Objective:Organized lung cancer screening is being considered in Switzerland. This study assesses knowledge, barriers, and expectations regarding screening among the population and healthcare professionals prior to a pilot project. Methods:A convergent, mixed method approach combined an online survey, focus groups and interviews with laypeople aged 50-79 years with a smoking history and healthcare professionals. Data were collected between June and August 2023 in the Canton of Vaud, Switzerland. Results:Among 952 survey respondents (79% women, 60% current or ex-smokers), 19% were aware of lung cancer screening, but 75% would participate if offered.Responders preferred information from general practitioners (72%) or official letters (46%). In qualitative interviews, the 24 participants emphasized clear, non-stigmatizing, emotionally engaging communication, accessible logistics, and supportive professional guidance. Eligibility criteria were often viewed as too restrictive. Conclusions:The implementation of lung cancer screening in Switzerland will require a multichannel communication campaign, training and tools for healthcare professionals, and clear eligibility criteria using a pedagogical approach.

In colorectal cancer (CRC) screening settings offering both colonoscopy and fecal immunochemical test (FIT), guidance on who should get colonoscopy could optimize resource use. This study aimed to identify efficient guidance strategies, maximizing quality-adjusted lifeyears (QALYs) gained for given colonoscopy demand. Using the MISCAN-Colon microsimulation model for Switzerland, we evaluated 3 strategy types: age-based, starting biennial FIT and switching to 10-yearly colonoscopy at a certain age; risk score-based, where only individuals with high CRC risk scores undergo colonoscopy; FIT-based, switching to colonoscopy after a quantitative FIT result just below the positivity cut-off and, in some strategies, also at a certain age. Reference strategies included (1) colonoscopy only and (2) equal proportions of individuals choosing FIT or colonoscopy at age 50. Age- and risk score-based strategies with switches or risk assessments at ages 54, 64, or 74 were efficient. Compared to the reference strategies, QALYs gained could increase by (1) 10.0% or (2) 6.7% without increasing colonoscopy demand. The FIT-based switching strategies were not efficient. Therefore, screening programs like those in Switzerland and the United States can improve efficiency by guiding individuals toward FIT or colonoscopy simply based on age. More complex approaches using prior FITs or risk scores would not outperform age-based approaches.

ObjectivesColorectal cancer (CRC) screening rates are low in Switzerland. This study tested whether a PCP intervention—training sessions and performance feedback within quality circles (QC) increased CRC screening rates.MethodsA pragmatic randomized controlled trial was conducted in Switzerland (2018–2021) with PCP in QC. The intervention included three training sessions, shared decision-making materials, and performance feedback based on 40 consecutive patients per PCP. The primary outcome was the difference in CRC screening rates between the intervention and control group after 12 months.ResultsOf 120 invited QC, nine participated (5 intervention, 4 control). A total of 63 PCPs (32 intervention, 31 control) collected data on 2,112 patients (1,130 intervention, 982 control; mean age 61.5, 53% women). Analysis clustered by PCP and QC showed screening rate was 58% in the intervention group vs. 42% in controls (OR1.98; 95% CI:1.14–3.42). Screening rates in the intervention group increased from 55% to 57.9% (absolute increase: 2.9%; 95% CI:1.1%–6.9%; OR1.29; 95% CI:1.08–1.55, p < 0.01).ConclusionTraining sessions and performance feedback in QC increased screening rates, but few QCs chose to participate.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT03510858.

IntroductionIn Switzerland, primary care physicians (PCP) prescribe colonoscopy for colorectal cancer (CRC) screening rather than offering a choice between colonoscopy and faecal occult blood test (FOBT). This study evaluated a training program promoting shared decision-making for CRC screening.MethodsPCP from a research network were randomized 1:1 into intervention or control. The intervention group received study materials, patient decision aids, evidence summary, FOBT sample kit, and personalized feedback on CRC screening practices. PCP documented CRC screening decisions of 40 consecutive patients (ages 50-75) four months post-intervention. The control group received no materials before data collection.ResultsOf 110 PCP randomized, 83 (76%) collected data on 3,171 patients (mean age 62, 50% women). PCP in the intervention group were more likely than controls to have at least one patient tested or planning FOBT (84% vs. 56%; unadjusted RR: 1.52; 95% CI: 1.13 to 2.04). In a sensitivity analysis restricted to 62 PCP who participated in a previous data collection, 72% (21/29) already met the primary outcome in the intervention group at baseline and 49% (16/33) in the control group (RR: 1.49; 95% CI: 0.98 to 2.28). When contrasting the change within PCP from the 2017 and 2018 data collection, there was no significant increase in proportion of PCP who met primary outcome between intervention and control group, while it might have increased the proportion of PCP already prescribing FOBT to prescribe it to more of their patients.ConclusionA mailed intervention increased FOBT prescriptions, but selection bias may have influenced results.

