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PubMed2006

Neonatal illicit drug screening practices in Iowa: the impact of utilization of a structured screening protocol.

OBJECTIVE: The purpose of the study was to determine the neonatal illicit drug screening practices of Iowa birthing hospitals. STUDY DESIGN: Cross-sectional survey design was implemented. The impact of structured screening protocols on the numbers of neonates screened and positive testing in 2004 was reviewed. RESULTS: Of 81 birthing hospitals, 53 (65%) participated in the study. Screening and positive test rates were higher in hospitals utilizing a structured screening protocol compared to those not utilizing one (10.9 versus 2.1% and 0.9 versus 0.2%, respectively, P < 0.0001). Hospitals with higher population, numbers of outpatients, inpatients, deliveries, and availability of drug abuse treatment services utilized a structured screening protocol more often. CONCLUSION: Utilization of a structured screening protocol increases the number of neonates screened for illicit drugs and positive testing rate regardless of urbanization. Regional standardization of structured screening protocols may improve the recognition of perinatal illicit drug exposure and provision of treatment services.

Clinical Protocols↗

PubMed2005

Should adults be screened for celiac disease? What are the benefits and harms of screening?

The symptoms of celiac disease are diverse, and the disease is often asymptomatic. Without active serologic screening, most cases probably remain undiagnosed. Recent serologic screening assays allow mass screening for the disease. However, there is no evidence as yet to suggest that symptom-free celiac disease patients run an increased risk of small intestinal lymphoma or other complications. The prevention of osteoporosis seems to be the strongest indicator for widespread screening today. Screening asymptomatic individuals for celiac disease may be even harmful. A lifelong gluten-free diet is not easy to maintain, and the subject's quality of life may deteriorate. It is also debatable whether patients found by active screening adhere to a gluten-free diet similarly to symptomatic ones. The cost-effectiveness of population screening is dubious. Serologic screening should be applied in individuals with even subtle symptoms indicative of celiac disease, such as subclinical-isolated iron deficiency. In various autoimmune conditions, the risk of celiac disease is approximately 5% and, in individuals with affected first-degree relatives, 15%. Infertility, neurologic symptoms such as polyneuropathy, ataxia, epilepsy with posterior cerebral calcification, and osteoporosis are conditions in which celiac disease should be kept in mind. Elevated aminotransferases and liver failure can lead to a diagnosis of celiac disease. Evidence today does not support mass screening of celiac disease. Instead, increased alertness should be observed in patients at risk of the condition.

Adult↗

PubMed2003

Stage and survival in breast cancer patients in screened and non-screened Danish and Swedish populations.

Comparisons between the Danish and Swedish Cancer Registry revealed a 9% difference in 5-year survival for breast cancer patients diagnosed between 1983 and 1989. The purpose of this study was to determine whether previous differences in survival and stage still exist or whether the Danish figures approach those of the Swedish registry. Complete population-based cohorts of patients with breast cancer in the years 1996-1997 from well-defined areas in Denmark and Sweden were compared. The study regions were a Danish (Funen) and a Swedish (Malmö) county with mammography screening and two Danish counties without screening. No difference in extent of disease or survival was observed between screening areas regardless of country. However, there were significant differences in stage distribution and survival between screening populations and Danish non-screening populations, to the benefit of populations provided with a screening programme. Five-year survival was 5-6%, higher in screening populations than in Danish non-screening counties. Corresponding disease-specific survival enhanced the difference. In a multivariate analysis increasing age, tumour size and stage decreased survival. Adjusting for these factors eliminated differences in survival according to country/county. Survival difference could be attributed to early diagnosis and favourable stage in populations offered mammography screening and was not related to nation. Denmark may, through early detection, approach the beneficial stage distribution and survival observed in Sweden.

Aged↗

PubMed2006

Uptake of cervical cancer screening in The Netherlands is mainly influenced by women's beliefs about the screening and by the inviting organization.

