole-population cytology from the national screening database; and general-population primary care records from the Clinical Practice Research Datalink. The authors explored the sensitivity and positive predictive value (PPV) of symptomatic cytology (earliest <12 months before diagnosis) to cervical cancer. RESULTS The estimated prevalence of cervical cancer among symptomatic women was between 0.4% and 0.9%. The sensitivity of moderate dyskaryosis (high-grade squamous intraepithelial lesion [HSIL]) or worse in women aged 20-29 years was 90.9% to 96.2% across datasets, regardless of symptom status. The PPV was estimated to be between 10.0% and 30.0%. For women aged 20-24 years, the PPV of '?invasive squamous carcinoma' was 25.4%, and 2.0% for severe or worse cytology. CONCLUSION Cytology has value beyond screening, and could be used as a diagnostic aid for earlier detection of cervical cancer in young women with gynaecological symptoms by ruling in urgent referral.
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Affiliation(s)
- Anita Ww Lim
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London
| | - Rebecca Landy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London
| | - Alejandra Castanon
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London
| | - Antony Hollingworth
- Department of Gynaecology, Whipps Cross University Hospital, Barts Health NHS Trust, London
| | - Willie Hamilton
- Department of Primary Care, St Luke's Campus, University of Exeter, Exeter
| | - Nick Dudding
- East Pennine Cytology Training Centre, Raynham House, Leeds
| | - Peter Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London
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Landy R, Pesola F, Castañón A, Sasieni P. Impact of cervical screening on cervical cancer mortality: estimation using stage-specific results from a nested case-control study. Br J Cancer 2016; 115:1140-1146. [PMID: 27632376 PMCID: PMC5117785 DOI: 10.1038/bjc.2016.290] [Citation(s) in RCA: 220] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/13/2016] [Accepted: 08/15/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND It is well established that screening can prevent cervical cancer, but the magnitude of the impact of regular screening on cervical cancer mortality is unknown. METHODS Population-based case-control study using prospectively recorded cervical screening data, England 1988-2013. Case women had cervical cancer diagnosed during April 2007-March 2013 aged 25-79 years (N=11 619). Two cancer-free controls were individually age matched to each case. We used conditional logistic regression to estimate the odds ratio (OR) of developing stage-specific cancer for women regularly screened or irregularly screened compared with women not screened in the preceding 15 years. Mortality was estimated from excess deaths within 5 years of diagnosis using stage-specific 5-year relative survival from England with adjustment for age within stage based on SEER (Surveillance, Epidemiology and End Results, USA) data. RESULTS In women aged 35-64 years, regular screening is associated with a 67% (95% confidence interval (CI): 62-73%) reduction in stage 1A cancer and a 95% (95% CI: 94-97%) reduction in stage 3 or worse cervical cancer: the estimated OR comparing regular (⩽5.5yearly) screening to no (or minimal) screening are 0.18 (95% CI: 0.16-0.19) for cancer incidence and 0.08 (95% CI: 0.07-0.09) for mortality. It is estimated that in England screening currently prevents 70% (95% CI: 66-73%) of cervical cancer deaths (all ages); however, if everyone attended screening regularly, 83% (95% CI: 82-84%) could be prevented. CONCLUSIONS The association between cervical cancer screening and incidence is stronger in more advanced stage cancers, and screening is more effective at preventing death from cancer than preventing cancer itself.
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Affiliation(s)
- Rebecca Landy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Bart's & The London School of Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Francesca Pesola
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Bart's & The London School of Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Alejandra Castañón
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Bart's & The London School of Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Peter Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Bart's & The London School of Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
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Speedie JMM, Mansour D, Landy R, Clement KM. A randomised trial comparing pain and ease of use of two different stabilising forceps for insertion of intrauterine contraception. J Fam Plann Reprod Health Care 2016; 42:241-246. [DOI: 10.1136/jfprhc-2016-101446] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 06/27/2016] [Accepted: 07/05/2016] [Indexed: 11/04/2022]
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Wahrendorf M, Akinwale B, Landy R, Matthews K, Blane D. Who in Europe Works beyond the State Pension Age and under which Conditions? Results from SHARE. J Popul Ageing 2016; 10:269-285. [PMID: 28890742 PMCID: PMC5569122 DOI: 10.1007/s12062-016-9160-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 09/05/2016] [Indexed: 11/28/2022]
Abstract
There is much research about those who exit the labour market prematurely, however, comparatively little is known about people working longer and about their employment and working conditions. In this paper, we describe the employment and working conditions of men and women working between 65 and 80 years, and compare them with previous conditions of those retired in the same age group. Analyses are based on wave 4 data from the Survey of Health, Ageing and Retirement in Europe (SHARE) with information collected between 2009 and 2011 from 17,625 older men and women across 16 European countries. Besides socio-demographic and health-related factors (physical and mental health), the focus lies on employment conditions (e.g. employment status, occupational position and working hours) and on stressful working conditions, measured in terms of low control at work and effort-reward imbalance. In case of retired people, information on working conditions refer to the last job before retirement. Following descriptive analyses, we then conduct multivariable analyses and investigate how working conditions and poor health are related to labour market participation (i.e. random intercept models accounting for country affiliation and adjusted for potential confounders). Results illustrate that people working between the ages of 65 and 80 are more likely to be self-employed (either with or without employees) and work in advantaged occupational positions. Furthermore, findings reveal that psychosocial working conditions are generally better than the conditions retired respondents had in their last job. Finally, in contrast to those who work, health tends to be worse among retired people. In conclusion, findings deliver empirical evidence that paid employment beyond age 65 is more common among self-employed workers throughout Europe, in advantaged occupations and under-favourable psychosocial circumstances, and that this group of workers are in considerably good mental and physical health. This highlights that policies aimed at increasing the state pension age beyond the age of 65 years put pressure on specific disadvantaged groups of men and women.