Objectives:This study aimed to estimate the proportion of individuals potentially eligible for lung cancer screening in Lausanne, canton of Vaud, Switzerland, and its associations with key sociodemographic and health-related covariates. Methods:We analyzed self-reported, cross-sectional data from three sources: Lausanne cohort 65+ (2014; n = 1,678; ages 65-70), CoLaus|PsyCoLaus (2014-2017; n = 3,839; ages 50-79), and the Swiss Health Survey (2022, representative of Vaud, ages 50-79). Eligibility was defined by the 2021 United States Preventive Services Task Force criteria. Screening eligibility prevalence was estimated separately in each dataset, and eligible and non-eligible participants were compared using bivariate hypothesis tests. Results:Eligibility was 18.2% in the Lc65+ cohort, 16.0% in CoLaus, and 14.4% in the Swiss Health Survey. Among eligible individuals, the prevalence of current smoking was 58.7% in Lc65+, 60.1% in the Swiss Health Survey, and 64.9% in CoLaus. Eligible participants tended to have a higher burden of comorbidities and social vulnerabilities, including cardiovascular disease, metabolic syndrome, depression, and lower education or income; statistically significant differences varied by dataset. Conclusion:In this Swiss population, about one in six adults met lung cancer screening criteria. Findings highlight the need for combining early detection with tobacco cessation, health promotion, and equitable access to care.

The COVID-19 pandemic severely disrupted usual hospital care, leading to widespread cancellations of elective procedures and sharp declines in admissions. Cancer patients, whose treatment depends on timely and coordinated interventions, were particularly vulnerable to pandemic-related disruptions. This study analyzes Swiss hospital cost trends across pre-lockdown, lockdown, and post-lockdown phases to examine differential resource allocation patterns between cancer and non-cancer patients. A retrospective observational study was conducted using administrative data from 3.9 million inpatient stays among adults. Monthly trends in total hospital stay costs and key cost components, including emergency services, intensive care, operating room, physician, nursing, and imaging services, were analyzed. A difference-in-differences model was employed to assess cost differentials between patient groups across the pandemic periods, adjusting for patient and hospital characteristics. During the lockdown, the average cost per hospital stay increased by CHF 2,049 (+ 15.7

Objectives:This study assessed the extent and factors of concurrent utilisation of cancer screenings in Switzerland. Methods:Data from the 2017 Swiss Health Survey, representing 1,091,813 females and 1,072,940 males aged 50-69, were analysed. Weighted descriptive analyses estimated sex-specific proportions of individuals concurrently up to date with recommended screening for cervical, breast, colorectal, prostate and skin cancer. Multivariable binomial weighted logistic regressions examined associations between concurrent utilisation and sociodemographic, lifestyle, health, health services utilisation, security and social support factors. Results:Approximately one in three Swiss residents were concurrent screening users. Concurrent utilisation increased with age and frequent medical visits. Among females, concurrent utilisation was positively associated with living in French- or Italian-speaking Switzerland and having tertiary education, and negatively associated with being divorced, separated or widowed, and with non-European origin. Among males, concurrent utilisation was positively associated with income, and negatively associated with unhealthy lifestyles, low health concern, and higher health insurance deductibles. Conclusion:Further research is needed to clarify the factors underlying differences in screening behaviours. Given the temporal instability of these behaviours, the findings should be interpreted cautiously.

