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PubMed2006

Outcomes among women younger than age 40 in a state breast cancer screening program.

BACKGROUND: The value of entering women younger than age 40 in breast cancer screening programs (SPs) remains unclear. METHODS: Data from the Oregon Breast and Cervical Cancer Program (BCCP) for the period December 31, 2000 through July 1, 2003 were reviewed with a focus on women 39 years of age or younger. Information on cancers detected in this group was extracted from The Oregon State Cancer Registry. RESULTS: Of the 13,636 women screened, 797 (5.8%) were younger than 40 (mean age 31.9 years). A total of 20.6% of the women were asymptomatic and therefore represented true incidence screening, while 79.4% were referred to the program for symptoms (prevalence screen). A total of 125 biopsies were done out of 797 women, which yielded 5 cancers. All 5 of these patients were symptomatic at presentation and had a negative family history. CONCLUSIONS: There are as yet no data in our state breast cancer SP to support screening of asymptomatic women younger than 40.

Adolescent↗

PubMed1989

Development of a Veterans Administration occurrence screening program.

In October 1988, the Department of Veterans Affairs (VA) established an occurrence screening program in its large, heterogeneous health care system. The program--comprising four stages: initial screening and clinical, peer, and service chief reviews--was designed to be sufficiently uniform for the collection of comparable data throughout the VA system, yet allow for local autonomy at 172 different facilities. Highly objective screening criteria were chosen so that identification of cases for review could be performed by automated procedures.

Decision Making, Organizational↗

PubMed1977

Analysis of a community hospital employee tuberculosis screening program 31 months after its inception.

The employee tuberculosis screening program for this 450-bed, medical-surgical hospital was evaluated as of November 30, 1975. On that date, there were 1,488 employees, excluding physicians and medical and nursing students. Of the 626 employees tested at least twice with purified protein derivative, 28 converted their test from negative (zero induration) to positive (greater than or equal to 10 mm of induration), and 20 converted their tests from weakly reactive (3 to 9 mm of induration) to positive (greater than or equal to 10 mm of induration and showing a 6-mm or greater increase in induration over that resulting from the first test). The rate of conversion (tests with purified protein derivative going from negative to positive) was no different between the groups with high and with low degrees of exposure to tuberculous patients, suggesting the possibility of nonhospital-acquired infection in the latter group. A direct relationship existed between increasing age and increasing rate of conversion, suggesting that some of the convertors were not newly infected, but were persons with boosted reactivity. These data illustrate some of the practical problems of monitoring for tuberculous infections and subsequently offering preventive therapy to convertors.

Adult↗

PubMed2005

Interpretation and use of weight information in the evaluation of eating disorders: counselor response to weight information in a National Eating Disorders Educational and Screening Program.

OBJECTIVE: Eating disorders are frequently undetected and inadequately treated in clinical settings. The current study investigated whether weight data were used appropriately in making recommendations for further care in the first National Eating Disorders Screening Program (NEDSP). METHOD: Accuracy of counselors' assessment of appropriateness of weight for height and adherence to an algorithm using weight to determine need for further evaluation were assessed for the 5,684 adult participants in a two-stage screening program held on college campuses. RESULTS: In 95% of cases, the counselors correctly used the algorithm developed for the NEDSP to assign participants to weight categories ranging from normal to extremely underweight. However, counselors were poorly adherent to an algorithm directing them to recommend urgent evaluation to all extremely underweight participants--that is, those with a weight at or below 75% of expected weight. Of the extremely underweight participants (n = 32), only 25.0% (n = 8) received an appropriate recommendation for urgent evaluation, whereas 59.4% (n = 19) received a recommendation for further (but nonurgent) evaluation, and 15.6% (n = 5) did not receive a recommendation to seek any evaluation. DISCUSSION: Clinicians appeared not to use weight data appropriately to make clinical recommendations for extremely underweight individuals. These results suggest that further specific emphasis on the health risks of extreme underweight may be helpful in training clinicians to manage patients with eating disorders.

Adolescent↗

PubMed1989

Prevalence of Chlamydia trachomatis infection in a population of asymptomatic women in a screening program for cervical cancer.