BACKGROUND: This study aims to examine the impact of women's characteristics (demographics, risk behaviour, and beliefs) on the uptake of cervical cancer screening, taking practice characteristics (demographic and organizational) into account. METHODS: Routinely collected data of screening status were sampled from electronic medical records of 32 Dutch general practices. Additionally, a questionnaire was sent to a sample of 2224 listed women-1204 screened, 1020 unscreened. We used a step-by-step, logistic, multilevel approach to examine determinants of the screening uptake. RESULTS: Analyses of data for 1392 women (968 screened and 424 unscreened) showed that women's beliefs about cervical screening and attendance are the best predictors of screening uptake, even when demographic and organizational aspects are taken into account. Women aged 40-50 years who felt high personal moral obligation, who had only one sexual partner ever, and who were invited and reminded by their own general practice had the greatest likelihood of screening uptake. A non-response study was performed; the non-responders to the questionnaire (mainly unscreened) thought they had less risk of cervical cancer, were less motivated, less often intended to get future screening, and were more convinced that cervical cancer cannot be cured. CONCLUSION: To improve the uptake rate, we should focus on the personal moral obligation of eligible women, beliefs about the risks of cervical cancer, and available cures. Invitations and reminders within general practices enhance the uptake rate.

Adult↗

PubMed2005

Flexible sigmoidoscopy in the PLCO cancer screening trial: results from the baseline screening examination of a randomized trial.

BACKGROUND: The Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial is a randomized clinical trial to test the effectiveness of cancer screening, including the effect of flexible sigmoidoscopy screening on colorectal cancer mortality. Here we report findings from the baseline screening flexible sigmoidoscopy examination. METHODS: Analyses included 77,465 men and women aged 55-74 years who were enrolled at 10 screening centers. The trial administered baseline risk factor questionnaires, offered 60-cm flexible sigmoidoscopy examinations, referred patients with screen-detected colorectal polyps or masses to personal physicians, and tracked subjects with polyps or masses to determine results from diagnostic follow-up. Cochran-Mantel-Haenszel statistics and logistic regression were used to test for differences in proportions according to sex and age. RESULTS: A total of 64 658 subjects (83.5%) underwent screening flexible sigmoidoscopy, and at least one polyp or mass was identified in 15,150 subjects (23.4%). Of these, 74.2% received follow-up lower endoscopic procedures. Follow-up lower endoscopy was more frequent in subjects with at least one larger (> or = 0.5 cm) polyp or mass (86.0% [95% confidence interval {CI} = 84.6% to 87.4%] and 81.0% [95% CI = 79.8% to 82.2%] in women and men, respectively) than in those with a smaller (< 0.5 cm) polyp or mass (69.1% [95% CI = 67.5% to 70.6%] and 65.4% [95% CI = 64.1% to 66.7%] in women and men, respectively). The yields per 1000 screened, depending on 5-year age group, were as follows: for colorectal cancer, 1.1-2.5 in women and 2.4-5.6 in men; for advanced adenoma, 18.0-30.4 in women and 36.1-49.1 in men; and for colorectal cancer or any adenoma, 50.6-79.6 in women and 101.9-128.6 in men. Approximately 77% (130/169) of the colorectal adenocarcinoma patients were stage I or II at diagnosis. CONCLUSIONS: Acceptance of screening flexible sigmoidoscopy was high. Diagnostic follow-up varied according to polyp size, yet cancer or adenoma detection rates met expectations.

Adenoma↗

PubMed2005

Women with learning disability and uptake of screening: audit of screening uptake before and after one to one counselling.

BACKGROUND: This study investigates the breast and cervical screening status of women with moderate to severe learning disability and whether uptake could be improved by one to one counselling. METHODS: An audit of screening uptake of women in contact with the National Health Service (NHS) learning disability service within the eligible age groups for breast and cervical screening before and after one to one counselling by a learning disability team nurse. RESULTS: Of the eligible 48 women, 37 (77 per cent) had undergone breast screening indicating that uptake was excellent and comparable to the average national and local uptake. As for cervical screening, of the 160 women who were identified as eligible and were contactable, only 26 (16 per cent) were having regular smear tests. At the end of the project, which involved one to one counselling by the nurses to encourage uptake, nine additional women underwent smear tests bringing the uptake rate to 22 per cent. For the remaining 96 women (60 per cent) the reasons at the time for non-uptake were recognized as appropriate. CONCLUSIONS: Although the uptake of breast screening was found to be good, cervical screening uptake for women with learning disability was low and remained low after a supportive intervention designed to increase uptake. The greater acceptability of breast screening in women with moderate to severe learning disability compared to cervical screening has been confirmed.

