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PubMed1986

Evaluation of a mass screening program for stomach cancer with a case-control study design.

In order to evaluate the effectiveness of a mass screening program for stomach cancer, a case-control study was conducted in Nose town in Osaka, Japan. The case series consisted of all deaths from stomach cancer during the period 1969-1981 (54 in males and 37 in females). For each case, 3 controls of the same sex and from the same precinct as the case, and born within 5 years of the case birth-year, were selected at random from Nose town residents alive at the date of death of the relevant case. We then investigated whether each case and corresponding controls had ever had screening tests before the date of diagnosis of the case. From the matched analysis of the distribution of screening in case-control combination, the odds ratio of screened vs. unscreened among those who died from stomach cancer compared to those who did not was calculated as 0.595 (90% confidence interval: 0.338-1.045) among males and 0.382 (0.185-0.785) among females. When the screening tests conducted within 12 months of diagnosis were ignored on the presumption that they were symptom-related, the odds ratio was calculated as 0.519 (0.297-0.905) among males and 0.486 (0.239-0.986) among females. These data strongly suggest that the mass screening program is effective in reducing stomach cancer mortality.

Adult↗

PubMed2001

A randomized controlled trial comparing three invitation strategies in a breast cancer screening program.

BACKGROUND: The objective of this study was to compare the response received by a population-based breast cancer screening program, according to three different invitation strategies: letters sent by mail from the program (program group), letters sent by mail from the Primary Health Care Team (PHT group), and direct contact through a trained professional (direct contact group). METHODS: We used a cluster-randomized controlled trial with assignment to invitation group using home address. Nine hundred eighty-six women of Barcelona (Spain), ages 50 to 64 years, were invited to participate in the program. The main outcome used was the response rate after the first invitation. RESULTS: Five hundred sixty-four women accepted the invitation (57.2%). The highest response rate was achieved in the direct contact group (63.5%), followed by the PHT group (55.6%), the program group being the one that attained the lowest response rate (52.1%). The direct contact group had a higher probability of participating than the PHT group (RR = 1.14, P = 0.037) or the program group (RR = 1.22, P = 0.003). The response rate in the direct contact group was 72.1% when the letter was received by the subject herself. The increase in response occurred particularly among women of lower educational level. CONCLUSIONS: Inviting women to participate in a breast cancer screening program through direct contact by trained personnel increased participation rate compared with mailed-letter methods. The positive effect appeared restricted to women with lower educational levels.

Breast Neoplasms↗

PubMed2003

Comprehensive breast cancer screening. Programs now include individual risk assessment.

A comprehensive breast cancer screening program needs to include risk assessment in addition to clinical breast examination and mammography. Women identified as being at increased risk should have an individualized schedule of screening mammography and a proven prevention program tailored to their level of risk. In this article, Drs Cardenas and Frisch review risk factors, screening methods, and individual risk assessment, then explain how to use them in conjunction to identify tumors at an earlier, more curable stage.

Aged↗

PubMed1997

Prostate-specific antigen levels from a mass screening program using highly sensitive RIA kits.

BACKGROUND: This study was designed to evaluate the distribution of prostate-specific antigen (PSA) levels of men in a mass screening program for prostatic disease. METHODS: A total of 763 men over 40 years of age underwent mass screening for prostatic disease in a Japanese prefecture using the highly sensitive Eiken kit and the Hybritech (Tandem-R) kit. The screening tests consisted of serum PSA determination, digital rectal examination, a questionnaire on symptoms, evaluation of prostate volume, and determination of the obesity rate. RESULTS: Serum PSA levels of all subjects were measured with both kits. The correlation between the values obtained by the Eiken kit and those of the Tandem-R kit was high (r = 0.990), but the values of the former were slightly higher than those of the latter. Serum PSA weakly correlated with age, however, when estimated within decade age brackets, the levels of PSA showed significant differences among only 1 pair of groups stratified by age. In contrast, the levels of PSA showed significant differences among 9 pairs of groups stratified by prostate volume. CONCLUSION: A highly sensitive assay kit is useful to evaluate both the distribution of PSA levels and the relationship of PSA values to age and prostate volume of men in mass screening programs for prostatic disease, since approximately 40% of the subjects who underwent the present mass screening showed PSA values under 1.0 ng/mL, which have been the the lower limit of detection of many PSA kits.