The prevalence of Chlamydia trachomatis infection in a population of women with no symptoms of sexually transmitted disease was investigated. These women, aged 35-55 years, participated in a screening program for cervical cancer. With the use of a direct immunofluorescence method, 109 out of 2,470 smears tested were positive for Chlamydia trachomatis, indicating an overall prevalence of 4.4%. No changes in prevalence were found when five-year cohorts of this group were analyzed, indicating that age-dependent changes or epidemiological factors do not result in a different (decreased) prevalence over the ages 35 to 55 years. The prevalence of Trichomonas vaginalis and fungi, as detected by cytological screening, was lower than that observed for Chlamydia trachomatis: 3.1 and 2.1%, respectively. Of the 109 smears positive for Chlamydia trachomatis, 90 showed cervical cells with reactive changes (out of 1,490 smears with PAP II), whereas no cytological changes were found in 15 cases (out of 884 smears with PAP I). Changes suggestive of mild or moderate dysplasia were found in only four cases (out of 93 smears with PAP III). The results indicate that Chlamydia trachomatis is associated with reactive changes of endocervical cells and raise serious questions about whether prevention of possible secondary effects such as infertility and pelvic inflammatory disease can be achieved by a combined screening program for cervical cancer and Chlamydia trachomatis.

Adult↗

PubMed1990

Occupational bladder cancer in textile dyeing and printing workers: six cases and their significance for screening programs.

Occupational bladder cancer due to aniline dye intermediates such as beta-naphthylamine and benzidine has long been known; benzidine congeners (o-tolidine and o-dianisidine) are highly suspect. Among 400 men from the Amalgamated Clothing and Textile Workers Union (ACTWU) Dyers locals in New York and New Jersey screened over a 4-year period, two cases of bladder cancer were detected. (Microscopic hematuria, not cytological evaluation, prompted further investigation.) Before a 1984 ACTWU screening program in North Carolina, three workers from the same plant self-reported bladder cancers. Another member, with inconclusive screening results, was diagnosed 2 years later. For these six cases, the mean age at detection was 56.5 years (age range, 38 to 79 years), a decade earlier than age at diagnosis of nonoccupational bladder cancer in men. The average latency from onset of exposure to diagnosis was 23.3 years. These cancers provide evidence to support the initiation of screening programs for high-risk workers. To overcome the emotional and economic disincentives faced by potential victims of occupational bladder cancer, training programs are needed. Worker involvement is required, through trade union representation where possible, to assure reliable training and the equitable distribution of screening and treatment costs.

Adult↗

PubMed1989

Results of a screening program for multiple endocrine neoplasia type 2A: a clinical study of a Japanese family.

A Japanese family of 87 members in five generations with multiple endocrine neoplasia type 2A (MEN 2A) is described regarding the utility of screening tests for early detection of medullary thyroid carcinoma and the potential for DNA diagnosis of MEN 2A gene carriers. The screening programs for family members in this series include measurements of plasma calcitonin concentrations after intravenous injection of pentagastrin (0.5 micrograms/kg/5 sec) and 24-hour urinary excretion of catecholamines. While 18 MEN 2A patients had been previously diagnosed, these screening programs revealed five additional patients with MEN 2A (aged 16, 19, 35, 37, and 57). Prediction of MEN 2A gene carriers by DNA analysis has been attempted but is not yet possible in this family.

Adolescent↗

PubMed2005

High prevalence of congenital hypothyroidism in the Greek Cypriot population: results of the neonatal screening program 1990-2000.

OBJECTIVE: To evaluate the results of the screening program for congenital hypothyroidism (CH) in the Greek Cypriot population. CHILDREN AND METHODS: During 1990-2000, 109,532 neonates were screened by TSH determination. Permanent CH was proven with biochemical findings after discontinuation of treatment for scintigraphy at the age of 3 years. RESULTS: Permanent CH was diagnosed in 61 infants, incidence 1/1800, with female/male ratio 2.05/1. The most common clinical findings were omphalocele (61%), large anterior fontanelles (49%) and edema of the eyelids (34%). The more delayed the bone maturation, the lower were initial T4 levels (p = 0.005). Bone maturation tended to be more advanced in thyroid hypoplasia and more delayed in thyroid agenesis (p = 0.049). Scintigraphy of the thyroid with TC99 revealed ectopia in 38%, thyroid agenesis in 36%, thyroid hypoplasia in 24% and dyshormonogenesis in 1.7%. Children with transient CH had significantly lower T4 and higher TSH values initially compared to those with permanent CH after birth; initial TSH level, however, failed to predict the nature of CH. Children with transient CH required less thyroxine dosage to maintain normal thyroid hormone levels and they had a normal thyroid gland on scintigraphy. The TSH level was normalized before the age of 2 months with a starting L-thyroxine dose of 10 microg/kg/daily. CONCLUSIONS: The incidence of primary CH in Greek Cypriots is 1/1800 live births. The most common etiology is thyroid dysgenesis. Initial T4 levels correlated with the degree of skeletal maturation and the etiology. Initial TSH level, although lower in children with transient CH, could not predict the nature of CH.

