What influences the decision to participate in colorectal cancer screening with faecal occult blood testing and sigmoidoscopy?

IntroductionUptake is an important determinant of the effectiveness of population-based screening. Uptake of colorectal cancer (CRC) screening generally remains sub-optimal.AimTo determine factors influencing the decision whether to participate or not among individuals invited for faecal occult blood test (FOBT) or flexible sigmoidoscopy (FS) screening.MethodsA questionnaire was sent to a stratified random sample of individuals aged 50–74, previously invited for a randomised CRC screening trial offering FOBT or FS, and a reference group from the same population not previously invited (screening naïve group). The questionnaire assessed reasons for (non)-participation, individuals’ characteristics associated with participation, knowledge, attitudes and level of informed choice.ResultsThe response rate was 75% (n = 341/452) for CRC screening participants, 21% (n = 676/3212) for non-participants and 38% (n = 192/500) for screening-naïve individuals. The main reasons for FOBT and FS participation were acquiring certainty about CRC presence and possible early CRC detection. Anticipated regret and positive attitudes towards CRC screening were strong predictors of actual participation and intention to participate in a next round. The main reason for non-participation in FOBT screening was lack of abdominal complaints. Non-participation in FS screening was additionally influenced by worries about burden. Eighty-one percent of participants and 12% of non-participants made an informed choice on participation.ConclusionOnly 12% of non-participants made an informed choice not to participate. These results imply that governments and/or organizations offering screening should focus on adequately informing and educating target populations about the harms and benefits of CRC screening. This may impact uptake of CRC screening.     

The validation of a simulation model incorporating radiation risk for mammography breast cancer screening in women with a hereditary-increased breast cancer risk

IntroductionFor women with a BRCA1 or BRCA2 mutation or a strong family history of breast cancer, there is no clear estimation of the risk of tumour induction versus the beneficial effects of mammography screening available. This study aims to validate the Simulation Model on Radiation Risk and breast cancer Screening (SiMRiSc) model in these women, which can provide information on the benefits and risks of screening for breast cancer for various screening scenarios.MethodsThe simulation model for breast cancer screening was developed and the values for model parameters including cancer induction due to radiation were derived from the literature. The simulation model was validated by comparing the outcome data of the model with the data from three published screening studies of women with an increased hereditary breast cancer risk. A sensitivity analysis was used to estimate the error margins of the outcome data and to analyse the sensitivity of the simulation model to each parameter.ResultsThe model predicted 71 ± 4% of the reported tumours. When excluding the excess number of incident tumours detected in the first screening round, the model predicted 85 ± 6% of the tumours reported. The model was most sensitive to changes in the parameters related to lifetime breast cancer risk and sensitivity of mammography.ConclusionsWe conclude that the simulation model is suitable for the provision of accurate benefits’ and risks’ estimations necessary for the refinement of the screening guidelines for women at an increased risk of breast cancer.     

Informed decision making does not affect health-related quality of life in lung cancer screening (NELSON trial)

BackgroundIt is believed that making an informed decision about (screening) participation is associated with better health-related quality of life (HRQoL) outcomes. This is the first study in cancer screening to explore this association in subjects participating in a lung cancer computed tomography (CT) screening trial.MethodsParticipants that made either an informed decision to participate (n = 155) or not (n = 133) were selected for this study. Differences in HRQoL, measured as generic HRQoL (Short Form 12 [SF-12] and EuroQol questionnaire [EQ-5D]), anxiety/distress (State-Trait Anxiety Inventory [STAI-6], Impact of Event Scale [IES] and Consequences of Screening-Lung Cancer [COS-LC]), were tested with Mann–Whitney U tests and ANOVA at three assessment points (when deciding about participation, before trial randomisation and 2 months after receiving the CT result).ResultsSubjects who made an informed decision to participate had no better scores than those who did not make an informed decision for 23 out of 24 HRQoL comparisons, except for a better mean score for mental health (Mental Component Summary (MCS) = 53.9 ± 9.2 versus 51.0 ± 10.1, p = 0.003) before randomisation. For subjects with an indeterminate CT result (n = 64), no significant differences were found between subjects with (n = 35) or without (n = 29) an informed decision.ConclusionSubjects who did not make an informed decision to participate in lung cancer CT screening trial did not experience worse HRQoL during screening than subjects who did make an informed decision, either in general or after receiving an indeterminate result.     

