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BMJ (Clinical Research Ed.) Sep 2018To investigate the efficacy and safety of prostate-specific antigen (PSA) testing to screen for prostate cancer. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To investigate the efficacy and safety of prostate-specific antigen (PSA) testing to screen for prostate cancer.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
Electronic search of Cochrane Central Register of Controlled Trials, Web of Science, Embase, Scopus, OpenGrey, LILACS, and Medline, and search of scientific meeting abstracts and trial registers to April 2018.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Randomised controlled trials comparing PSA screening with usual care in men without a diagnosis of prostate cancer.
DATA EXTRACTION
At least two reviewers screened studies, extracted data, and assessed the quality of eligible studies. A parallel guideline committee Rapid Recommendation) provided input on the design and interpretation of the systematic review, including selection of outcomes important to patients. We used a random effects model to obtain pooled incidence rate ratios (IRR) and, when feasible, conducted subgroup analyses (defined a priori) based on age, frequency of screening, family history, ethnicity, and socioeconomic level, as well as a sensitivity analysis based on the risk of bias. The quality of the evidence was assessed with the GRADE approach.
RESULTS
Five randomised controlled trials, enrolling 721 718 men, were included. Studies varied with respect to screening frequency and intervals, PSA thresholds for biopsy, and risk of bias. When considering the whole body of evidence, screening probably has no effect on all-cause mortality (IRR 0.99, 95% CI 0.98 to 1.01; moderate certainty) and may have no effect on prostate-specific mortality (IRR 0.96, 0.85 to 1.08; low certainty). Sensitivity analysis of studies at lower risk of bias (n=1) also demonstrates that screening seems to have no effect on all-cause mortality (IRR 1.0, 0.98 to 1.02; moderate certainty) but may have a small effect on prostate-specific mortality (IRR 0.79, 0.69 to 0.91; moderate certainty). This corresponds to one less death from prostate cancer per 1000 men screened over 10 years. Direct comparative data on biopsy and treatment related complications from the included trials were limited. Using modelling, we estimated that for every 1000 men screened, approximately 1, 3, and 25 more men would be hospitalised for sepsis, require pads for urinary incontinence, and report erectile dysfunction, respectively.
CONCLUSIONS
At best, screening for prostate cancer leads to a small reduction in disease-specific mortality over 10 years but has does not affect overall mortality. Clinicians and patients considering PSA based screening need to weigh these benefits against the potential short and long term harms of screening, including complications from biopsies and subsequent treatment, as well as the risk of overdiagnosis and overtreatment.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO registration number CRD42016042347.
Topics: Aged; Biopsy; Early Detection of Cancer; Erectile Dysfunction; Humans; Magnetic Resonance Imaging; Male; Mass Screening; Medical Overuse; Middle Aged; Prostate-Specific Antigen; Prostatic Neoplasms; Randomized Controlled Trials as Topic; Urinary Incontinence
PubMed: 30185521
DOI: 10.1136/bmj.k3519 -
Journal of Medical Internet Research Jul 2021Cancer is a leading cause of death, and although screening can reduce cancer morbidity and mortality, participation in screening remains suboptimal. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cancer is a leading cause of death, and although screening can reduce cancer morbidity and mortality, participation in screening remains suboptimal.
OBJECTIVE
This systematic review and meta-analysis aims to evaluate the effectiveness of social media and mobile health (mHealth) interventions for cancer screening.
METHODS
We searched for randomized controlled trials and quasi-experimental studies of social media and mHealth interventions promoting cancer screening (breast, cervical, colorectal, lung, and prostate cancers) in adults in MEDLINE, Embase, PsycINFO, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, and Communication & Mass Media Complete from January 1, 2000, to July 17, 2020. Two independent reviewers screened the titles, abstracts, and full-text articles and completed the risk of bias assessments. We pooled odds ratios for screening participation using the Mantel-Haenszel method in a random-effects model.
RESULTS
We screened 18,008 records identifying 39 studies (35 mHealth and 4 social media). The types of interventions included peer support (n=1), education or awareness (n=6), reminders (n=13), or mixed (n=19). The overall pooled odds ratio was 1.49 (95% CI 1.31-1.70), with similar effect sizes across cancer types.
CONCLUSIONS
Screening programs should consider mHealth interventions because of their promising role in promoting cancer screening participation. Given the limited number of studies identified, further research is needed for social media interventions.
