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PubMedDate not supplied

Screening protocols for diseases in women: a review of screening principles and examination of practices.

Screening for disease prior to the manifestation of clinical symptoms is a secondary method of disease prevention. Its use in clinical laboratory testing is based on disease prevalence, etiology, and physiology and on characteristics of the screening tests, including sensitivity, specificity, and positive and negative predictive values. An overview of the principles of screening is presented. Analytic evaluation methods, such as cost-effectiveness analysis, use data relevant to screening programs to examine new protocols. Results of studies reported in the literature are included in the discussion of screening with clinical laboratory tests for three diseases affecting women. Development of effective and appropriate screening protocols for specific diseases incorporate scientific data from randomized controlled trials and economic analytical evaluation methods in conjunction with societal perspectives and desires.

Bias↗
PubMedDate not supplied

Waiting for a diagnosis after an abnormal screening mammogram. SMPBC diagnostic process workgroup. Screening Mammography Program of British Columbia.

BACKGROUND: Women with abnormal screening mammograms require diagnostic assessment and experience anxiety until a diagnosis is established. This report evaluated the timeliness of diagnosis after an abnormal screening mammogram in the Screening Mammography Program of British Columbia (SMPBC). METHODS: Information on diagnostic interventions following an abnormal screen (N = 10,314) provided through 11 regional SMPBC services between January 1, 1993 and June 30, 1994 were abstracted and analyzed. RESULTS: The median time from abnormal screen to diagnosis was 3.4 weeks with regional variation of 2.0 to 4.7 weeks; 10% waited 8.7 weeks or longer. For the 19% of women proceeding to open biopsy, the median diagnostic interval was 7.1 weeks with regional variation of 4.6 to 9.3 weeks; 10% waited 13.1 weeks or longer. INTERPRETATION: After an abnormal screening mammogram, women waited many weeks for a definitive diagnosis, especially those proceeding to open biopsy. Opportunities for process improvement were identified.

Breast Neoplasms↗
PubMed2001

Inaccurate estimation of risk in second trimester serum screening for Down syndrome among women who have already had first trimester screening.

Problems can arise in prenatal screening for Down syndrome when tests are performed in the first and second trimester and some women who have a negative first trimester test have a second trimester serum test. The second test result does not usually take account of the previous one being negative. Even if it does, it is often inaccurate. Using published data the extent of the error was examined. The age-specific risk of an affected pregnancy in such women will be lower than if no first trimester test had been performed. The distributions of the screening markers in affected and unaffected pregnancies will be different from those in unscreened women. If the appropriate age-specific risk and marker distributions are not used, error will arise. For example, a 35-year-old woman with nuchal translucency (NT), pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotrophin (hCG) levels at the normal median would have a risk of 1 in 6500. If she then had the Triple Test with alpha-fetoprotein (AFP), unconjugated oestriol, and hCG levels of 0.7, 0.7 and 1.5 multiples of the median (MoM), respectively, her risk, ignoring the previous result, would be overestimated (1 in 95 compared with the correct estimate of 1 in 705). If the previous result was included, but the age-specific risk and second trimester marker distributions were not revised, her risk would be underestimated (1 in 820). If the correct age-specific risk and screening marker distributions were used, risk estimates would be accurate, but two tests would be less efficient than integrating all the screening information into a single test. The practice of offering second trimester serum screening to women who have already been screened is best avoided.

Adult↗
PubMed2002

[Photographic screening for diabetic retinopathy in the county of North Jutland. The first fully digitalized telemedicine-screening clinic].

Screening for diabetic retinopathy was introduced in Denmark in 1988. At present, screening is carried out in four of the 14 counties, thus being available to a minority of diabetic subjects. According to the WHO but also the National Board of Health, all diabetic patients should undergo screening for diabetic retinopathy. Not only does screening pay off in terms of preservation of vision, it is also cost-effective, as confirmed in the present study. The first fully digitized clinic for retinopathic screening in diabetic patients was recently introduced in the County of North Jutland. Preliminary results from this clinic indicate that all procedures can be handled in this fully digitized system. We therefore predict that fully digitized clinics for retinopathic screening will be introduced throughout Denmark in the future.

Denmark↗
PubMed2003

[Hospital costs and benefits of screening for abdominal aortic aneurysm. Results from a randomized screening trial].

