Cancer screening is a strategy focused on highrisk populations rather than universal populationwide screening, based on a comprehensive evaluation of epidemiological principles and practical feasibility. The effective...Cancer screening is a strategy focused on highrisk populations rather than universal populationwide screening, based on a comprehensive evaluation of epidemiological principles and practical feasibility. The effectiveness of screening depends on factors such as disease prevalence, as well as the sensitivity and specificity of the screening technology employed.展开更多
Objective:To describe temporal changes associated with deployment of an optical character recognition(OCR)-enabled OneIdentity(One-ID)digital platform for rural cervical cancer screening,focusing on over-screening rat...Objective:To describe temporal changes associated with deployment of an optical character recognition(OCR)-enabled OneIdentity(One-ID)digital platform for rural cervical cancer screening,focusing on over-screening rates,CIN2+detection,colposcopy follow-up,and CIN2+management.Methods:A multi-county pre-post observational study was conducted in six rural counties in Shanxi,Yunnan,and Sichuan Provinces(2021±2024),encompassing 153,978 encounters.The digital platform integrates OCR identity capture,deterministic One-ID linkage,and real-time duplicate alerts.Over-screening proportions before and after digital deployment were compared,changes in CIN2+detection rate were evaluated,and colposcopy follow-up and CIN2+management were assessed.Differences were tested withχ2 or Fisher's exact tests.Results:Among 153,978 encounters,the proportion of over-screening decreased from 12.64%in 2023 to 0.17%in 2024 with an absolute reduction of 12.17%(95%CI:11.94±12.40;P<0.001).The share of women receiving a first screening within the preceding 3 y increased from 78.3%to 88.2%(P<0.001).Colposcopy completion improved from 64.1%to 84.9%.The CIN2+detection rate rose from 0.35%(2021±2023 pooled)to 0.67%in 2024(P<0.001)and CIN2+management completion increased from 56.0%to 76.2%(95%CI:13.3±27.2;P<0.001).These improvements were consistent across age groups,counties,and screening strategies.Conclusions:The OCR-enabled One-ID platform substantially reduced over-screening,increased CIN2+detection rate,and strengthened case follow-up/management,particularly where baseline tracking was weak,supporting scalable digital reinforcement of rural screening programmes.展开更多
In Western countries, clinical trials on prostate cancer screening demonstrated a limited benefit for patient survival. In the Asia-Pacific region, including Japan, the rate of prostate-specific antigen （PSA） testin...In Western countries, clinical trials on prostate cancer screening demonstrated a limited benefit for patient survival. In the Asia-Pacific region, including Japan, the rate of prostate-specific antigen （PSA） testing remains very low compared with Western countries, and the benefits of population-based screening remain unclear. This review describes the current status of population screening and diagnosis for prostate cancer in Japan and discusses the efficacy of population screening for the Asian population. Since the 1990s, screening systems have been administered by each municipal government in Japan, and decreases in the prostate cancer mortality rate are expected in some regions where the exposure rate to PSA screening has increased markedly. A population-based screening cohort revealed that the proportion of metastatic disease in cancer detected by screening gradually decreased according to the increased exposure rate, and a decreasing trend in the proportion of cancer with high serum PSA levels after population screening was started. The prognosis of the prostate cancer detected by population screening was demonstrated to be more favorable than those diagnosed outside of the population screening. Recent results in screening cohorts demonstrated the efficacy of PSA. These recent evidences regarding population-based screening in Japan may contribute to establishing the optimal prostate cancer screeninK system in Asian individuals.展开更多
Normally, cellular responses to modified siRNAs or new siRNA delivery systems have been studied in group cell behavior by PCR, western blotting and fluorescence microscopy. In this study, we present a novel high-conte...Normally, cellular responses to modified siRNAs or new siRNA delivery systems have been studied in group cell behavior by PCR, western blotting and fluorescence microscopy. In this study, we present a novel high-content screening （HCS） strategy to evaluate a novel delivery system （named CLD） of siRNA therapeutics, with which both the content of intracellular siRNAs and changes in protein expressing levels have been quantified in group cells and cellular population. We also observed that with the better cell uptake, CLD provided siRNA therapeutics （siBraf） better antitumor capability. This novel strategy was proved to be with efficiency, accuracy and high competency to adherent cell lines, thus making siRNA research more simplified.展开更多
Whitebacked planthopper (WBPH) -resistance in a japonica / indica doubled haploid (DH) rice population established from a cross between WBPH-resistant japonica Chun]iang 06 and susceptible indica TN1, was comparativel...Whitebacked planthopper (WBPH) -resistance in a japonica / indica doubled haploid (DH) rice population established from a cross between WBPH-resistant japonica Chun]iang 06 and susceptible indica TN1, was comparatively evaluated through a field experiment based on the WBPH immigrant density and standardized seedbox screening test (SSST). All the susceptible DH lines in the field experiment behaved accordingly in SSST. However, 35 of resistant 66 lines (53%) in the field, were categorized to susceptible groups in SSST. Likewise, there were no significant differences in WBPH immigrant densities among 70 DH lines that were highly resistant to susceptible in SSST. The results revealed that SSST could not evaluate properly WBPH resistance in the DH lines. Four QTLs for WBPH-resistance phenotyped by the immigrant density were detected on chromosomes 2, 3, 4, and 11. Of them, the QTL on chromosome 4 was the most effective (LOD 21.8, variance 78%). Five QTLs associated with seedling mortality were mapped on chromosomes 2, 3, 4, 5 and 6. In addition to the QTL (LOD 10.5, variance 68%) on chromosome 4, there was another major QTL (LOD 12.7, variance 71%) located on chromosome 5, which was SSST-specific but might be irrespective of the WBPH resistance traits.展开更多
Pancreatic cancer is a serious growing health issue in developed countries.For patients diagnosed with pancreatic cancer,the five year survival rate is below 5%.One major important reason leads to the poor survival ra...Pancreatic cancer is a serious growing health issue in developed countries.For patients diagnosed with pancreatic cancer,the five year survival rate is below 5%.One major important reason leads to the poor survival rate is lack of early detection of pancreatic cancer.Over 80% of the patients are diagnosed in advanced disease stages.Screening for pancreatic cancer is a desirable option for high risk individuals to allow early detection and treatment of curable pancreatic neoplasms at a pre-invasive stage.This article highlights the need,endpoint,population,method,diagnostic yield,and the problems of current screening programs.展开更多