Effective biennial mammographic screening in women aged 40-49

BackgroundThe United Kingdom is currently moving the age limit for invitation in its national breast screening programme downwards from 50 to 47. In contrast, the US Preventive Services Task Force concluded that, because of borderline statistical significance on effectiveness of mammographic screening, the current evidence is insufficient to advise screening in women aged 40–49.Material and methodsWe designed a case-referent study to investigate the effect of biennial mammographic screening on breast cancer mortality for women in their forties. In Nijmegen, the Netherlands, screening started in 1975. A total of 272 breast cancer deaths were identified, and 1360 referents aged 40–69 were sampled from the population invited for screening. Effectiveness was estimated by calculating the odds ratio (OR) indicating the breast cancer death rate in screened versus unscreened women.ResultsIn women aged 40–49, the effect of screening was OR = 0.50 (95% confidence interval (CI) = 0.30–0.82). This result is similar to those aged 50–59 (OR = 0.54; 95% CI = 0.35–0.85) and 60–69 (OR = 0.65; 95% CI = 0.38–1.13).ConclusionOur results add convincing evidence about the effectiveness of biennial mammographic screening in women aged 40–49.     

Hormonal therapy for oestrogen receptor-negative breast cancer is associated with higher disease-specific mortality

BackgroundTamoxifen has a remarkable impact on the outcome of oestrogen receptor (ER)-positive breast cancer. Without proven benefits, tamoxifen is occasionally prescribed for women with ER-negative disease. This population-based study aims to estimate the impact of tamoxifen on the outcome of ER-negative disease.MethodsWe identified all women (n = 528) diagnosed with ER-negative invasive breast cancer between 1995 and 2005. With Cox regression analysis, we calculated breast cancer mortality risks of patients treated with tamoxifen compared with those treated without tamoxifen. We adjusted these risks for the individual probabilities (propensity scores) of having received tamoxifen.ResultsSixty-nine patients (13%) with ER-negative disease were treated with tamoxifen. Five-year disease-specific survival for women treated with versus without tamoxifen were 62% [95% confidence interval (CI) 48% to 76%] and 79% (95% CI 75% to 83%), respectively (P_Log-rank < 0.001). For ER-negative patients, risk of death from breast cancer was significantly increased in those treated with tamoxifen compared with patients treated without tamoxifen (adjusted hazard ratio = 1.7, 95% CI 1.1–2.9, P = 0.031).ConclusionOur results show that patients with ER-negative breast cancer treated with tamoxifen have an increased risk of death from their disease. Tamoxifen use should be avoided for these patients.     

Effect of protocol-related variables and women's characteristics on the cumulative false-positive risk in breast cancer screening

BackgroundReducing the false-positive risk in breast cancer screening is important. We examined how the screening-protocol and women's characteristics affect the cumulative false-positive risk.MethodsThis is a retrospective cohort study of 1 565 364 women aged 45–69 years who underwent 4 739 498 screening mammograms from 1990 to 2006. Multilevel discrete hazard models were used to estimate the cumulative false-positive risk over 10 sequential mammograms under different risk scenarios.ResultsThe factors affecting the false-positive risk for any procedure and for invasive procedures were double mammogram reading [odds ratio (OR) = 2.06 and 4.44, respectively], two mammographic views (OR = 0.77 and 1.56, respectively), digital mammography (OR = 0.83 for invasive procedures), premenopausal status (OR = 1.31 and 1.22, respectively), use of hormone replacement therapy (OR = 1.03 and 0.84, respectively), previous invasive procedures (OR = 1.52 and 2.00, respectively), and a familial history of breast cancer (OR = 1.18 and 1.21, respectively). The cumulative false-positive risk for women who started screening at age 50–51 was 20.39% [95% confidence interval (CI) 20.02–20.76], ranging from 51.43% to 7.47% in the highest and lowest risk profiles, respectively. The cumulative risk for invasive procedures was 1.76% (95% CI 1.66–1.87), ranging from 12.02% to 1.58%.ConclusionsThe cumulative false-positive risk varied widely depending on the factors studied. These findings are relevant to provide women with accurate information and to improve the effectiveness of screening programs.     

