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Organization of screening in technically advanced countries: Iceland.

Mass screening for cervical carcinoma in Iceland over the past 20 years (1964-1983) has resulted in a 60% drop in the incidence of and mortality from the disease in the country. A study of the screening histories of the 77 incident cases of grossly invasive cervical cancer diagnosed in Iceland in the past nine years showed that 70% of the tumours occurred in women who had failed to attend screening or had done so very irregularly. Approximately 20% of the cervical cancers were either diagnostic or therapeutic failures, in that the women had been diagnosed with cytological changes but this did not result in the prevention of the tumour. The remaining 10% of the incident cervical carcinomas seemed to have escaped cytological detection and proved to be unusual types of cancer. Prevention of the last cases of cervical cancer is becoming increasingly laborious because of difficulties in maintaining interest among the public to attend regular screening. Women may escape surveillance of a cytological abnormality unless they are constantly reminded about follow-up visits. A small, but significant number of the tumours may continue to escape detection because of their unusual nature, but alterations in sampling techniques and increased awareness of the rarer forms of the disease could alter this.

Adult↗

Early detection and surgical treatment of esophageal carcinoma.

From 1960-1980, the technic of abrasive cytologic examination by means of a "balloon catheter" has been used to detect esophageal carcinoma in high-incidence areas with rates of positive diagnosis varying from 87.8% to 91.9%. An application of this technic in mass screenings has led to detection of a large number of very early cases of esophageal carcinoma, of which only about 50% showed positive X-ray findings and 75% showed positive endoscopic findings. Intraluminal staining with toluidine blue through a fiberoptic esophagoscope gave a positive biopsy in 83.9%. In a 16-year period from 1964 through 1979, 237 patients with Stage I esophageal carcinoma underwent surgery. The resectability rate was 100% and the operative mortality 2.5%. Pathologic study of the resected specimens showed carcinoma in situ in 84 cases (35.4%) and early infiltrative carcinoma confined to only the mucosa and submucosa in 153 cases (64.6%). The 5- and 10-year survival rates following resection were 85.9% and 55.6%, respectively. In surgery on 1,647 patients with more advanced carcinoma of the esophagus and who underwent surgery between 1958 and 1979, (resectability rate of 83.4% and a resection mortality of 4.1%), the p-TNM histopathological classification of these patients showed that 72.3% had Stage III and 8.8% had Stage IV diseases, with either extra-esophageal tumor invasion and/or regional lymph node involvements, or distant metastases. The 5-, 10- and 15-year survivals, as calculated by the number of resections were 30.3%, 21.2% and 16.2%, respectively. Analysis showed that prognosis was related to staging of the disease, the extent of tumor invasion, length of the lesion, and the presence or absence of nodal involvement.

Adult↗