TRIAL REGISTRATION
PROSPERO International Prospective Register of Systematic Reviews CRD42019139615; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=139615.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
RR2-10.1136/bmjopen-2019-035411.
Topics: Adult; Biomedical Technology; Early Detection of Cancer; Humans; Neoplasms; Social Media; Technology; Telemedicine
PubMed: 34328423
DOI: 10.2196/26759 -
Clinics (Sao Paulo, Brazil) Apr 2017Developing countries have limited healthcare resources and use different strategies to diagnose breast cancer. Most of the population depends on the public healthcare... (Review)
Review
Developing countries have limited healthcare resources and use different strategies to diagnose breast cancer. Most of the population depends on the public healthcare system, which affects the diagnosis of the tumor. Thus, the indicators observed in developed countries cannot be directly compared with those observed in developing countries because the healthcare infrastructures in developing countries are deficient. The aim of this study was to evaluate breast cancer screening strategies and indicators in developing countries. A systematic review and the Population, Intervention, Comparison, Outcomes, Timing, and Setting methodology were performed to identify possible indicators of presentation at diagnosis and the methodologies used in developing countries. We searched PubMed for the terms "Breast Cancer" or "Breast Cancer Screening" and "Developing Country" or "Developing Countries". In all, 1,149 articles were identified. Of these articles, 45 full articles were selected, which allowed us to identify indicators related to epidemiology, diagnostic intervention (diagnostic strategy, diagnostic infrastructure, percentage of women undergoing mammography), quality of intervention (presentation of symptoms at diagnosis, time to diagnosis, early stage disease), comparisons (trend curves, subpopulations at risk) and survival among different countries. The identification of these indicators will improve the reporting of methodologies used in developing countries and will allow us to evaluate improvements in public health related to breast cancer.
Topics: Breast Neoplasms; Developing Countries; Early Detection of Cancer; Female; Humans; Mammography; Mass Screening; Survival Rate
PubMed: 28492725
DOI: 10.6061/clinics/2017(04)09 -
Public Health Jun 2021The objective of this study is to estimate the pooled uptake of cervical cancer screening and identify its predictors in Sub-Saharan Africa. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The objective of this study is to estimate the pooled uptake of cervical cancer screening and identify its predictors in Sub-Saharan Africa.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
We searched PubMed, EMBASE, CINAHL, African Journals OnLine, Web of Science and Scopus electronic databases from January 2000 to 2019. All observational studies published in the English language that reported cervical cancer uptake and/or predictors in Sub-Saharan Africa were initially screened. We assessed methodological quality using the Newcastle-Ottawa Scale. An inverse variance-weighted random-effects model meta-analysis was performed to estimate the pooled uptake and odds ratio (OR) of predictors with a 95% confidence interval (CI). The I test statistic was used to check between-study heterogeneity, and the Egger's regression statistical test was used to check publication bias.
RESULTS
We initially screened 3537 citations and subsequently 29 studies were selected for this review, which included a total of 36,374 women. The uptake of cervical cancer screening in Sub-Saharan Africa was 12.87% (95% CI: 10.20, 15.54; I = 98.5%). A meta-analysis of seven studies showed that knowledge about cervical cancer increased screening uptake by nearly five times (OR: 4.81; 95% CI: 3.06, 7.54). Other predictors of cervical screening uptake include educational level, age, Human Immune deficiency Virus (HIV) status, contraceptive use, perceived susceptibility and awareness about screening locations.
CONCLUSIONS
Cervical screening uptake is low in Sub-Saharan Africa as a result of several factors. Health outreach and promotion programmes to target these identified predictors are required.