Increased risk of lung cancer in individuals with a family history of the disease: a pooled analysis from the International Lung Cancer Consortium

Background and methodsFamilial aggregation of lung cancer exists after accounting for cigarette smoking. However, the extent to which family history affects risk by smoking status, histology, relative type and ethnicity is not well described. This pooled analysis included 24 case-control studies in the International Lung Cancer Consortium. Each study collected age of onset/interview, gender, race/ethnicity, cigarette smoking, histology and first-degree family history of lung cancer. Data from 24,380 lung cancer cases and 23,305 healthy controls were analysed. Unconditional logistic regression models and generalised estimating equations were used to estimate odds ratios and 95% confidence intervals.ResultsIndividuals with a first-degree relative with lung cancer had a 1.51-fold increase in the risk of lung cancer, after adjustment for smoking and other potential confounders (95% CI: 1.39, 1.63). The association was strongest for those with a family history in a sibling, after adjustment (odds ratios (OR) = 1.82, 95% CI: 1.62, 2.05). No modifying effect by histologic type was found. Never smokers showed a lower association with positive familial history of lung cancer (OR = 1.25, 95% CI: 1.03, 1.52), slightly stronger for those with an affected sibling (OR = 1.44, 95% CI: 1.07, 1.93), after adjustment.ConclusionsThe occurrence of lung cancer among never smokers and similar magnitudes of the effect of family history on lung cancer risk across histological types suggests familial aggregation of lung cancer is independent of those risks associated with cigarette smoking. While the role of genetic variation in the aetiology of lung cancer remains to be fully characterised, family history assessment is immediately available and those with a positive history represent a higher risk group.     

What determines individuals’ preferences for colorectal cancer screening programmes? A discrete choice experiment

IntroductionIn many countries uptake of colorectal cancer (CRC) screening remains low.AimTo assess how procedural characteristics of CRC screening programmes determine preferences for participation and how individuals weigh these against the perceived benefits from participation in CRC screening.MethodsA discrete choice experiment was conducted among subjects in the age group of 50–75 years, including both screening-naïve subjects and participants of a CRC screening programme. Subjects were asked on their preferences for aspects of CRC screening programmes using scenarios based on pain, risk of complications, screening location, preparation, duration of procedure, screening interval and risk reduction of CRC-related death.ResultsThe response was 31% (156/500) for screening-naïve and 57% (124/210) for CRC screening participants. All aspects proved to significantly influence the respondents’ preferences. For both groups combined, respondents required an additional relative risk reduction of CRC-related death by a screening programme of 1% for every additional 10 min of duration, 5% in order to expose themselves to a small risk of complications, 10% to accept mild pain, 10% to undergo preparation with an enema, 12% to use 0.75 l of oral preparation combined with 12 h fasting and 32% to use an extensive bowel preparation. Screening intervals shorter than 10 years were significantly preferred to a 10-year screening interval.ConclusionThis study shows that especially type of bowel preparation, risk reduction of CRC related death and length of screening interval influence CRC screening preferences. Furthermore, improving awareness on CRC mortality reduction by CRC screening may increase uptake.     

Physical activity in a German breast cancer patient cohort: one-year trends and characteristics associated with change in activity level

BackgroundPhysical activity (PA) is increasingly discussed as concomitant therapy after breast cancer diagnosis and can add to the alleviation of therapy- and disease-related symptoms. The objectives of this study were to describe PA behaviour in the course of breast cancer and to identify factors associated with change in PA.Methods1,067 German postmenopausal breast cancer patients were asked about their PA behaviour before breast cancer diagnosis, during therapy and 1 year after surgery. MET-hours per week (MET = metabolic equivalent) were calculated based on quantitative information about walking, bicycling for transportation purposes and sports by multiplying the average hours per week spent at each activity with an individual intensity score. Factors associated with change in MET·h/week in the course of breast cancer were identified using multiple linear regression.ResultsMedian PA decreased significantly during therapy from 36 to 14 MET·h/week (p < .001). Patients treated with chemo- and/or radiotherapy had a stronger decline in PA compared to patients without adjuvant therapy or those treated only with hormones (adjusted β = −9.73 to −13.54). The presence of medical risk factors (β = −5.56) was also associated with a decrease of PA during therapy. In contrast, participation in rehabilitation (β = 7.62) was associated with an increase of PA after therapy.ConclusionIn the light of the drastic decline in PA during therapy, programs promoting PA seem obligatory for all breast cancer patients. Patients treated with chemo- and/or radiotherapy and those with medical risk factors should particularly be assisted in reaching recommended activity levels by targeted interventions during and after therapy.     

