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[An overview of breast cancer mass screening in Japan].

To establish the effective mass screening projects for the breast cancer, our study group cosponsered by the Welfare Ministry was organized by 11 regional groups. From 1968 to 1986, 643, 513 women at the initial screening and 719, 189 women at the subsequent screening were examined by physical examination. Out of them, abnormalities were present in 24, 864 women (3.9%) and 23,880 (3.3%), respectively. A detection of cancer was made in 833 women (detection rate 1.3%) and 428 women (0.6%), respectively. As the examinees increased from year to year, the subsequent examinees were over the initial ones. It was suggested that most of examinees had been fixed year by year and the detection rate of initial screening had been higher than that of the subsequent one. Then more initial examinees are expected to be increased. Women 30 to 59 years of age were mostly screened, but women aged 60 or more should be increased. Of women with abnormal physical findings, women over 90% took the second examination. But more effective, economical and safer screening instruments are expected to be developed and be used at the first examination.

Adult↗

[Developments in mass screening for uterine cancer in the past 10 years (1972-1981) in Shimane Prefecture--cell sampling method and the central cytological diagnostic system].

Mass screenings for uterine cancer have been done on 200,000 women in Shimane Prefecture, Japan, from 1972-1981. Up to 1978, a cotton-tipped applicator was used for sample procurement and since that time a wooden spatula type instrument has been used. A central, cytological diagnostic system has been used since 1979. The cytology activity index (CAI) was about 90 each year. The rate of second examination performed is about 60% for women requiring an accurate examination. Cancer detection rates increased from 0.05% to 0.12%, the false negative rate decreased, cytological and histological findings were in close parallel and the mortality rates have decreased. These positive results are attributed to the use of the wooden spatula and central diagnostic systems. By the mass screening for uterine cancer during these 10 years, 81 women were detected as having carcinoma in situ and 107 women as having invasive carcinoma in the histological findings. The number of first screenings has decreased gradually, but the number examined 6 times or more has increased. These results include that same women have tended to undergo the mass screening examination. In women over 50 y.o., particularly those 60 or over, the number screened was low, yet the incidence of invasive cancer exceeded that in other groups.

Adult↗

[Effectiveness of magnetic resonance angiography for mass screening of unruptured intracranial aneurysms].

Magnetic resonance angiography (MRA) is widely used in screening for unruptured intracranial aneurysm (UIA) in the prevention of onset of subarachnoid hemorrhage (SAH) in Japan. However, the clinical efficacy of mass screening of UIA using MRA has not been established. This study aims to establish the clinical efficacy of mass screening of UIA using MRA by decision-making. The decision tree is constructed simulating a flow of population (100,000 persons, aged 50-59) starting from the MRA screening until the final outcomes of quality adjusted life or death in ten years. In order to estimate the numerical values various parameters were used as follows, prevalence rate: 1%; sensitivity of MRA: 74%; specificity of MRA: 76%; death rate by intracranial angiography: 0.1%; rupture rate of UIA: 2%/year; death rate of SAH: 57%; and death rate for surgery for UIA: 0.0%. The following results were obtained: 1. The number of lives saved by the MRA screening was 760, while the number saved without MRA was 79. 2. The number of deaths in those receiving the MRA screening was 52, while the number of deaths without MRA was 104. 3. The level of quality adjusted life with the MRA screening was higher than that without MRA in all cases. In conclusion, mass screening of UIA using MRA appears to be effective.

Decision Making↗

[Studies on a cell sampling method in mass screening for uterine cervical cancer--comparison of data obtained with a cotton tipped applicator, wooden spatula and cotton tipped applicator plus colposcopy].

In mass screening tests for uterine cancer carried out Shimane Prefecture, we used three different scraping methods. This summary is a report of a comparison of the findings with each method. Results are as follows: From 1973-1982, 214, 798 Japanese women were examined in mass screening tests. Among the 42, 443 examined using a cotton tipped applicator, there were 15 (0.035%) with mild dysplasia, 8 (0.019%) with severe dysplasia, 6 (0.014%) with carcinoma in situ and 8 (0.019%) with invasive carcinoma. In 38,106 women examined using the spatula, 25 (0.066%) had a mild dysplasia, 10 (0.026%) a severe dysplasia, 18 (0.047%) a carcinoma in situ and 26 (0.068%) an invasive carcinoma. In 134,249 examined using a cotton tipped applicator plus colposcopy, 283 (0.211%) had a mild dysplasia 108 (0.080%) a severe dysplasia, 57 (0.042%) a carcinoma in situ and 78 (0.058%) an invasive carcinoma. Thus, the use of a cotton tipped applicator plus colposcopy leads to higher rates of detection of mild and severe dysplasia. In the group with a negative Papanicolaou smear and for whom the cotton tipped applicator plus colposcopy was used, there were 214 with a mild dysplasia, 65 with a severe dysplasia, 11 with a carcinoma in situ and 7 with an invasive carcinoma. The combination of cotton tipped applicator and colposcopy proved to be the most effective for mass screenings for uterine cancer, as the detection rates for severe dysplasia and carcinoma in situ were higher and there were fewer incidences of false negative results.