Identification of carriers of fragile X syndrome(FXS) with the subsequent prenatal diagnosis and knowledge of FXS-associated genetic profiles are essential for intervention in specific populations. We report the resul...Identification of carriers of fragile X syndrome(FXS) with the subsequent prenatal diagnosis and knowledge of FXS-associated genetic profiles are essential for intervention in specific populations. We report the results of carrier screening of 39,458 East Asian adult women and prenatal diagnosis from 87 FXS carriers.The prevalence of FXS carriers and full mutation fetuses was estimated to be 1/581 and 1/3124 in East Asian populations, respectively. We confirmed the validity of the current threshold of CGG trinucleotide repeats for FMR1 categorization;the integral risks of full mutation expansion were approximately 6.0%,43.8%, and 100% for premutation alleles with 55—74, 75—89, and ≥ 90 CGG repeats, respectively. The protective effect of AGG(adenine-guanine-guanine nucleotides) interruption in East Asian populations was validated, which is important in protecting premutation alleles with 75—89 CGG repeats from full mutation expansion. Finally, family history was shown not an effective indicator for FXS carrier screening in East Asian populations, and population-based screening was more cost-effective. This study provides an insight into the largest carrier screening and prenatal diagnosis for FXS in East Asian populations to date. The FXSassociated genetic profiles of East Asian populations are delineated, and population-based carrier screening is shown to be promising for FXS intervention.展开更多
To clarify the recent trends in prostate-specific antigen （PSA） distribution in men in Japan, we analyzed the PSA distributions of men undergoing PSA-based population screening. We summarized the annual individual d...To clarify the recent trends in prostate-specific antigen （PSA） distribution in men in Japan, we analyzed the PSA distributions of men undergoing PSA-based population screening. We summarized the annual individual data of PSA-based population screening in Kanazawa, Japan, from 2000 to 2011, and analyzed baseline serum PSA values of the participants at the first population screening. Serum PSA distributions were estimated in all participants and those excluding prostate cancer patients according to age. From 2000 to 2011, 19 620 men participated aged 54-69 years old in this screening program. Mean baseline serum PSA level of all participants at the first screening was 2.64 ng m1-1 in 2000, and gradually decreased to approximately 1.30 ng ml-I in 2006. That of participants excluding prostate cancer patients was 1.46 ng m1-1 in 2000, and there was no remarkable change during the study period. The 95t＂ percentiles in the participants excluding prostate cancer patients detected at the first population screening of men aged 54-59, 60-64, and 65-69 years old were 2.90, 3.60, and 4.50 ng m1-1, respectively. After the commencement of population screening, the proportion of prostate cancer patients with high serum PSA levels decreased. However, there were no changes in serum PSA levels in men without prostate cancer. Age-specific PSA reference level of men without prostate cancer in Japan was similar to that in China and Korea.展开更多
The risk of breast cancer(BC) overdiagnosis attributed to mammography screening is an unresolved issue, complicated by heterogeneity in the methodology of quantifying its magnitude, and both political and scientific e...The risk of breast cancer(BC) overdiagnosis attributed to mammography screening is an unresolved issue, complicated by heterogeneity in the methodology of quantifying its magnitude, and both political and scientific elements surrounding interpretation of the evidence on this phenomenon. Evidence from randomized trials and also from observational studies shows that mammography screening reduces the risk of BC death; similarly, these studies provide sufficient evidence that overdiagnosis represents a serious harm from population breast screening. For both these outcomes of screening, BC mortality reduction and overdiagnosis, estimates of magnitude vary between studies however overdiagnosis estimates are associated with substantial uncertainty. The trade-off between the benefit and the collective harms of BC screening, including false-positives and overdiagnosis, is more finely balanced than initially recognized, however the snapshot of evidence presented on overdiagnosis does not mean that breast screening is worthless. Future efforts should be directed towards(a) ensuring that any changes in the implementation of BC screening optimize the balance between benefit and harms, including assessing how planned or actual changes modify the risk of overdiagnosis;(b) informing women of all the outcomes that may affect them when they participate in screening using well-crafted and balanced information; and(c) investing in research that will help define and reduce the ensuing overtreatment of screen-detected BC.展开更多
Quantitative research of the origin of sulfur isotopes is a difficult problem that has puzzled geochemists all along. In the study of the middle and lower reaches of the Yangtze River and the Dongpo orefield in Hunan ...Quantitative research of the origin of sulfur isotopes is a difficult problem that has puzzled geochemists all along. In the study of the middle and lower reaches of the Yangtze River and the Dongpo orefield in Hunan Province, the authors successfully applied the mathematical model of mixed population screening to quantitatively resolving the problem on the origin of sulfur isotopes, which is significant in finding out the source of mineralizing matter and metallogenic mechanisms.展开更多
Correlation analysis between the hematological parameters mean corpuscular hemoglobin (MCH) and mean corpuscular volume (MCV) for thalassemia screening in large population was discussed. A total of 4920 peripheral blo...Correlation analysis between the hematological parameters mean corpuscular hemoglobin (MCH) and mean corpuscular volume (MCV) for thalassemia screening in large population was discussed. A total of 4920 peripheral blood samples of reproductive age persons were collected from Guangdong province of China. The hematological parameters MCH and MCV values of samples were first measured, and then the DNA analyses for thalassemia were conducted. All samples were composed by 4463 non-thalassemia and 457 thalassemia, and among 457 thalassemia samples, 311 were α-thalassemia, 133 were β-thalassemia, and 13 were α & β-thalassemia. In accordance with non-thalassemia, thalassemia, α-thalassemia, β-thalassemia, α & β-thalassemia and the entire group itself, a total of six sample groups were divided. The corresponding correlation coefficients between the measured MCH and MCV values for the six sample groups were 0.880, 0.968, 0.966, 0.962, 0.980 and 0.965 respectively. For the thalassemia carriers, highly significant correlation between MCH and MCV were observed. The fitting equations between MCH and MCV values were also obtained. The results indicated that the feasibility for thalassemia screening using MCV or MCH independently as parameter, and provided suitable strategy to select parameters and models for thalassemia screening in large population.展开更多
Objective: This paper aims to screen and analyze the current status of high-risk stroke patients in Shashi District of Jingzhou City and the exposure levels of related risk factors, and provides suggestions as the ref...Objective: This paper aims to screen and analyze the current status of high-risk stroke patients in Shashi District of Jingzhou City and the exposure levels of related risk factors, and provides suggestions as the references for prevention and treatment of stroke. Methods: Using cluster sampling, on-site investigations were conducted on 1060 permanent residents aged 40 years and over at 3 townships and 2 communities in Shashi District of Jingzhou City from January 2018 to December 2018. Risk assessment of stroke is based on the stroke risk screening form. Statistical analysis was performed by using SPSS 22.0 software. Results: After making a stroke risk assessment, a total of 313 high-risk stroke patients were screened, and the detection rate was 29.53%. The exposure rate of risk factors from high to low was hypertension (70.93%), dyslipidemia (46.33%), less physical exercise (46.01%), diabetes (36.10%), overweight (33.55%), smoking (33.23%), family history of stroke (24.92%), atrial fibrillation or valvular heart disease (7.35%). There are statistically significant differences among all risk factors between the high-risk group and middle and low-risk groups (P Conclusion: The detection rate of high-risk stroke patients in Shashi District of Jingzhou City is high. Hypertension, dyslipidemia and less physical exercise are the main risk factors of stroke occurrence and recurrence in the region. The prevention and treatment of risk factors for stroke should be strengthened to control the incidence and recurrence rate of stroke.展开更多