Adult↗

PubMedDate not supplied

Promoting participation in a population screening program for breast and cervical cancer: a randomized trial of different invitation strategies.

AIMS AND BACKGROUND: Attendance level has been identified as a major determinant of cost-effectiveness of organized screening programs. We tested the effectiveness of 4 different invitation systems in the context of an organized population screening program for cervical and breast cancer. METHODS: Women eligible for invitation--8385 for cervical and 8069 for breast cancer screening--listed in the rosters of 43 and 105 general practitioners (GP), respectively, who had accepted to collaborate in the program, were randomized to 4 invitation groups: Group A--letter signed by the GP, with a prefixed appointment; Group B--open-ended invitation, signed by the GP, prompting women to contact the screening center to arrange an appointment; Group C--letter (same as for group A), signed by the program coordinator, with a prefixed appointment; Group D--extended letter (highlighting the benefits of early cancer detection) signed by the GP, with a prefixed appointment. Assignment to the interventions was based on a randomized block design (block=GP). RESULTS: Assuming Group A as the reference, the overall compliance with cervical cancer screening was reduced by 39% in Group B (RR=0.61; 95% CI, 0.56-0.68) and by 14% in Group C (RR=0.86; 95% CI, 0.78-0.93); no difference was observed for Group D (RR=1.03; 95% CI, 0.95-1.1). The response pattern was similar for breast screening (Group B: RR=0.71; 95% CI, 0.65-0.76; Group C: RR=0.87; 95% CI, 0.81-0.94; Group D: RR=1.01; 95% CI, 0.94-1.08). CONCLUSIONS: Personal invitation letters signed by the woman's GP, with preallocated appointments, induce a significant increase in compliance with screening. Efficiency can be ensured through the adoption of overbooking, provided that attendance levels are regularly monitored.

Adult↗

PubMed1979

Improved case finding for pediatric hearing loss: cost analysis of school screening programs.

The majority of school hearing conservation programs employ pure tone identification audiometry as a basis of referral for further evaluation. An analysis of the cost impact of school screening programs is presented and a method of relating costs to screening program accuracy is described. This type of analysis may be used as a model for estimating cost impact and cost-benefit for pure tone audiometry and other techniques of screening for hearing loss.

Child↗

PubMed2003

Improving participation in Chlamydia screening programs: perspectives of high-risk youth.

BACKGROUND: Many young people at highest risk for chlamydial infection do not use chlamydia screening services. OBJECTIVES: To describe young people's beliefs and opinions about obstacles to and motivators for obtaining testing and to provide recommendations for how to improve youth participation in chlamydia screening programs. METHODS: Eight focus group interviews (4 male and 4 female groups) were conducted with young people using a semistructured interview guide. Thirty-two male and 23 female volunteers (mean age, 18.2 years; age range, 15-24 years) were recruited from Job Corps and Department of Youth Services sites. The main outcome measure was categorization of textual data using content analysis techniques. Data were coded by 2 investigators into categories of responses based on research questions and spontaneously offered comments. Satisfactory intercoder agreement was achieved. RESULTS: Participants described many obstacles to testing, including concern that someone will know they were tested or tested positive, fear about discovering they have a sexually transmitted disease, and fear of acquired immunodeficiency syndrome. Many participants were unsure what physical effects chlamydia produced or thought it was possible to die of a chlamydial infection. Participants recommended providing more information about the effects of chlamydia, availability of urine testing, and ease of treatment to motivate more young people to seek testing. They also emphasized the need to make sexually transmitted disease screening services more private and confidential. There was an overwhelming interest in using a home Chlamydia test (much like a home pregnancy test) if one were available. CONCLUSIONS: To increase youth participation in screening programs, it will be necessary to address their concerns, dispel misconceptions, and provide more information about chlamydia. A home Chlamydia test might be one way to increase screening.