Topics: Africa South of the Sahara; Early Detection of Cancer; Female; HIV Infections; Humans; Mass Screening; Uterine Cervical Neoplasms
PubMed: 34082174
DOI: 10.1016/j.puhe.2021.04.014 -
CA: a Cancer Journal For Clinicians 2023There remains a need to synthesize linkages between social determinants of health (SDOH) and cancer screening to reduce persistent inequities contributing to the US... (Review)
Review
There remains a need to synthesize linkages between social determinants of health (SDOH) and cancer screening to reduce persistent inequities contributing to the US cancer burden. The authors conducted a systematic review of US-based breast, cervical, colorectal, and lung cancer screening intervention studies to summarize how SDOH have been considered in interventions and relationships between SDOH and screening. Five databases were searched for peer-reviewed research articles published in English between 2010 and 2021. The Covidence software platform was used to screen articles and extract data using a standardized template. Data items included study and intervention characteristics, SDOH intervention components and measures, and screening outcomes. The findings were summarized using descriptive statistics and narratives. The review included 144 studies among diverse population groups. SDOH interventions increased screening rates overall by a median of 8.4 percentage points (interquartile interval, 1.8-18.8 percentage points). The objective of most interventions was to increase community demand (90.3%) and access (84.0%) to screening. SDOH interventions related to health care access and quality were most prevalent (227 unique intervention components). Other SDOH, including educational, social/community, environmental, and economic factors, were less common (90, 52, 21, and zero intervention components, respectively). Studies that included analyses of health policy, access to care, and lower costs yielded the largest proportions of favorable associations with screening outcomes. SDOH were predominantly measured at the individual level. This review describes how SDOH have been considered in the design and evaluation of cancer screening interventions and effect sizes for SDOH interventions. Findings may guide future intervention and implementation research aiming to reduce US screening inequities.
Topics: Humans; Social Determinants of Health; Early Detection of Cancer; Health Status Disparities; Lung Neoplasms; Educational Status
PubMed: 37329257
DOI: 10.3322/caac.21801 -
Asian Pacific Journal of Cancer... Apr 2018Background: Cervical cancer is the second most common cancer in women worldwide; early detection can play a key role in reducing the associated morbidity. The objective... (Review)
Review
Background: Cervical cancer is the second most common cancer in women worldwide; early detection can play a key role in reducing the associated morbidity. The objective of this study was to systematically assess the effects of educational interventions on cervical cancer screening (CCS) behavior of women. Methods: In this review the Cochrane library, Web of Science, Science Direct, PubMed, Scopus and search engine of Google scholar were searched for all interventional studies (trails, pre- and post-test or quasi-experimental) published in 2000-2017 for a systematic review, The search was based on the following keywords: cervix cancer, uterine cervical neoplasms, screening, prevention and control, Papanicolaou Test, pap test, pap smear, education, intervention, systematic review. Due to the heterogeneity of the data, a qualitative analysis was performed. Results: Thirty seven articles with 15,658 female participants in different parts of world were included in the review. About three quarters of the articles covered behavior change interventions. About one fourth of the articles were based on health education methods. The heath belief model is the most popular used framework for cervical cancer screening interventions. The results of our study showed that different health education methods (such as calls, mailed postcards, mother/daughter education. consultation sessions, picture books, videos, PowerPoint slides, small group discussions, educational brochures, radio broadcast education, lecture presentations, tailored counseling and a fact sheet, Self-learning package, face-to- face interviews and etc) are effective in modifying cervical cancer screening behavior of women. Conclusions: Our results showed that the different interventions and health behavior change frameworks provide an effective base for cervical cancer prevention. Heath providers can chose educational methods based on the particular client situations.
Topics: Early Detection of Cancer; Early Intervention, Educational; Female; Health Education; Humans; Uterine Cervical Neoplasms
PubMed: 29693331
DOI: 10.22034/APJCP.2018.19.4.875 -
Annals of Internal Medicine Feb 2016In 2009, the U.S. Preventive Services Task Force recommended biennial mammography screening for women aged 50 to 74 years and selective screening for those aged 40 to 49... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In 2009, the U.S. Preventive Services Task Force recommended biennial mammography screening for women aged 50 to 74 years and selective screening for those aged 40 to 49 years.
PURPOSE
To review studies of the effectiveness of breast cancer screening in average-risk women.
DATA SOURCES
MEDLINE and Cochrane databases to 4 June 2015.
STUDY SELECTION
English-language randomized, controlled trials and observational studies of screening with mammography, magnetic resonance imaging, and ultrasonography that reported breast cancer mortality, all-cause mortality, or advanced breast cancer outcomes.
DATA EXTRACTION
Investigators extracted and confirmed data and dual rated study quality; discrepancies were resolved through consensus.
