Screening and overdiagnosis : public health implications

Overdiagnosis is the diagnosis of an abnormality that bears no substantial health hazard and no benefit for patients to be aware of. Resulting mainly from the use of increasingly sensitive screening and diagnostic tests, as well as broadened definitions of conditions requiring an intervention, overdiagnosis is a growing but still largely misunderstood public health issue. Fear of missing a diagnosis or of litigation, financial incentives or patient's need of reassurance are further causes of overdiagnosis. The main consequence of overdiagnosis is overtreatment. Treating an overdiagnosed condition bears no benefit but can cause harms and generates costs. Overtreatment also diverts health professionals from caring for those most severely ill. Recognition of overdiagnosis due to screening is challenging since it is rarely identifiable at the individual level and difficult to quantify precisely at the population level. Overdiagnosis exists even for screening of proven efficacy and efficiency. Measures to reduce overdiagnosis due to screening include heightened sensitization of health professionals and patients, active surveillance and deferred treatment until early signs of disease progression and prognosis estimation through biomarkers (including molecular) profiling. Targeted screening and balanced information on its risk and benefits would also help limit overdiagnosis. Research is needed to assess the the public health burden and implications of overdiagnosis due to screening activity

Fine forecasts: encouraging the media to include ultraviolet radiation information in summertime weather forecasts

Melanoma and skin cancer are largely attributable to over-exposure to solar ultraviolet radiation (UVR). Reports of UVR levels within media weather forecasts appear to be well received by the public and have good potential to communicate the need for appropriate sun protection to a broad audience. This study describes provision of UVR messages by New Zealand newspapers, radio and TV stations over a 4-year period, and examines the impact of an intervention which aimed to address media concerns about the financial costs of accessing UVR information for broadcast. Newspaper and radio presentation of UVR information increased immediately after these costs were removed; however, among radio stations it dropped in subsequent years. Among those media that were presenting UVR, this information was broadcast throughout the summer period and repeated throughout the day. Furthermore, most reports included concomitant, behavioral sun protection messages. At the final assessment (summer 2001/02), 66% of radio stations, both TV channels and 48% of newspapers reported UVR information in summertime weather reports. Efforts to further increase UVR presentation will need to address media concerns about time constraints on weather forecasts and media perceptions of poor audience demand or understanding of some UVR message

Dense breast on screening mammography: utility and futility of additional ultrasound.

High breast density decreases the sensitivity of mammography. Regardless of masking effect, it is also a stronger predictor for breast cancer than most other risk factors, including family history. Up to 50% of women have dense breast (categories C+D). The relative risk is 2.1 to 2.3 in women with extremely dense breast (category d). There is little consensus on the potential need of additional measures. Breast Ultrasound (US) may be proposed as an adjunctive test, as it is non-invasive and non-irradiating. Since 2012, our program for breast cancer screening propose to realise an additional US to the women with category d breasts. An evaluation of the data of the first year showed that less 50% of the women act upon the recommendation. In spite of the low compliance supplementary cancers were found. Since, no more evaluation was performed. The aim of this study was: To evaluate the effect of the recommendation in term of additional cancer's identification, additional biopsies and additional investigations. To identify the reasons of non compliance

Une bibliothèque de recherche face à l'édition électronique

Le développement des collections de périodiques a toujours constitué une composante majeure des politiques d'acquisition des bibliothèques de recherche. Aujourd'hui, les voilà confrontées simultanément, et de manière aiguë, à une difficulté certes récurrente : l'augmentation ininterrompue du coût des abonnements, et à une nouveauté radicale encore très difficile à maîtriser et qui engendre plutôt des surcoûts : la mise sur le marché de documents numérisés, principalement des périodiques. Organe d'un établissement pionnier en matière d'utilisation des réseaux informatiques pour la diffusion des résultats de la recherche, la bibliothèque du CERN a depuis plusieurs années déjà intégré cette nouvelle donne dans sa politique d'acquisition

Detailed site distribution of melanoma and sunlight exposure: aetiological patterns from a Swiss series

Background: The relation between detailed cutaneous distribution of melanoma and indicators of sun exposure patterns has scantily been explored in moderately sun-sensitive populations. Patients and methods: The precise site of 1658 primary malignant melanoma, registered from 1995 to 2002, in Switzerland were retrieved and clinically validated. Relative melanoma density (RMD) was computed by the ratio of observed to expected number of melanoma allowing for body site surface areas, and further adjusted for site-specific melanocyte density. Results: Sites of highest risks were the face, shoulder and upper arm for both sexes, the back for men, and leg for women. Major features of this series were: (i) an unexpectedly high RMD for the face in women (5.6 versus 3.7 in men), (ii) the absence of a male predominance for melanoma on the ears and (iii) for the upper limbs, a steady gradient of increasing melanoma density with increasing proximity to the trunk, regardless of sex. Age and sex patterns of RMD parallelled general indicators of sun exposure and behaviour, except for the hand (RMD = 0.2). Conclusion: RMD increased with (cumulative) site sun exposure, but a few notable exceptions support the impact of intermittent exposure in melanoma ris