Bone Development↗

PubMed2006

Demographic and past screening behaviors of men attending a free community screening program for prostate cancer.

This study characterizes demographic and past prostate screening behaviors of men who participated in a free screening for prostate cancer. Demographics, past prostate screening behavior, perceived risk, and cancer worry were assessed in 1,680 men. Mean age was 58.2 years, 56% were White, and 76% had health insurance. Men with insurance were more likely to have had a previous prostate-specific antigen (PSA) test and digital rectal exam (DRE). White men were more likely to have had a previous PSA and DRE and to have discussed PSA testing with a physician than African American men. African American men reported greater perceived risk and more worry than White men. Screening differences between African American and White men were explained by insurance status. These results may help guide the development of and promotion for future screening programs. Future efforts should be directed at increasing awareness about screening procedures for prostate cancer.

Adult↗

PubMed2005

[Introduction of a mammography screening program in Germany. Consideration of benefits and risks].

For women between 50 and 70 years of age, X-ray mammography presently represents the most effective method for early breast cancer detection. It is commonly accepted that quality assured mammography examinations conducted at regular intervals can reduce mortality from breast cancer. In the year 2002, the German Bundestag agreed to the implementation of a mammography screening program for Germany based on the European guidelines. The effectiveness of a mammography screening program is controversially discussed and two of the most commonly cited hazards are the occurrence of false-positive results and the so-called overdiagnosis. Another issue of criticism is the radiation risk due to the mammography examinations. However, in women aged 50-70 years the radiation risk has no substantial importance. In contrast to the present situation in Germany in which opportunistic screening is widespread, standardized quality assured screening will guarantee that false-positive rates are kept as low as possible and that further assessment diagnostics are effective and minimally invasive.

Adult↗

PubMedDate not supplied

Cost and effectiveness of the California triple marker prenatal screening program.

PURPOSE: To report the utilization of services offered and pregnancy outcomes for a unique statewide prenatal triple marker screening program and to present a cost-benefit analysis. A state population of 32 million with considerable ethnic and age distribution and with a wide variety of delivery systems providing prenatal care was considered. The entire pregnant population who appeared for care before 20 weeks gestation, approximately one-half million per year during the years of 1995 to 1997, was included in the study. METHODS: Mandatory offering of serum testing, using alpha-fetoprotein from 1986 to 1995, and the addition of human chorionic gonadotropin and unconjugated estriol in 1995, with systematic follow-up of serum screen positives with ultrasound and amniocentesis. This study collected and analyzed the program data and reports of outcomes and collected similar information from the birth defects registry. RESULTS: Triple marker serum screening was accepted by 67.4% of the women eligible and yielded an initial positive rate of 7.3%. More than 90% of the initially screen positive pregnancies were seen at a prenatal diagnostic center. After correction of gestational age, 71.3% had amniocentesis. The overall amniocentesis rate among women screened was 2.6%. The Program's detection rate was predicted to be 85% for neural tube defects, and, based on Monte Carlo modeling, was theoretically calculated to be 62% for Down syndrome. In practice, detection rates were 75% for neural tube defects and 41% for Down syndrome due to lower than expected amniocentesis acceptance rate. Nevertheless, at a 5% discount rate, the screening program was cost beneficial at a ratio of 2.69:1. The cost per case detected was $35,365 and per case prevented was $110,741. CONCLUSION: It is possible to implement a cost-effective population-based screening in compliance with quality standards in a diverse ethnic population with a variety of health-care providers. Triple marker screening in the second trimester is a cost beneficial program even if utilization of all services is less than ideal.

Biomarkers↗

PubMed2007

Use of modeling to evaluate the cost-effectiveness of cancer screening programs.