INTRODUCTION: The hospital costs and benefits of screening older males for abdominal aortic aneurysms (AAA) are unknown. MATERIAL AND METHODS: In 1994, a hospital-based screening trial of 12,658 65-73-year-old males in the County of Viborg, Denmark, was started. AAA > 5 cm were referred for surgery. The remaining AAA were offered annual control scans. Those with aortic ectasia (def.: 2.5-2.9 cm) were rescreened at 5-year intervals. AAA-operations and deaths of AAA at hospital were registered. Finally, costs of screening, surveillance, and treatment were registered. Data on causes of death outside hospitals could not be obtained. RESULTS: The attendance rate was 76%, of whom 191 (4.0%) had AAA. The average observation time was 5.13 years. 60 in the screened and 41 in the control group were operated (P = 0.06), 7 and 27 were operated as an emergency (P < 0.001), and 6 and 19 died at the hospitals due to AAA (p = 0.009). The costs per scan were 83.50 DKK, 81,400 DKK per elective operation (71,485 DKK after screening), and 117,000 DKK for an emergency operation. The costs per prevented hospital death were 67,855 DKK or approx. 7,540 DKK per life year saved (1 GBP = 12 DKK). DISCUSSION: Screening older males for AAA in Denmark seems very cost-effective and reduces hospital mortality of AAA by 68% and probably the overall AAA-specific mortality by 73%.

Aged↗
PubMedDate not supplied

[Screening for mild cognitive impairment: usefulness of the 7-Minute Screen Test].

INTRODUCTION: The <<7- Minute Screen>> is a neurocognitive screening test for the detection of Alzheimer's disease (AD) patients in primary care settings. It consists of 4 brief subtests (orientation, memory, visuoconstruction and verbal fluency) and provides a broader neuropsychological profile than other widely used screening tests, The aim of the present study was to study the usefulness of this screening test for the detection of Mild Cognitive Impairment (MCI). METHODS: Thirty-two patients with probable AD (NINCDS-ADRDA criteria), 25 patients with MCI, and 35 healthy control subjects, matched for age and education, underwent a comprehensive neuropsychological battery and the Rio-de-la-Plata version of the 7-Minute Screen. RESULTS. This test showed 93 % sensitivity and 97% specificity in detecting mild-moderate Alzheimer's disease MMSE<24), but it exhibited a substantially decreased sensitivity (28 %) in its ability to detect MCI in AD (MMSE >2 4 ). CONCLUSION: The screening batteries do not replace a m o re compre h e n s i ve neuro psychological assessment. Th ey are useful in detecting patients with mild dementia, but caution must be the rule when considering a diagnosis of MCI.

Aged↗
PubMed2004

[Less refusal to participate in HIV screening among pregnant women in the Amsterdam region since the introduction of standard HIV screening using the opting-out method].

In 2003 the Municipal Health Service in Amsterdam started to screen pregnant women for HIV according to the opting-out method. In this method the HIV test is routinely included in the prenatal screening along with hepatitis B virus (HBV) and syphilis. If the woman does not want to be tested for HIV then she must actively opt out of this test. This screening method was chosen because in the universal screening method used in 2002, women had to give their explicit consent to test for HIV and this led to a high refusal rate (13.6%), especially among women from AIDS-endemic countries. After the introduction of the opting-out method, the refusal rate fell from 3% in the first quarter of 2003 to 1.4% in the last quarter of 2003. None of the women refused to be tested for HBV or syphilis. In 2003, the HIV prevalence among pregnant women was 0.3% (35/13.621). The experiences with this screening method in Amsterdam were used to implement the national opting-out method for HIV screening in pregnant women, which was introduced on 1 January 2004.

Adolescent↗
PubMed1988

[Evaluation of the cost-effectiveness of school screening for hereditary hemoglobin abnormalities: prospective study in Bouches-du-Rhône. School screening for hemoglobinopathies].

Screening in schools for heterozygote carriers of haemoglobinopathies traits has been carried out experimentally in southeast France ("Bouches du Rhône", the Marseille region) since 1977. The study compares, in cost-effectiveness terms, the screening strategy now followed with 27 alternative strategies in all the pupils (14-16 years). Although the frequency of heterozygote carriers in this school population as a whole is only 7.9% carriers for beta-thalassaemia gene and 2.5% carriers for HbS, prospective costs per diagnosis still seem reasonable: from 1544 to 4997 French francs (1987) depending on the strategy, and 2099 to 7380 francs if beta-thalassaemia alone is screened. In comparison with the current screening strategy, cost-effectiveness ratios could be improved by using haemoglobin electrophoresis as a preselection test, or a blood count if beta-thalassaemia alone is screened. Further improvement of cost-effectiveness ratios could be obtained by limiting screening to ethnic groups most "at risk"; but such strategies raise ethical and acceptability issues.

Adolescent↗
PubMed1983

[Evaluation of mass-screening for cervical cancer in Santo-Cho. Effect of repeat cytological screening].

