Use of recommended screening tests can reduce new colorectal cancers (CRC) and deaths, but screening uptake is suboptimal in the United States (U.S.). The Centers for Disease Control and Prevention (CDC) funded a second round of the Colorectal Cancer Control Program (CRCCP) in 2015 to increase screening rates among individuals aged 50-75 years. The 30 state, university, and tribal awardees supported by the CRCCP implement a range of multicomponent interventions targeting health systems that have low CRC screening uptake, including low-income and minority populations. CDC invited a select subset of 16 CRCCP awardees to form a learning laboratory with the goal of performing targeted evaluations to identify optimal approaches to scale-up interventions to increase uptake of CRC screening among vulnerable populations. This commentary provides an overview of the CRCCP learning laboratory, presents findings from the implementation of multicomponent interventions at four FQHCs participating in the learning laboratory, and summarizes key lessons learned on intervention implementation approaches. Lessons learned can support future program implementation to ensure scalability and sustainability of the interventions as well as guide future implementation science and evaluation studies conducted by the CRCCP learning laboratory.

Screening is a special issue in medical questions concerning disease prevention. Preconditions for screening are clearly defined by the World Health Organization. High prevalence, effectiveness of therapy, availability of accepted test procedure and consensus concerning the economic concerns are necessary for successful implementation of a screening program. Preventive diagnostic studies can only be understood if one is familiar with the statistical terms sensitivity, specificity, prevalence, incidence and bias (especially overdiagnosis and lead time bias). Aspects of radiation protection are especially important in asymptomatic volunteers. The new radiation protection law in Germany also gives the opportunity to define new screening procedures even with use of radiation exposure in individual prevention programs. Potential diseases for radiological secondary prevention with high mortality are malignant tumors (especially breast cancer, lung cancer, colorectal cancer) and cardiovascular diseases (coronary heart disease, stroke or aortic aneurysm).

The two main histological subtypes of oesophageal cancer, squamous cell carcinoma and adenocarcinoma, have distinct risk factor profiles. For oesophageal squamous cell carcinoma, tobacco smoking and excess alcohol use are the main risk factors. For adenocarcinoma, gastro-oesophageal reflux disease and obesity are main risk factors, whereas tobacco smoking is a moderately strong risk factor and infection with Helicobacter pylori decreases the risk. Dietary factors may influence the risk of both types of oesophageal cancer. Genetic factors are involved in the aetiology, but their influence is generally low. The striking male predominance in oesophageal adenocarcinoma is unexplained, although sex hormones may play a role. Risk prediction models combining information on multiple risk factors have shown promising potential in identifying high-risk individuals for targeted prevention and early detection, which should prompt further studies. More high-quality research efforts are warranted for better understanding of the aetiology of oesophageal cancer, particularly in developing countries.

From 2015, Norway has implemented high-risk human papilloma virus (hrHPV) testing in primary screening for cervical cancer. Women 34-69 years, living in four counties, have been pseudo-randomly assigned (1:1 randomization) to either hrHPV testing every 5 years (followed by cytology if hrHPV positive), or cytology testing every 3 years (followed by hrHPV testing if low-grade cytology is detected). We compared anxiety and depression scores among participants by screening arm and results. 1,008 women answered a structured questionnaire which included the validated Patient Health Questionnaire-4 (PHQ-4). The Relative Risk Ratio (RRR) of mild vs normal anxiety and depression scores, and moderate/severe vs normal anxiety and depression scores, were estimated by multinomial logistic regression with 95% confidence intervals (95% CI). Compared to women who were screened with cytology, women randomized to hrHPV testing were not more likely to have mild anxiety and depression scores (RRR 0.96, CI 0.70-1.31) nor more likely to have moderate/severe anxiety and depression scores (RRR 1.14, CI 0.65-2.02). Women with five different combinations of abnormal screening test results were not more likely to have mild or moderate/severe vs normal anxiety and depression scores than women with normal screening results. The likelihood of having abnormal long-term (4 to 24 months after the screening) anxiety or depression scores among women 34 years and older was not affected by screening method or screening results. The results of this study suggest that a change to hrHPV testing in primary screening would not increase psychological distress among participants. This article is protected by copyright. All rights reserved.

Respiratory diseases are a major cause of late morbidity and mortality amongst childhood cancer survivors. This population-based study investigates respiratory hospital admissions in long-term survivors of cancers diagnosed in young people to identify specific respiratory morbidities, treatment-related risks and their relationship to subsequent morbidity and mortality. Population-based cancer registrations in Yorkshire, England, diagnosed between 1990 and 2011 aged 0-29 years, were linked to inpatient Hospital Episode Statistics (HES) for admissions up to 2017. All 5-year survivors were included in analysis (n=4235). Admission rates were compared to age- and sex- matched general population rates. Competing risk regression models were used to assess associations between treatment exposures and risk of admission. Risk of death following admission was calculated using Cox regression. By age 40, cumulative incidence for an admission for any type of respiratory condition was 49%. Respiratory admission rates were 1.86 times higher in cancer survivors than in the general population (95% Confidence Interval (CI) 1.73-2.01), and varied by respiratory condition and age at diagnosis. Treatment with chemotherapy with known lung toxicity increased the risk of admission for all respiratory conditions (subdistribution Hazard ratio (sHR)=1.26, 95%CI 1.03-1.53) and pneumonia (sHR= 1.48, 95%CI 1.01-2.17). Subsequent mortality was highest in those admitted for pneumonia compared to other respiratory conditions (28% and 15% respectively). Survivors of childhood and young adult cancer remain at significantly increased risk of respiratory complications several decades after treatment, emphasising the importance for clinical initiatives for prevention, early detection and treatment. This article is protected by copyright. All rights reserved.

Recruitment challenges hinder behavioral intervention research in cancer survivors. The purpose was to examine the reasons for declining and intervention preferences of study-eligible breast cancer survivors declining a trial of a four-session couple-based Intimacy Enhancement intervention (refusers) and explore whether refusers differed from participants on key characteristics. Partnered, post-treatment breast cancer survivors reporting sexual concerns who were eligible for but declined participation in the intervention trial were approached to complete a standardized 5-min telephone survey assessing reasons for declining and support preferences. Demographic, clinical, and sexual concerns information were collected during screening. Trial participants and refusers were compared on key variables of age, race, hormone therapy use, time since treatment, level of sexual concerns, and recruitment method using t-tests or chi-square tests. Among the 31 women who declined the trial and completed the survey, the most common reasons for declining were time commitment (74%) and partner noninterest (32%). Most (61%) reported that the telephone format played little to no role in their refusal. Eighty-one percent wanted their partners involved in a program addressing sexual concerns. The two most preferred resources were informational websites (45%) and meeting with a professional (26%). Trial participants and refusers did not differ on any key factors examined. Developing intimacy interventions that are very brief, partner-optional, or that use stepped care may bolster uptake. The methods used to examine study-eligible candidates' needs and preferences could be employed in other health populations, thus having broader implications for research design.