BACKGROUND X-ray gastric cancer(GC)screening has been shown to decrease mortality.Population-based X-ray GC screening has been performed in Hiroshima Prefe-cture,Japan,since 1983 but time trends and the efficacy of th...BACKGROUND X-ray gastric cancer(GC)screening has been shown to decrease mortality.Population-based X-ray GC screening has been performed in Hiroshima Prefe-cture,Japan,since 1983 but time trends and the efficacy of the method over 39 years have not been assessed.METHODS This was a population-based retrospective study.The data were derived from aggregated data of the Hiroshima Regional Health Medical Promotion Organization,including the number and rate of participants and those requiring esophagogastroduodenoscopies(EGDs),the number and rate of participants diagnosed as having GC,and the positive predictive value of the abnormal findings detected by X-ray and confirmed by EGDs.The number and rate of esophageal cancers were also collected.Further,the cost of detecting one GC was evaluated.RESULTS The number of participants has decreased during the last four decades,from 39925 in 1983 to 12923 in 2021.The rate of those requiring EGDs decreased significantly in recent years(P<0.001).The number of participants diagnosed as having GC has also declined,from 76 to 10 cases.However,the rate of cases diagnosed as GC among the participants remained around 0.1%.The positive predictive value increased significantly in recent years except during 1983-1991.The number and rate of accidentally detected esophageal cancers have risen recently,from 0%in 2008 to 0.02%in 2021,one-fifth of the diagnosis rate of GC.One GC diagnosis costs approximately 4200000 Japanese Yen(30000 United States Dollars)for the X-ray screenings and EGDs.CONCLUSION X-ray GC screening in Hiroshima has been efficient,but one challenge is the cost.Esophageal cancers may also need to be considered because they have gradually increased in recent years.展开更多
Metabolic dysfunction-associated steatotic liver disease is the most prevalent chronic liver condition,affecting over one-third of the global population,with cirrhosis present in up to 3.3%of cases.Early detection of ...Metabolic dysfunction-associated steatotic liver disease is the most prevalent chronic liver condition,affecting over one-third of the global population,with cirrhosis present in up to 3.3%of cases.Early detection of advanced liver disease in at-risk populations can enable timely intervention,prevent progression,and reduce complications.This review focuses on the current recommendations for early detection of advanced liver disease,evaluates the evidence for the performance of non-invasive tests in the target population for screening,and examines the multifaceted burden of screening,including economic implications and psychological impacts.Additionally,we discuss future directions,such as integrating liver health into a multidisciplinary care framework.Current guidelines recommend case-finding,targeting individuals with type 2 diabetes,metabolically complicated obesity,or persistent elevated liver enzymes.The Fibrosis-4 index is widely endorsed as a first-line non-invasive test,yet the diagnostic performance in primary care settings seems suboptimal,particularly for pre-cirrhotic disease.Sequential strategies incorporating novel non-invasive tests may improve accuracy and cost-effectiveness.Confirmation typically involves vibration-controlled transient elastography.Key challenges include a large eligible population,uncertainties in optimal screening intervals,patient adherence to follow-up,and limited real-world cost-effectiveness data.Integrating liver health assessment into cardiometabolic care pathways,reflex testing,telehealth,and patient education may enhance uptake.While challenges remain,early detection of advanced liver disease is already likely cost-effective.Ongoing advances in screening pathways and treatment options are expected to further strengthen the case for widespread implementation.展开更多
AIM To assess proportions, related conditions and survival of interval cancer(IC).METHODS The programme has a linkage with different clinical databases and cancer registers to allow suitable evaluation. This evaluatio...AIM To assess proportions, related conditions and survival of interval cancer(IC).METHODS The programme has a linkage with different clinical databases and cancer registers to allow suitable evaluation. This evaluation involves the detection of ICs after a negative faecal inmunochemical test(FIT), interval cancer FIT(IC-FIT) prior to a subsequent invitation, and the detection of ICs after a positive FIT and confirmatory diagnosis without colorectal cancer(CRC) detected and before the following recommended c o l o n o s c o p y, I C-c o l o n o s c o p y. W e c o n d u c t e d a retrospective observational study analyzing from January 2009 to December 2015 1193602 invited people onto the Programme(participation rate of 68.6%).RESULTS Two thousand five hundred and eighteen cancers were diagnosed through the programme, 18 cases of IC-colonoscopy were found before the recommended follow-up(43542 colonoscopies performed) and 186 IC-FIT were identified before the following invitation of the 769200 negative FITs. There was no statistically significant relation between the predictor variables of ICs with sex, age and deprivation index, but there was relation between location and stage. Additionally, it was observed that there was less risk when the location was distal rather than proximal(OR = 0.28, 95%CI: 0.20-0.40, P < 0.0001), with no statistical significance when the location was in the rectum as opposed to proximal. When comparing the screen-detected cancers(SCs) with ICs, significant differences in survival were found(P < 0.001); being the 5-years survival for SCs 91.6% and IC-FIT 77.8%.CONCLUSION These findings in a Population Based CRC Screening Programme indicate the need of population-based studies that continue analyzing related factors to improve their detection and reducing harm.展开更多
Colorectal cancer(CRC)is the second most common cancer in Europe and its incidence is steadily increasing.This trend could be reversed through timely secondary prevention(screening).In the last twenty years,CRC screen...Colorectal cancer(CRC)is the second most common cancer in Europe and its incidence is steadily increasing.This trend could be reversed through timely secondary prevention(screening).In the last twenty years,CRC screening programs across Europe have experienced considerable improvements(fecal occult blood testing;transition from opportunistic to population based program settings).The Czech Republic is a typical example of a country with a long history of nationwide CRC screening programs in the face of very high CRC incidence and mortality rates.Each year,approximately 8000 people are diagnosed with CRC and some 4000 die from this malignancy.Twenty years ago,the first pilot studies on CRC screening led to the introduction of the opportunistic Czech National Colorectal Cancer Screening Program in 2000.Originally,this program was based on the guaiac fecal occult blood test(FOBT)offered by general practitioners,followed by colonoscopy in cases of FOBT positivity.The program has continuously evolved,namely with the implementation of immunochemical FOBTs and screening colonoscopy,as well as the involvement of gynecologists.Since the establishment of the Czech CRC Screening Registry in 2006,2405850 FOBTs have been performed and 104565 preventive colonoscopies recorded within the screening program.The overall program expanded to cover 25.0%of the target population by 2011.However,stagnation in the annual number of performed FOBTs lately has led to switching to the option of a population-based program with personal invitation,which is currently being prepared.展开更多
