scholarly journals A Quantitative Framework to Study Potential Benefits and Harms of Multi-cancer Early Detection Testing

2021 ◽  
Author(s):  
Boshen Jiao ◽  
Roman Gulati ◽  
Hormuzd A. Katki ◽  
Philip E. Castle ◽  
Ruth Etzioni
Keyword(s):  
Incidence Rates ◽  
Disease Prevalence ◽  
Mortality Reduction ◽  
Blood Draw ◽  
Population Impact ◽  
Cancer Early Detection ◽  
Mathematical Expressions ◽  
Potential Benefits ◽  
Potential Population ◽  
Expected Mortality

AbstractBackgroundMulti-cancer tests permit identification of multiple cancers with one blood draw. The objective of this study was to quantify potential population impact of a multi-cancer test.MethodsWe formulate mathematical expressions for expected numbers of (1) individuals exposed to unnecessary confirmation tests (UCT), (2) cancers detected (CD), and (3) lives saved (LS) given disease prevalence and mortality and the test’s performance and expected mortality reduction. We consider additions of colorectal, liver, lung, ovary, and pancreatic cancer to a test for breast cancer using published performance characteristics of a multi-cancer test and prevalence of each cancer at ages 50, 60, or 70 based on 5-year incidence rates and corresponding 15-year probabilities of cancer death in the Surveillance, Epidemiology, and End Results registry, assuming 20% mortality reduction for each.ResultsUCT depends on screening age but is overwhelmingly determined by overall specificity of the test and is relatively insensitive to the types and number of cancers included. For a given overall specificity, UCT/CD is most favorable for higher-prevalence cancers (e.g., UCT/CD = 5.6 for breast+lung versus 6.5 for breast+liver at age 50). Under a common mortality reduction, UCT/LS is most favorable when the test includes higher-mortality cancers (e.g., UCT/LS = 48.5 for breast+lung versus 74.7 for breast+liver at age 50).ConclusionsThe harm-benefit tradeoffs of multi-cancer testing depend on the number and type of cancers included. Overall specificity is paramount for controlling unnecessary confirmation tests. For a given overall specificity, multi-cancer tests should prioritize prevalent and/or lethal cancers for which curative treatments exist.

scholarly journals Incidence, Characteristics, and Outcome of COVID-19 in Adults on Kidney Replacement Therapy: A Regionwide Registry Study

2020 ◽  
pp. ASN.2020060875
Author(s):  
Johan De Meester ◽  
Dirk De Bacquer ◽  
Maarten Naesens ◽  
Bjorn Meijers ◽  
Marie M. Couttenye ◽  
...  
Keyword(s):  
General Population ◽  
Excess Mortality ◽  
Mortality Rates ◽  
Incidence Rates ◽  
Registry Study ◽  
Additional Risk ◽  
Mortality Burden ◽  
Kidney Replacement Therapy ◽  
Expected Mortality ◽  
Chronic Comorbidities

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection disproportionally affects frail, elderly patients and those with multiple chronic comorbidities. Whether patients on RRT have an additional risk because of their specific exposure and complex immune dysregulation is controversial.MethodsTo describe the incidence, characteristics, and outcomes of SARS-CoV-2 infection, we conducted a prospective, multicenter, region-wide registry study in adult patients on RRT versus the general population from March 2 to May 25, 2020. This study comprised all patients undergoing RRT in the Flanders region of Belgium, a country that has been severely affected by coronavirus disease 2019 (COVID-19).Results At the end of the epidemic wave, crude and age-standardized cumulative incidence rates of SARS-CoV-2 infection were 5.3% versus 2.5%, respectively, among 4297 patients on hemodialysis, and 1.4% versus 1.6%, respectively, among 3293 patients with kidney transplants (compared with 0.6% in the general population). Crude and age-standardized cumulative mortality rates were 29.6% versus 19.9%, respectively, among patients on hemodialysis, and 14.0% versus 23.0%, respectively, among patients with transplants (compared with 15.3% in the general population). We found no excess mortality in the hemodialysis population when compared with mean mortality rates during the same 12-week period in 2015–2019 because COVID-19 mortality was balanced by lower than expected mortality among uninfected patients. Only 0.18% of the kidney transplant population died of SARS-CoV-2 infection.ConclusionsMortality associated with SARS-CoV-2 infection is high in patients on RRT. Nevertheless, the epidemic’s overall effect on the RRT population remained remarkably limited in Flanders. Calculation of excess mortality and age standardization provide a more reliable picture of the mortality burden of COVID-19 among patients on RRT.

scholarly journals Poverty: socioeconomic characterization at tuberculosis

2007 ◽  
Vol 15 (spe) ◽  
pp. 762-767 ◽  
Author(s):  
Maria de Lourdes Sperli Geraldes Santos ◽  
Silvia Helena Figueiredo Vendramini ◽  
Claudia Eli Gazetta ◽  
Sonia Aparecida Cruz Oliveira ◽  
Tereza Cristina Scatena Villa
Keyword(s):  
Socioeconomic Factors ◽  
Incidence Rate ◽  
Total Variation ◽  
Social Factors ◽  
Incidence Rates ◽  
Disease Prevalence ◽  
Socioeconomic Factor ◽  
Census Tracts ◽  
Socioeconomic Characteristics ◽  
The City

