programas cribado cancer


Nota Bibliográfica

Esta Nota es una recopilación de publicaciones (artículos, informes, libros) sobre cribado de cáncer resultado de una revisión no sistemática de la literatura.

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Josep A Espinás. Pla Director d'Oncología de Catalunya.
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Nota bibliográfica cribado miscelánea 2014-11

Leive A, Stratmann T. Do national cancer screening guidelines reduce mortality?. J Popul Econ. 2014;1–21. Available from: doi: 10.1007/s00148-014-0536-6.

 The effectiveness of cancer screening is a salient health policy issue that remains unresolved. This article sheds new light on the benefits of population-wide cancer screening. We investigate changes in mortality after the introduction of screening guidelines for breast and prostate cancers in the USA and UK. We use differences in the timing of guideline adoption, differences in ages recommended for screening, and differences in which cancers are detectable by screening to identify the effect of cancer screening guidelines. Our quadruple-differencing strategy finds a moderately sized mortality benefit from mammography and prostate-specific antigen (PSA) screening guidelines among recommended age groups and little change in mortality rates among age groups not recommended to receive screening. As a falsification test, we verify that prostate cancer rates among men did not fall after the introduction of mammography screening and breast cancer rates among women did not fall after the introduction of the PSA test.

Segura PP, Fombella JPB, Lorenzo BP, Martín MR, Lopez PG. SEOM guide to primary and secondary prevention of cancer: 2014.Clin Transl Oncol. 2014;16(12):1072–8. Available from: doi: 10.1007/s12094-014-1215-5. PMID: 25358801.

CONCLUSION: The diffusion of these preventive tools can reduce the incidence of cancer and increase the number of early diagnostics in the most prevalent tumors.

Miller JW, Plescia M, Ekwueme DU. Public health national approach to reducing breast and cervical cancer disparities. Cancer. 2014;120(S16):2537–9. Available from: doi: 10.1002/cncr.28818.
Breast and cervical cancer have had disparate impact on the lives of women. The burden of breast and cervical cancer is more prominent among some racial and ethnic minority women. Providing comprehensive care to all medically underserved women is a critical element in continuing the battle to reduce cancer burden and eliminate disparities. The National Breast and Cervical Cancer Early Detection Program is the only nationally organized cancer screening program for underserved women in the United States. Its public health goal is to ensure access to high-quality screening, follow-up, and treatment services for diverse and vulnerable populations that, in turn, may reduce disparities.


Nota bibliográfica cribado miscelánea2014-10

Pasechnikov V, Chukov S, Fedorov E, Kikuste I, Leja M. Gastric cancer : Prevention , screening and early diagnosis. World J Gastroenterol. 2014;20(38):13842–62. doi: 10.3748/wjg.v20.i38.13842.

 Gastric cancer continues to be an important healthcare problem from a global perspective. Most of the cases in the Western world are diagnosed at late stages when the treatment is largely ineffective. Helicobacter pylori (H. pylori ) infection is a well-established carcinogen for gastric cancer. While lifestyle factors are important, the efficacy of interventions in their modification, as in the use of antioxidant supplements, is unconvincing. No organized screening programs can be found outside Asia (Japan and South Korea). Although several screening approaches have been proposed, including indirect atrophy detection by measuring pepsinogen in the circulation, none of them have so far been implemented, and more study data is required to justify any implementation. Mass eradication of H. pylori in high-risk areas tends to be cost-effective, but its adverse effects and resistance remain a concern. Searches for new screening biomarkers, including microRNA and cancer-autoantibody panels, as well as detection of volatile organic compounds in the breath, are in progress. Endoscopy with a proper biopsy follow-up remains the standard for early detection of cancer and related premalignant lesions. At the same time, new advanced high-resolution endoscopic technologies are showing promising results with respect to diagnosing mucosal lesions visually and targeting each biopsy. New histological risk stratifications (classifications), including OLGA and OLGIM, have recently been developed. This review addresses the current means for gastric cancer primary and secondary prevention, the available and emerging methods for screening, and new developments in endoscopic detection of early lesions of the stomach.