Carcinoma in Situ↗

Comparative analysis of patients with clinically diagnosed colorectal cancer and those detected by mass screening.

OBJECTIVE: To analyze the differences and similarities between patients with colorectal cancer (CRC) who had been clinically diagnosed (CD) and those detected by mass screening (MS), and thus clarify the practical significance of CRC screening in China. METHODS: All the data for the CRC patients in the CD group were collected by registration through a cohort study, and the patients in the MS group were selected from mass screening of a natural population of 19 852 in Beijing Metropolitan area. CRC was confirmed pathologically in both groups. RESULTS: Patients over the age of 50 years with CRC comprised 81.9% of the CD group and 83.3% of the MS group; the percentage of Dukes A + B was 41.1% and 91.7%, respectively; 0.28% of individuals with risk factors in the MS group were found to have CRC, whereas 0.05% did not (P < 0.05). Endoscopically, 44.7% of the protruding type CRC were Dukes A or B compared with only 10% of the ulcerated type (chi(2) = 22.304, P < 0.001). The positivity rate of the fecal occult blood (FOB) test was 79.9% in Dukes A + B and 82.0% in Dukes C + D, showing no difference between the FOB test and Dukes staging in diagnosing CRC (chi(2) = 0.087, P = 0.768). The percentage of patients with increased serum concentration of carcinoembryonic antigen in Dukes C + D was significantly higher than that in Dukes A + B (chi(2) = 5.547, P = 0.019). Among the moderately and well-differentiated CRC, 51.8% (159/307) were Dukes A + B, resulting in a significant difference (chi(2) = 14.504, P < 0.001). There was a familial history of malignancies in 17.9% of CRC cases and 14.6% of their first-degree relatives suffered from malignant tumors. CONCLUSIONS: The incidence of CRC in Beijing Metropolitan area has been rising significantly. The staging and prognosis of CRC involves symptomatology, laboratory tests, endoscopic findings and pathologic characteristics. Mass screening is effective for detecting early CRC in China.

Age Factors↗

The effect of mass screening by physical examination combined with regular breast self-examination on clinical stage and course of Japanese women with breast cancer.

A mass screening program for breast cancer in Japan consists of physical examination (PE) and education on regular breast self-examination (BSE). The effect of PE with BSE on clinical stages and courses of breast cancer patients were retrospectively analyzed. Clinical stages and courses were compared between; i) patients who were examined in outpatient clinics (OPC, n=587), ii) patients who were detected by mass screening with regular BSE [BSE(+), n=68], and iii) without BSE [BSE(-), n=178]. Clinical stage in BSE(+) was significantly earlier than that in BSE(-) or OPC. As early stage cancer was most common in BSE(+), conservative surgery was mostly selected. Survival curve in BSE(+) was significantly better than those in BSE(-) or OPC. BSE complements the role of mass screening by PE for early detection and a more favorable clinical course.

Breast Neoplasms↗

[Mass-screenings for osteoporosis using computed X-ray densitometry (CXD): in a mobile unit].

The early diagnosis and treatment of osteoporosis is considered to be important for the prevention of fractures which often cause elderly to become bed-ridden. Computed X-ray densitometry (CXD), a method to measure bone mineral content in the metacarpus II utilizing a simple X-ray image, has been used for mass-screening of osteoporosis, because of its utility and reliability. However, due to its requiring adequate X-ray equipment, this method is often unsuitable for use in small facilities in a remote mountain areas. The use of CXD for osteoporosis screening, was attempted in a mobile unit for tuberculosis screening, by our public health center. The results showed that it is possible to use CXD in combination with a mobile unit, correcting the obtained values according to the radiographic conditions. With this set-up, CXD was used for mass-screening of osteoporosis in a total of 1150 subjects living in mountainous areas of Yoshino-gun, Nara prefecture, and CXD was found to be convenient and effective for mass-screening. The use of CXD in a mobile chest X-ray unit can be expected to be useful for mass-screening of osteoporosis especially in remote mountainous areas having inadequate X-ray equipment.

