Which Lynch syndrome screening programs could be implemented in the "real world"? A systematic review of economic evaluations

Purpose: Lynch syndrome (LS) screening can significantly reduce cancer morbidity and mortality in mutation carriers. Our aim was to identify cost-effective LS screening programs that can be implemented in the "real world."Methods: We performed a systematic review of full economic evaluations of genetic screening for LS in different target populations; health outcomes were estimated in life-years gained or quality-adjusted life-years.Results: Overall, 20 studies were included in the systematic review. Based on the study populations, we identified six categories of LS screening program: colorectal cancer (CRC)-based, endometrial cancer-based, general population-based, LS family registry-based, cascade testing-based, and genetics clinic-based screening programs. We performed an in-depth analysis of CRC-based LS programs, classifying them into three additional subcategories: universal, age-targeted, and selective. In five studies, universal programs based on immunohistochemistry, either alone or in combination with the BRAF test, were cost-effective compared with no screening, while in two studies age-targeted programs with a cutoff of 70 years were cost-effective when compared with age-targeted programs with lower age thresholds. Conclusion: Universal or <70 years-age-targeted CRC-based LS screening programs are cost-effective and should be implemented in the "real world

Astronomical Frequencies for Climate Research At the Decadal To Century Time Scale

Short-term variations of the elements representing the Earth's motion around the Sun and its rotation have been analyzed over the last 6000 years using 1-year steps. Their low-frequency part is compared first to the values obtained from a secular theory of the planetary long-term motion showing that they can be considered reliable enough to represent adequately the motion of the Earth over the last 5000 years. Spectral analysis of these values shows that the main periodicities are 2.67, 3.98, 5.26, 5.93, 7.9, 9.8, 11.9, 14.7, 15.8, 29, 42, 61, 122, 165 and 250 years for the eccentricity as well as for the climatic precession, with an additional component at around 930 years for the eccentricity and around 840 years for the climatic precession. Periodicities at 2.67, 3.8, 5.9, 8.0, 9.3, 11.9, 14.7, 18.6, 29, 135, 250 and 840 vr are also shown for the obliquity. Spectral analyses of the daily July mid-month insolation at 65-degrees-N show essentially the same periodicities as the climatic precession and the obliquity, i.e. 2.67, 3.98, 5.92, 8.1, 11.9, 15.7, 18.6, 29, 40, 61 and around 900 years. Finally a wider analysis of the insolation pattern was performed related to the large periodicity band of the insolation time series for the solstices and the equinoxes for 7 different latitudes. In equatorial latitudes the insolation variance is largely explained by precession. But precession dominates everywhere with the obliquity signal being stronger at polar latitudes at the solstices. The amplitudes of the insolation change at these frequencies is of the order of 0.2 Wm-2 at the maximum