Adolescent↗

PubMed1996

Twenty-year outcome analysis of genetic screening programs for Tay-Sachs and beta-thalassemia disease carriers in high schools.

Programs for education, screening, and counseling of senior-high-school students, in populations at high risk for Tay-Sachs and beta-thalassemia diseases, have existed for >20 years in Montreal. Four process and outcome variables are reported here: (i) voluntary participation rates in the high-school cohort; (ii) uptake rates for the screening test; (iii) origin of carrier couples seeking the prenatal diagnosis option in the programs; and (iv) change in incidence of the two diseases. Between 1972 and 1992, we screened 14,844 Ashkenazi-Jewish students, identified 521 HexA-deficient carriers (frequency 1:28), reached 89% of the demographic cohort in the educational component of the program, and achieved 67% voluntary participation in the subsequent screening phase. The corresponding data for the beta-thalassemia program are 25,274 students (mainly of Mediterranean origin) representing 67% of the cohort with 61% voluntary participation in the screening phase (693 carriers; frequency 1:36). From demographic data, we deduce that virtually all the carriers identified in the high-school screening program remembered their status, had their partner tested if they did not already know they were a carrier couple, and took up the options for reproductive counseling/prenatal diagnosis. In Montreal, the current origin of all couples using prenatal diagnosis for Tay-Sachs and beta-thalassemia diseases is the corresponding genetic screening/testing program, whereas, at the beginning of the programs, it was always because there was a history of an affected person in the family. Incidence of the two diseases has fallen by 90%-95% over 20 years; the rare new cases are born (with two exceptions) outside the target communities or to nonscreened couples.

Adolescent↗

PubMed1994

Utilization of a questionnaire to provide follow-up services in an infant hearing screening program.

An important goal of any neonatal hearing screening program is to provide adequate monitoring and follow-up services for all newborns tested. This is often the most difficult component of the program to administer. An attempt was made to obtain follow-up information through the use of a questionnaire modeled after Jacobson and Jacobson (1990). This questionnaire was administered by mail or telephone to 119 parents whose infants had passed a hearing screening as neonates in four hospitals. Forty-four percent of all parents contacted by either means responded to the questionnaire; however, response rates varied by as much as 36 percent, depending on the hospital in which a child was born. Our results suggest that the successful use of follow-up questionnaires depends greatly upon hospital demographics. When limitations are considered, however, they may provide an alternative to on-site follow-up services for infants who pass initial screening.

Hearing Disorders↗

PubMed1987

Screening for secretory otitis media: evaluation of some impedance screening programs for long-lasting secretory otitis media in 7-year-old children.

In an unselected cohort of 387 seven-year-old children 90% had all 9 planned impedance audiometries during their first year at school. The results from these 348 children were analyzed in different impedance screening programs, as 3 consecutive screening series, each comprising two or 3 tests at an interval of 4-8 weeks. The specificity of the ASHA and Nashville programs was too low in finding long-lasting secretory otitis media, namely about 70%, so that there were too many false positive cases. Therefore, a new impedance screening program was designed. It had about the same sensitivity (80%) but a far better specificity (95%) than the ASHA and Nashville programs. The predictive value of a positive test was 15% in the ASHA and Nashville programs, but 3 times better (48%) in the designed Hirtshals program. The Hirtshals program had a referral rate of 9% compared with the 32-36% in the ASHA and Nashville programs. The frequencies of retesting were 31% in the ASHA program, 52% in the Nashville Program and 45% in the Hirtshals program. Before general screening for long-lasting secretory otitis media can be recommended, additional information is needed.

Acoustic Impedance Tests↗

PubMed1996

Evaluation of the utility of spirometry in a regional public health screening program for workers exposed to welding fumes.