Absorptiometry, Photon↗

Cervical mass screening in Norway--510,000 smears a year.

In 1990 the Norwegian Department of Health and Social Affairs decided to start a national screening program for cervical cancer. All women aged 25 to 70 years are offered cervical screening every 3 years. The mass screening is organized and run by a central unit, comprising the Cancer Registry of Norway and the National Health Screening Service. For the first 3 years, all spontaneous cervical screening in Norway is recorded in a central, computerized register. In addition, a pilot project has been implemented in two counties to evaluate the organizational aspects of the screening program. A total of 509,641 cervical smears were recorded during the first year of registration. The test frequency was highest in the age group 20 to 29 years (28.4%), while relatively few tests were performed on women in the age group 60 to 69 years (6.6%). The majority of smears (88.6%) had normal tissue morphology, whereas 2.9% displayed different cytological abnormalities. Human papillomavirus (HPV) changes and mild (CIN 1) and moderate (CIN 2) dysplasia had the highest smear rate in women under 40 years. Malignant cellular changes had the highest rate in older age groups. The imbalance in the age distribution of smears and the confinement of cytological abnormalities to the youngest and the oldest age groups support the wide target age range of the screening program.

Adolescent↗

"Wait and see" strategy in localized neuroblastoma in infants: an option not only for cases detected by mass screening.

Neuroblastomas in infants may regress or mature spontaneously. Consequently, some authors have applied a "wait and see" strategy for tumors found by urinary mass screening. Recently, improved technique and increasing frequency of ultrasound examinations have led to an increase of neuroblastoma cases in pre- and post-natal period. We describe five cases, four diagnosed by routine ultrasound examination and one detected by urinary mass screening, who were monitored with a "wait and see" strategy in order to spare surgery. Median age at diagnosis was 4 months (range 2-10 months). All tumors were adrenal neuroblastomas. All patients met the following criteria: localized tumors, tumor size less than 5 cm in diameter, absence of invasive growth, vanillylmandelic acid (VMA) and homovanillic acid (HVA) less than 50 microg/mg creatinine, and informed consent of parents. Monitoring was performed by monthly ultrasound examinations and urine catecholamine analysis. Median follow-up is 14 months (5-28 months). Three tumors showed spontaneous regression, one is still under observation. In one patient the tumor increased in size and was resected after 14 months of observation displaying favorable histology, but chromosome 1p imbalance. Previous reports describe the adoption of a "wait and see" strategy in selected cases of localized neuroblastoma detected by mass screening. Our study confirms that this strategy may be similarly applied in incidentally or clinically detected cases. However, possible benefit has to be carefully balanced against possible risks.

Disease Progression↗

Risk of leukemia among participants of gastric mass screening survey in Japan: a population-based, case-control study.

To assess the risks of leukemia for individuals participating in a gastric mass screening program using barium photofluorographic examination in Japan, a population-based, case-control study was carried out. The histories of participation in the last 10 years of 79 leukemia cases diagnosed between 1978 and 1985 and twofold controls matched for sex, age (+/- 5 years), and residence were investigated using the records of the gastric mass screening program. The odds ratio of any type of leukemia for those participating at least once in the last 10 years was 1.09 (95% confidence interval, 0.61-1.96) and that of myeloid type was 0.88 (95% confidence interval, 0.38-2.27). Even when the histories of the preceding 5 years were ignored, no significant excess risks were found among patients with any type and myeloid type of leukemia. These results suggest that there is insufficient evidence to support the positive association between the incidence of leukemia and participation in gastric mass screening. The limitations and implications of this analysis are discussed.

Adult↗

Effectiveness of gastric mass screening in Japan.

The age-adjusted death rate from stomach cancer has been on a downward trend during the past 25 years in Japan. During the same period, a gastric mass screening program has been continually and actively conducted throughout the country as a secondary prevention for cancer, aimed at reducing the mortality from stomach cancer through early detection. The number of examinees now amounts to over 5,000,000 a year. According to many studies to evaluate the effectiveness of the mass screening program, it is suggested that the gastric mass screening in Japan contributed toward reducing the mortality from stomach cancer.

Adult↗

Observation of untreated patients with neuroblastoma detected by mass screening: a "wait and see" pilot study.

