High accuracy of a blood ctDNA-based multimodal test to detect colorectal cancer.

BACKGROUND: Detection of circulating tumor DNA (ctDNA) is a minimally invasive and convenient blood-based screening strategy that may increase effectiveness of colorectal cancer (CRC) screening. PATIENTS AND METHODS: A novel multimodal ctDNA-based blood assay that integrates genomics, epigenomics and fragmentomics, as well as proteomics in a refined version, was tested in blood samples from two cohorts: (i) consecutive fecal immunochemical test (FIT)-positive individuals from the CRC Barcelona stool-based screening program; (ii) patients diagnosed with CRC. Primary endpoint was the performance of the test to detect CRC at different tumor-node-metastasis (TNM) stages. Secondary endpoint was the ability of the test to detect advanced precancerous lesions (advanced adenoma or advanced serrated lesion). RESULTS: A total of 623 blood samples were analyzed in the primary analysis. Sensitivity and specificity of the assay to detect CRC was 93% and 90%, respectively. The sensitivity of CRC detection according to TNM stages was 84% for stage I, 94% for stage II and 96% for stage III (70/73) (P< 0.024). Sensitivity to detect advanced precancerous lesions was 23% with a refined version of the test (including protein and updating bioinformatic thresholding). CONCLUSION: A blood-based multimodal ctDNA assay detected CRC with high accuracy. This minimally invasive, accessible and convenient assay may help to increase the effectiveness of CRC screening.

Evaluating the appropriateness of a community pharmacy model for a colorectal cancer screening program in Catalonia (Spain).

Background The traditional model of community pharmacy has changed, with patients, caregivers and consumers having access to many cognitive services other than the traditional dispensing and supply of medicines. In December 2009, a population-based colorectal cancer screening program started in Barcelona, introducing the community pharmacist and the professional expertise of the pharmacist into the organisational model. Aim To evaluate the program implementation process in the pharmacies, identify barriers and facilitators, and know the opinion of the professionals involved in the colorectal cancer screening program in Catalonia (Spain). Methods Cross-sectional study of the pharmacies that participated in the first round of the program during the first and second trimester of 2010 in Barcelona. A validated questionnaire was used to analyse several functional aspects in the implementation process. Qualitative aspects about the opinion of the pharmacist were studied. A descriptive and bivariate analysis was performed. Results All the pharmacies involved in the program (n = 74) participated in the study. The majority of the sample population was composed of women (70.3%), mean age 44.9 years, and most of them (74%) had attended a specific training session. Pharmacists considered their participation in the program to be an added value to their professional role and a way to increase consumer's confidence on this kind of services. The average time to provide the service was estimated to be less than 10 minutes per consumer. Only three (4.1%) pharmacists considered that the program involved a lot of extra work in the daily activities of the pharmacy. The level of satisfaction of the pharmacists was very high. Conclusions Community pharmacies can be a successful alternative and great resource to implement a population cancer screening program. This functional model can improve the accessibility and participation rates on target population. The level of motivation of the community pharmacist, the specific training program and the perception to give a better care for their patients can be an enabler.

[Construction and validation of an evaluation tool of sexual health using self-administered questionnaires for an application to metabolic diseases]. / Mise au point et validation d'un outil d'évaluation de la santé sexuelle sous forme d'auto-questionnaires pour une application aux maladies métaboliques.

AIM: To elaborate and validate in general population a survey built with self-administered questionnaires in French about evaluation of sexual health for an application to men and women with metabolic disease. MATERIALS AND METHODS: Study built with four questionnaires (socio-familial environment [MSPSS scale], self-esteem [Rosenberg scale], anxiety and depression scale [Sigmund and Snaith scale], and male [BISF-M] or female [BISF-W] sexuality) translated in French and distributed to 232 men and 260 women. RESULTS: Hundred and eleven men aged 18 to 56 years and 142 women aged 20 to 60 years answered the self-administered questionnaire. Analysis showed several links between self-esteem, anxiety and depression and the different domains of male sexuality, justifying their association. Comparison between men and women confirmed the differences of sexual approach between the two sexes. CONCLUSION: Results in our population were concordant with those already reported in literature, indicating the validity and the reliability of our questionnaire and its multiparametric approach. Data obtained in this population will allow to use this multiparametric tool with patients affected by a metabolic disease.

Association of perceived stigma and mood and anxiety disorders: results from the World Mental Health Surveys.