Cost-effectiveness analysis (CEA) is an analytic tool that provides a framework for comparing the health benefits and resource expenditures associated with competing medical and public health interventions, thereby allowing decision makers to identify interventions that yield the greatest amount of health, given their resource constraints. Models are important components of most, if not all, CEAs, and they play a key role in evaluating the cost-effectiveness of cancer screening programs, in particular. In this article, we describe the basic types of models used to evaluate cancer screening programs and provide examples of the use of models in CEAs and to guide cancer screening policy. Finally, we offer some suggestions for important concepts to consider when interpreting model results.

Cost-Benefit Analysis↗

PubMed1996

Randomized trial of a psychologic distress screening program after breast cancer: effects on quality of life.

PURPOSE: Although psychosocial intervention can reduce psychosocial distress following breast cancer, many women who are experiencing problems are not identified and offered additional help. This trial assessed effects on quality of life of psychologic distress screening among newly diagnosed, nonmetastatic breast cancer patients. PATIENTS AND METHODS: From 1990 to 1992, all eligible patients in one regional breast cancer center were identified and offered study participation. Women in both control and experimental groups received brief psychosocial intervention from a social worker at initial treatment. The experimental group also had monthly telephone screening of distress levels using a brief, validated instrument, with additional psychosocial intervention offered only to those with high distress at screening. RESULTS: Among 282 eligible patients, 89% were randomized and completed the study. Participants' psychologic distress levels decreased over the study period (P = .0001). However, no between-group differences were observed. Mean distress scores among control and experimental women at 0-, 3-, and 12-month interviews were 20.7 and 20.4, 15.5 and 15.0, and 14.6 and 13.5, respectively. No between-group differences were observed with respect to physical health, functional status, social and leisure activities, return to work, or marital satisfaction. CONCLUSION: Our results indicate that, among patients who receive a minimal psychosocial intervention as part of their initial cancer care, a distress screening program does not improve quality of life. Minimal psychosocial intervention at initial treatment may be effective in reducing distress, thus making it difficult to obtain additional benefit from a screening program.

Breast Neoplasms↗

PubMedDate not supplied

Screening program for colorectal cancer: participation and follow up.

The benefit of screening for colorectal cancer with the fecal occult blood test (FOBT) remains controversial. In 1985, an annual FOBT screening program for colorectal cancer was begun at Harvard Community Health Plan (HCHP). We subsequently reviewed 409 randomly selected medical records of members over age 50 to determine whether screening had been performed, how members with positive test results were evaluated by their physicians, and what gastrointestinal lesions were found as a result of positive screening tests. One hundred and ninety seven of 409 members (48%) were screened at least once during the two-year study period. One hundred and eight of 180 members (60%) who had one periodic health review (PHR) and 72 of 88 members (82%) who had two or more PHRs during the study period were screened at least once. Sixteen of 197 members who were screened at least once (8%) had positive tests. Eleven of the 16 members with positive tests were adequately evaluated by their physicians. Four had colorectal polyps and five had some other benign gastrointestinal lesion. The conclusion drawn is that FOBT screening for colorectal cancer is practical in the HMO setting. Members who have periodic health reviews are more likely to participate in screening. Physicians and members must be better educated to ensure adequate evaluation of positive tests.

Colorectal Neoplasms↗

PubMed2026

Fecal immunochemical tests from population-based colorectal cancer screening programs support prospective microbiome cohorts.

BACKGROUND: Large, prospective cohorts are needed to research the gut microbiome's role in colorectal cancer (CRC) risk. We evaluated the gut microbiome leveraging residual fecal immunochemical tests (FIT) from a CRC screening program in Turin, Italy, and conducted one of the largest population-based case-control studies across the adenoma-carcinoma sequence to date. METHODS: We extracted DNA from residual FIT stool, used whole-genome shotgun sequencing, and included those with CRC (N = 44), advanced adenomas (N = 269), early adenomas (N = 134), and FIT-negative controls (N = 478). Alpha diversity, beta diversity, and species, gene, and pathway relative abundances were estimated. Multivariable logistic regression models were used to estimate associations of these metrics with colorectal neoplasms. RESULTS: Alpha diversity was mostly inversely associated with colorectal neoplasms, particularly early adenomas (OR: 0.45, 95% CI: 0.25-0.80; P = 0.01). Presence of oral pathogens, including Parvimonas micra, was associated with higher odds of CRC. Furthermore, Escherichia coli and Bacteroides fragilis were strongly associated with higher odds of all colorectal neoplasms. Several genes and pathways were associated with colorectal neoplasms. CONCLUSIONS: Our findings align with smaller studies of the gut microbiome and colorectal neoplasms, supporting that CRC screening programs provide opportunities to prospectively study the gut microbiome's association with cancer risk in large populations.