BACKGROUND Colorectal cancer(CRC)is a serious threat worldwide.Although early screening is suggested to be the most effective method to prevent and control CRC,the current situation of early screening for CRC is still...BACKGROUND Colorectal cancer(CRC)is a serious threat worldwide.Although early screening is suggested to be the most effective method to prevent and control CRC,the current situation of early screening for CRC is still not optimistic.In China,the incidence of CRC in the Yangtze River Delta region is increasing dramatically,but few studies have been conducted.Therefore,it is necessary to develop a simple and efficient early screening model for CRC.AIM To develop and validate an early-screening nomogram model to identify individuals at high risk of CRC.METHODS Data of 64448 participants obtained from Ningbo Hospital,China between 2014 and 2017 were retrospectively analyzed.The cohort comprised 64448 individuals,of which,530 were excluded due to missing or incorrect data.Of 63918,7607(11.9%)individuals were considered to be high risk for CRC,and 56311(88.1%)were not.The participants were randomly allocated to a training set(44743)or validation set(19175).The discriminatory ability,predictive accuracy,and clinical utility of the model were evaluated by constructing and analyzing receiver operating characteristic(ROC)curves and calibration curves and by decision curve analysis.Finally,the model was validated internally using a bootstrap resampling technique.RESULTS Seven variables,including demographic,lifestyle,and family history information,were examined.Multifactorial logistic regression analysis revealed that age[odds ratio(OR):1.03,95%confidence interval(CI):1.02-1.03,P<0.001],body mass index(BMI)(OR:1.07,95%CI:1.06-1.08,P<0.001),waist circumference(WC)(OR:1.03,95%CI:1.02-1.03 P<0.001),lifestyle(OR:0.45,95%CI:0.42-0.48,P<0.001),and family history(OR:4.28,95%CI:4.04-4.54,P<0.001)were the most significant predictors of high-risk CRC.Healthy lifestyle was a protective factor,whereas family history was the most significant risk factor.The area under the curve was 0.734(95%CI:0.723-0.745)for the final validation set ROC curve and 0.735(95%CI:0.728-0.742)for the training set ROC curve.The calibration curve demonstrated a high correlation between the CRC high-risk population predicted by the nomogram model and the actual CRC high-risk population.CONCLUSION The early-screening nomogram model for CRC prediction in high-risk populations developed in this study based on age,BMI,WC,lifestyle,and family history exhibited high accuracy.展开更多
Klinefelter syndrome （KS） is the set of symptoms that result from the presence of an extra X chromosome in males. Postnatal population-based KS screening will enable timely diagnosis of this common chromosomal disea...Klinefelter syndrome （KS） is the set of symptoms that result from the presence of an extra X chromosome in males. Postnatal population-based KS screening will enable timely diagnosis of this common chromosomal disease, providing the opportunity for early intervention and therapy at the time point when they are most effective and may prevent later symptoms or complications. Therefore, through this study, we introduced a simple high-resolution melting （HRM） assay for KS screening and evaluated its clinical sensitivity and specificity in three medical centers using 1373 clinical blood samples. The HRM assay utilized a single primer pair to simultaneously amplify specific regions in zinc finger protein, X-linked （ZFX） and zinc finger protein, Y-linked （ZFY）. In cases of KS, the ratios of ZFX/ZFYare altered compared to those in normal males. As a result, the specific melting profiles differ and can be differentiated during data analysis. This HRM assay displayed high analytical specificity over a wide range of template DNA amounts （5 ng-50 ng） and reproducibility, high resolution for detecting KS mosaicism, and high clinical sensitivity （100%） and specificity （98.1%）. Moreover, the HRM assay was rapid （2 h per run）, inexpensive （0.2 USD per sample）, easy to perform and automatic, and compatible with both whole blood samples and dried blood spots. Therefore, this HRM assay is an ideal postnatal population-based KS screening tool that can be used for different age groups.展开更多
After newborn screening is completed, most states retain leftover dried bloodspots. These dried bloodspots are stored for varying lengths of time among different state newborn screening programs. Dried bloodspots are ...After newborn screening is completed, most states retain leftover dried bloodspots. These dried bloodspots are stored for varying lengths of time among different state newborn screening programs. Dried bloodspots are a unique and valuable resource for the development of new newborn screening tests, quality assurance and biomedical research. Recent changes to the 2014 Newborn Screening Reauthorization Saves Lives Act require explicit parental consent for the retention and use of dried bloodspots in federally funded research. This has raised several ethical and regulatory issues and highlighted the challenges of respecting individual autonomy and public health goals. This article provides an overview of these issues and discusses methods for obtaining parental consent. These issues may be applicable to consent for the storage and use of biospecimens among other settings according to proposed changes to the Common Rule.展开更多
BACKGROUND The implementation of a colorectal cancer(CRC)screening programme may increase the awareness of Primary Care Physicians,reduce the diagnostic delay in CRC detected outside the scope of the screening program...BACKGROUND The implementation of a colorectal cancer(CRC)screening programme may increase the awareness of Primary Care Physicians,reduce the diagnostic delay in CRC detected outside the scope of the screening programme and thus improve prognosis.AIM To determine the effect of implementation of a CRC screening programme on diagnostic delays and prognosis of CRC detected outside the scope of a screening programme.METHODS We performed a retrospective intervention study with a pre-post design.We identified 322 patients with incident and confirmed CRC in the pre-implantation cohort(June 2014–May 2015)and 285 in the post-implantation cohort(June 2017-May 2018)in the Cancer Registry detected outside the scope of a CRC screening programme.In each patient we calculated the different healthcare diagnostics delays:global,primary and secondary healthcare,referral and colonoscopyrelated delays.In addition,we collected the initial healthcare that evaluated the patient,the home location(urban/rural),and the CRC stage at diagnosis.We determined the two-year survival and we performed a multivariate proportional hazard regression analysis to determine the variables associated with survival.RESULTS We did not detect any differences in the patient or CRC baseline-related variables.A total of 20.1%of patients was detected with metastatic disease.There was a significant increase in direct referral to colonoscopy from primary healthcare(25.5%,35.8%;P=0.04)in the post-implantation cohort.Diagnostic delay was reduced by 24 d(106.64±148.84 days,82.84±109.31 d;P=0.02)due to the reduction in secondary healthcare delay(46.01±111.65 d;29.20±60.83 d;P=0.02).However,we did not find any differences in CRC stage at diagnosis or in two-year survival(70.3%;P=0.9).Variables independently associated with twoyear risk of death were age(Hazard Ratio-HR:1.06,95%CI:1.04-1.07),CRC stage(II HR:2.17,95%CI:1.07-4.40;III HR:3.07,95%CI:1.56-6.08;IV HR:19.22,95%CI:9.86-37.44;unknown HR:9.24,95%CI:4.27-19.99),initial healthcare consultation(secondary HR:2.93,95%CI:1.01-8.55;emergency department HR:2.06,95%CI:0.67-6.34),hospitalization during the diagnostic process(HR:1.67,95%CI:1.17-2.38)and urban residence(HR:1.44,95%CI:1.06-1.98).CONCLUSION Although implementation of a CRC screening programme can reduce diagnostic delays for CRC detected in symptomatic patients,this has no effect on CRC stage or survival.展开更多
文摘Cancer screening is a strategy focused on highrisk populations rather than universal populationwide screening, based on a comprehensive evaluation of epidemiological principles and practical feasibility. The effectiveness of screening depends on factors such as disease prevalence, as well as the sensitivity and specificity of the screening technology employed.