INTRODUCTION:Colorectal cancer (CRC) screening relies primarily on colonoscopy and fecal immunochemical testing (FIT). Aligning utilization of these options with individual CRC risk may optimize benefit with lower risks, individual burden, and societal costs. We studied the effect of communicating personalized CRC risk and corresponding screening recommendations on risk-appropriate screening uptake in an organized screening setting. METHODS:Randomized controlled trial among residents aged 50-69 years not yet invited for screening in Vaud, Switzerland. The intervention was a mailed brochure communicating individual 15-year CRC risk and screening recommendation. The control group received a usual brochure comparing FIT and colonoscopy. The primary outcome was self-reported risk-appropriate screening (FIT if <3% risk, FIT or colonoscopy if ≥3% and <6%, and colonoscopy if ≥6%) at 6 months. A secondary outcome was overall screening uptake. RESULTS:Of 5,396 invitations, 1,059 people responded (19%) of whom 258 were randomized to intervention and 257 to control materials (average 15-year risk 1.4% [SD = 0.5], age 52.2 years [SD = 2.2], 51% women). Risk-appropriate screening completion was 37% in the intervention group and 23% in the control group (absolute difference 14%, 95% confidence interval 6%-22%). Overall screening uptake was 50% in the intervention group and 49% in the control group (absolute difference 1%, 95% confidence interval -7% to 10%). DISCUSSION:In a population not known to be at elevated CRC risk, brochures providing personalized CRC risk and screening recommendations improved risk-appropriate screening without impacting overall screening uptake. This approach could be helpful for aligning screening methods, risks, and benefits with cancer risk and resource allocation.

BACKGROUND:Duplicate and near-duplicate medical documents are problematic in document management, clinical use, and medical research. In this study, we focus on multisourced medical documents in the context of a population-based cancer registry in Switzerland. Although the data collection process is well-regulated, the volume of transmitted documents steadily increases and the presence of full or near-duplicates slows down and complicates document processing. Identifying near-duplicates is particularly challenging because the large number of documents makes pairwise comparison non-feasible. METHODS:We implemented a system based on both normal hash functions, Simhash (Locality Sensitive Hashing), and Smith-Waterman text alignment similarity. Simhash offers good performance and confirming its results by the Smith-Waterman algorithm with a selected similarity threshold reduces the false positive rate to near zero without lowering sensitivity. Extracted differences in near-duplicate content documents are shown by highlighting differences in original PDF documents. We validated the method using 3042 manually verified document pairs containing 1252 full-duplicate and 398 near-duplicate pairs. The area under the curve (AUC) was 0.96, sensitivity 0.92, specificity 1.00, PPV 1.00, and NPV 0.91. For the same size simulated data, corresponding values were 0.86, 0.72, 1.00, 1.00, and 0.77, respectively. RESULTS:We applied the method against 224,398 medical documents in the cancer registry. We found 5.5% of duplicates on the text level, and 0.17-0.24% near-duplicates depending on the used parameters and threshold values. Most near-duplicates related to the same patient and originated from the same transmitter. Manual evaluation showed that only 2% of differences were in medical contents and 83% in administrative data (21% in patient, 11% in doctor, and 51% in other administrative data). Many near-duplicates looked strikingly similar from a human perspective. CONCLUSIONS:We demonstrated that our method can efficiently find all full-duplicates and most near-duplicates in a large set of multisourced medical documents. Potential ways to further improve this method are discussed. The method can be applied to documents in all domains.

UVR and air pollution in occupational settings were associated with melanoma incidence. Melanoma related to these risk factors is only recognized as an occupational disease in a few countries, while other occupational risk factors are largely neglected.

Cancer screening can have a significant public health impact when it is based on validated tests, accessible to the entire target population, and integrated into organized programs with quality assurance, as is the case for breast and colorectal cancer in most Swiss cantons. Cervical cancer screening, however, remains opportunistic in Switzerland and is not conducted as part of a structured program. A 4-year pilot project for lung cancer screening is underway in the canton of Vaud, with a national reimbursement request for low-dose CT scan under review. Discussions regarding skin and prostate cancer screenings are ongoing, though no reimbursement plans are in place yet. In the longer term, personalized, risk-based approaches, blood-based tests, and self-sampling methods could expand and refine cancer screening strategies.

