@article{pmid31488415,

title = {False-Positive Results in a Population-Based Colorectal Screening Program: Cumulative Risk from 2000 to 2017 with Biennial Screening},

author = {Ibáñez-Sanz G and Garcia M and Milà N and Hubbard RA and Vidal C and Binefa G and Benito L and Moreno V and Adverse Effects on Colorectal Cancer Screening in Catalonia (EACC) Study Working Group},

doi = {10.1158/1055-9965.EPI-18-1368},

issn = {1538-7755},

year  = {2019},

date = {2019-11-01},

journal = {Cancer Epidemiol Biomarkers Prev},

volume = {28},

number = {11},

pages = {1909--1916},

abstract = {BACKGROUND: The aim of this study was to estimate the cumulative risk of a false-positive (FP) result in a fecal occult blood test (FOBT) through 7 screening rounds and to identify its associated factors in a population-based colorectal cancer screening program.nnMETHODS: Retrospective cohort study, which included participants ages 50 to 69 years of a colorectal cancer screening program in Catalonia, Spain. During this period, 2 FOBTs were used (guaiac and immunochemical). A discrete-time survival model was performed to identify risk factors of receiving a positive FOBT with no high-risk adenoma or colorectal cancer in the follow-up colonoscopy. We estimated the probability of having at least 1 FP over 7 screening rounds.nnRESULTS: During the period of 2000 to 2017, the cumulative FP risk was 16.3% (IC: 14.6%-18.3%), adjusted by age, sex, and type of test. The median number of screens was 2. Participants who began screening at age 50 years had a 7.3% [95% confidence interval (CI), 6.35-8.51] and a 12.4% (95% CI, 11.00-13.94) probability of an FP with 4 screening rounds of guaiac-based test and immunochemical test, respectively. Age, the fecal immunochemical test, first screening, and number of personal screens were factors associated with an FP result among screenees.nnCONCLUSIONS: The cumulative risk of an FP in colorectal screening using FOBT seems acceptable as the colonoscopy, with its high accuracy, lengthens the time until additional colorectal screening is required, while complication rates remain low.nnIMPACT: It is useful to determine the cumulative FP risk in cancer screening for both advising individuals and for health resources planning.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30998054,

title = {Moderators of the efficacy of a web-based stress management intervention for college students},

author = {Coudray C and Palmer R and Frazier P},

doi = {10.1037/cou0000340},

issn = {0022-0167},

year  = {2019},

date = {2019-11-01},

journal = {J Couns Psychol},

volume = {66},

number = {6},

pages = {747--754},

abstract = {High levels of stress are common among college students. Web-based interventions may be one way to teach students stress management skills. Although previous research has demonstrated the overall efficacy of web-based stress management interventions, little attention has been paid to who might benefit most from these interventions. In this study, we analyzed data from 3 prior studies ( = 782) to examine moderators of the efficacy of a web-based stress management intervention that focused on increasing perceived present control (i.e., aspects of stressors that are controllable in the present). Specific moderators assessed in regression analyses were baseline scores on outcome measures (perceived stress, stress symptoms, anxiety, depression) and the putative mechanism (perceived present control) of the intervention. Baseline symptom levels moderated the effects of the intervention on all outcomes, such that the intervention was more effective for students with more baseline symptoms. Baseline levels of present control had less consistent moderating effects, but significant interactions indicated that the intervention was more effective for those with lower levels of present control. The novel Johnson-Neyman technique was used to identify specific cutoff scores on these measures, below which the effect of the intervention was not significant, and scores on the measures associated with varying effect sizes. Findings from the Johnson-Neyman analyses can inform the development of screening criteria for future research and clinical application. Because the intervention was more effective for students with higher levels of baseline distress, it may be better suited for an indicated rather than universal prevention approach. (PsycINFO Database Record (c) 2019 APA, all rights reserved).},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31132476,

title = {Changes in mammographic density over time and the risk of breast cancer: An observational cohort study},

author = {Román M and Sala M and Baré M and Posso M and Vidal C and Louro J and Sánchez M and Peñalva L and Castells X and BELE study group},

