Implantation of a biochemical and genetic screening programme for family hypercholesterolaemia. Collaboration between the clinical laboratory and lipid units: Design of the ARIAN Project

INTRODUCTION AND OBJECTIVE

Familial hypercholesterolaemia (FH) is the most common genetic disorder associated with premature coronary artery disease due to the presence of LDL-C cholesterol increased from birth. It is underdiagnosed and undertreated. The primary objective of the ARIAN project was to determine the number of patients diagnosed with FH after implementing a new screening procedure from the laboratory.

MATERIAL AND METHODS

This project was designed as a retrospective analysis by consulting the computer system. We selected from databases serum samples from patients ≥ 18 years with direct or calculated LDL-C>250mg/dL from 1 January 2017 to 31 December 2018. Once secondary causes had been ruled out, the requesting primary care physician was notified that their patient might have FH and to arrange a priority appointment in the lipid unit. All patients with a score of ≥ 6 points according to the Dutch Lipid Clinic Criteria were proposed for a genetic study RESULTS: By December 30th, 2020, 24 centres out of the initial 55 had submitted results. The number of patients analysed up to that point was 3,266,341, which represents 34% of the population served in those health areas (9,727,434).

CONCLUSIONS

The identification of new subjects with FH through this new strategy from the laboratory and their referral to lipid units should increase the number of patients treated in lipid units and initiate familial cascade screening.

[Participation of the immigrant population in breast cancer screening in Tarragona, Spain]

OBJECTIVE

To evaluate the differences between autochthonous and allochthonous women's participation in a breast cancer screening programme.

METHOD

Retrospective study based on data from the Breast Cancer Screening Programme of the province of Tarragona (2008-2015). The sample is the target population of the programme with known country of origin.

RESULTS

Cohort of 40,824 women. Allochthonous women participate less than autochthonous women (41.8% vs. 72.3%) although they have a similar global detection rate to the latter but with differences according to the human development index of their country of origin. Both groups present similar tumour stages on detection (p=.59).

CONCLUSIONS

Strategies specifically aimed at the immigrant population are required to improve their participation in breast cancer screening.

Comparative study of RetCamRetCam II vs. binocular ophthalmoscopy in a screening program for retinopathy of prematurity

OBJECTIVE

To determine the performance of RetCam vs. binocular ophthalmoscopy (BIO) in a screening program for retinopathy of prematurity (ROP).

METHODS

Observational comparative study with prospective data collection. Examinations with RetCam (n=169) were performed on 83 infants included in a screening program for ROP and stored for analysis at a later stage. An experienced ophthalmologist examined the ocular fundus with binocular indirect ophthalmoscopy (BIO). The RetCam images were assessed for the presence of ROP, zone, grade, and presence of plus disease. RetCam and BIO data were compared by visually to estimate sensitivity, specificity, positive (VPP) and negative (VPN) predictive values.

RESULTS

ROP disease was detected in 108 eyes with BIO, and in 74 with RetCam. Out of 306 eyes examined with RetCam, false negative results were found in 34 eyes, with no false positives. Sensitivity of RetCam exam vs. BIO was 0.68, and specificity was 0.99. Positive predictive value was 0.93 and negative predictive value was 0.85. All 34 ROP cases not detected with RetCam were in zone III or outer zone II. They were all mild and regressed spontaneously. No threshold ROP was missed with RetCam.

CONCLUSION

Binocular indirect ophthalmoscopy is the reference method for the diagnosis of ROP. RetCam may be used as an alternative for ROP screening.

[Proportion of breast cancer in women aged 50 to 69 years from Girona, Spain, according to detection method]

BACKGROUND AND OBJECTIVE

The aim of this study was to determine the tumor stage, the proportion of cases and the age specific rate of breast cancer (BC) cases according to detection method.

MATERIAL AND METHOD

Cases of women aged 50 to 69 years diagnosed with BC in the Girona province during 1999-2006 were extracted from the population-based Girona Cancer Registry (n=1,254). BC was classified by detection method: screen-detected cancer, interval cancer and others. Proportion of cases and age-specific incidence were calculated according to detection method.

RESULTS

During the period 2002-2006, the proportion of screen-detected cancers, interval cancers and other cancers were 42.2%, 5.8% and 52.2%, respectively. After implementation of the early detection of breast cancer program (PDPCM), the incidence of screen-detected cases raised; thereafter, interval cancers also increased and the rate of other cancers decreased.

CONCLUSIONS

In the Girona province during the fully implemented PDPCM period (2002-2006), interval cancers represented a low proportion (5.8%) of women diagnosed with BC at 50 to 69 years old.

[Cost-benefit analysis of a population-based cervical cancer screening program designed for Cantabria]

INTRODUCTION

Cervical cancer is the second most common cancer worldwide in women, with an annual mortality of 3.6 per 100.000 women in Spain. An opportunistic screening protocol is currently being developed in Cantabria. The objective of the study is to propose a population-based screening program in Cantabria and assess its cost-benefits.

PATIENTS AND METHODS

The population-based program design has been carried out according to the description of the natural course of cervical cancer and its incidence and mortality in Cantabria during 2000-2009. There have been some proposals to increase participation in the program and to evaluate its quality. Costs and benefits (direct and indirect) have been analyzed in several scenarios by modifying the frequency of tests (3-5 years), the age at which the program can be accessed (21, 25 or 30 years), the coverage of the program (60-80%), and discount rates (0-3-6%).

RESULTS

A program carried out with coverage of 80% and tests performed every 3 years generates annual costs of €893.000 (discount rate of 3%) compared to the current opportunistic protocol. Scenarios with tests performed every 5 years generate an annual benefit higher than €618.000, depending on the age of accessing the program.

CONCLUSIONS

Scenarios with coverage lower than 60% or with women over 30 years old having access to the program are not of interest because of the lower health benefits. However, performing tests every 5 years is more economically advantageous than every 3 years, with similar health benefits.