Cancer is a major public health issue, and monitoring its incidence is important to suggest and evaluate the impact of preventive interventions. However, estimating trends in cancer incidence is often difficult due to changes in screening or other detection processes over time, which can artificially inflate or deflate the observed incidences. We propose a new method for estimating trends in cancer incidence adjusted for such changes, using a constrained Almon distributed lag model. Unlike other approaches, our method does not rely on any knowledge of cancer progression, or detailed evolution of screening practice over time. It requires the registration of the stages (I-IV) of detected cancers while assuming that the distribution of these stages remains constant in the absence of any change in screening practice. Our method is able to recover the real underlying cancer incidence in simulated data reproducing either no change or a gradual or sudden change in screening practice. For illustration, it is applied to registry data from the canton of Geneva, Switzerland, to estimate breast cancer incidence for the period 1991-2016, where it downwardly corrects the observed incidence when an organized screening program was started.

In Switzerland, breast cancer screening takes the form of organised programmes or opportunistic screening. Current programmes cover fifteen out of twenty-six cantons, offer a standardised framework and strict quality control with periodic evaluations. Opportunistic screening broadens access but without systematic quality control, data or equity of access. In both cases, screening leads to earlier detection and reduced mortality of breast cancer but exposes patients to the risks of false positives and overdiagnosis. Abstaining from screening increases the risk of late diagnosis and heavy treatment. An interprofessional approach involving primary care physicians, specialists and public health actors is essential to inform women and offer them high-quality screening that is better integrated into their care pathway.

Objective: Population-based cancer registries receive numerous free-text pathology reports from which cancer cases are manually coded according to international standards. Skin cancer is the most frequent cancer in Caucasian populations, and its incidence is increasing. We developed an AI-based method to identify skin cancer, locate relevant key terms in pathological reports, and suggest coding for the main clinical variables. Methods: We explored multiple neural network architectures and found out that convolutional neural networks with customised noise-robust loss functions offer the best performance for identifying cancer types and pre-coding subsite, morphology, behaviour, grade, laterality, and first line of treatment of skin cancer cases. Previously registered cases were used as training data. We additionally applied an attention mechanism to extract and highlight reports' key diagnostic terms. These highlights facilitate human review of pre-coding results. We evaluated performance of the method by using manually coded cases in a separate test set. Results: The accuracies of detecting skin cancer types were 0.98-0.99, and F1 scores 0.93-0.96. Pre-coding accuracy and weighted F1 score were: ICD-O subsite (4 digits): 0.89-0.91 and 0.89-0.91, morphology (4 digits): 0.61-0.90 and 0.63-0.89, morphology (3-digits): 0.86-0.98 and 0.89-0.98, tumour behaviour: 0.96-0.98 and 0.96-0.98, laterality: 0.99 and 0.98-0.99. Also, accuracy (0.96) and weighted F1 score (0.96) for the grade were estimated for squamous cell carcinoma (SCC) of the skin, and treatments for SCC and melanoma (accuracies 0.84 and 0.87, weighted F1 scores and 0.82 and 0.87). The extracted key words matched ICD-O code descriptions with high precision. Conclusion: We piloted our method in the Vaud Cancer Registry, Switzerland. It was able to identify and pre-code skin cancer cases efficiently and find correct key terms in reports. Medical coders found pre-coding useful and time saving. Integration of the method in the registry document workflow and its extension to other cancer types are intended.