基金supported by the Chongqing Tencent Sustainable Development Foundation through the project"Comprehensive Prevention and Control Demonstration Project for Eliminating Cervical Cancer and Breast Cancer in Low Health Resource Areas of China"(Project No.SD20240904145730)by the Tencent Sustainable Social Value(SSV)Inclusive Health Lab(Project No.SSVPJ202307060001)。
文摘Objective:To describe temporal changes associated with deployment of an optical character recognition(OCR)-enabled OneIdentity(One-ID)digital platform for rural cervical cancer screening,focusing on over-screening rates,CIN2+detection,colposcopy follow-up,and CIN2+management.Methods:A multi-county pre-post observational study was conducted in six rural counties in Shanxi,Yunnan,and Sichuan Provinces(2021±2024),encompassing 153,978 encounters.The digital platform integrates OCR identity capture,deterministic One-ID linkage,and real-time duplicate alerts.Over-screening proportions before and after digital deployment were compared,changes in CIN2+detection rate were evaluated,and colposcopy follow-up and CIN2+management were assessed.Differences were tested withχ2 or Fisher's exact tests.Results:Among 153,978 encounters,the proportion of over-screening decreased from 12.64%in 2023 to 0.17%in 2024 with an absolute reduction of 12.17%(95%CI:11.94±12.40;P<0.001).The share of women receiving a first screening within the preceding 3 y increased from 78.3%to 88.2%(P<0.001).Colposcopy completion improved from 64.1%to 84.9%.The CIN2+detection rate rose from 0.35%(2021±2023 pooled)to 0.67%in 2024(P<0.001)and CIN2+management completion increased from 56.0%to 76.2%(95%CI:13.3±27.2;P<0.001).These improvements were consistent across age groups,counties,and screening strategies.Conclusions:The OCR-enabled One-ID platform substantially reduced over-screening,increased CIN2+detection rate,and strengthened case follow-up/management,particularly where baseline tracking was weak,supporting scalable digital reinforcement of rural screening programmes.
文摘In Western countries, clinical trials on prostate cancer screening demonstrated a limited benefit for patient survival. In the Asia-Pacific region, including Japan, the rate of prostate-specific antigen （PSA） testing remains very low compared with Western countries, and the benefits of population-based screening remain unclear. This review describes the current status of population screening and diagnosis for prostate cancer in Japan and discusses the efficacy of population screening for the Asian population. Since the 1990s, screening systems have been administered by each municipal government in Japan, and decreases in the prostate cancer mortality rate are expected in some regions where the exposure rate to PSA screening has increased markedly. A population-based screening cohort revealed that the proportion of metastatic disease in cancer detected by screening gradually decreased according to the increased exposure rate, and a decreasing trend in the proportion of cancer with high serum PSA levels after population screening was started. The prognosis of the prostate cancer detected by population screening was demonstrated to be more favorable than those diagnosed outside of the population screening. Recent results in screening cohorts demonstrated the efficacy of PSA. These recent evidences regarding population-based screening in Japan may contribute to establishing the optimal prostate cancer screeninK system in Asian individuals.
基金Ministry of Science and Technology of China(Grant No.2012CB720604)NSFC(Grant No.20932001)
文摘Normally, cellular responses to modified siRNAs or new siRNA delivery systems have been studied in group cell behavior by PCR, western blotting and fluorescence microscopy. In this study, we present a novel high-content screening （HCS） strategy to evaluate a novel delivery system （named CLD） of siRNA therapeutics, with which both the content of intracellular siRNAs and changes in protein expressing levels have been quantified in group cells and cellular population. We also observed that with the better cell uptake, CLD provided siRNA therapeutics （siBraf） better antitumor capability. This novel strategy was proved to be with efficiency, accuracy and high competency to adherent cell lines, thus making siRNA research more simplified.
文摘Whitebacked planthopper (WBPH) -resistance in a japonica / indica doubled haploid (DH) rice population established from a cross between WBPH-resistant japonica Chun]iang 06 and susceptible indica TN1, was comparatively evaluated through a field experiment based on the WBPH immigrant density and standardized seedbox screening test (SSST). All the susceptible DH lines in the field experiment behaved accordingly in SSST. However, 35 of resistant 66 lines (53%) in the field, were categorized to susceptible groups in SSST. Likewise, there were no significant differences in WBPH immigrant densities among 70 DH lines that were highly resistant to susceptible in SSST. The results revealed that SSST could not evaluate properly WBPH resistance in the DH lines. Four QTLs for WBPH-resistance phenotyped by the immigrant density were detected on chromosomes 2, 3, 4, and 11. Of them, the QTL on chromosome 4 was the most effective (LOD 21.8, variance 78%). Five QTLs associated with seedling mortality were mapped on chromosomes 2, 3, 4, 5 and 6. In addition to the QTL (LOD 10.5, variance 68%) on chromosome 4, there was another major QTL (LOD 12.7, variance 71%) located on chromosome 5, which was SSST-specific but might be irrespective of the WBPH resistance traits.