doi = {10.1016/j.breast.2019.04.007},

issn = {1532-3080},

year  = {2019},

date = {2019-08-01},

journal = {Breast},

volume = {46},

pages = {108--115},

abstract = {BACKGROUND: The effect of changes in mammographic density over time on the risk of breast cancer remains inconclusive.nnMETHODS: We used information from four centres of the Breast Cancer Screening Program in Spain in the period 1996-2015. We analysed individual level data from 117,388 women first screened age 50-54, with at least two screening examinations. Breast density was determined using the BI-RADS classification (A to D in increasing order) at earliest and latest screening examination. Adjusted Poisson regression models were used to estimate the relative risk (RR) and 95% confidence intervals (95%CI) of the association between changes in mammographic density and breast cancer risk over time.nnRESULTS: During an average 5.8 years of follow-up, 1592 (1.36%) women had a breast cancer diagnosis. An increase in density category increased breast cancer risk, and a decrease in density decreased the risk, compared with women who remained in the same BI-RADS category. Women whose density category increased from B to C or B to D had a RR of 1.55 (95%CI = 1.24-1.94) and 2.32 (95%CI = 1.48-3.63), respectively. The RR for women whose density increased from C to D was 1.51 (95%CI = 1.03-2.22). Changes in BI-RADS density were similarly associated with the risk for invasive cancer than for ductal carcinoma in situ.nnCONCLUSIONS: Although a modest proportion of women changed BI-RADS density category, mammographic density changes modulated the risk of breast cancer and identified women at a differential risk. Using two longitudinal measures of BI-RADS density could help target women for risk-based screening strategies.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30663156,

title = {Changes in dietary intake, plasma carotenoids and erythrocyte membrane fatty acids in breast cancer survivors after a lifestyle intervention: results from a single-arm trial},

author = {Buckland G and Travier N and Arribas L and Del Barco S and Pernas S and Zamora E and Bellet M and Cirauqui B and Margelí M and Muñoz M and Tusquets I and Arcusa A and Javierre C and Moreno F and Valverde Y and Jansen E and Chajès V and Castro C and Agudo A},

doi = {10.1111/jhn.12621},

issn = {1365-277X},

year  = {2019},

date = {2019-08-01},

journal = {J Hum Nutr Diet},

volume = {32},

number = {4},

pages = {468--479},

abstract = {BACKGROUND: The influence of nutrition on breast cancer prognosis is still inconclusive and therefore dietary interventions incorporating dietary biomarkers are needed to confirm compliance with dietary goals and clarify biological mechanisms. The present study assessed whether a lifestyle intervention in breast cancer survivors could affect dietary biomarkers of fruit and vegetables and fatty acids.nnMETHODS: In this phase II single-arm trial, 37 overweight/obese early stage breast cancer patients completed a 12-week diet and exercise intervention. The intervention involved 1-h weekly diet sessions delivered by a dietician and 75-min bi-weekly physical activity sessions of moderate-to-high intensity led by trained monitors. Before and after the intervention, three 24-h dietary recalls were carried out to calculate nutrient intakes and, in addition, blood samples were taken to measure plasma carotenoids, vitamin E and retinol concentrations and erythrocyte membrane fatty acid (EFA) composition. Wilcoxon signed rank tests were used to assess changes in dietary and biomarkers measurements over the intervention period.nnRESULTS: After the intervention, there was a significant increase in the intake of dietary carotenoids (+15.1% compared to baseline) but not plasma carotenoids levels (+6.3%). Regarding the EFA levels, we observed a significant decrease in percentage of saturated fatty acids (-1.4%) and n-6 polyunsaturated fatty acids (-2.9%) and an increase in monounsaturated fatty acids (1.7%) and total and long-chain n-3 polyunsaturated fatty acids (by 13.1% and 13.7%, respectively). A favourable decrease in the ratio of long-chain n-6 to n-3 polyunsaturated fatty acids (-9.1%) was also observed.nnCONCLUSIONS: After a short-term diet and exercise intervention in overweight/obese breast cancer survivors, we observed significant changes in dietary nutrients and fatty acid biomarkers, suggesting positive dietary changes that could be relevant for breast cancer prognosis.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31337864,