BACKGROUND: The COVID-19 pandemic disrupted healthcare systems worldwide. This raised concerns about delays in cancer diagnosis and treatment, with potentially worse patient outcomes. The aim of this nationwide, population-based cohort study was to investigate the impact of the COVID-19 pandemic on cancer incidence, stage distribution and one-year survival in Switzerland. METHODS: We used national cancer registry data for the period 2017–2021 from the National Agency for Cancer Registration in Switzerland, covering all except three cantons. We estimated national cancer incidence counts and calculated age-standardised incidence rates for all cancers and separately for female breast cancer, colorectal cancer, lung cancer, melanoma and prostate cancer. We calculated proportional stage distributions for cancer types and estimated observed and relative one-year survival for all cancers and cancer types based on Swiss population life tables. Results were analysed descriptively. RESULTS: We included 218,736 cancer cases diagnosed between 2017 and 2021. Annual incidence counts of all cancer cases increased in 2020 (2.1%) and 2021 (7.3%) compared to the mean of 2017–2019. When evaluating monthly incidence counts, we observed a substantial decrease during the COVID-19 lockdown period, which was largest in April 2020 (−19.9% for all cancers). This decrease was most pronounced for female breast cancer (−39.9%), followed by prostate cancer (−29.0%), colorectal cancer (−28.7%) and melanoma (−26.9%). An increase in incidence counts for all cancers was observed in March 2021 (18.8%). We observed no clear shift in stage distributions across 2017–2021. The observed and relative one-year survival for all cancers and individual cancer types was similar in 2020 and slightly higher in 2021 compared to 2017–2019. CONCLUSIONS: This nationwide study suggests that the pandemic had no major effect on short-term cancer patient outcomes. These findings are of importance for policymakers and the public health system regarding future pandemics.

Using a standardized data template, this study retrospectively collected data about colorectal cancer (CRC) screening activity in 2020 and 2021 to estimate the impact of the COVID-19 pandemic compared to the pre-pandemic period (2018 or 2019). Data were collected from 17 programs in 14 countries of which 15 were population-based programs. Invitation coverage was decreased by up to 53.7 % in 2020. Participation among those invited was similar in both periods for all programs. The maximum backlog in invitations was less than 7.4 months in 2020 and 3.3 months for 2021. Nine out of 15 programs observed a decrease in the number of detected CRCs in 2020. Four programs showed a positive percentage change in CRCs detected in 2021 relative to the pre-pandemic period. Half of the countries observed a worse stage-distribution in 2020/2021. Overall, organized CRC screening programs operated at lower screening activity, but screening outcomes were similar compared to the pre-pandemic period.

The COVID-19 pandemic exerted unprecedented pressure on healthcare systems worldwide, leading governments and hospitals to postpone elective procedures to prioritize care for COVID-19 patients. Cancer patients, who often require frequent interactions with hospital services, may have been disproportionately affected by these disuptions in healthcare delivery. This study aimed to analyze and compare hospital care provided to cancer and non-cancer inpatients during the lockdown and post-lockdown periods in Switzerland. This study analyzed comprehensive adult acute care inpatient records from national administrative hospital data spanning 2017 to 2021. Using monthly patient-level data, comparative interrupted time series and difference-in-differences analysis were conducted to assess changes in hospital care between patients with and without an ICD-10 cancer diagnosis. Changes in admission volumes, hospital outcomes (length of stay, mortality), and cancer-specific treatments (chemotherapy, radiation therapy, and palliative care) during the lockdown and post-lockdown phases of the pandemic were analyzed. Hospital admissions decreased substantially during the lockdown period. From March to May 2020, non-cancer patients experienced a reduction of 17′368 admissions (-18

Objective In 2019, a BMJ Rapid Recommendation advised against colorectal cancer (CRC) screening for adults with a predicted 15-year CRC risk below 3%. Using Switzerland as a case study, we estimated the population-level impact of this recommendation.Design We predicted the CRC risk of all respondents to the population-based Swiss Health Survey. We derived the distribution of risk-based screening start age, assuming predicted risk was calculated every 5 years between ages 25 and 70 and screening started when this risk exceeded 3%. Next, the MISCAN-Colon microsimulation model evaluated biennial faecal immunochemical test (FIT) screening with this risk-based start age. As a comparison, we simulated screening initiation based on age and sex.Results Starting screening only when predicted risk exceeded 3% meant 82% of women and 90% of men would not start screening before age 65 and 60, respectively. This would require 43%–57% fewer tests, result in 8%–16% fewer CRC deaths prevented and yield 19%–33% fewer lifeyears gained compared with screening from age 50. Screening women from age 65 and men from age 60 had a similar impact as screening only when predicted risk exceeded 3%.Conclusion With the recommended risk prediction tool, the population impact of the BMJ Rapid Recommendation would be similar to screening initiation based on age and sex only. It would delay screening initiation by 10–15 years. Although halving the screening burdens, screening benefits would be reduced substantially compared with screening initiation at age 50. This suggests that the 3% risk threshold to start CRC screening might be too high.