文摘Pancreatic cancer is a serious growing health issue in developed countries.For patients diagnosed with pancreatic cancer,the five year survival rate is below 5%.One major important reason leads to the poor survival rate is lack of early detection of pancreatic cancer.Over 80% of the patients are diagnosed in advanced disease stages.Screening for pancreatic cancer is a desirable option for high risk individuals to allow early detection and treatment of curable pancreatic neoplasms at a pre-invasive stage.This article highlights the need,endpoint,population,method,diagnostic yield,and the problems of current screening programs.
基金supported by the National Natural Science Foundation of China(82071662,to Q.G.)。
文摘Identification of carriers of fragile X syndrome(FXS) with the subsequent prenatal diagnosis and knowledge of FXS-associated genetic profiles are essential for intervention in specific populations. We report the results of carrier screening of 39,458 East Asian adult women and prenatal diagnosis from 87 FXS carriers.The prevalence of FXS carriers and full mutation fetuses was estimated to be 1/581 and 1/3124 in East Asian populations, respectively. We confirmed the validity of the current threshold of CGG trinucleotide repeats for FMR1 categorization;the integral risks of full mutation expansion were approximately 6.0%,43.8%, and 100% for premutation alleles with 55—74, 75—89, and ≥ 90 CGG repeats, respectively. The protective effect of AGG(adenine-guanine-guanine nucleotides) interruption in East Asian populations was validated, which is important in protecting premutation alleles with 75—89 CGG repeats from full mutation expansion. Finally, family history was shown not an effective indicator for FXS carrier screening in East Asian populations, and population-based screening was more cost-effective. This study provides an insight into the largest carrier screening and prenatal diagnosis for FXS in East Asian populations to date. The FXSassociated genetic profiles of East Asian populations are delineated, and population-based carrier screening is shown to be promising for FXS intervention.
文摘To clarify the recent trends in prostate-specific antigen （PSA） distribution in men in Japan, we analyzed the PSA distributions of men undergoing PSA-based population screening. We summarized the annual individual data of PSA-based population screening in Kanazawa, Japan, from 2000 to 2011, and analyzed baseline serum PSA values of the participants at the first population screening. Serum PSA distributions were estimated in all participants and those excluding prostate cancer patients according to age. From 2000 to 2011, 19 620 men participated aged 54-69 years old in this screening program. Mean baseline serum PSA level of all participants at the first screening was 2.64 ng m1-1 in 2000, and gradually decreased to approximately 1.30 ng ml-I in 2006. That of participants excluding prostate cancer patients was 1.46 ng m1-1 in 2000, and there was no remarkable change during the study period. The 95t＂ percentiles in the participants excluding prostate cancer patients detected at the first population screening of men aged 54-59, 60-64, and 65-69 years old were 2.90, 3.60, and 4.50 ng m1-1, respectively. After the commencement of population screening, the proportion of prostate cancer patients with high serum PSA levels decreased. However, there were no changes in serum PSA levels in men without prostate cancer. Age-specific PSA reference level of men without prostate cancer in Japan was similar to that in China and Korea.
文摘The risk of breast cancer(BC) overdiagnosis attributed to mammography screening is an unresolved issue, complicated by heterogeneity in the methodology of quantifying its magnitude, and both political and scientific elements surrounding interpretation of the evidence on this phenomenon. Evidence from randomized trials and also from observational studies shows that mammography screening reduces the risk of BC death; similarly, these studies provide sufficient evidence that overdiagnosis represents a serious harm from population breast screening. For both these outcomes of screening, BC mortality reduction and overdiagnosis, estimates of magnitude vary between studies however overdiagnosis estimates are associated with substantial uncertainty. The trade-off between the benefit and the collective harms of BC screening, including false-positives and overdiagnosis, is more finely balanced than initially recognized, however the snapshot of evidence presented on overdiagnosis does not mean that breast screening is worthless. Future efforts should be directed towards(a) ensuring that any changes in the implementation of BC screening optimize the balance between benefit and harms, including assessing how planned or actual changes modify the risk of overdiagnosis;(b) informing women of all the outcomes that may affect them when they participate in screening using well-crafted and balanced information; and(c) investing in research that will help define and reduce the ensuing overtreatment of screen-detected BC.
文摘Quantitative research of the origin of sulfur isotopes is a difficult problem that has puzzled geochemists all along. In the study of the middle and lower reaches of the Yangtze River and the Dongpo orefield in Hunan Province, the authors successfully applied the mathematical model of mixed population screening to quantitatively resolving the problem on the origin of sulfur isotopes, which is significant in finding out the source of mineralizing matter and metallogenic mechanisms.
文摘Correlation analysis between the hematological parameters mean corpuscular hemoglobin (MCH) and mean corpuscular volume (MCV) for thalassemia screening in large population was discussed. A total of 4920 peripheral blood samples of reproductive age persons were collected from Guangdong province of China. The hematological parameters MCH and MCV values of samples were first measured, and then the DNA analyses for thalassemia were conducted. All samples were composed by 4463 non-thalassemia and 457 thalassemia, and among 457 thalassemia samples, 311 were α-thalassemia, 133 were β-thalassemia, and 13 were α & β-thalassemia. In accordance with non-thalassemia, thalassemia, α-thalassemia, β-thalassemia, α & β-thalassemia and the entire group itself, a total of six sample groups were divided. The corresponding correlation coefficients between the measured MCH and MCV values for the six sample groups were 0.880, 0.968, 0.966, 0.962, 0.980 and 0.965 respectively. For the thalassemia carriers, highly significant correlation between MCH and MCV were observed. The fitting equations between MCH and MCV values were also obtained. The results indicated that the feasibility for thalassemia screening using MCV or MCH independently as parameter, and provided suitable strategy to select parameters and models for thalassemia screening in large population.
文摘Objective: This paper aims to screen and analyze the current status of high-risk stroke patients in Shashi District of Jingzhou City and the exposure levels of related risk factors, and provides suggestions as the references for prevention and treatment of stroke. Methods: Using cluster sampling, on-site investigations were conducted on 1060 permanent residents aged 40 years and over at 3 townships and 2 communities in Shashi District of Jingzhou City from January 2018 to December 2018. Risk assessment of stroke is based on the stroke risk screening form. Statistical analysis was performed by using SPSS 22.0 software. Results: After making a stroke risk assessment, a total of 313 high-risk stroke patients were screened, and the detection rate was 29.53%. The exposure rate of risk factors from high to low was hypertension (70.93%), dyslipidemia (46.33%), less physical exercise (46.01%), diabetes (36.10%), overweight (33.55%), smoking (33.23%), family history of stroke (24.92%), atrial fibrillation or valvular heart disease (7.35%). There are statistically significant differences among all risk factors between the high-risk group and middle and low-risk groups (P Conclusion: The detection rate of high-risk stroke patients in Shashi District of Jingzhou City is high. Hypertension, dyslipidemia and less physical exercise are the main risk factors of stroke occurrence and recurrence in the region. The prevention and treatment of risk factors for stroke should be strengthened to control the incidence and recurrence rate of stroke.
