Uptake of Cancer Screening Tests Among Recipients of Solid Organ Transplantation

Abstract

Population-based cancer screening recommendations are also suggested for solid organ transplant recipients (SOTR); however, recommendation adherence is unknown. In a population-based cohort of SOTR in Ontario between 1997 and 2010, we determined the uptake of breast, cervical, and colorectal cancer screening tests and identified factors associated with up-to-date screening using recurrent event analysis. We identified 4436 SOTR eligible for colorectal, 2252 for cervical, and 1551 for breast cancer screening. Of those, 3437 (77.5%), 1572 (69.8%), and 1417 (91.4%), respectively, were not up-to-date for cancer screening tests during the observation period. However, these rates are likely an overestimate due to the inability to differentiate between tests done for screening or for diagnosis. SOTR with fewer comorbidities had higher rates of becoming screen up-to-date. Assessment by a primary care provider (PCP) was associated with becoming up-to-date with cancer screening (breast relative risk [RR] = 1.40, 95% confidence interval [CI]: 1.12-1.76, cervical RR = 1.29, 95% CI: 1.06-1.57, colorectal RR = 1.30, 95% CI: 1.15-1.48). Similar results were observed for continuity of care by transplant specialist at a transplant center. In conclusion, cancer screening for most SOTR does not adhere to standard recommendations. Involvement of PCPs in posttransplant care and continuity of care at a transplant center may improve the uptake of screening.

Risk factors associated with post–kidney transplant malignancies: an article from the Cancer-Kidney International Network

“…Modelling studies by Wong et al [ 219 , 220 ] suggest that screening for colon and cervical cancer would be cost effective in the kidney transplant population. In a population-based cohort of Ontario between 1997 and 2010, 77.5, 69.8 and 91.4% of eligible solid organ transplant recipients were not up to date with colorectal, cervical and breast cancer screening, respectively [ 221 ]. Solid organ transplant recipients with fewer co-morbidities, assessment by a primary care provider and continuity of care by a transplant specialist at a transplant centre were associated with higher rates of becoming screen up to date in this study [ 221 ].…”

Gynecologic cancers and solid organ transplantation

“…Likewise, 2 studies of kidney transplant recipients reported in Nordic countries reported 2-fold increases in cervical cancer risk among kidney transplant recipients, with no increase in uterine or ovarian cancers. 19 An Australian study of 166 lung transplant recipients reported an approximate 5-fold increase in low-and high-grade CIN incidence posttransplant when compared to a reference population. 6 The increase in this study of in situ (high-grade cervical intraepithelial neoplasia grade 3, CIN3) but not invasive cervical cancer may be explained by increased medical visits leading to earlier detection of noninvasive cervical lesions.…”

“…However, a recent Canadian study of cervical cancer screening posttransplant showed lower adherence compared with the general population. 19 An Australian study of 166 lung transplant recipients reported an approximate 5-fold increase in low-and high-grade CIN incidence posttransplant when compared to a reference population. 20 The preponderance of evidence suggests that cervical cancer is increased and, therefore, cervical cancer screening remains a priority for SOT recipients, as discussed in more detail below.…”

“…67,68 There is evidence that adherence to recommended cervical cancer screening guidelines can be low in transplant recipients. 19 A self-sampling cervical swab for high-risk HPV has recently been studied and has shown to be well-accepted, feasible, and have sensitivity and specificity similar to that of clinician-collected samples. 69 Further study into whether this strategy would help adherence in the transplant population is needed.…”

Nephrologists' perspectives on cancer screening in patients with chronic kidney disease: An interview study

“…Early detection through screening has been shown to reduce cancer‐specific mortality in the general population. However, there is a lack of robust evidence regarding the benefits and harms, treatment effectiveness, and cancer‐related prognosis to support screening in the CKD population, with the uptake of cancer screening in patients with CKD remaining low …”