BACKGROUND: Recent studies have indicated that mass screening for neuroblastoma detects tumors that otherwise would have regressed spontaneously without recognition. Therefore, we started an observation program for these patients to determine how frequently spontaneous regression occurs. PROCEDURE: Eighteen patients were detected by mass screening between June 1994 and December 1996. Eight of these cases matched the following criteria and entered the observation program: Stage I or II, less than 5 cm in diameter; no involvement of large vessels or organs; not difficult to resect; informed consent. If there were an increase in tumor size, an elevation of tumor markers, or evidence of metastasis, the tumor would be immediately resected. RESULTS: Five of the eight cases showed spontaneous regression. Although the remaining three tumors were resected 6-10 months after diagnosis, all patients survived without evidence of recurrence. CONCLUSIONS: At least 60% of neuroblastoma cases who entered our observation program regressed spontaneously.

Adrenal Gland Neoplasms↗

Outcome in patients with lung cancer found on lung cancer mass screening roentgenograms, but who did not subsequently consult a doctor.

GOALS OF THE STUDY: To evaluate the outcome in patients with lung cancer found on lung cancer mass screening roentgenograms, but who did not subsequently consult a doctor. PATIENTS AND METHODS: This study enrolled 198 asymptomatic patients with lung cancer found by lung cancer mass screening during the 9-year period. Five-year survival rates in patients who did not consult a doctor or who stopped consulting a doctor in spite of abnormal shadows detected on last mass screening chest roentgenograms (n=45, delayed consultation group) and in patients who subsequently consulted a doctor when abnormal shadows were detected (n=153, control group) were evaluated by the method of Kaplan and Meier and clinical variables were examined as possible predictors of survival time by the Cox proportional-hazards model. RESULTS: There was a significant difference between the 5-year survival rates in the delayed consultation group and in the control group (21 vs. 51%, log rank: P=0.0003, Wilcoxon: P=0.0009). The risk of death increased 115.0% for the 1-year delay in consultation (hazard ratio: 2.150, 95% CI: 1.203-3.842, P=0.0097). With regard to the reason why they did not consult a doctor, many of them answered that they did not have any respiratory symptoms. CONCLUSION: The 1-year delay in consultation had a great significance in that these patients did not receive any treatment for lung cancer for 1 year, and the 1-year delay in treatment itself affected the outcome.

Adult↗

Laparoscopic resection of an adrenal neuroblastoma detected by mass screening that grew in size during the observation period.

Neuroblastomas (NB) identified by mass screening tests are characterized by benign features. Recently, laparoscopic resection has been applied to the treatment of patients with small adrenal NB (<2-3 cm). However, an increasing number of cases of small NB are followed without any treatment in Japan because many cases regress spontaneously. We describe a case of right adrenal NB detected by mass screening that increased in size during an observation period of 8 months. In this case, laparoscopic resection was performed successfully. The size of the tumor was 27 x 20 x 18 mm at diagnosis and 51 x 42 x 35 mm when it was excised. Small adrenal NB that do not regress during the observation period may require laparoscopic resection before they reach 5 cm in maximum diameter.

Adrenal Gland Neoplasms↗

Ultrasonographic mass screening for thyroid carcinoma: a study in women scheduled to undergo a breast examination.

This study was carried out to clarify the sensitivity of ultrasonographic mass screening for thyroid carcinoma. Between December 1997 and July 1998, a total of 1401 subjects who were scheduled to undergo either a breast examination or a follow-up examination for breast cancer were enrolled in this study. Patients with thyroid nodules were classified into two groups according to their potential risk for malignancy based on the ultrasonographic findings. Ultrasonographic high-risk patients for thyroid cancer underwent an ultrasound guided fine-needle aspiration biopsy (FNAB) and were advised to undergo a thyroidectomy based on the FNAB results. The characteristics of the thyroid cancer patients detected by mass screening were then compared with those of 106 consecutive female patients with clinical thyroid cancer during the same period. Thyroid nodules were detected in 353 (25.2%) of the subjects, 94 (26.6%) of whom were placed in the high-risk group for thyroid cancer. Among the 94 high-risk patients, 43 underwent a thyroidectomy and 37 turned out to have thyroid carcinomas. The detection rate for thyroid cancer was 2.6% for all subjects. The tumor size was significantly smaller than that of the clinically detected cancer group (P < 0.05). Ultrasonographic mass screening for thyroid carcinoma in women who require breast examinations is thus considered to be effective for the detection of subclinical thyroid carcinoma.