DATA SYNTHESIS
Fair-quality evidence from a meta-analysis of mammography trials indicated relative risks (RRs) for breast cancer mortality of 0.92 for women aged 39 to 49 years (95% CI, 0.75 to 1.02) (9 trials; 3 deaths prevented per 10,000 women over 10 years); 0.86 for those aged 50 to 59 years (CI, 0.68 to 0.97) (7 trials; 8 deaths prevented per 10,000 women over 10 years); 0.67 for those aged 60 to 69 years (CI, 0.54 to 0.83) (5 trials; 21 deaths prevented per 10,000 women over 10 years); and 0.80 for those aged 70 to 74 years (CI, 0.51 to 1.28) (3 trials; 13 deaths prevented per 10,000 women over 10 years). Risk reduction was 25% to 31% for women aged 50 to 69 years in observational studies of mammography screening. All-cause mortality was not reduced with screening. Advanced breast cancer was reduced for women aged 50 years or older (RR, 0.62 [CI, 0.46 to 0.83]) (3 trials) but not those aged 39 to 49 years (RR, 0.98 [CI, 0.74 to 1.37]) (4 trials); less evidence supported this outcome.
LIMITATIONS
Most trials used imaging technologies and treatments that are now outdated, and definitions of advanced breast cancer were heterogeneous. Studies of effectiveness based on risk factors, intervals, or other modalities were unavailable or methodologically limited.
CONCLUSION
Breast cancer mortality is generally reduced with mammography screening, although estimates are not statistically significant at all ages and the magnitudes of effect are small. Advanced cancer is reduced with screening for women aged 50 years or older.
PRIMARY FUNDING SOURCE
Agency for Healthcare Research and Quality.
Topics: Age Factors; Aged; Breast Neoplasms; Early Detection of Cancer; Female; Humans; Mammography; Mass Screening; Middle Aged; Risk Factors; Time Factors
PubMed: 26756588
DOI: 10.7326/M15-0969 -
PloS One 2017Although cervical cancer is largely preventable through screening, detection and treatment of precancerous abnormalities, it remains one of the top causes of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Although cervical cancer is largely preventable through screening, detection and treatment of precancerous abnormalities, it remains one of the top causes of cancer-related morbidity and mortality globally.
OBJECTIVES
The objective of this systematic review is to understand the evidence of the effect of cervical cancer education compared to control conditions on cervical cancer screening rates in eligible women population at risk of cervical cancer. We also sought to understand the effect of provider recommendations for screening to eligible women on cervical cancer screening (CCS) rates compared to control conditions in eligible women population at risk of cervical cancer.
METHODS
We used the PICO (Problem or Population, Interventions, Comparison and Outcome) framework as described in the Cochrane Collaboration Handbook to develop our search strategy. The details of our search strategy has been described in our systematic review protocol published in the International Prospective Register of systematic reviews (PROSPERO). The protocol registration number is CRD42016045605 available at: http://www.crd.york.ac.uk/prospero/display_record.asp?src=trip&ID=CRD42016045605. The search string was used in Pubmed, Embase, Cochrane Systematic Reviews and Cochrane CENTRAL register of controlled trials to retrieve study reports that were screened for inclusion in this review. Our data synthesis and reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). We did a qualitative synthesis of evidence and, where appropriate, individual study effects were pooled in meta-analyses using RevMan 5.3 Review Manager. The Higgins I2 was used to assess for heterogeneity in studies pooled together for overall summary effects. We did assessment of risk of bias of individual studies included and assessed risk of publication bias across studies pooled together in meta-analysis by Funnel plot.
RESULTS
Out of 3072 study reports screened, 28 articles were found to be eligible for inclusion in qualitative synthesis (5 of which were included in meta-analysis of educational interventions and 8 combined in meta-analysis of HPV self-sampling interventions), while 45 were excluded for various reasons. The use of theory-based educational interventions significantly increased CCS rates by more than double (OR, 2.46, 95% CI: 1.88, 3.21). Additionally, offering women the option of self-sampling for Human Papillomavirus (HPV) testing increased CCS rates by nearly 2-fold (OR = 1.71, 95% CI: 1.32, 2.22). We also found that invitation letters alone (or with a follow up phone contact), making an appointment, and sending reminders to patients who are due or overdue for screening had a significant effect on improving participation and CCS rates in populations at risk.
CONCLUSION
Our findings supports the implementation of theory-based cervical cancer educational interventions to increase women's participation in cervical cancer screening programs, particularly when targeting communities with low literacy levels. Additionally, cervical cancer screening programs should consider the option of offering women the opportunity for self-sample collection particularly when such women have not responded to previous screening invitation or reminder letters for Pap smear collection as a method of screening.