Plasminogen activator inhibitor-1 promoter polymorphism is not associated with the aggressiveness of disease in prostate cancer

AimsPAI-1 (plasminogen activator inhibitors-1) regulates plasminogen activation, and is related to tumour development. This study aims to test whether the promoter polymorphism in the PAI-1 gene is related to the aggressiveness of disease in prostate cancer.Materials and methodsIn the present study, Taqman SNP genotyping assay was used to detect PAI-1 4G/5G polymorphism in DNA from paraffin-embedded tissues of 98 Caucasian patients with prostate cancer.ResultsThe distribution of the genotypes is in Hardy–Weinberg equilibrium. The genotype had no statistically significant relationship with other prognostic factors. Similar risks for recurrence were seen in individuals with the 4G/4G and 4G/5G genotypes compared to those with 5G/5G genotype (odds ratio [OR] 2.65, 95% CI: 0.41–16.94, P = 0.30; OR = 2.19, 95% CI: 0.38–12.49, P = 0.38).ConclusionWe concluded that PAI-1 promoter polymorphism is not associated with the aggressiveness of disease in prostate cancer.     

Reaching women who do not participate in the regular cervical cancer screening programme by offering self-sampling kits: A systematic review and meta-analysis of randomised trials

IntroductionPopulation coverage for cervical cancer screening is an important determinant explaining differences in the incidence of cervical cancer between countries. Offering devices for self-sampling has the potential to increase participation of hard-to-reach women.MethodsA systematic review and meta-analysis were performed to evaluate the participation after an invitation including a self-sampling device (self-sampling arm) versus an invitation to have a sample taken by a health professional (control arm), sent to under-screened women.ResultsSixteen randomised studies were found eligible. In an intention-to-treat analysis, the pooled participation in the self-sampling arm was 23.6% (95% confidence interval (CI) = 20.2–27.3%), when self-sampling kits were sent by mail to all women, versus 10.3% (95% CI = 6.2–15.2%) in the control arm (participation difference: 12.6% [95% CI = 9.3–15.9]). When women had to opt-in to receive the self-sampling device, as used in three studies, the pooled participation was not higher in the self-sampling compared to the control arm (participation difference: 0.2% [95% CI = −4.5–4.9%]).ConclusionAn increased participation was observed in the self-sampling arm compared to the control arm, if self-sampling kits were sent directly to women at their home address. However, the size of the effect varied substantially among studies. Since participation was similar in both arms when women had to opt-in, future studies are warranted to discern opt-in scenarios that are most acceptable to women.     

The influence of menopausal hormone therapy on tumour characteristics and survival in endometrial cancer patients

IntroductionMenopausal hormone therapy (MHT) is a well-established factor in endometrial carcinogenesis, and therefore, could have prognostic implications. We investigated the effects of ever use of MHT on tumour grade and depth of myometrial invasion and 5-year relative survival in postmenopausal endometrial cancer patients.Materials and methodsWe used a nationwide, population-based case–case design, of 683 Swedish women aged 50–74 years diagnosed with endometrial cancer during 1994 to 1995, followed up to 5 years after diagnosis. We applied polytomous multiple logistic regression to investigate the associations between the use of MHT and tumour grade, and myometrial invasion and Poisson regression for modelling 5-year excess mortality.ResultsCompared to never use, ever use of any MHT entailed lower risks of having moderately and poorly differentiated tumours. The lowest odds ratios for poorly differentiated tumours were seen for ever users of cyclically combined oestrogen–progestin [OR = 0.23 (95% CI = 0.07 – 0.73)]. Ever users of any form of MHT; particularly, medium potency MHT users, had significantly lower risks for tumours with deep myometrial invasion. Adjusted estimated relative excess hazard ratios revealed significantly improved survival for ever users of any form of MHT [RER = 0.40 (95% CI = 0.16 – 0.97)]; in particular ever users of any form of oestrogens [RER = 0.38 (95% CI = 0.15 – 0.99)].ConclusionEndometrial cancer patients who were ever users of MHT had more favourable tumour characteristics and better survival compared to never users of MHT. These findings support the notion that MHT induces endometrial cancer with less aggressive characteristics.     