Effectiveness of organised versus opportunistic mammography screening

Background: Detailed comparison of effectiveness between organised and opportunistic mammography screening operating in the same country has seldom been carried out. Patients and methods: Prognostic indicators, as defined in the European Guidelines, were used to evaluate screening effectiveness in Switzerland. Matching of screening programmes' records with population-based cancer registries enabled to compare indicators of effectiveness by screening and detection modality (organised versus opportunistic screening, unscreened, interval cancers). Comparisons of prognostic profile were also drawn with two Swiss regions uncovered by service screening of low and high prevalence of opportunistic screening, respectively. Results: Opportunistic and organised screening yielded overall little difference in prognostic profile. Both screening types led to substantial stage shifting. Breast cancer prognostic indicators were systematically more favourable in Swiss regions covered by a programme. In regions without a screening programme, the higher the prevalence of opportunistic screening, the better was the prognostic profile. Conclusions: Organised screening appeared as effective as opportunistic screening. Mammography screening has strongly influenced the stage distribution of breast cancer in Switzerland, and a favourable impact on mortality is anticipated. Extension of organised mammography screening to the whole of Switzerland can be expected to further improve breast cancer prognosis in a cost-effective wa

Breast cancer screening programme in Switzerland 2010-2015

This fourth national monitoring report for Swiss Cancer Screening shows the results of organised mammogra-phy screening in Switzerland for the years 2010-2015, subdivided into two triennial periods, 2010-2012 and 2013-2015, respectively. The number of regional programmes increased from 7 in 2010 to 10 in 2015, currently covering the geograph-ical area of 12 cantons. In 2015, 56.5 percent of the 50-69 years old women in Switzerland lived in an area covered by a breast cancer screening programme, nearly a doubling of coverage since 2010. The results in this monitoring report are based on available data from 7 programmes (VD, VS, GE, FR, BEJUNE, SG-GR, TG) in the period 2010-2012 and from 8 programmes (with BE) in the period 2013-2015. The coverage by invitation rate increased from 91% in 2010-2012 to 98% in 2013-2015. Almost 290,000 from the 680,000 eligible women in 2013-2015 attended for screening, resulting in a participation rate of 42.5%. The participa-tion decreased by more than 4% compared to 2010-2012, mainly due to the low participation in the large new programme of Canton of Bern. Similar decreases between the two triennial periods were found in the first round participation (32.9% vs. 38.3%) and in the reattendance of the women who participated in the previous round (81.7% vs. 85.6%). Without Bern, the overall participation rate was stable around 47% and the first round participation around 38-39%. Participation rates are likely slightly underestimated, as some participa-tion records could not be extracted from the new information system MC-SIS. Prevalent screening in 2013-2015 led to a recall rate (73.0 per 1000 women screened) slightly higher than recommended by the European Guidelines but substantially lower than in 2010-2012 (86.9 per 1000). The main consequence of the reduced recall rate is a substantially lower false-positive rate (67 vs. 80 per 1000). There is a concomitant but less pronounced decrease in breast cancer detection (6.1 vs. 6.9 per 1000) given the slightly increased positive predictive value of the screening examination (8.4% vs. 8.0%). Although the classi-fications of tumour characteristics are partly incomplete, most tumour distribution proportions are in accord-ance with the European Guidelines

Training primary care physicians to offer their patients faecal occult blood testing and colonoscopy for colorectal cancer screening on an equal basis: a pilot intervention with before-after and parallel group surveys.

Primary care physicians (PCPs) should prescribe faecal immunochemical testing (FIT) or colonoscopy for colorectal cancer screening based on their patient's values and preferences. However, there are wide variations between PCPs in the screening method prescribed. The objective was to assess the impact of an educational intervention on PCPs' intent to offer FIT or colonoscopy on an equal basis. Survey before and after training seminars, with a parallel comparison through a mailed survey to PCPs not attending the training seminars. All PCPs in the canton of Vaud, Switzerland. Of 592 eligible PCPs, 133 (22%) attended a seminar and 106 (80%) filled both surveys. 109 (24%) PCPs who did not attend the seminars returned the mailed survey. A 2 h-long interactive seminar targeting PCP knowledge, skills and attitudes regarding offering a choice of colorectal cancer (CRC) screening options. The primary outcome was PCP intention of having their patients screened with FIT and colonoscopy in equal proportions (between 40% and 60% each). Secondary outcomes were the perceived role of PCPs in screening decisions (from paternalistic to informed decision-making) and correct answer to a clinical vignette. Before the seminars, 8% of PCPs reported that they had equal proportions of their patients screened for CRC by FIT and colonoscopy; after the seminar, 33% foresaw having their patients screened in equal proportions (p<0.001). Among those not attending, there was no change (13% vs 14%, p=0.8). Of those attending, there was no change in their perceived role in screening decisions, while the proportion responding correctly to a clinical vignette increased (88-99%, p<0.001). An interactive training seminar increased the proportion of physicians with the intention to prescribe FIT and colonoscopy in equal proportions

ScanProsite: detection of PROSITE signature matches and ProRule-associated functional and structural residues in proteins

ScanProsite—http://www.expasy.org/tools/scanprosite/—is a new and improved version of the web-based tool for detecting PROSITE signature matches in protein sequences. For a number of PROSITE profiles, the tool now makes use of ProRules—context-dependent annotation templates—to detect functional and structural intra-domain residues. The detection of those features enhances the power of function prediction based on profiles. Both user-defined sequences and sequences from the UniProt Knowledgebase can be matched against custom patterns, or against PROSITE signatures. To improve response times, matches of sequences from UniProtKB against PROSITE signatures are now retrieved from a pre-computed match database. Several output modes are available including simple text views and a rich mode providing an interactive match and feature viewer with a graphical representation of result