文摘BACKGROUND X-ray gastric cancer(GC)screening has been shown to decrease mortality.Population-based X-ray GC screening has been performed in Hiroshima Prefe-cture,Japan,since 1983 but time trends and the efficacy of the method over 39 years have not been assessed.METHODS This was a population-based retrospective study.The data were derived from aggregated data of the Hiroshima Regional Health Medical Promotion Organization,including the number and rate of participants and those requiring esophagogastroduodenoscopies(EGDs),the number and rate of participants diagnosed as having GC,and the positive predictive value of the abnormal findings detected by X-ray and confirmed by EGDs.The number and rate of esophageal cancers were also collected.Further,the cost of detecting one GC was evaluated.RESULTS The number of participants has decreased during the last four decades,from 39925 in 1983 to 12923 in 2021.The rate of those requiring EGDs decreased significantly in recent years(P<0.001).The number of participants diagnosed as having GC has also declined,from 76 to 10 cases.However,the rate of cases diagnosed as GC among the participants remained around 0.1%.The positive predictive value increased significantly in recent years except during 1983-1991.The number and rate of accidentally detected esophageal cancers have risen recently,from 0%in 2008 to 0.02%in 2021,one-fifth of the diagnosis rate of GC.One GC diagnosis costs approximately 4200000 Japanese Yen(30000 United States Dollars)for the X-ray screenings and EGDs.CONCLUSION X-ray GC screening in Hiroshima has been efficient,but one challenge is the cost.Esophageal cancers may also need to be considered because they have gradually increased in recent years.
文摘Metabolic dysfunction-associated steatotic liver disease is the most prevalent chronic liver condition,affecting over one-third of the global population,with cirrhosis present in up to 3.3%of cases.Early detection of advanced liver disease in at-risk populations can enable timely intervention,prevent progression,and reduce complications.This review focuses on the current recommendations for early detection of advanced liver disease,evaluates the evidence for the performance of non-invasive tests in the target population for screening,and examines the multifaceted burden of screening,including economic implications and psychological impacts.Additionally,we discuss future directions,such as integrating liver health into a multidisciplinary care framework.Current guidelines recommend case-finding,targeting individuals with type 2 diabetes,metabolically complicated obesity,or persistent elevated liver enzymes.The Fibrosis-4 index is widely endorsed as a first-line non-invasive test,yet the diagnostic performance in primary care settings seems suboptimal,particularly for pre-cirrhotic disease.Sequential strategies incorporating novel non-invasive tests may improve accuracy and cost-effectiveness.Confirmation typically involves vibration-controlled transient elastography.Key challenges include a large eligible population,uncertainties in optimal screening intervals,patient adherence to follow-up,and limited real-world cost-effectiveness data.Integrating liver health assessment into cardiometabolic care pathways,reflex testing,telehealth,and patient education may enhance uptake.While challenges remain,early detection of advanced liver disease is already likely cost-effective.Ongoing advances in screening pathways and treatment options are expected to further strengthen the case for widespread implementation.
基金Supported by The Basque Health Service,Bio Cruces and Bio Donostia Research Institutes supported this study,since the evaluation of screening programmes such as Colorectal Cancer is a strategy included in the Health planOsteba(Basque Office for Health Technology Assessment of the Ministry for Health)offered the methodological support to ensure that data were aligned with the quality requirements and needs of the local health system
文摘AIM To assess proportions, related conditions and survival of interval cancer(IC).METHODS The programme has a linkage with different clinical databases and cancer registers to allow suitable evaluation. This evaluation involves the detection of ICs after a negative faecal inmunochemical test(FIT), interval cancer FIT(IC-FIT) prior to a subsequent invitation, and the detection of ICs after a positive FIT and confirmatory diagnosis without colorectal cancer(CRC) detected and before the following recommended c o l o n o s c o p y, I C-c o l o n o s c o p y. W e c o n d u c t e d a retrospective observational study analyzing from January 2009 to December 2015 1193602 invited people onto the Programme(participation rate of 68.6%).RESULTS Two thousand five hundred and eighteen cancers were diagnosed through the programme, 18 cases of IC-colonoscopy were found before the recommended follow-up(43542 colonoscopies performed) and 186 IC-FIT were identified before the following invitation of the 769200 negative FITs. There was no statistically significant relation between the predictor variables of ICs with sex, age and deprivation index, but there was relation between location and stage. Additionally, it was observed that there was less risk when the location was distal rather than proximal(OR = 0.28, 95%CI: 0.20-0.40, P < 0.0001), with no statistical significance when the location was in the rectum as opposed to proximal. When comparing the screen-detected cancers(SCs) with ICs, significant differences in survival were found(P < 0.001); being the 5-years survival for SCs 91.6% and IC-FIT 77.8%.CONCLUSION These findings in a Population Based CRC Screening Programme indicate the need of population-based studies that continue analyzing related factors to improve their detection and reducing harm.
基金Supported by The Intern Grant Agency of the Czech Ministry of Health(IGA),No.NT 13673-4
文摘Colorectal cancer(CRC)is the second most common cancer in Europe and its incidence is steadily increasing.This trend could be reversed through timely secondary prevention(screening).In the last twenty years,CRC screening programs across Europe have experienced considerable improvements(fecal occult blood testing;transition from opportunistic to population based program settings).The Czech Republic is a typical example of a country with a long history of nationwide CRC screening programs in the face of very high CRC incidence and mortality rates.Each year,approximately 8000 people are diagnosed with CRC and some 4000 die from this malignancy.Twenty years ago,the first pilot studies on CRC screening led to the introduction of the opportunistic Czech National Colorectal Cancer Screening Program in 2000.Originally,this program was based on the guaiac fecal occult blood test(FOBT)offered by general practitioners,followed by colonoscopy in cases of FOBT positivity.The program has continuously evolved,namely with the implementation of immunochemical FOBTs and screening colonoscopy,as well as the involvement of gynecologists.Since the establishment of the Czech CRC Screening Registry in 2006,2405850 FOBTs have been performed and 104565 preventive colonoscopies recorded within the screening program.The overall program expanded to cover 25.0%of the target population by 2011.However,stagnation in the annual number of performed FOBTs lately has led to switching to the option of a population-based program with personal invitation,which is currently being prepared.
基金Supported by the Project of NINGBO Leading Medical Health Discipline,No.2022-B11Ningbo Natural Science Foundation,No.202003N4206Public Welfare Foundation of Ningbo,No.2021S108.