Screening for colorectal cancer: Comparison of perceived test burden of guaiac-based faecal occult blood test,faecal immunochemical test and flexible sigmoidoscopy

BackgroundPerceived burden of colorectal cancer (CRC) screening is an important determinant of participation in subsequent screening rounds and therefore crucial for the effectiveness of a screening programme. This study determined differences in perceived burden and willingness to return for a second screening round among participants of a randomised population-based trial comparing a guaiac-based faecal occult blood test (gFOBT), a faecal immunochemical test (FIT) and flexible sigmoidoscopy (FS) screening.MethodsA representative sample of the Dutch population (aged 50–74 years) was randomised to be invited for gFOBT, FIT and FS screening. A random sample of participants of each group was asked to complete a questionnaire about test burden and willingness to return for CRC screening.ResultsIn total 402/481 (84%) gFOBT, 530/659 (80%) FIT and 852/1124 (76%) FS screenees returned the questionnaire. The test was reported as burdensome by 2.5% of gFOBT, 1.4% of FIT and 12.9% of FS screenees (comparing gFOBT versus FIT p = 0.05; versus FS p < 0.001). In total 94.1% of gFOBT, 94.0% of FIT and 83.8% of FS screenees were willing to attend successive screening rounds (comparing gFOBT versus FIT p = 0.84; versus FS p < 0.001). Women reported more burden during FS screening than men (18.2% versus 7.7%; p < 0.001).ConclusionsFIT slightly outperforms gFOBT with a lower level of reported discomfort and overall burden. Both FOBTs are better accepted than FS screening. All three tests have a high level of acceptance, which may affect uptake of subsequent screening rounds and should be taken into consideration before implementing a CRC screening programme.     

Informed decision making on PSA testing for the detection of prostate cancer: An evaluation of a leaflet with risk indicator

BackgroundPopulation-based screening for prostate cancer (PCa) remains controversial. To help men making informed decisions about prostate specific antigen (PSA) screening a risk indicator (www.uroweb.org) was developed. This risk indicator is embedded in a leaflet that informs men about the pros and cons of PCa screening and enables calculation of the individual risk of having a biopsy detectable PCa.AimTo assess the effect of providing a leaflet including individualized risk estimation on informed decision making of men, i.e. knowledge about PCa and PSA screening, attitude towards undergoing a PSA test and intention to have a PSA test.MethodsAn intervention study among 2000 men, aged 55–65 years, randomly selected from the population registry of the city of Dordrecht, the Netherlands, in 2008. Men were sent a questionnaire on knowledge of PCa, attitude and intention to have a PSA test. Men without a history of (screening for) PCa were sent the leaflet and Questionnaire 2 within 2 weeks after returning Questionnaire 1. Validated health and anxiety measures were used.ResultsOne thousand and twenty seven of 2000 men completed Questionnaire 1 (51%), of whom 298 were excluded due to a history of (screening for) PCa. Of the 729 remaining men, 601 completed Questionnaire 2 as well. At the second assessment significantly more men met the requirements of informed decision making (15% versus 33%, p < 0.001), more men had relevant knowledge (284/601, 50% versus 420/601, 77%, p < 0.001) and the intention to have a PSA test had increased (p < 0.001).ConclusionsProviding information on PCa screening combined with individualized risk estimation enhanced informed decision making and may be used for shared decision making on PSA screening of physicians and patients.     

The impact of alcohol consumption on the risk of cancer among men: A 20-year follow-up study from Finland

IntroductionAlcohol consumption is associated with certain cancer types and cancer deaths but there is paucity of information on the relationship between alcohol and total cancer risk. Hence, we examined this association.MethodsWe analysed data from a prospective population-based cohort study of 2627 men from Eastern Finland who had no history of cancer at baseline. There were 515 incident cancer cases accrued over 52,540 person years during the 20 years of follow-up.ResultsWe observed a linear relationship between alcohol consumption and cancer. Men within the highest quintile of alcohol consumption (>115 g/week) had a 42% increased risk of total cancer compared with those within the lowest quintile (relative risk (RR) 1.42, 95% confidence interval (CI) 1.07–1.88; P_trend = 0.03) after adjusting for age, smoking, total energy intake and cardio-respiratory fitness. The results were the same after excluding cancer cases diagnosed during the first 2 years of follow-up. Men who consumed ?28.2 g/day of alcohol (median) had a relative risk of 1.22, 95% CI 1.03–1.46; P-value 0.03) compared to those who consumed less.ConclusionAbout 6.7% of the cancer cases in this cohort were due to alcohol consumption. Strategies to reduce cancer burden need to incorporate reduction in alcohol consumption, probably beyond the level currently recommended.     