This study aimed to evaluate the epidemiological status of Tuberculosis regarding to the socioeconomic characteristics of São José do Rio Preto between 1998 and 2004. Indexes estimated for 432 urban census tracts from the demographic census of 2000, sorted systematically according to the values of socioeconomic factors and grouped into quartiles were taken into account. The socioeconomic characterization was outlined based on Schooling, Income, and Number of Residents. The incidence rates were considered for 1998, 1999, 2003, and 2004. The socioeconomic factor accounted for 87% of the total variation. The disease prevalence is higher in the poorest areas. The incidence rate and the risk of being infected by TB in the poorest areas declined in 2003 and 2004. The results confirm that TB is determined by the population's living conditions in the city studied. It strengthens the relevance of understanding the TB conditional social factors to transform the worrisome scenario in which this population is inserted.

scholarly journals The role of antiviral treatment in curbing the COVID-19 pandemic: a modeling study.

2021 ◽  
Author(s):  
Laura Matrajt ◽  
Elizabeth R Brown ◽  
Dobromir Dimitrov ◽  
Holly Janes
Keyword(s):  
Viral Load ◽  
Treatment Efficacy ◽  
Antiviral Treatment ◽  
Antiviral Effect ◽  
Vaccination Rate ◽  
Agent Based ◽  
Population Impact ◽  
Late Treatment ◽  
Potential Population

Despite the development of safe and effective vaccines, effective treatments for COVID-19 disease are still desperately needed. Recently, two antiviral drugs have shown to be effective in reducing hospitalizations in clinical trials. In the present work, we use an agent-based mathematical model to assess the potential population impact of the use of antiviral treatments in four countries, corresponding to four current levels of vaccination coverage: Kenya, Mexico, United States (US) and Belgium, with 1.5, 38, 57 and 74% of their populations vaccinated. For each location, we varied antiviral coverage and antiviral effect in reducing viral load (25, 50, 75 or 100% reduction). Irrespective of location, widespread antiviral treatment of symptomatic infections (≥50% coverage) is expected to prevent the majority of COVID-19 deaths. Furthermore, even treating 20% of adult symptomatic infections, is expected to reduce mortality by a third in all countries, irrespective of the assumed treatment efficacy in reducing viral load. Our results suggest that early antiviral treatment is needed to mitigate transmission, with early treatment (within two days of symptoms) preventing 50% more infections compared to late treatment (started on days 3 to 5 after developing symptoms). Our results highlight the synergistic effect of vaccination and antiviral treatment: as vaccination rate increased, antiviral treatment had a bigger impact on overall transmission. These results suggest that antiviral treatments can become a strategic tool that, in combination with vaccination, can significantly control SASRS-CoV-2 transmission and reduce COVID-19 hospitalizations and deaths.

Observed and expected mortality in the German skin cancer screening pilot project SCREEN

2017 ◽  
Vol 25 (3) ◽  
pp. 166-168 ◽  
Author(s):  
Nora Eisemann ◽  
Annika Waldmann ◽  
Bernd Holleczek ◽  
Alexander Katalinic
Keyword(s):  
Cancer Screening ◽  
Skin Cancer ◽  
Pilot Project ◽  
Mortality Reduction ◽  
Skin Cancer Screening ◽  
Melanoma Diagnosis ◽  
Mortality Ratio ◽  
Expected Mortality ◽  
Melanoma Mortality

Objective The main purpose of skin cancer screening is melanoma mortality reduction. Before the implementation of nationwide German skin cancer screening, the pilot project SCREEN was conducted in Schleswig-Holstein in 2003–2004. We aimed to determine whether the pilot project had achieved a mortality reduction. Methods Using an incidence-based approach (patients with both melanoma diagnosis and death in 2003–2008), we compared the observed melanoma mortality of the SCREEN cohort to the melanoma mortality expected without screening in the general population of Saarland. Results The age- and sex-standardized melanoma mortality ratio (SMR) for 5.5 years of follow-up was 0.59 (95% confidence interval, 0.40–0.83). Conclusion Our results indicate reduced mortality in the SCREEN cohort. Several potential biases cannot be excluded, but most of them tend to inflate the SMR.

scholarly journals On the need for the development of a cancer early detection, diagnostic, prognosis, and treatment response system

2020 ◽  
Vol 6 (2) ◽  
pp. FSO439 ◽  
Author(s):  
Tobore Onojighofia Tobore
Keyword(s):  
Early Detection ◽  
Detection System ◽  
Lifestyle Changes ◽  
Noncommunicable Disease ◽  
Morbidity And Mortality ◽  
Response System ◽  
Cancer Early Detection ◽  
Cancer Morbidity ◽  
Potential Benefits ◽  
Smart Wearable

Cancer is the second leading cause of noncommunicable disease deaths in the world. In 2018, there were over 18 million new cancer cases and approximately 10 million people died from the disease globally. In 2019, almost two million new cases of cancer will be diagnosed in USA and over 600,000 people are expected to die from the disease. The incidence of cancer is expected to rise because of lifestyle changes and a rapidly aging population. Evidence suggests that early detection is critical to reducing cancer morbidity and mortality. In this paper, the development of an integrated smart wearable and biomarker detection system is proposed to help reduce cancer morbidity and mortality. The potential benefits and limitations of the system are discussed.

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