title = {Prevalence of healthy lifestyles against cancer in Spanish women},

author = {Toribio MJ and Lope V and Castelló A and Salas D and Vidal C and Ascunce N and Santamariña C and Moreo P and Pedraz-Pingarrón C and Sánchez-Contador C and Aragonés N and Pérez-Gómez B and Pollán M},

doi = {10.1038/s41598-019-47180-x},

issn = {2045-2322},

year  = {2019},

date = {2019-07-01},

journal = {Sci Rep},

volume = {9},

number = {1},

pages = {10638},

abstract = {Modifying behavior towards healthier lifestyles could prevent a significant number of malignant tumors. We evaluated the prevalence of healthy habits against cancer in Spanish women free of this disease, taking as a reference the recommendations for cancer prevention included in the European Code Against Cancer (ECAC), and we explored the characteristics associated with it. Our population comprised 3,584 women recruited in a population-based cross-sectional study carried out in 7 breast cancer screening programs. Information was directly surveyed and used to calculate a score based on ECAC recommendations referred to bodyweight, physical activity, diet, breastfeeding, tobacco, alcohol and hormone replacement therapy use. The degree of adherence was estimated with a score that evaluated null (0 points), partial (0.5 points) and full adherence (1 point) of each specific recommendation. Associations were explored using binary and ordinal logistic regression models. The median score was 5.7 out of 9 points. Recommendations with lower adherence were those related to intake of red/processed meat and foods high in salt (23% of total adherence), physical activity (24%) and body weight (29%), and recommendations with greater adherence where those related to hormone replacement therapy use (91%), vegetable intake (84%), alcohol (83%) and tobacco (61%). Overall adherence was better among older women, parous women, and in those living in rural areas, and worse among women with higher caloric intake. These recommendations should be evaluated periodically. Screening programs can be an appropriate place to disseminate this information.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31236712,

title = {Communication Channels Used by Women to Contact a Population-Based Breast Cancer Screening Program in Catalonia, Spain},

author = {Travier N and Vidal C and Garcia M and Benito L and Medina P and Moreno V},

doi = {10.1007/s10916-019-1382-6},

issn = {1573-689X},

year  = {2019},

date = {2019-06-01},

journal = {J Med Syst},

volume = {43},

number = {8},

pages = {244},

abstract = {Communication is a corner stone of population-based breast cancer screening programs that need to invite all the women from their target population and provide them with balanced information on screening to guaranty informed participation. Invited women also need to be able to contact screening programs to get further information on screening procedures and/or cancel and reschedule appointments. This study describes the communication channels used by women invited for breast cancer screening to contact the program. The study population consisted of 141,684 women, aged 50-69 years, who were invited during 2015-2016 for screening by the Catalan Breast Cancer Screening Program (Spain). Multiple logistic regression models were performed to assess the association between age, screening history, socioeconomic status and reasons for contacting the program and the outcome variables (contact with the program; contact through information and communication technology (ICT) channels). Among the 141,684 women invited for BC screening, 22.5% contacted the screening office mainly to reschedule (42.2%) and cancel (29.2%) appointments. While the communication channel mostly used was the telephone, 24.8% of the women used ICT. ICT was more frequently used by women who had never been screened. Women who wanted to change their appointment were 65% (OR 1.65, 95%CI 1.54-1.76) more likely to use ICT than women who wanted to cancel it. This study showed the need to reinforce communication between women and breast cancer screening programs and the importance of offering communication channels suiting all women's needs to facilitate appointments' rescheduling and cancelling and therefore improve screening programs' efficiency.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30594532,

title = {Testing behavioral interventions to optimize participation in a population-based colorectal cancer screening program in Catalonia, Spain},

author = {Stoffel S and Benito L and Milà N and Travier N and Binefa G and Vidal C and Espinosa J and Moreno V and Garcia M},