Adolescent↗

Quantitative Beutler test for newborn mass screening of galactosemia using a fluorometric microplate reader.

BACKGROUND: The Beutler enzyme spot test is an effective assay for newborn mass screening of galactosemia, but it is qualitative and relies on visual interpretation. We describe a quantitative, instrumental modification of the assay. METHODS: We modified the macroscopic visual Beutler enzyme spot test by adding extraction of blood components from filter paper, deproteinization with acetone-methanol, and quantification and recording by a fluorescent microplate reader and personal computer. All handling was performed in microplates. The measurement time was 90 min. RESULTS: Fluorescence intensity (FI) of healthy controls correlated with hematocrit and galactose-1-phosphate uridyltransferase (GALT) activity. Patients with GALT deficiency were distinguished clearly from healthy subjects and heterozygous carriers by FI. FI decreased to 75% of the initial activity after storage at 25 degrees C for 3 days and to 40% after storage at 37 degrees C for 7 days. Screening of 46 742 newborns yielded 1 false-positive result (in a heterozygous carrier), 1 patient with glucose-6-phosphate dehydrogenase deficiency, and no apparent false negatives as judged by concurrent measurements of galactose and galactose-1-phosphate. CONCLUSIONS: The quantitative Beutler test can provide precise GALT activity in newborn mass screening, and can take into consideration the influence of high temperature and humidity, duration between sampling and testing, and anemia. This method is clinically useful, simple, automated, and highly reliable for newborn mass screening of galactosemia.

Blood Specimen Collection↗

[Voiding disturbance in elderly males examined by prostate mass screening. Gunma Urological Oncology Study Group].

Information about voiding disturbance was obtained from 34,140 elderly males in Gunma Aged Club Association (Q group) through a questionnaire and from 8,129 males by prostate mass screening for prostate disease (MS group) as to: (1) the characteristics of the subjects examined by the mass screening, (2) the relationship between the voiding disturbance and aging and (3) the frequency of voiding disturbance in the normal elderly males. In MS group, the percentage of young subjects, especially less than 60 years old, who complained voiding disturbance was higher than the expected percentage on the assumption that it increases with aging. The percentage of voiding disturbance in these young subjects was also higher than that of males in the same decade in Q group. In their past and present history, the percentage of benign prostatic hypertrophy (BPH) in these young subjects was higher than the expected percentage on the assumption that the incidence of BPH increases with aging. Judging from these results, it was estimated that they were not satisfied with the medical care by which they were treated or were being treated, and they received this mass screening to obtain consultation for their complains. Loss of the force was related with the prostate size estimated by digital rectal examination but not with aging. However, nocturia was well related with aging but not with the prostate size. Hesitancy, strain and dribbling were not apparently related with either the prostate size or aging. It was demonstrated that frequency of nocturia was 0 to 1 in less than 60 years old normal males, 0 to 2 in 60 to 79 years old ones and 0 to 3 in over 80 years old ones. The other symptoms studied in each decade were also analyzed and discussed.

Aged↗

[Mass screening for colorectal cancer in France. Experience in 165,000 people in the department of Calvados].

OBJECTIVES: Screening for colorectal cancer is a major public health problem in France as in most developed countries. Several controlled trials are on-going in Europe. The aim of the study was to determine requirements for success of mass-screening for colorectal cancer in France. METHODS: A mass-screening program has been conducted between April 1991 and June 1994 in the department of Calvados for 164,364 people aged 45-74 years. The screening test was first proposed by general practitioners and occupational doctors during appointments. Secondly, a postal invitation to obtain the test, free of charge, by doctor or chemist, was sent. RESULTS: Global participation rate was 43.4%; 40.2% of tests were distributed during the first phase, 47.1% during the second phase and 12.7% were distributed by a private health institute. Participation was higher for females (47.1%) than males (39.2%) and for urban districts (46.5%) than rural districts (24.4%). In case of positive test, colonoscopy has been more frequently achieved in urban districts and when test has been distributed by a physician. Positivity rate was 2.8%. Positive predictive value was 8.0% for a cancer and 13.5% for an adenoma larger than 1 cm. Because both positivity rate and positive predictive value were higher for males than females and increased with age, rate of cancer or large adenoma screened was almost three times higher for males than females and markedly increased with age. CONCLUSIONS: In France, different recruitment methods have to be used to reach a satisfactory participation to a mass-screening campaign. Such a program requires involvement of general practitioners and close coordination between practitioners and health care insurance agencies.

Adenoma↗