The objective of this study was to determine the usefulness of spirometry in the screening of chronic pulmonary problems related to exposure to welding fumes, in a regional public health-based screening program. Pulmonary questionnaires and spirometric tests were administered twice at 5-year intervals on 229 welders/cutters (mean age, 39.9 years from 31 metal manufacturing plants. The baseline mean value at the first test for the forced expiratory volume in one second (FEV1) was 102% of predicted, the forced vital capacity (FVC) was 107%, and the FEV1/FVC ratio was 79%. The mean annual changes in the three spirometric indicators were -47 mL, -46 mL, and -0.3%, respectively. The usefulness of spirometry was assessed by looking at the relationship between exposure to welding fumes and changes in spirometric indices, in multivariate linear regression analysis, accounting for age, height, and smoking. A high lifetime exposure to welding fumes was associated with better lung functions in the cross-sectional approach (healthy worker effect) but not in the longitudinal approach, where no association was found. We concluded that the public health regional application of this screening program generated too many sources of variation for spirometry to fulfill the objective of early detection of pulmonary function decline related to exposure to welding fumes. Based on these observations, we recommend that maintaining questionnaire screening, with spirometry reserved as a second-line diagnostic intervention.

Adult↗

PubMed1977

An eye screening program in a Chinese-Canadian community.

A screening program staffed by ophthalmologists, ophthalmology residents, ophthalmic assistants, social workers and Chinese-speaking volunteers and directed at a Chinese immigrant community, was conducted at the Mount Sinai Hospital, Toronto. The Chinese population had been hesitant to use our hospital facilities and we hoped to overcome their fears, as well as to detect previously undiagnosed ocular problems. The program succeeded in finding many eye problems, some serious, and in encouraging this immigrant group to come for proper medical care. We describe the method of setting up and conducting such an undertaking, which involved the Departments of Ophthalmology and Social work, hospital administrators and volunteers from the community.

China↗

PubMedDate not supplied

[Congenital hip dysplasia. The controversial results of a screening program].

The authors report their experience in a screening program for congenital hip dislocation. Goal of this study is to recognize the best technique for early diagnosis in this disease. The result show that we need further study and complete cooperation between pediatrician, radiologist and orthopedist to realize the best cost/benefit ratio.

Female↗

PubMed1999

Pilot neonatal screening program for lysosomal storage disorders, using lamp-1.

We have demonstrated that the lysosome associated membrane protein (LAMP-1) is elevated in plasma from approximately 70% of lysosomal storage disorder patients. As part of the development of a newborn screening program for lysosomal storage disorders we have developed a first tier screening assay based upon the level of LAMP-I in blood spots taken from newborn Guthrie cards. To determine the effectiveness of the first-tier marker a prospective pilot Guthrie neonatal screening program for the identification of LSD was commenced in April 1998. Prior to commencement of the pilot program ethical approval was obtained and information leaflets regarding the neonatal screening of LSD were distributed to parents at the time of their infant's Guthrie collection. The LAMP-1 assay utilizes a chicken polyclonal and a mouse monoclonal in a sandwich time resolved fluorescent immunoassay. LAMP-1 blood-spot calibrators and quality control specimens were developed and shown to be stable and reproducible. To date 11,183 infants have been screened using LAMP-1. The population distribution is described with a median and 98th percentile of 220pg/l whole blood and 483microg/l whole blood respectively. Acceptable CV% for intra and inter assay of 8.9% and 10% respectively were obtained.

Antigens, CD↗

PubMed2002

Parasitic infections in Thai workers that pursue overseas employment: the need for a screening program.

Stool examination is a requirement of the screening program for Thai workers seeking overseas employment. We report on the prevalence of intestinal parasitic infections among these workers; the stool examination results of 2,213 Thai workers who visited the Out-patients Department of the King Chulalongkorn Memorial Hospital between September 2000 and January 2001 were analysed. One hundred and thirty-five (6.1%) were found to be infected with 1 or 2 species of parasite. There were 54 (40%), 47 (34.8%), and 25 (18.5%) cases infected with nematodes, platyhelminths and protozoa, respectively. The commonest parasite was Opisthorchis viverrini (28.9%). Most nematode infections were due to Strongyloides stercoralis (19.2%); most protozoal infections were due to Giardia lamblia (17.0%). Mixed infections were found in 9 cases. Not unexpectedly, the rate of intestinal parasitic infection among Thai workers remains high. Screening for the parasitic infections among these workers can help to decrease their rate of rejection by the countries in which overseas employment is sought.