OBJECTIVE: We assessed the prevalence of perceived stigma among persons with mental disorders and chronic physical conditions in an international study. METHOD: Perceived stigma (reporting health-related embarrassment and discrimination) was assessed among adults reporting significant disability. Mental disorders were assessed with Composite International Diagnostic Interview (CIDI) 3.0. Chronic conditions were ascertained by self-report. Household-residing adults (80,737) participated in 17 population surveys in 16 countries. RESULTS: Perceived stigma was present in 13.5% (22.1% in developing and 11.7% in developed countries). Suffering from a depressive or an anxiety disorder (vs. no mental disorder) was associated with about a twofold increase in the likelihood of stigma, while comorbid depression and anxiety was even more strongly associated (OR 3.4, 95%CI 2.7-4.2). Chronic physical conditions showed a much lower association. CONCLUSION: Perceived stigma is frequent and strongly associated with mental disorders worldwide. Efforts to alleviate stigma among individuals with comorbid depression and anxiety are needed.

[Development and validation of an algorithm to identify cancer recurrences from hospital data bases]. / Desarrollo y validación de un algoritmo para identificar recidivas de cáncer a partir de bases de datos hospitalarias.

OBJECTIVES: Hospital cancer registries and hospital databases are valuable and efficient sources of information for research into cancer recurrences. The aim of this study was to develop and validate algorithms for the detection of breast cancer recurrence. METHODS: A retrospective observational study was conducted on breast cancer cases from the cancer registry of a third level university hospital diagnosed between 2003 and 2009. Different probable cancer recurrence algorithms were obtained by linking the hospital databases and the construction of several operational definitions, with their corresponding sensitivity, specificity, positive predictive value and negative predictive value. RESULTS: A total of 1,523 patients were diagnosed of breast cancer between 2003 and 2009. A request for bone gammagraphy after 6 months from the first oncological treatment showed the highest sensitivity (53.8%) and negative predictive value (93.8%), and a pathology test after 6 months after the diagnosis showed the highest specificity (93.8%) and negative predictive value (92.6%). The combination of different definitions increased the specificity and the positive predictive value, but decreased the sensitivity. CONCLUSIONS: Several diagnostic algorithms were obtained, and the different definitions could be useful depending on the interest and resources of the researcher. A higher positive predictive value could be interesting for a quick estimation of the number of cases, and a higher negative predictive value for a more exact estimation if more resources are available. It is a versatile and adaptable tool for other types of tumors, as well as for the needs of the researcher.

[Can a mobile phone short message increase participation in breast cancer screening programmes?]. / ¿Puede un mensaje de teléfono móvil incrementar la participación en programas de cribado poblacional de cáncer de mama?

OBJECTIVE: To evaluate the impact of a mobile phone short message on women's uptake in a breast cancer screening programme. METHODS: A total of 703 women from a Basic Health Area of Barcelona, and with a mobile phone number registered, were invited to participate in a breast cancer screening programme between 25 January 2011 and 22 March 2011. The control group (n=470) followed the usual appointment track, and the intervention group (n=233) received, after the first letter of invitation, a mobile phone short message reminder. The differences between the two groups were analysed, comparing the uptake rates according to age, educational level, and participation in previous round, as well as the number of re-invitation calls to non-attenders according to uptake, age and level of education;and the percentages of exclusions of both groups. RESULTS: The intervention group had a greater uptake than the control group (78.1% vs. 72.3%), with a significant trend observed in the 55-59 years age group (P=.036) and the low secondary educational level (P=.014).The intervention group mean of re-invitation calls of non-attenders lower than the control group (.41 vs. .65, P<.05), a pattern observed in all the categories of the independent variables, and among younger age groups, lower and middle educational levels, and previously participating women (.09 vs. .19, P=.012). CONCLUSIONS: The inclusion of a mobile phone short message in a breast cancer screening programme may increase uptake rates and lead to a management improvement.

Breast cancer detection risk in screening mammography after a false-positive result.