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Affiliation(s)
- Morten Wahrendorf
- Institute for Medical Sociology, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Bola Akinwale
- International Centre for Life Course Studies in Society and Health, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Rebecca Landy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Katey Matthews
- Cathie Marsh Institute for Social Research, University of Manchester, Manchester, UK
| | - David Blane
- International Centre for Life Course Studies in Society and Health, Department of Epidemiology and Public Health, University College London, London, UK
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Castanon A, Landy R, Sasieni PD. Is cervical screening preventing adenocarcinoma and adenosquamous carcinoma of the cervix? Int J Cancer 2016; 139:1040-5. [PMID: 27096255 PMCID: PMC4915496 DOI: 10.1002/ijc.30152] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 04/12/2016] [Indexed: 11/17/2022]
Abstract
While the incidence of squamous carcinoma of the cervix has declined in countries with organised screening, adenocarcinoma has become more common. Cervical screening by cytology often fails to prevent adenocarcinoma. Using prospectively recorded cervical screening data in England and Wales, we conducted a population-based case-control study to examine whether cervical screening leads to early diagnosis and down-staging of adenocarcinoma. Conditional logistic regression modelling was carried out to provide odds ratios (ORs) and 95% confidence intervals (CIs) on 12,418 women with cervical cancer diagnosed between ages 30 and 69 and 24,453 age-matched controls. Of women with adenocarcinoma of the cervix, 44.3% were up to date with screening and 14.6% were non-attenders. The overall OR comparing women up to date with screening with non-attenders was 0.46 (95% CI: 0.39-0.55) for adenocarcinoma. The odds were significantly decreased (OR: 0.22, 95% CI: 0.15-0.33) in up to date women with Stage 2 or worse adenocarcinoma, but not for women with Stage1A adenocarcinoma 0.71 (95% CI: 0.46-1.09). The odds of Stage 1A adenocarcinoma was double among lapsed attenders (OR: 2.35, 95% CI: 1.52-3.62) compared to non-attenders. Relative to women with no negative cytology within 7 years of diagnosis, women with Stage1A adenocarcinoma were very unlikely to be detected within 3 years of a negative cytology test (OR: 0.08, 95% CI: 0.05-0.13); however, the odds doubled 3-5 years after a negative test (OR: 2.30, 95% CI: 1.67-3.18). ORs associated with up to date screening were smaller for squamous and adenosquamous cervical carcinoma. Although cytology screening is inefficient at preventing adenocarcinomas, invasive adenocarcinomas are detected earlier than they would be in the absence of screening, substantially preventing Stage 2 and worse adenocarcinomas.
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Affiliation(s)
- Alejandra Castanon
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Bart's and the London School of MedicineQueen Mary University of LondonCharterhouse SquareLondonUnited Kingdom
| | - Rebecca Landy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Bart's and the London School of MedicineQueen Mary University of LondonCharterhouse SquareLondonUnited Kingdom
| | - Peter D. Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Bart's and the London School of MedicineQueen Mary University of LondonCharterhouse SquareLondonUnited Kingdom
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Sasieni P, Castanon A, Landy R, Kyrgiou M, Kitchener H, Quigley M, Poon LCY, Shennan A, Hollingworth A, Soutter WP, Freeman‐Wang T, Peebles D, Prendiville W, Patnick J. Risk of preterm birth following surgical treatment for cervical disease: executive summary of a recent symposium. BJOG 2016; 123:1426-9. [PMID: 26695087 PMCID: PMC5064613 DOI: 10.1111/1471-0528.13839] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2015] [Indexed: 11/06/2022]
Affiliation(s)
- P Sasieni
- Centre for Cancer PreventionWolfson Institute of Preventive MedicineQueen Mary University of LondonLondonUK
| | - A Castanon
- Centre for Cancer PreventionWolfson Institute of Preventive MedicineQueen Mary University of LondonLondonUK
| | - R Landy
- Centre for Cancer PreventionWolfson Institute of Preventive MedicineQueen Mary University of LondonLondonUK
| | - M Kyrgiou
- Institute of Reproduction and Developmental BiologyDepartment of Surgery & CancerImperial CollegeLondonUK
| | - H Kitchener
- Institute of Cancer SciencesSt Mary's HospitalUniversity of ManchesterManchesterUK
| | - M Quigley
- National Perinatal Epidemiology UnitUniversity of OxfordOxfordUK
| | - LCY Poon
- Harris Birthright Research Centre for Fetal MedicineKing's College HospitalLondonUK
| | - A Shennan
- Women's Health Academic CentreKing's College LondonLondonUK
| | - A Hollingworth
- Centre for Cancer PreventionWolfson Institute of Preventive MedicineQueen Mary University of LondonLondonUK
| | - WP Soutter
- Institute of Reproduction and Developmental BiologyDepartment of Surgery & CancerImperial CollegeLondonUK
| | | | - D Peebles
- Institute for Women's Health UCLLondonUK
| | - W Prendiville
- International Agency for Research on CancerWorld Health OrganizationLyonFrance
| | - J Patnick
- NHS Cancer Screening ProgrammesPublic Health EnglandSheffieldUK
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