Adult↗

PubMed2006

Who attends skin cancer screening in Western Australia? Results from the Lions Cancer Institute Skin Cancer Screening Program.

OBJECTIVE: To examine the characteristics of persons attending a skin cancer screening clinic in Western Australia and compare the effectiveness of screening in different socio-demographic subgroups. METHODS: Questionnaires were completed by 5,950 self-selected participants who voluntarily attended the Western Australian Lions Cancer Institute's targeted skin cancer screening clinics during the period 1996-2003. A risk assessment technique was used to identify individuals at high risk of developing melanoma. Provisional diagnoses of suspicious lesions were given at the screening by a medical specialist. Suspicious lesions were later matched with histopathologically confirmed malignant melanomas reported to the Western Australia Cancer Registry. RESULTS: Fifty-seven per cent of attendees were female. The mean age of attendees was 53 years. The yield of suspicious malignant melanomas detected was 24.7 per 1,000 participants screened; the yield of confirmed malignant melanomas detected was 3.0 per 1,000 participants screened. Persons over 50 years of age were three times more likely to have a histopathologically confirmed malignant melanoma detected at the screening than those younger than 50 years (p = 0.049). CONCLUSIONS: The yield of confirmed melanomas detected by the Lions Cancer Institute is among the highest reported by a skin cancer screening program. This may have been attributable to the risk assessment technique used by the program. IMPLICATIONS: A free community skin cancer screening program that targets high-risk individuals can detect melanomas.

Adult↗

PubMed1988

Evaluation of the modified Bac-T-Screen and FiltraCheck-UTI urine screening systems for detection of clinically significant bacteriuria.

Previous evaluations of the Bac-T-Screen system (Vitek Systems, Inc., Hazelwood, Mo.) demonstrated excellent sensitivity with specimens from patients with clinically significant bacteriuria (including infections with small numbers of uropathogens) but poor specificity with specimens from noninfected patients. In the study reported here, the sensitivity and specificity of the Bac-T-Screen system with a modified decolorizing reagent were evaluated. A manual filtration system, FiltraCheck-UTI (Vitek Systems), for screening urine specimens, Gram stains of mixed urine specimens, and quantitative cultures were also evaluated. The test sensitivity for clinically significant bacteriuria was greater than 96% with the original Bac-T-Screen system as well as the modified system and the manual system. In comparison, the sensitivities of the Gram stains and quantitative cultures (greater than or equal to 10(5) CFU/ml) were 82 and 77%, respectively. Of the 375 patients classified as noninfected by clinical parameters, 34% had positive screening tests with the original Bac-T-Screen system, as compared with 13 and 11% with the modified Bac-T-Screen and FiltraCheck-UTI systems, respectively. Thus, the modified Bac-T-Screen system and the manual FiltraCheck-UTI system have sensitives comparable to that of the original Bac-T-Screen system and markedly improved test specificities.

Bacteria↗

PubMed1995

Is the three year breast screening interval too long? Occurrence of interval cancers in NHS breast screening programme's north western region.

OBJECTIVE: To report the detection rate of interval cancers in women screened by the NHS breast screening programme. DESIGN: Detection of interval cancers by computer linkage of records held by the screening centres in the North Western Regional Health Authority with breast cancer registrations at the regional cancer registry. SETTING: North Western Regional Health Authority. SUBJECTS: 137,421 women screened between 1 March 1988 and 31 March 1992 who had a negative screening result. RESULTS: 297 invasive interval cancers were detected. The rate of detection of interval cancers expressed as a proportion of the underlying incidence was 31% in the first 12 months after screening, 52% between 12 and 24 months, and 82% between 24 and 36 months. CONCLUSION: The incidence of interval cancers in the third year after breast screening approaches that which would have been expected in the absence of screening and suggests that the three year interval between screens is too long.

Breast Neoplasms↗

PubMed2001

Computer modelling of the Swedish two county trial of mammographic screening and trade offs between participation and screening interval.