BACKGROUND: False-positives are a major concern in breast cancer screening. However, false-positives have been little evaluated as a prognostic factor for cancer detection. Our aim was to evaluate the association of false-positive results with the cancer detection risk in subsequent screening participations over a 17-year period. METHODS: This is a retrospective cohort study of 762,506 women aged 45-69 years, with at least two screening participations, who underwent 2,594,146 screening mammograms from 1990 to 2006. Multilevel discrete-time hazard models were used to estimate the adjusted odds ratios (OR) of breast cancer detection in subsequent screening participations in women with false-positive results. RESULTS: False-positives involving a fine-needle aspiration cytology or a biopsy had a higher cancer detection risk than those involving additional imaging procedures alone (OR = 2.69; 95%CI: 2.28-3.16 and OR = 1.81; 95%CI: 1.70-1.94, respectively). The risk of cancer detection increased substantially if women with cytology or biopsy had a familial history of breast cancer (OR = 4.64; 95%CI: 3.23-6.66). Other factors associated with an increased cancer detection risk were age 65-69 years (OR = 1.84; 95%CI: 1.67-2.03), non-attendance at the previous screening invitation (OR = 1.26; 95%CI: 1.11-1.43), and having undergone a previous benign biopsy outside the screening program (OR = 1.24; 95%CI: 1.13-1.35). CONCLUSION: Women with a false-positive test have an increased risk of cancer detection in subsequent screening participations, especially those with a false-positive result involving cytology or biopsy. Understanding the factors behind this association could provide valuable information to increase the effectiveness of breast cancer screening.

Can the Gail model increase the predictive value of a positive mammogram in a European population screening setting? Results from a Spanish cohort.

AIMS OF THE STUDY: The Gail Model (GM) is the most well-known model to assess the individual risk of breast cancer (BC). Although its discriminatory accuracy is low in the clinical context, its usefulness in the screening setting is not well known. The aim of this study is to assess the utility of the GM in a European screening program. METHODS: Retrospective cohort study of 2200 reassessed women with information on the GM available in a BC screening program in Barcelona, Spain. The 5 year-risk of BC applying the GM right after the screening mammogram was compared first with the actual woman's risk of BC in the same screening round and second with the BC risk during the next 5 years. RESULTS: The curves of BC Gail risk overlapped for women with and without BC, both in the same screening episode as well as 5 years afterward. Overall sensitivity and specificity in the same screening episode were 22.3 and 86.5%, respectively, and 46.2 and 72.1% 5 years afterward. ROC curves were barely over the diagonal and the concordance statistics were 0.59 and 0.61, respectively. CONCLUSION: The GM has very low accuracy among women with a positive mammogram result, predicting BC both in the concomitant episode and 5 years later. Our results do not encourage the use of the GM in the screening context to aid the referral decision or the type of procedures after a positive mammogram or to identify women at high risk among those with a false-positive outcome.

¿Puede un mensaje de teléfono móvil incrementar la participación en programas de cribado poblacional de cáncer de mama? / Can a mobile phone short message increase participation in breast cancer screening programmes?

Objetivo. Evaluar el impacto del mensaje de teléfono móvil sobre la participación de las mujeres en un programa de detección precoz de cáncer de mama. Métodos. Se seleccionaron las 703 mujeres de un área básica de salud de Barcelona, invitadas a participar en un programa de detección precoz de cáncer de mama entre el 25 de enero de 2011 y el 22 de marzo de 2011 y con número de teléfono móvil registrado. Aleatoriamente se asignaron a grupo control (n = 470), que siguió el circuito habitual de citación, y grupo de intervención (n = 233), el cual recibió además un mensaje de texto recordatorio, tras la primera carta de invitación. Se compararon las tasas de participación entre ambos grupos según la edad, el nivel educativo y el comportamiento en ronda anterior, el número de llamadas de recitación según la participación, la edad y el nivel educativo y las diferencias en los porcentajes de exclusiones. Resultados. Globalmente el grupo de intervención presentó mayor participación (78,1 vs. 72,3%), tendencia que obtuvo significación estadística en las mujeres de 55-59 años (p = 0,036) y con nivel educativo medio (p = 0,014). El grupo de intervención presentó una media de llamadas de recitación significativamente menor (0,41 vs. 0,65), patrón observado en todas las categorías de las variables independientes y significativo en las franjas de edad más jóvenes, niveles educativos bajo y medio y mujeres previamente participantes (0,09 vs. 0,19, p = 0,012). Conclusiones. La incorporación del mensaje de teléfono móvil en un programa de detección precoz de cáncer de mama puede suponer un aumento de las tasas de participación y una mejora en la gestión del mismo (AU)