Hamashima C. Current issues and future perspectives of gastric cancer screening. World J Gastroenterol. 2014;20(38):13767–74. doi: 10.3748/wjg.v20.i38.13767.
Gastric cancer remains the second leading cause of cancer death worldwide. About half of the incidence of gastric cancer is observed in East Asian countries, which show a higher mortality than other countries. The effectiveness of 3 new gastric cancer screening techniques, namely, upper gastrointestinal endoscopy, serological testing, and “screen and treat” method were extensively reviewed. Moreover, the phases of development for cancer screening were analyzed on the basis of the biomarker development road map. Several observational studies have reported the effectiveness of endoscopic screening in reducing mortality from gastric cancer. On the other hand, serologic testing has mainly been used for targeting the high-risk group for gastric cancer. To date, the effectiveness of new techniques for gastric cancer screening has remained limited. However, endoscopic screening is presently in the last WJG 20th Anniversary Special Issues (8): Gastric cancer TOPIC HIGHLIGHT WJG| 13767 October 14, 2014|Volume 20|Issue 38| trial phase of development before their introduction to population-based screening. To effectively introduce new techniques for gastric cancer screening in a community, incidence and mortality reduction from gastric cancer must be initially and thoroughly evaluated by conducting reliable studies. In addition to effectiveness evaluation, the balance of benefits and harms must be carefully assessed before introducing these new techniques for population-based screening.

Liu BY, O’Malley J, Mori M, Fagnan LJ, Lieberman D, Morris CD, et al. The association of type and number of chronic diseases with breast, cervical, and colorectal cancer screening. J Am Board Fam Med. United States; 2014;27(5):669–81. doi: 10.3122/jabfm.2014.05.140005. PMID: 25201936.

CONCLUSION: Specific chronic conditions were found to be associated with up-to-date status for cancer screening. This finding may help practices to identify patients who need to receive cancer screening.


Nota bibliográfica cribado miscelánea 2014-09

Zapka JM, Edwards HM, Chollette V, Taplin SH. Follow-up to Abnormal Cancer Screening Tests: Considering the Multilevel Context of Care. Cancer Epidemiol Biomarkers Prev. 2014; Available from: doi: 10.1158/1055-9965.EPI-14-0454.

 The call for multilevel interventions to improve the quality of follow-up to abnormal cancer screening has been out for a decade, but published work emphasizes individual approaches, and conceptualizations differ regarding the definition of levels. To investigate the scope and methods being undertaken in this focused area of follow-up to abnormal tests (breast, colon, cervical), we reviewed recent literature and grants (2007–2012) funded by the National Cancer Institute. A structured search yielded 16 grants with varying definitions of “follow-up” (e.g., completion of recommended tests, time to diagnosis); most included minority racial/ethnic group participants. Ten grants concentrated on measurement/intervention development and 13 piloted or tested interventions (categories not mutually exclusive). All studies considered patient-level factors and effects. Although some directed interventions at provider levels, few measured group characteristics and effects of interventions on the providers or levels other than the patient. Multilevel interventions are being proposed, but clarity about endpoints, definition of levels, and measures is needed. The differences in the conceptualization of levels and factors that affect practice need empirical exploration, and we need to measure their salient characteristics to advance our understanding of how context affects cancer care delivery in a changing practice and policy environment. Cancer Epidemiol Biomarkers Prev; 23(10); 1–9. ©2014 AACR.

Van Agt HME, Korfage IJ, Essink-Bot M-L. Interventions to enhance informed choices among invitees of screening programmes—a systematic review. Eur J Public Health. 2014;24(5):789–801. Available from: doi: 10.1093/eurpub/ckt205.

