Journal of Medical Screening

GP list inflation occurs when the number of patients registered at a GP practice exceeds the number of residents. It may be associated with out-of-date patient contact data, affecting invitations for cancer screening. We examined whether bowel, breast and cervical screening coverage was associated with list inflation after adjusting for deprivation and ethnicity.

We used ecological data, with GP practice the unit of analysis. Outcomes were NHS Fingertips 2019–2020 screening programme performance data. List inflation/deflation was calculated as the difference between GP-registered patients in July 2021 and Office for National Statistics population estimates in their Lower Super Output Areas (LSOA). Percentage White population was calculated using census (2021) data. Index of multiple deprivation (IMD) score was available from NHS Fingertips. Linear regression models were used to examine correlations between outcomes and list inflation before and after adjustment for deprivation and ethnicity.

The study included 6085 GP practices covering the whole of England. Median list inflation was 8.6% (interquartile range (IQR) 4.7%–16.9%). List inflation was a significant independent predictor of screening coverage. For each 10 percentage points increase in list inflation, coverage declined as follows: −1.96% (95% CI: −2.19, −1.73), −2.20% (95% CI: −2.39, −2.02), −0.99% (95% CI: −1.15, −0.84) and −1.59% (95% CI: −1.75, −1.43) for breast, cervical (aged 25–49), cervical (aged 50–64) and bowel cancer screening, respectively.

It is important to control for variations in list inflation as well as population demographics when comparing screening programme coverage. Uptake improvement initiatives should include strategies for overcoming issues with out-of-date registration data.

This study sought to determine participation by eligible Irish Travellers, a minority ethnic group, in the cancer screening programmes in Ireland (bowel, breast and cervical screening) and to determine barriers/facilitators to screening.

This study was co-designed with the National Cancer Control Programme (NCCP) and Pavee Point Traveller and Roma Centre, Ireland. A survey questionnaire, adapted from the NCCP's 2022 National Survey on Cancer Awareness, was disseminated to Travellers via Traveller Community Health Workers (TCHWs).

A total of 574 survey questionnaires were distributed across 12 different Primary Health Care Traveller Projects in the Republic of Ireland and 483 (84%) were returned completed; 148 (30.6%) were from men and 306 (63.1%) from women (6.3%, missing data). High proportions had ever attended breast (72.6%) and cervical (65.4%) screening. Bowel screening uptake was low in both men (12.5%) and women (19.2%). Low proportions recalled receiving an invitation to programmes. The faecal immunochemical test test used in the BowelScreen programme prompted embarrassment as a barrier in eligible men (62.5%); embarrassment was lower in women for bowel (38.5%), breast (32.9%) and cervical (30.4%) screening. Fear was the second highest barrier. The main facilitators of screening attendance were talking to TCHW and an invitation respectively, particularly in women eligible for bowel (50%; 53.8%), breast (49.3%; 50.7%) and cervical screening (47.6%; 48.2%), but lower in men (25%; 37.5%); 25% cited the family doctor as facilitator.

Travellers face barriers accessing mainstream health services; easy access to screening must be ensured. The TCHW is a key facilitator. There is a need for universal ethnic identifiers to facilitate routine monitoring of participation and outcomes for Travellers in screening.

Lung cancer is a leading cause of cancer-related mortality in India, with most cases diagnosed at advanced stages. Low-dose computed tomography (LDCT) screening has been shown to enhance early detection and improve survival rates, but its cost-effectiveness in India remains unclear.

To evaluate the cost-effectiveness of LDCT screening for lung cancer compared to chest X-ray (CXR) and no screening in India using a Markov model.

A Markov model simulated the natural progression of lung cancer, comparing LDCT, CXR, and no screening in a high-risk hypothetical population in the age group of 30 to 65 years. The model incorporated transition probabilities, costs, and quality-adjusted life years (QALYs) with data from published literature, cancer registries, and Global Cancer Observatory. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB). Sensitivity analyses, including probabilistic sensitivity analysis, threshold analysis, and budget impact, were conducted to evaluate model robustness.

LDCT screening yielded the highest effectiveness (23.71 QALYs), compared to 19.82 for CXR and 13.43 for no screening. Although LDCT incurred the highest cost (₹380064.75), it also provided the highest NMB (₹5232241.18), making it the most cost-effective option. The ICER for LDCT (₹36429.44) remained below the willingness-to-pay threshold, confirming its economic viability. Sensitivity analyses further validated LDCT's robustness across scenarios.

LDCT is a cost-effective strategy for lung cancer screening in India, offering significant health benefits despite higher costs. Policymakers should consider integrating LDCT into national cancer screening programs, with further research needed to optimise screening intervals and target populations.