A cytological screening program for the early detection of cervical cancer was started in the county of Santoh-Choh, north-eastern Shiga Prefecture in 1969. During the first four years between 1969 and 1972 all of the women aged more than 35 resident in this county took part in the screening program, and cervical cancer was found in 15 women out of a population of 2,960. The annual detection rate of 0.25% for the disease during this period was significantly higher than the average rate of 0.16% for the whole of Shiga Prefecture. Cervical cancer detection frequency in this county has subsequently been reduced over 7 years to about one third (0.09%) of the frequency before 1972. In this county, cervical cancer was found in three women who had received the annual repeat screenings more than three times. Re-evaluation of the previous smears in these patients revealed that two smears should have been diagnosed as positive. The present findings indicate that the effects of a mass-screening program may be improved by (1) the participation, at least once, in the screening program by all female residents, (2) annual repeat screening for more than three years and (3) adequate quality and/or accuracy control in the laboratory.

Adult↗
PubMed1995

Assessing the effectiveness of a screening campaign: who is missed by 80% cervical screening coverage?

A case-control study was conducted to assess the effectiveness of a regional call programme in reaching women at risk of cervical cancer. Home interviews were conducted with a random sample of 614 women aged 20-64 who were identified from a computerized register as either having had a smear test within the previous 3 years or not having an up-to-date smear history. Unscreened women fell principally into two age cohorts: under 35 years and over 50 years. A small social class differential was found to persist following the campaign. Overall, unscreened women were not at epidemiologically higher risk than the screened population. Thirty-five per cent of unscreened women reported never having had sexual intercourse compared to 3% of screened women: 17% of the unscreened and 38% of screened women reported two or more lifetime sexual partners. No difference was observed between screened and unscreened women in the frequency of current cigarette smoking (37% unscreened, 38% screened). Cigarette smoking was, however, associated with social class (31% classes 1 or 2 compared with 50% classes 4 and 5). Level of practical difficulties did not differentiate those who attended from those who did not, suggesting that recent changes to delivery or screening services have been effective in ensuring equity of access. Non-attenders and lower class women held more negative attitudes towards the test procedure and were less likely to believe that they were at risk of cervical cancer. Perceived personal risk was not associated with cigarette smoking, suggesting that further attention might be given to this factor in educational campaigns.

Adult↗
PubMed1994

Fecal occult blood screening for colorectal cancer. Is mortality reduced by chance selection for screening colonoscopy?

Annual fecal occult blood test (FOBT) screening using rehydrated Hemoccult slides has been reported in the Minnesota Colon Cancer Control Study to reduce colorectal cancer mortality by about 33%. However, some of the benefit of FOBT screening may come from "chance" selection of persons for colonoscopic examination because of the high positivity rate of FOBT (about 10%) that may occur for reasons other than a bleeding cancer or polyp. To determine how much this mechanism could account for the benefit of FOBT screening, we used a simple mathematical model to simulate the course of a cohort of screened persons, incorporating published data including those from the Minnesota study. The results suggest that one third to one half of the mortality reduction observed from FOBT screening in the Minnesota study may be attributable to chance selection for colonoscopy. We conclude that annual FOBT screening with rehydration is a haphazard method for selecting persons for colonoscopy.

Colonoscopy↗
PubMed1996

[5 years neuroblastoma screening in Austria: rate of participation, results and a comparison with other screening areas].

In late 1990 a screening program for the early detection of neuroblastoma in infants was introduced in Austria. The program is performed on a voluntary basis in collaboration with general pediatricians and practitioners. Filter strips for urine collection are distributed to parents of infants aged seven to nine months on the occasion of a routine check up. The samples are sent to the laboratory by parents and analysed for vanillylmandelic acid (VMA) and homovanillic acid (HVA). Between January 1991 and December 1995 125,201 infants were screened. The compliance rate was 26.8% for Austria, but great differences were seen for different regions (65% in Carinthia, 10% in Vorarlberg). 30 children were admitted to hospital for investigation of repeatedly elevated urine catecholamines. A neuroblastoma was identified in 16 cases. In 12 of these cases at least one unfavorable prognostic factor was present (stage > or = 3, elevated LDH, unfavorable histology, N-myc amplification, di- or tetraploidy). Neuroblastoma screening of infants aged more than six months seems to detect predominantly those tumors which are unlikely to regress spontaneously. The observation of one false negative case, however, demonstrates that neuroblastomas which become clinically manifest at a later date may remain undetected by early screening. Possible advantages of shifting screening to a later age and repeated screening are discussed.

Austria↗
PubMed1997

Community screening for rheumatic disorder: cross cultural adaptation and screening characteristics of the COPCORD Core Questionnaire in Brazil, Chile, and Mexico. The PANLAR-COPCORD Working Group. Pan American League of Associations for Rheumatology. Community Oriented Programme for the Control of Rheumatic Disease.