Objective. To evaluate the impact of a mobile phone short message on women's uptake in a breast cancer screening programme. Methods. A total of 703 women from a Basic Health Area of Barcelona, and with a mobile phone number registered, were invited to participate in a breast cancer screening programme between 25 January 2011 and 22 March 2011. The control group (n = 470) followed the usual appointment track, and the intervention group (n = 233) received, after the first letter of invitation, a mobile phone short message reminder. The differences between the two groups were analysed, comparing the uptake rates according to age, educational level, and participation in previous round, as well as the number of re-invitation calls to non-attenders according to uptake, age and level of education;and the percentages of exclusions of both groups. Results. The intervention group had a greater uptake than the control group (78.1% vs. 72.3%), with a significant trend observed in the 55-59 years age group (P = .036) and the low secondary educational level (P = .014).The intervention group mean of re-invitation calls of non-attenders lower than the control group (.41 vs. .65, P < .05), a pattern observed in all the categories of the independent variables, and among younger age groups, lower and middle educational levels, and previously participating women (.09 vs. .19, P = .012). Conclusions. The inclusion of a mobile phone short message in a breast cancer screening programme may increase uptake rates and lead to a management improvement (AU)

Desarrollo y validación de un algoritmo para identificar recidivas de cáncer a partir de bases de datos hospitalarias / Development and validation of an algorithm to identify cancer recurrences from hospital data bases

Objetivos. Los registros de tumores hospitalarios y las bases de datos hospitalarias son una fuente de información valiosa y eficiente para la investigación de recidivas de cáncer. El objetivo de este estudio fue desarrollar y validar algoritmos para identificar recidivas de cáncer de mama. Métodos. Estudio observacional retrospectivo de casos de cáncer de mama del registro de tumores de un centro hospitalario universitario de tercer nivel diagnosticados entre 2003 y 2009. A partir del cruce de bases de datos hospitalarias y la construcción de definiciones operativas se obtuvieron diferentes algoritmos de probable recidiva de cáncer con su correspondiente sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo. Resultados. Se identificaron 1.523 pacientes diagnosticados de cáncer entre 2003 y 2009. La solicitud de gammagrafía ósea tras 6 meses desde el primer tratamiento oncológico obtuvo la mayor sensibilidad (53,8%) y valor predictivo negativo (93,8%), y la realización de una prueba de anatomía patológica tras 6 meses desde el diagnóstico obtuvo la mayor especificidad (93,8%) y valor predictivo negativo (92,6%). La combinación de definiciones aumentó la especificidad y el valor predictivo positivo pero disminuyó la sensibilidad. Conclusiones. Se elaboraron diferentes algoritmos diagnósticos cuyas definiciones pueden ser útiles según los intereses y recursos del investigador. Un mayor valor predictivo positivo podría interesar para una estimación rápida del número de casos, y un mayor valor predictivo negativo para dar una estimación más exacta si se dispone de mayores recursos. Estos algoritmos se configuran como una herramienta versátil y adaptable a otros tumores y a las necesidades del investigador (AU)

Objectives. Hospital cancer registries and hospital databases are valuable and efficient sources of information for research into cancer recurrences. The aim of this study was to develop and validate algorithms for the detection of breast cancer recurrence. Methods. A retrospective observational study was conducted on breast cancer cases from the cancer registry of a third level university hospital diagnosed between 2003 and 2009. Different probable cancer recurrence algorithms were obtained by linking the hospital databases and the construction of several operational definitions, with their corresponding sensitivity, specificity, positive predictive value and negative predictive value. Results. A total of 1,523 patients were diagnosed of breast cancer between 2003 and 2009. A request for bone gammagraphy after 6 months from the first oncological treatment showed the highest sensitivity (53.8%) and negative predictive value (93.8%), and a pathology test after 6 months after the diagnosis showed the highest specificity (93.8%) and negative predictive value (92.6%). The combination of different definitions increased the specificity and the positive predictive value, but decreased the sensitivity. Conclusions. Several diagnostic algorithms were obtained, and the different definitions could be useful depending on the interest and resources of the researcher. A higher positive predictive value could be interesting for a quick estimation of the number of cases, and a higher negative predictive value for a more exact estimation if more resources are available. It is a versatile and adaptable tool for other types of tumors, as well as for the needs of the researcher (AU)

[Psychology and fecundity. Motivations for parenthood]. / Psychologie et fécondité. Les motivations à la parenté

Questions relating to population problems are more and more important at different levels, i.e. political, economic, national and international. In demographical research, sociological analyses were routine, but other disciplines such as psychology have rarely been emphasized for understanding mechanisms of fecondity. In a preliminary research on motivations to parenthood, this article proposes a critical analysis of the main orientations of research in the area of fecondity: socio-psychological studies, analytical and other works psychologically oriented on attitudes, motivations and values towards the child. It also delines the conceptual frame for a new research.