Associations of sexual dysfunction symptoms with PSA-detected localised and advanced prostate cancer: A case-control study nested within the UK population-based ProtecT (Prostate testing for cancer and Treatment) study

BackgroundSexual dysfunction might be symptomatic of cancer spreading beyond the prostate by local invasion, a mechanism of tumour progression associated with prognosis. Conversely, among men with raised prostate-specific antigen (PSA) levels, a negative association might be expected if sexual dysfunction was symptomatic of benign, rather than malignant, prostatic disease.Patients and methodsCases and controls were selected from among men recruited to the UK population-based ProtecT (Prostate testing for cancer and Treatment) study. Men aged 50–69 years were invited for PSA testing and those with a PSA level ?3.0 ng/ml were invited for biopsy. We investigated whether symptoms of sexual dysfunction, determined by self-completed questionnaire prior to biopsy, were associated with prostate cancer.ResultsOf the 8924 men who had a PSA level ?3.0 ng/ml (11% of the men who had a PSA test), 6585 underwent biopsy of whom 2813 and 421, respectively, were subsequently diagnosed with localised and advanced prostate cancer and 3351 had a negative biopsy result. No individual symptom of sexual dysfunction was associated with risk of prostate cancer. The symptom score was associated with advanced (odds ratio (OR) per one unit increase in score = 1.06; 1.00–1.12; P = 0.07) but not with localised (OR = 1.00; 0.97–1.02; P = 0.9) prostate cancer (P = 0.05 for heterogeneity).ConclusionsOur study provides weak evidence that sexual dysfunction may be associated with PSA-detected advanced, but not localised, prostate cancer among men with raised PSA levels.     

Comparing attitudes of younger and older patients towards cancer clinical trials

ObjectivesTo determine the attitudes of patients towards cancer clinical trials (CCTs) and assess the differences between older and younger patients.Materials and MethodsPatients with cancer, receiving treatment or in follow-up in University Hospital Waterford, Ireland were eligible. Patients completed a self-administered questionnaire. To determine attitudes towards CCTs, patients indicated their preference if offered participation in three hypothetical studies (cancer prevention/screening trial; CCT comparing standard to new treatment; a trial of new drug where no standard exists). Patients' reasons to or not to participate in CCTs were explored.ResultsFrom May 2014 to March 2015, 219 patients were accrued, 119 < 65 years and 100 ≥ 65 years. Twenty-two (18%) younger and 4 (4%) older patients had been/were actively enrolled on a CCT (p = 0.0012). No older patient and 5 (4%) of younger patients had enquired about CCT availability. For the CCT questions, 85 (71%) younger vs 57 (57%) older patients would participate in a prevention/screening CCT (p = 0.033); 60 (50%) vs 44 (44%) for standard vs new drug (p = 0.415), and 83 (69%) vs 78 (78%) for a CCT where no standard exists (p = 0.218). The most common reason to participate in a CCT was a recommendation from the oncologist − 98% < 65 years vs 87% ≥ 65 years (p = 0.001), with health problems being the leading reason not to participate, 86% vs 72% (p = 0.01), respectively.ConclusionsOlder and younger patients in this study gave similar importance to reasons for and against participation in CCTs. Most patients did not actively seek out a CCT, which may reflect a lack of awareness and a need for better education.     