doi = {10.1016/j.ypmed.2018.12.013},

issn = {1096-0260},

year  = {2019},

date = {2019-02-01},

journal = {Prev Med},

volume = {119},

pages = {58--62},

abstract = {The aim of the study was to measure the effect of three cost-neutral behavioral interventions on participation compared to the standard invitation letter in a population-based colorectal cancer screening program in 2014. For that purpose, a four-arm randomized field trial was conducted among 5077 individuals aged 50 to 69 years. Over an 8-week period, each week was randomly allocated to the intervention or the control conditions. Individuals assigned to the intervention conditions additionally received a prompt to write down the date to pick up the screening test in a pharmacy. Two of the three intervention groups also included an additional paragraph in the invitation letter on either: 1) the high proportion of individuals participating regularly (social norms condition) or 2) the importance of regular participation (benefit condition). We measured screening participation before and after receiving a reminder letter six weeks after the screening invitation. An overall 8.0 percentage point increase in CRC screening was achieved as a direct result of receiving a reminder letter; however none of the intervention strategies influenced participation. The only significant difference was found for newly invited individuals. There, participation rates decreased from 34.9% to 24.2% when the invitation mailing mentioned the importance of regular participation (OR: 0.60; 95% CI: 0.38-0.95). While none of the intervention strategies improved participation rates we found that praising the benefit of regular screening may discourage individuals who have never been invited before as the continuous behavior may be perceived as a large request. Nevertheless, the reminder letter boosted participation rates independently of the intervention assigned.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31713528,

title = {Dissemination of health technologies: Trends in the use of diagnostic test in breast cancer screening},

author = {Natal C and Fernandez-Somoano A and Torá-Rocamora I and Vidal C and Castells X and Tardón A and Benign Lesion Study Group and Benign Lesion Study Group},

doi = {10.1016/j.jhqr.2019.02.007},

issn = {2603-6479},

year  = {2019},

date = {2019-01-01},

journal = {J Healthc Qual Res},

volume = {34},

number = {4},

pages = {177--184},

abstract = {OBJECTIVE: To analyse trends in the use of diagnostic test in breast cancer screening programs in Spain.nnMATERIALS AND METHODS: Retrospective study of 542,695 women who had undergone at least one screening mammogram in any of the screening centres of three administrative regions in Spain, between 1996 and 2011. Process measures were: overall recall rate, overall invasive test rate, and rates of each type of invasive test (fine-needle aspiration biopsy, core-needle biopsy and surgical biopsy). As results measures were included detection of benign lesions rate, ductal in situ cancer rate and invasive cancer rate. Adjusted by age rates were estimated year by year for each measure and, also, the annual percent of change and its corresponding joint points.nnRESULTS: Core-needle biopsy rates decreased between 1996 and 1999 and changed trends in 1999-2011 with an increase of 4.9% per year. Overall recall rate declined by 4.6% from 1999 to 2004, invasive test rate declined between 1996 and 2004 by 24.3%. Fine-needle aspiration biopsy rate changes were: a 22.4% declined per year (1996-1998), and 13.5% declined per year (1998-2005). Benign lesions rate decreased from 1996 to 2011, 21.4% per year (1996-2001) and 6.0% (2001-2011). Ductal carcinoma in situ and invasive cancer had no-statistically significant changes.nnCONCLUSION: The introduction of core-needle biopsy was slow and not concurrent with the reduction in the use of other diagnostic tests, but also represented a reduction in the rate of overall diagnostic tests and in the detection rate of benigns lesions without affecting the cancer detection rates.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30913217,

title = {Effect of information about the benefits and harms of mammography on women's decision making: The InforMa randomised controlled trial},

author = {Pérez-Lacasta MJ and Martínez-Alonso M and Garcia M and Sala M and Perestelo-Pérez L and Vidal C and Codern-Bové N and Feijoo-Cid M and Toledo-Chávarri A and Cardona À and Pons A and Carles-Lavila M and Rue M and with the InforMa Group},