Conclusion: The empirical evidence regarding interventions to improve informed decision making in screening is limited. It is unknown which strategies to enhance informed decision making are most effective, although DAs are promising. Systematic development of interventions to enhance informed choices in screening deserves priority, especially in disadvantaged groups


Nota bibliográfica cribado c miscelánea 2014-07/08

Lansdorp-Vogelaar PhD I, Gulati MS R, Mariotto PhD AB, Schechter MD, MA CB, de Carvalho MSc TM, Knudsen PhD AB, et al. Personalizing Age of Cancer Screening Cessation Based on Comorbid Conditions: Model Estimates of Harms and Benefits. Ann Intern Med. Philadelphia; 2014;161(2):104. Available from:

Lansdorp-Vogelaar et al estimate the harms and benefits of cancer screening by age and comorbid conditions to inform decisions about screening cessation. Screening 1,000 women with average life expectancy at age 74 years for breast cancer resulted in 79 to 96 (range across models) false-positive results, 0.5 to 0.8 overdiagnosed cancer cases, and 0.7 to 0.9 prevented cancer deaths. Although absolute numbers of harms and benefits differed across cancer sites, the ages at which to cease screening were consistent across models and cancer sites. For persons with no, mild, moderate, and severe comorbid conditions, screening until ages 76, 74, 72, and 66 years, respectively, resulted in harms and benefits similar to average-health persons.

Narod SA. Modern approaches to cancer prevention: Universal or personal? J Cancer Policy. (0). Available from:  doi:

Moynihan R, Henry D, Moons KGM. Using Evidence to Combat Overdiagnosis and Overtreatment: Evaluating Treatments, Tests, and Disease Definitions in the Time of Too Much. PLoS Med. 2014;11(7):e1001655. Available from:
Overdiagnosis and related overtreatment are increasingly recognised as major problems. “Positive” average results from trials of treatments can mask situations where many participants at low risk of disease may receive no benefit. The evaluation of diagnostic tests usually involves assessing how well tests detect presence versus absence of a certain disease—rather than how well they detect clinically meaningful stages of disease. Changes to disease definitions typically do not involve evaluation of potential harms of overdiagnosis, and are often conducted by heavily conflicted panels. We offer suggestions for improving the way evidence is produced, analysed, and interpreted, to help combat overdiagnosis and related overtreatment. These include routine consideration of overdiagnosis and related overtreatment in studies of tests and treatments, and clearer stratification by baseline risk to identify treatment thresholds where benefits are likely to outweigh harms

Royce TJ, Hendrix LH, Stokes WA, Allen IM, Chen RC. Cancer Screening Rates in Individuals With Different Life Expectancies. JAMA Intern Med. 2014; Available from:  doi: 10.1001/jamainternmed.2014.3895. PMID: 25133746.

Conclusions and Relevance: A substantial proportion of the US population with limited life expectancy received prostate, breast, cervical, and colorectal cancer screening that is unlikely to provide net benefit. These results suggest that overscreening is common in both men and women, which not only increases health care expenditure but can lead to net patient harm.

Cervera Deval J, Sentís Crivillé M, Zulueta JJ. Sobrediagnóstico en cribado de cáncer. Radiologia. 2014;(0). Available from:  doi:   

Resumen En los programas de diagnóstico precoz, se considera sobrediagnóstico al diagnóstico de una enfermedad que sin cribado nunca se hubiera diagnosticado, y como se espera que dicho diagnóstico no cause la muerte, se trata innecesariamente. El sobrediagnóstico es un sesgo del propio cribado y un efecto no deseado de la prevención secundaria y de la mejora de la sensibilidad de las técnicas diagnósticas. A priori es difícil de discriminar qué diagnósticos son los clínicamente relevantes y en cuáles se podría evitar el tratamiento. Para minimizar el efecto de sobrediagnóstico, el cribado debe dirigirse a población considerada de riesgo. Abstract

Gross CP. Cancer Screening in Older Persons: A New Age of Wonder. JAMA Intern Med. 2014; Available from: doi: 10.1001/jamainternmed.2014.3901. PMID: 25133660


Nota bibliográfica cribado miscelánea 2014-06

Wald NJ, Bestwick JP. Is the area under an ROC curve a valid measure of the performance of a screening or diagnostic test? J Med Screen. 2014;21(1):51–6.
 Available from: oi: 10.1177/0969141313517497.
The AUC is an unreliable measure of screening performance because in practice the standard deviation of a screening or diagnostic test in affected and unaffected individuals can differ. The problem is avoided by not using AUC at all, and instead specifying DRs for given FPRs or FPRs for given DRs


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