OBJECTIVES: A computerised model of the Swedish two county trial of mammographic screening was built to explore the applicability of deterministic group modelling for health policy analysis and to examine trade offs between screening interval and population coverage on breast cancer mortality. METHODS: Powersim system dynamics modelling software running on a PC was used. Model inputs were published data on the populations and screening regimens used in the trial, a Swedish female population life table, incidence of breast cancer in Sweden, 95% confidence intervals (95% CIs) for mean sojourn time and screening sensitivity, and survival after diagnosis. RESULTS: The model's output--cumulative mortality from breast cancer--agreed closely with trial results. This was robust to uncertainties in key input variables. Furthermore, with hypothetical screening regimes that had a fixed total number of mammograms over a fixed period a positive association was found between more even distribution of mammograms among a population and reduction in breast cancer mortality. For example, screening 50% of a hypothetical population annually produced a 33% reduction in breast cancer mortality, whereas screening 100% of the population every 2 years produced a 48% reduction. CONCLUSIONS: Deterministic group simulation modelling can be used to build reliable, evidence based quantitative models for policy analysis. This opens health policy simulation modelling to epidemiological researchers and will assist them in identifying important information needs--such as breast cancer survival according to sojourn time (the time between cancer being detectable by screening and becoming symptomatic). Scenarios examining reductions in mortality for a given number of mammograms showed that the more equitable the distribution of screening mammograms, the greater the reduction in deaths from breast cancer.

Adult↗

PubMed1994

Population-based mammography screening in Swedish clinical practice: prevalence and incidence screening in Uppsala County.

PURPOSE: To evaluate the results of a population-based mammography screening program in Uppsala County, Sweden, and to compare the findings with those of the randomized Swedish studies. MATERIALS AND METHODS: There were 43,074 women (aged 40-69 years) who were invited to the first screening round. Women aged 40-54 years were examined with two-view mammography, whereas women aged 55-69 years were examined with one-view mammography. During the second screening round, two-view mammography was used to screen dense breasts. RESULTS: The attendance rate was 87% in the first screening round and 78% in the second screening round. The recall rate for further examination was 4.6% in the first round and 5.7% in the second round. On average, five cancers were found per 1,000 women examined in both screening rounds. The rate of advanced breast cancers of stage II or higher decreased statistically significantly from 0.16% in the first screening round to 0.08% in the second screening round (P = .007). CONCLUSION: The results of the Swedish two-county study can be duplicated in clinical practice.

Aged↗

PubMed2003

Who comes to voluntary, community-based alcohol screening? Results of the first annual National Alcohol Screening Day, 1999.

OBJECTIVE: The feasibility of the 1999 voluntary, community-based National Alcohol Screening Day (NASD) was assessed by determining 1) the extent to which community and college sites were registered to hold screenings and the extent to which the subjects came to participate, 2) the demographic and clinical characteristics of the participants at these screening sites, and 3) the extent to which individuals who were referred for evaluation and treatment adhered to follow-up recommendations. METHOD: Registered community and college sites were documented. Screening forms returned by the participants were analyzed. A subgroup of randomly selected participants from community and college sites was contacted by telephone. RESULTS: A total of 1,218 community sites and 367 [corrected] college sites participated in NASD. At the 1,089 sites that reported results, 32,876 people participated, 18,043 were screened, and 5,959 were referred for treatment. Forty-three percent of those screened at these sites had a score of 8 or more on the Alcohol Use Disorders Identification Test (AUDIT), indicating harmful or hazardous drinking. Only 13% of those screened had previous alcohol treatment. In the subgroup that participated in the follow-up survey (N=704), community participants (N=337) had higher mean scores on the AUDIT than the college participants (N=337). Approximately 50% of the community participants and 20% of the college participants adhered to the recommendation to pursue follow-up. CONCLUSIONS: Voluntary, community-based screening for alcohol problems is feasible and offers education, screening, and referral for many individuals with harmful or hazardous drinking behavior.

Adult↗

PubMed1995

Monitoring interval cancers in breast screening programmes: the east Anglian experience. Quality Assurance Management Group of the East Anglian Breast Screening Programme.