Interval cancers in the Antwerp European randomised study of screening for prostate cancer study, using a 6 year screening interval

BackgroundThe European randomised study of screening for prostate cancer (ERSPC) was initiated to evaluate the effect of Prostate Specific Antigen (PSA) screening on prostate cancer mortality. Variations in screening modalities between participating centres, such as the interval between screening rounds are likely to affect the outcome of screening.MethodsThe study describes the number and characteristics of interval cancers in men in the screening arm of the Antwerp ERSPC aged 55–65 years at the time of randomisation and participating in the screening rounds they were invited for. The interval between the first screening rounds was 6 years on average. Interval cancers were defined as cancers diagnosed during the screening interval but not detected by screening. Cases with a positive screening test were considered as interval cancers if diagnosis through biopsy occurred more than 1 year after screening. Interval cancer cases were identified through linkage with cancer registries. Aggressive interval cancer was defined as cancer with at least one of the following characteristics: stage M1 or N1, Gleason score higher than 7 or World Health Organisation (WHO) score of 3.ResultsThe 10 year cumulative incidence of interval cancers was 3.0% (n = 50) and the cumulative incidence of aggressive interval cancers was 0.5% (n = 8). During the first screening interval 36 interval cancers were detected. Of these 20 (55.6%) were detected more than 4 years after the initial screening and 5 (13.9%) were considered aggressive. All aggressive interval cancers emerged more than 4 years after initial screening.ConclusionThe occurrence of interval cancers in this study was higher than in the ERSPC centres that used a shorter screening interval. Aggressive interval cancers only started to emerge 4 years after initial screening.     

Implementation of uHear™ - an iOS-based application to screen for hearing loss - in older patients with cancer undergoing a comprehensive geriatric assessment

ObjectiveValidation of uHear™ as a screening tool to detect hearing loss in older patients with cancer without a known diagnosis of presbycusis, as part of a Comprehensive Geriatric Assessment (CGA).Materials and MethodsPatients (≥ 70 years) with a histologically confirmed diagnosis of cancer, were enrolled at the time of CGA screening. Patients were evaluated by uHear™, which was compared to conventional audiometry as gold standard. We defined a pure-tone average (PTA) of ≥ 40 dB HL as the pass or fail screening cut-off. Validation of uHear™ was defined in terms of diagnostic accuracy through Receiver Operating Characteristics (ROC)-analysis. To accept uHear™, we estimated that the Area Under the ROC-curve (AUC) had to differ significantly from 0.50 with an AUC of at least 0.70. The Whispered Voice Test and Hearing Handicap Inventory for the Elderly were also administered.ResultsThirty-three patients consented for participation. In one patient, the results of one ear were excluded from the analysis as the patient was documented with a known hearing disorder in that ear. Significant hearing loss, defined by a PTA of ≥ 40 dB HL calculated from the air conduction thresholds at 0.5, 1.0 and 2.0 kHz, was found in 15.4% of tested ears. uHear™ showed excellent diagnostic accuracy with an AUC ± SE of 0.98 ± 0.14. It provided maximum sensitivity (100.0%) but poor specificity (36.4%) at our predefined cut-off score of ≥ 40 dB HL.ConclusionuHear™ can be implemented as a screening tool to detect hearing loss in older patients with cancer within a CGA.     

Site-specific cancer risk in the Baltic cohort of Chernobyl cleanup workers, 1986–2007

ObjectiveTo assess site-specific cancer risk in the Baltic cohort of Chernobyl cleanup workers, 1986–2007.MethodsThe Baltic cohort includes 17,040 men from Estonia, Latvia and Lithuania who participated in the environmental cleanup after the accident at the Chernobyl Nuclear Power Station in 1986–1991 and who were followed up for cancer incidence until the end of 2007. Cancer cases diagnosed in the cohort and in the male population of each country were identified from the respective national cancer registers. The proportional incidence ratio (PIR) with 95% confidence interval (CI) was used to estimate the site-specific cancer risk in the cohort. For comparison and as it was possible, the site-specific standardised incidence ratio (SIR) was calculated for the Estonian sub-cohort, which was not feasible for the other countries.ResultsOverall, 756 cancer cases were reported during 1986–2007. A higher proportion of thyroid cancers in relation to the male population was found (PIR = 2.76; 95% CI 1.63–4.36), especially among those who started their mission shortly after the accident, in April–May 1986 (PIR = 6.38; 95% CI 2.34–13.89). Also, an excess of oesophageal cancers was noted (PIR = 1.52; 95% CI 1.06–2.11). No increased PIRs for leukaemia or radiation-related cancer sites combined were observed. PIRs and SIRs for the Estonian sub-cohort demonstrated the same site-specific cancer risk pattern.ConclusionConsistent evidence of an increase in radiation-related cancers in the Baltic cohort was not observed with the possible exception of thyroid cancer, where conclusions are hampered by known medical examination including thyroid screening among cleanup workers.