doi = {10.1371/journal.pone.0214057},

issn = {1932-6203},

year  = {2019},

date = {2019-01-01},

journal = {PLoS One},

volume = {14},

number = {3},

pages = {e0214057},

abstract = {BACKGROUND: In Spain, women invited to breast screening are not usually informed about potential harms of screening. The objective of the InforMa study is to assess the effect of receiving information about the benefits and harms of breast screening on informed choice and other decision-making outcomes, in women approaching the age of invitation to mammography screening.nnMETHODS: Two-stage randomised controlled trial. In the first stage, 40 elementary territorial units of the public healthcare system were selected and randomised to intervention or control. In the second stage, women aged 49-50 years were randomly selected. The target sample size was 400 women. Women in the intervention arm received a decision aid (DA) with detailed information on the benefits and harms of screening. Women in the control arm received a standard leaflet that did not mention harms and recommended accepting the invitation to participate in the Breast Cancer Screening Program (BCSP). The primary outcome was informed choice, defined as adequate knowledge and intentions consistent with attitudes. Secondary outcomes included decisional conflict, worry about breast cancer, time perspective, opinions about the DA or the leaflet, and participation in the BCSP.nnRESULTS: In the intervention group, 23.2% of 203 women made an informed choice compared to only 0.5% of 197 women in the control group (p < 0.001). Attitudes and intentions were similar in both study groups with a high frequency of women intending to be screened, 82.8% vs 82.2% (p = 0.893). Decisional conflict was significantly lower in the intervention group. No differences were observed in confidence in the decision, anxiety, and participation in BCSP.nnCONCLUSIONS: Women in Spain lack knowledge on the benefits and harms of breast screening. Providing quantitative information on benefits and harms has produced a considerable increase in knowledge and informed choice, with a high acceptance of the informative materials.nnTRIAL REGISTRATION: Trial identifier NCT03046004 at ClinicalTrials.gov registry. Registered on February 4 2017. Trial name: InforMa study.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30599878,

title = {Mammographic breast density: How it affects performance indicators in screening programmes?},

author = {Posso M and Louro J and Sánchez M and Román M and Vidal C and Sala M and Baré M and Castells X and BELE study group},

doi = {10.1016/j.ejrad.2018.11.012},

issn = {1872-7727},

year  = {2019},

date = {2019-01-01},

journal = {Eur J Radiol},

volume = {110},

pages = {81--87},

abstract = {OBJECTIVES: To investigate how breast density affects screening performance indicators in a digital mammography context.nnMETHODS: We assessed the effect of breast density over the screen-detected and interval cancers rates, false-positives, specificity, sensitivity, recall rate, positive predictive value of recall (PPV-1), and PPV of invasive tests (PPV-2). Radiologists classified breast density using the BIRADS System. We used generalized estimating equations to account for within-woman correlation by means of the robust Huber-White variance estimator.nnRESULTS: We included 177,164 women aged 50-69 years who underwent 499,251 digital mammograms from 2004 to 2015 in Spain. According to the fibroglandular tissue percentage, 24.7% of mammograms were classified as BI-RADS 1 (<25% glandular), 54.7% as BI-RADS 2 (25-50% glandular), 14.0% as BI-RADS 3 (51-75% glandular) and 6.6% as BI-RADS 4 (>75% glandular). Overall, women with BI-RADS 3 had the highest screen-detected cancer rate (5.9 per 1000) and BI-RADS 4 the highest interval cancer rate (2.4 per 1000). Sensitivity decreased from 89.2% in women with BI-RADS 1 to 67.9% in BI-RADS 4. Both PPV-1 and PPV-2 decreased from 10.4% to 5.7% and from 49.8% to 32.4% in women with BI-RADS 1 and BI-RADS 4, respectively. Women aged 60-69 years with BI-RADS 4 had the lowest sensitivity (54.9%) and the highest interval cancer rate (3.8 per 1000).nnCONCLUSIONS: Performance screening measures are negatively affected by breast density falling to a lower sensitivity and PPV, and higher interval cancer rate as breast density increases. Particularly women aged 60-69 years with >75% glandular breasts had the worst results and therefore may be candidates for screening using other technologies.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}