To assess variation in fecal hemoglobin concentration according to year and season of fecal immunochemical test screening in Sweden, the detection rate of advanced neoplasia, and factors that could influence fecal immunochemical test positivity including sex, age, comorbidity, and laboratory testing quality.

We performed a cross-sectional analysis of participants in the fecal immunochemical test arm of the randomized controlled trial SCREESCO between March 2014 and December 2019 and of participants in the screening program of Stockholm–Gotland, Sweden, who underwent a one-sample fecal immunochemical test between October 2015 and October 2024.

A total of 33,232 individuals from SCREESCO and 315,664 individuals from the Stockholm–Gotland screening program were included. Fecal immunochemical test hemoglobin concentrations were generally higher in the winter but this varied over calendar years. In SCREESCO, the median fecal immunochemical test concentration was 0.0 μg hemoglobin/g feces in December 2015, 1.0 μg hemoglobin/g feces in June and 5.0 μg hemoglobin/g feces in December 2016, and 0.0 μg hemoglobin/g feces in June 2017. This was paralleled by a similar variation in the Stockholm–Gotland screening program. In months with higher fecal immunochemical test positivity in SCREESCO, there was a higher number of colonoscopies and a lower rate of advanced neoplasia detected. Male sex, higher age, and higher comorbidity were also associated with higher fecal immunochemical test positivity.

The variation in the number of colonoscopies and detection rate of advanced neoplasia paralleled the seasonal variation in fecal immunochemical test and warrants further studies on seasonal variation of fecal immunochemical test to optimize fecal immunochemical test-based colorectal cancer screening.

To study the implications of implementing artificial intelligence (AI) as a decision support tool in the Norwegian breast cancer screening program concerning cost-effectiveness and time savings for radiologists.

In a decision tree model using recent data from AI vendors and the Cancer Registry of Norway, and assuming equal effectiveness of radiologists plus AI compared to standard practice, we simulated costs, effects and radiologist person-years over the next 20 years under different scenarios: 1) Assuming a €1 additional running cost of AI instead of the €3 assumed in the base case, 2) varying the AI-score thresholds for single vs. double readings, 3) varying the consensus and recall rates, and 4) reductions in the interval cancer rate compared to standard practice.

AI was unlikely to be cost-effective, even when only one radiologist was used alongside AI for all screening exams. This also applied when assuming a 10% reduction in the consensus and recall rates. However, there was a 30–50% reduction in the radiologists’ screen-reading volume. Assuming an additional running cost of €1 for AI, the costs were comparable, with similar probabilities of cost-effectiveness for AI and standard practice. Assuming a 5% reduction in the interval cancer rate, AI proved to be cost-effective across all willingness-to-pay values.

AI may be cost-effective if the interval cancer rate is reduced by 5% or more, or if its additional cost is €1 per screening exam. Despite a substantial reduction in screening volume, this remains modest relative to the total radiologist person-years available within breast centers, accounting for only 3–4% of person-years.

United Kingdom (UK) guidelines recommend delaying cervical screening due during pregnancy to 12 weeks postnatal, despite a lack of supporting evidence. This questionnaire-based study aimed to determine the feasibility of a clinical study of cervical screening and urine self-sampling for human papillomavirus (HPV) at 6 weeks postnatal, as pilot work suggested this would improve uptake, if offered at the routine postnatal check-up.

Females who were pregnant/recently pregnant were invited to participate in a web-based questionnaire. Questions assessed acceptability of postnatal cervical screening at 6 weeks postnatal, analysed with chi-square, Fisher's exact and Mann–Whitney tests. Free-text responses were coded using the Theoretical Framework of Acceptability (TFA) to conduct a qualitative content analysis.

Among the 454 participants, 266 (58.6%) would be more likely to undergo cervical screening if offered at 6 weeks postnatal, and an even higher proportion expressed increased willingness if urine self-sampling were offered (n = 338; 74.4%). Two-thirds (308/454; 67.8%) would be willing to be screened at 6 weeks postnatal for a research study and 356/454 (78.4%) if it would be limited only to urine self-sampling. When considering screening modality, over half (245/454; 54%) would prefer urine self-sampling to cervical screening, although a fifth (93/454; 21%) preferred conventional sampling. Free-text responses were provided by 279 participants, and these highlighted that affective attitude and burden TFA constructs underpinned prospective acceptability of having screening at 6 weeks postnatal.

Offering cervical screening at the 6-week postnatal check-up has potential to increase cervical screening participation. Most participants would be interested in taking part in the research. The feasibility of screening at 6 weeks postnatal and concurrent acceptability should be tested in pilot clinical studies.