Interval cancer rates are a major determinant of the success of a screening programme. In the Swedish two county study, on which the United Kingdom programme is based, a 39% reduction in mortality was observed in screened women aged 50-64. Using data from the Swedish study, the relationship between interval cancer incidence and the likely future effect on breast cancer mortality was quantified. In East Anglia, as elsewhere in the United Kingdom, interval cancers rates are nearly double those obtained in Sweden: interval cancer rates in the first, second, and third years respectively, after a negative screen were 24%, 59%, and 79% of the expected underlying incidence in the absence of screening. The corresponding figures from the two county study were 17%, 30%, and 56%. From these it was estimated that the mortality reduction in East Anglia will be 21%, which is lower than the 35% observed in invited women in this age group in the Swedish two county study and the 25% specified in the Health of the Nation target. In a rereading exercise, using screening mammograms from women who were screen normal, who had screen detected cancers, or who subsequently developed interval cancers, four out of five radiologists recommended recall for around 70% of the original mammograms (classed as screen normal at time of screening) from 33 interval cancers. This suggests that sensitivity is a contributory factor to the higher interval cancer rates in East Anglia.

Aged↗

PubMed1997

Neonatal screening for cystic fibrosis in the Trent region (UK): two-stage immunoreactive trypsin screening compared with a three-stage protocol with DNA analysis as an intermediate step.

OBJECTIVES: To assess neonatal screening for cystic fibrosis using immunoreactive trypsin, either alone or in conjunction with DNA analysis for the delta F508 mutation. A novel three-stage screening protocol was compared with the previously introduced two-stage immunoreactive trypsin-DNA protocol. DESIGN: (a) Collection of data from a 4 1/2 year period (phase 1) of two-stage immunoreactive trypsin screening. The initial dried blood samples were obtained at 6 days of age and repeat samples at 27 days of age from babies with results above the 99.5th centile. Babies with persistent hypertrypsinaemia were referred for a diagnostic sweat test. (b) Retrospective DNA analysis: patients with cystic fibrosis diagnosed in phase 1 were genotyped and most samples from babies with increased initial immunoreactive trypsin but normal results in the second sample were analysed for the delta F508 mutation. (c) Phase 2, a prospective study of a three-stage neonatal screening protocol, in which only babies heterozygous for the delta F508 cystic fibrosis mutation progressed to the second immunoreactive trypsin test. SETTING: The Trent neonatal screening programme. SUBJECTS: 437 859 babies born between August 1989 and March 1996. MAIN OUTCOME MEASURES: Proportions of unaffected babies requiring a second blood sample or a sweat test. Overall sensitivity for the detection of cystic fibrosis. RESULTS: The two-stage screen failed to identify six out of 94 cases of cystic fibrosis (without meconium ileus). The introduction of the DNA analysis step would have resulted in one additional case being missed. With the three-stage screen there was a 92% reduction in babies requiring a second blood sample and an 80% reduction in negative sweat tests, results close to the predictions of the retrospective study. CONCLUSIONS: The three-stage screening protocol is a marked improvement on the two-stage immunoreactive trypsin strategy and on the two-stage immunoreactive trypsin-DNA strategy recently introduced in some other screening programmes.

Cystic Fibrosis↗

PubMed2004

A randomised controlled trial and cost effectiveness study of systematic screening (targeted and total population screening) versus routine practice for the detection of atrial fibrillation in the over 65s: (SAFE) [ISRCTN19633732].

BACKGROUND: Atrial fibrillation (AF) has been recognised as an important independent risk factor for thromboembolic disease, particularly stroke for which it provides a five-fold increase in risk. This study aimed to determine the baseline prevalence and the incidence of AF based on a variety of screening strategies and in doing so to evaluate the incremental cost-effectiveness of different screening strategies, including targeted or whole population screening, compared with routine clinical practice, for detection of AF in people aged 65 and over. The value of clinical assessment and echocardiography as additional methods of risk stratification for thromboembolic disease in patients with AF were also evaluated. METHODS: The study design was a multi-centre randomised controlled trial with a study population of patients aged 65 and over from 50 General Practices in the West Midlands. These purposefully selected general practices were randomly allocated to 25 intervention practices and 25 control practices. GPs and practice nurses within the intervention practices received education on the importance of AF detection and ECG interpretation. Patients in the intervention practices were randomly allocated to systematic (n = 5000) or opportunistic screening (n = 5000). Prospective identification of pre-existing risk factors for AF within the screened population enabled comparison between high risk targeted screening and total population screening. AF detection rates in systematically screened and opportunistically screened populations in the intervention practices were compared to AF detection rate in 5,000 patients in the control practices.