文摘BACKGROUND Colorectal cancer(CRC)is a serious threat worldwide.Although early screening is suggested to be the most effective method to prevent and control CRC,the current situation of early screening for CRC is still not optimistic.In China,the incidence of CRC in the Yangtze River Delta region is increasing dramatically,but few studies have been conducted.Therefore,it is necessary to develop a simple and efficient early screening model for CRC.AIM To develop and validate an early-screening nomogram model to identify individuals at high risk of CRC.METHODS Data of 64448 participants obtained from Ningbo Hospital,China between 2014 and 2017 were retrospectively analyzed.The cohort comprised 64448 individuals,of which,530 were excluded due to missing or incorrect data.Of 63918,7607(11.9%)individuals were considered to be high risk for CRC,and 56311(88.1%)were not.The participants were randomly allocated to a training set(44743)or validation set(19175).The discriminatory ability,predictive accuracy,and clinical utility of the model were evaluated by constructing and analyzing receiver operating characteristic(ROC)curves and calibration curves and by decision curve analysis.Finally,the model was validated internally using a bootstrap resampling technique.RESULTS Seven variables,including demographic,lifestyle,and family history information,were examined.Multifactorial logistic regression analysis revealed that age[odds ratio(OR):1.03,95%confidence interval(CI):1.02-1.03,P<0.001],body mass index(BMI)(OR:1.07,95%CI:1.06-1.08,P<0.001),waist circumference(WC)(OR:1.03,95%CI:1.02-1.03 P<0.001),lifestyle(OR:0.45,95%CI:0.42-0.48,P<0.001),and family history(OR:4.28,95%CI:4.04-4.54,P<0.001)were the most significant predictors of high-risk CRC.Healthy lifestyle was a protective factor,whereas family history was the most significant risk factor.The area under the curve was 0.734(95%CI:0.723-0.745)for the final validation set ROC curve and 0.735(95%CI:0.728-0.742)for the training set ROC curve.The calibration curve demonstrated a high correlation between the CRC high-risk population predicted by the nomogram model and the actual CRC high-risk population.CONCLUSION The early-screening nomogram model for CRC prediction in high-risk populations developed in this study based on age,BMI,WC,lifestyle,and family history exhibited high accuracy.
文摘Klinefelter syndrome （KS） is the set of symptoms that result from the presence of an extra X chromosome in males. Postnatal population-based KS screening will enable timely diagnosis of this common chromosomal disease, providing the opportunity for early intervention and therapy at the time point when they are most effective and may prevent later symptoms or complications. Therefore, through this study, we introduced a simple high-resolution melting （HRM） assay for KS screening and evaluated its clinical sensitivity and specificity in three medical centers using 1373 clinical blood samples. The HRM assay utilized a single primer pair to simultaneously amplify specific regions in zinc finger protein, X-linked （ZFX） and zinc finger protein, Y-linked （ZFY）. In cases of KS, the ratios of ZFX/ZFYare altered compared to those in normal males. As a result, the specific melting profiles differ and can be differentiated during data analysis. This HRM assay displayed high analytical specificity over a wide range of template DNA amounts （5 ng-50 ng） and reproducibility, high resolution for detecting KS mosaicism, and high clinical sensitivity （100%） and specificity （98.1%）. Moreover, the HRM assay was rapid （2 h per run）, inexpensive （0.2 USD per sample）, easy to perform and automatic, and compatible with both whole blood samples and dried blood spots. Therefore, this HRM assay is an ideal postnatal population-based KS screening tool that can be used for different age groups.
文摘After newborn screening is completed, most states retain leftover dried bloodspots. These dried bloodspots are stored for varying lengths of time among different state newborn screening programs. Dried bloodspots are a unique and valuable resource for the development of new newborn screening tests, quality assurance and biomedical research. Recent changes to the 2014 Newborn Screening Reauthorization Saves Lives Act require explicit parental consent for the retention and use of dried bloodspots in federally funded research. This has raised several ethical and regulatory issues and highlighted the challenges of respecting individual autonomy and public health goals. This article provides an overview of these issues and discusses methods for obtaining parental consent. These issues may be applicable to consent for the storage and use of biospecimens among other settings according to proposed changes to the Common Rule.
基金by the Spain’s Carlos III Health Care Institute by means of project PI17/00837(Co-funded by European Regional Development Fund/European Social Fund"A way to make Europe"/"Investing in your future").
文摘BACKGROUND The implementation of a colorectal cancer(CRC)screening programme may increase the awareness of Primary Care Physicians,reduce the diagnostic delay in CRC detected outside the scope of the screening programme and thus improve prognosis.AIM To determine the effect of implementation of a CRC screening programme on diagnostic delays and prognosis of CRC detected outside the scope of a screening programme.METHODS We performed a retrospective intervention study with a pre-post design.We identified 322 patients with incident and confirmed CRC in the pre-implantation cohort(June 2014–May 2015)and 285 in the post-implantation cohort(June 2017-May 2018)in the Cancer Registry detected outside the scope of a CRC screening programme.In each patient we calculated the different healthcare diagnostics delays:global,primary and secondary healthcare,referral and colonoscopyrelated delays.In addition,we collected the initial healthcare that evaluated the patient,the home location(urban/rural),and the CRC stage at diagnosis.We determined the two-year survival and we performed a multivariate proportional hazard regression analysis to determine the variables associated with survival.RESULTS We did not detect any differences in the patient or CRC baseline-related variables.A total of 20.1%of patients was detected with metastatic disease.There was a significant increase in direct referral to colonoscopy from primary healthcare(25.5%,35.8%;P=0.04)in the post-implantation cohort.Diagnostic delay was reduced by 24 d(106.64±148.84 days,82.84±109.31 d;P=0.02)due to the reduction in secondary healthcare delay(46.01±111.65 d;29.20±60.83 d;P=0.02).However,we did not find any differences in CRC stage at diagnosis or in two-year survival(70.3%;P=0.9).Variables independently associated with twoyear risk of death were age(Hazard Ratio-HR:1.06,95%CI:1.04-1.07),CRC stage(II HR:2.17,95%CI:1.07-4.40;III HR:3.07,95%CI:1.56-6.08;IV HR:19.22,95%CI:9.86-37.44;unknown HR:9.24,95%CI:4.27-19.99),initial healthcare consultation(secondary HR:2.93,95%CI:1.01-8.55;emergency department HR:2.06,95%CI:0.67-6.34),hospitalization during the diagnostic process(HR:1.67,95%CI:1.17-2.38)and urban residence(HR:1.44,95%CI:1.06-1.98).CONCLUSION Although implementation of a CRC screening programme can reduce diagnostic delays for CRC detected in symptomatic patients,this has no effect on CRC stage or survival.