Topics: Bias; Early Detection of Cancer; Female; Health Education; Humans; Mass Screening; Papillomaviridae; Patient Education as Topic; Prospective Studies; Quality of Life; Treatment Outcome; Uterine Cervical Neoplasms
PubMed: 28873092
DOI: 10.1371/journal.pone.0183924 -
Annals of Family Medicine Mar 2018Although the digital rectal examination (DRE) is commonly performed to screen for prostate cancer, there is limited data to support its use in primary care. This review... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Although the digital rectal examination (DRE) is commonly performed to screen for prostate cancer, there is limited data to support its use in primary care. This review and meta-analysis aims to evaluate the diagnostic accuracy of DRE in screening for prostate cancer in primary care settings.
METHODS
We searched MEDLINE, Embase, DARE (Database of Abstracts of Reviews of Effects), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) from their inception to June 2016. Six reviewers, in pairs, independently screened citations for eligibility and extracted data. Pooled estimates were calculated for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of DRE in primary care settings using an inverse-variance meta-analysis. We used QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) and GRADE (Grades of Recommendation Assessment, Development, and Evaluation) guidelines to assess study risk of bias and quality.
RESULTS
Our search yielded 8,217 studies, of which 7 studies with 9,241 patients were included after the screening process. All patients analyzed underwent both DRE and biopsy. Pooled sensitivity of DRE performed by primary care clinicians was 0.51 (95% CI, 0.36-0.67; I = 98.4%) and pooled specificity was 0.59 (95% CI, 0.41-0.76; I = 99.4%). Pooled PPV was 0.41 (95% CI, 0.31-0.52; I = 97.2%), and pooled NPV was 0.64 (95% CI, 0.58-0.70; I = 95.0%). The quality of evidence as assessed with GRADE was very low.
CONCLUSION
Given the considerable lack of evidence supporting its efficacy, we recommend against routine performance of DRE to screen for prostate cancer in the primary care setting.
Topics: Digital Rectal Examination; Early Detection of Cancer; Humans; Male; Primary Health Care; Prostatic Neoplasms
PubMed: 29531107
DOI: 10.1370/afm.2205 -
The American Journal of Clinical... Dec 2018There is great overlap between the presentation of cachexia, sarcopenia, and malnutrition. Distinguishing between these conditions would allow for better targeted...
BACKGROUND
There is great overlap between the presentation of cachexia, sarcopenia, and malnutrition. Distinguishing between these conditions would allow for better targeted treatment for patients.
OBJECTIVES
The aim was to systematically review validated screening tools for cachexia, sarcopenia, and malnutrition in adults and, if a combined tool is absent, make suggestions for the generation of a novel screening tool.
DESIGN
A systematic search was performed in Ovid Medline, EMBASE, CINAHL, and Web of Science. Two reviewers performed data extraction independently. Each tool was judged for validity against a reference method. Psychometric evaluation was performed as was appraisal of the tools' ability to assess the patient against consensus definitions.
RESULTS
Thirty-eight studies described 22 validated screening tools. The Cachexia score (CASCO) was the only validated screening tool for cachexia and performed well against the consensus definition. Two tools assessed sarcopenia [the Short Portable Sarcopenia Measure (SPSM) and the SARC-F (Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls)] and scored well against the 1998 Baumgartner definition. The SPSM required large amounts of equipment, and the SARC-F had a low sensitivity. Nineteen tools screened for malnutrition. The 3-Minute Nutrition Score performed best, meeting consensus definition criteria (European Society for Clinical Nutrition and Metabolism) and having a sensitivity and specificity of >80%. No tool contained all of the currently accepted components to screen for all 3 conditions. Only 3 tools were validated against cross-sectional imaging, a clinical tool that is gaining wider interest in body-composition analysis.
CONCLUSIONS
No single validated screening tool can be implemented for the simultaneous assessment of cachexia, sarcopenia, and malnutrition. The development of a tool that encompasses consensus definition criteria and directs clinicians toward the underlying diagnosis would be optimal to target treatment and improve outcomes. We propose that tool should incorporate a stepwise assessment of nutritional status, oral intake, disease status, age, muscle mass and function, and metabolic derangement.
Topics: Adult; Aged; Body Composition; Cachexia; Consensus; Diagnosis, Differential; Humans; MEDLINE; Malnutrition; Mass Screening; Middle Aged; Muscle Strength; Muscle, Skeletal; Nutrition Assessment; Reproducibility of Results; Sarcopenia; Sensitivity and Specificity; Weight Loss
PubMed: 30541096
DOI: 10.1093/ajcn/nqy244