Humans↗

PubMed1991

Effect of a mass screening program on the risk of cervical cancer.

In Finland, the organized mass screening program for cervical cancer was initiated in the mid-1960s. In the early 1970s, the program became nationwide and it covered the age groups of 30 to 55 years. Currently, the screened age groups are 25 to 60 years, and the screening interval is 5 years. The organized program has resulted in a substantial decrease in the incidence of and mortality from cervical cancer. The reduction in age-specific incidence for all age groups from 30-34 to 50-54 years between the 1960s and 1980s was over 70%. At the age of 60 years and over there has been a slight decrease since the mid-1970s. The trends in mortality from cervical cancer have decreased correspondingly. Between the 1960s and 1980s, the reduction in age-specific mortality for age groups from 30-34 to 54-59 years was about 80%. The decrease was about 50% in the age group 60 to 69 years. At the age of 70 years and over, the decrease was smaller.

Adult↗

PubMed1983

Current sickle cell screening program for newborns in New York City, 1979-1980.

The newborn screening program mandated by the New York State Public Health Law requires that every baby born in the state be tested for eight conditions including sickle cell anemia. Although sickle cell screening of newborns has been in operation since 1975, the follow-up program for case retrieval to obtain repeat blood samples for definitive diagnosis and referral of diagnosed patients for ongoing medical care was established only in 1979. Of the 106,565 blood samples tested in New York City Newborn Screening Laboratory, March 1, 1979 to February 29, 1980, 141 infants were identified on repeat blood testing as having various forms of sickle cell disease (SS, SC and S beta-Thalassemia) and were referred for ongoing medical care. Data received on 131 patients from follow-up clinics revealed that the disease diagnosis made by the Newborn Screening Laboratory was confirmed in all patients. There were no deaths reported among the study patients (131 infants) followed for the period of 8-20 months despite the life-threatening complications among eight patients. Binomial distribution of the data on Black infants according to the Hardy-Weinberg equation showed reasonable agreement between the observed and computed incidence of various forms of sickle cell disease.

Anemia, Sickle Cell↗

PubMed2006

The effect of instituting a prehospital-discharge newborn bilirubin screening program in an 18-hospital health system.

OBJECTIVE: Kernicterus is a rare but devastating condition. The prevention of bilirubin-induced brain injury is based on the detection of infants at risk for developing severe hyperbilirubinemia. In an 18-hospital health system, Intermountain Health Care (IHC), we initiated a program of predischarge bilirubin screening of all neonates and coupled this with a results assessment using a percentile-based nomogram. Data during 2 periods of time, before versus after initiating the program, were compared to assess the effect of the program on significant hyperbilirubinemia and rehospitalization. METHODS: We conducted a historic cohort study involving all neonates delivered at > or =35 weeks' gestation, within IHC's 18-hospital system, during 2 periods of time: March 1, 2001, to December 31, 2002, versus January 1, 2003, to December 31, 2004. A bilirubin screening program, instituted in December 2002, called for a total serum bilirubin (TSB) or transcutaneous bilirubin measurement to be performed on every neonate either at the recognition of clinical jaundice or before discharge regardless of whether jaundice was observed. For nonjaundiced neonates, the nursery staff was encouraged to obtain the screening TSB at the same time they obtained the state-mandated newborn screen for inborn errors of metabolism. Bilirubin values were plotted on an hour-specific nomogram and the corresponding percentile was used to guide evaluation, therapy, and follow-up. This study compared TSB data and readmission data for a 2-year period before versus a 2-year period after implementing the program. RESULTS: The study involved 101272 neonates: 48789 in period 1 and 52483 in period 2. Before the program, 1 in every 77 neonates born at an IHC hospital had 1 or more serum bilirubin levels >20 mg/dL. After initiating the program, the incidence fell to 1 in 142 and the number of neonates with a level >25 mg/dL fell from 1 in 1522 before to 1 in 4037 after. The rate of hospital readmission with a primary diagnosis of jaundice fell from 0.55% in period 1 to 0.43% in period 2. CONCLUSIONS: Initiating a program of bilirubin screening in a multihospital health system, coupled with evaluating the results using a percentile-based nomogram, reduced the proportion of neonates with significant hyperbilirubinemia and reduced the rate of hospital readmissions with jaundice.

Bilirubin↗