Employment↗

PubMed1979

Evaluation of a mass screening program for stomach cancer.

To evaluate a mass screening program for stomach cancer, we followed 32,789 subjects for 6.1 years by means of a record linkage to a population-based cancer registry. The results show that the mortality from stomach cancer among those studied decreased by 9% as compared with the expected number calculated on the basis of the sex- and age-specific rates among the general population. When the study subjects were limited to those aged 40-59 years, the decrease in stomach cancer deaths became more marked, i.e., a 26% decrease was observed. Because this study is not a controlled trial, the results must be interpreted with the reservation that some biases were present in the study subjects.

Adult↗

PubMed1996

[Evaluation of the tuberculosis infection screening program in pediatric population].

OBJECTIVE: To evaluate a screening program for tuberculosis (TBC) infection in a pediatric population in Spain using the tuberculin skin test (TST) and to analyze the distribution of the frequencies obtained. DESIGN: The study consists of a descriptive analysis carried out on a sample of the pediatric population from Mostoles and Alcorcon, two towns belonging to the Community of Madrid with 192,353 and 141,292 inhabitants, respectively. PATIENTS AND METHODS: A sample of 2,369 children was analyzed. The TST was performed over a ten-month period by trained, voluntary nurses from primary care units. The following variables were analyzed: risk factors for TBC infection, BCG vaccination and induration (mm) of the TST. In children with positive TST results, a search for infective foci and active tuberculosis was performed. RESULTS: The prevalence of TBC infection in the infantile population without risk factors was 0.7% (C.I. 95%, 0.4-1). No cases were found among children aged 3 months to 2 years. In the sample, 4.2% (C.I. 95%, 3.4-5) of the children had one or more risk factors for TBC-infection. Among children presenting risk factors for TBC, 5.1% (C.I. 95%, 1.6-11.8) had a positive result in the TST. However, 76.2% (C.I. 95%, 52.7-91.8) of children with a positive TST, no risk factors could be detected. CONCLUSIONS: Although a positive TST was more frequent in children with risk factors, as the majority of children in our population lacked risk factors for TBC infection, selective screening based on this parameter would not detect most cases of TBC-infection. Greater efforts should be made to better identify children with risk factors for TBC. According to our results, it is highly advisable to perform the TST once during childhood between 10 and 14 years, the period of highest prevalence, for both epidemiological and clinical reasons.

Adolescent↗

PubMed1992

Genotypic confirmation from the original dried blood specimens in a neonatal hemoglobinopathy screening program.

Dried blood spots are used for newborn screening because of ease of sample collection, handling, and shipment. DNA is stable and accessible in the filter paper matrix. Genotypic confirmation using initial specimens is demonstrated for a regional screening program. Seventy-five blinded samples underwent DNA analysis after Hb electrophoresis. DNA was microextracted from a 1/2-inch semicircle (25 microL whole blood equivalent), amplified, and analyzed by four different methods. Direct amplification without microextraction and automated sequencing from microextracted DNA also was performed. All four analyses agreed for the A and S alleles in 70 of 75 specimens. Three disagreements were clarified by the other semicircle from the original sample: two were due to polymerase chain reaction contamination and one to contamination of one of four analytical tests. Two would have required analysis of a second specimen, one because of polymerase chain reaction failure and the second because the patient had S/beta-thalassemia. Direct amplification without microextraction was successful in an additional 77 of 78 specimens for analysis of the A, S, C, and E alleles. Automated direct sequencing from microextracted DNA was demonstrated for the A, S, and C alleles. Analysis of microextracted DNA from dried blood specimens for A and S alleles reduced the need for and costs of obtaining a second specimen for confirmation by 97%. Direct amplification without microextraction for analysis of A, S, and C alleles permits additional reduction in personnel time and costs. We have demonstrated that microextracted DNA is amenable to automated sequencing after asymmetric polymerase chain reaction. Direct genotypic confirmation can facilitate diagnosis and initiation of medical intervention.

Alleles↗