Aged↗

PubMed2003

Colorectal cancer screening practices among attendees at a cancer screening clinic.

BACKGROUND: Little is known about colorectal cancer (CRC) screening behaviors among patients seen in a general cancer screening clinic. METHODS: Age-eligible respondents completed a brief self-administered survey examining self-reported compliance with CRC screening recommendations and beliefs about the benefits of CRC screening. RESULTS: Overall compliance with CRC screening among respondents was 43%. Although compliance did not differ by gender, persons aged 65+ years were more than five times more likely to be compliant with CRC screening (OR = 5.29, CI = 2.06-13.58). While a majority of respondents (87%) reported that they would complete CRC screening if recommended by a doctor, only 54% had talked with their doctors about examinations for CRC. Males were more likely to report they would complete testing if recommended by their doctors (OR = 6.81, CI = 1.46-31.8) and twice as likely to report having talked to their doctors about CRC testing (OR = 2.71, CI = 1.32-5.56). CONCLUSIONS: Efforts to enhance CRC screening behaviors among motivated subpopulations seeking preventive care might consider opportunities to augment physician-patient dialogues regarding the need for screening tests. In addition, the dissonance between the recognized need for CRC testing and lack of compliance warrants further examination.

Aged↗

PubMed2001

Mass population screening for colorectal cancer: factors influencing subjects' choice of screening test.

OBJECTIVES: To identify socio-demographic, economic, medical and attitudinal factors that explain subjects' choice of test for screening for colorectal cancer (biennial faecal occult blood test versus once-only flexible sigmoidoscopy). METHODS: Data obtained from a questionnaire, administered by general practitioners and returned by approximately 2700 asymptomatic subjects. Thereafter, logistic regression modelling to explain willingness to participate in screening, whether or not a test preference is expressed, and the nature of the preference. RESULTS: An interest in undertaking screening is more probable if the subject is white, older, married and possesses a high health motivation. An intention to participate is more probable if the subjects are particularly worried about the disease, feel themselves to be particularly susceptible to it, and have already had experience of screening for colorectal and (if female) other cancers. Persons in receipt of a household income below 10,000 Pounds are less likely to express an interest in screening. Women are more likely to express a test preference and this preference is more likely to be for the faecal occult blood test. Subjects' worries and perception of risk are associated with reported experiences of cancer, stomach problems and depression. A positive attitude towards screening is positively associated with frequency of dental visits. CONCLUSIONS: Socio-demographic, economic and other factors evidently influence subjects' preferences for particular screening tests and, by implication, the likelihood of compliance with any future screening offer. The models support the view that participation in colorectal cancer screening has as much to do with a positive attitude towards health and health promotion generally as with any specific concern about the disease.

Adult↗

PubMed2006

Alcohol screening in dental patients: the prevalence of hazardous drinking and patients' attitudes about screening and advice.

BACKGROUND: Because heavy drinking is a risk factor for oral cancer, dentists should screen patients for alcohol use. The authors investigated heavy drinking in dental patients and patients' attitudes about alcohol screening. METHODS: A convenience sample of 408 patients attending an emergency walk-in dental clinic served as subjects. Patients completed the Alcohol Use Disorders Identification Test-C (AUDIT-C), a three-item alcohol screening test, and an opinion survey regarding attitudes about the acceptability of alcohol screening and counseling by dentists. RESULTS: One in four patients had positive screening results for heavy alcohol use. The majority of subjects (> 75 percent) were in support of dentists' inquiries and advice about alcohol use. Age, sex and drinking status were not predictive of patients' opinions about alcohol screening. CONCLUSIONS: One hundred three of the dental patients exhibited evidence of hazardous alcohol consumption, a risk factor for oropharyngeal cancer. The majority of patients reported that they would readily accept alcohol screening and alcohol counseling by dentists. CLINICAL IMPLICATIONS: Because studies have shown that some dentists hesitate to screen for alcohol use because of a belief that screening is unacceptable to patients, these results may encourage a change in practice.

Adult↗