OBJECTIVE: (1) To adapt the Community Oriented Programme for the Control of Rheumatic Disease (COPCORD) Core Questionnaire (CCQ) for use as a rheumatic disease screening instrument in Spanish and Portuguese communities in Brazil, Chile, and Mexico, including translation and back translation, and assessment of cross cultural equivalence and reliability. (2) To determine the screening characteristics of the CCQ, specifically the sensitivity and specificity of Spanish and Portuguese versions for detecting cases of rheumatic disorder compared with a full clinical examination by a rheumatologist. (3) To determine the number of clinical examinations that could be avoided in population studies by applying the CCQ followed by a clinical examination in positive CCQ screenees. METHODS: Translation and assessment of cross cultural equivalence were conducted by practising rheumatologists in Brazil, Chile, and Mexico using standardized methods. Back translation was done by an independent rheumatologist (Brazil), a radiologist (Chile), and a general physician (Mexico). Interviewer agreement was assessed in all sites in a convenience sample. Sensitivity and specificity were assessed by independently administering the CCQ and a full clinical examination to a sample of 200 persons aged 15 years or older, randomly selected from communities in Sao Paulo, Brazil (n = 200), Temuco, Chile (n = 200), and Mexico City, Mexico (n = 200). RESULTS: (1) Cross cultural equivalence and back translation of the modified questionnaire were satisfactory. Interviewer agreement was acceptable. (2) In groups from Brazil, Chile, and Mexico, respectively, the overall prevalence of rheumatic disease based on clinical examination was 33.3, 45.1, and 46.3%. The sensitivity and specificity of 2 definitions of a positive CCQ screening for the presence of rheumatic disorder were: Definition 1 (no trauma, present pain, tenderness, swelling or stiffness in bones, joints or muscles): sensitivity, 91.8, 96.0, 84.0; specificity, 70.0, 35.5, 61.0; Definition 2 (Definition 1 plus pain intensity > or = 4 and 11 point category rating scale): sensitivity, 66.2, 86.3, 42.7; specificity, 82.3, 41.9, 80.0. (3) In groups from Brazil, Chile, and Mexico, respectively, positive screening by Definition 1 followed by a clinical examination avoids 499, 213, and 403 clinical examination per 1000 respondents screened and yields an overall prevalence of rheumatic disorder of 30, 43, and 40%. The addition of pain intensity (Definition 2) increased the total number of examinations avoided, but reduced the prevalence estimate compared to Definition 1 (22.0, 39.0, and 20.0%). CONCLUSION: The CCQ appears promising as a screening tool to detect rheumatic disorder in Spanish and Portuguese speaking communities in a developing country. The findings suggest that the CCQ followed by a full clinical examination in positive respondents can provide an acceptable estimate of prevalence of rheumatic disorder. The total number of clinical examinations that must be administered in population based prevalence surveys can be reduced by using the CCQ, while maintaining satisfactory accuracy. Our findings need to be confirmed in further applications of the CCQ.

Adolescent↗
PubMedDate not supplied

Screening behaviors and long-term compliance with mammography guidelines in a breast cancer screening program.

INTRODUCTION: Screening for breast cancer is generally underused. In an effort to remove common barriers to screening, a free breast cancer screening and education program was created for the employees of a large hospital, incorporating mammography, clinical breast examination (CBE), and breast self-examination (BSE). METHODS: The present study was conducted to evaluate the screening behaviors and long-term compliance of asymptomatic women over age 50 who participated in the program. Data were obtained from questionnaires administered at the time of enrollment (time 1) and annual reenrollment, as well as from radiology records. (Time 2 represents the most recent data.) Long-term compliance with mammography guidelines was measured by calculating a compliance quotient (CQ) for each participant. RESULTS: From time 1 to time 2, subjects significantly increased their use of mammography, CBE, and BSE. At time 2, 89.5% of women had ever received a mammogram, 42.7% had gotten one in the last year, nearly all women (94.6%) had received at least one CBE, 58.0% reported annual CBE, and 44.6% of women practiced monthly BSE. CQ was higher among women who remained in the program longer, were still active in the program at the time of the study, and used screening prior to enrollment. It was also higher in Caucasians and women with a family history of breast cancer. CONCLUSIONS: These results show that a worksite program that eliminates common barriers to screening can significantly increase use of early detection practices. It also demonstrates one method of quantifying long-term compliance with mammography guidelines.

Age Factors↗
PubMed1997

A family practice residency cervical screening project: perceived screening barriers.

BACKGROUND AND OBJECTIVES: A community-based family practice residency program initiated a cervical screening project to provide free Pap smears to women who had not had one in 3 years. The research identified reasons why patients had not been screened within the past 3 years. METHODS: A total of 214 consecutive participants in the free Pap smear clinic completed questionnaires. The questionnaire asked about reasons why screening had not occurred over the last 3 years. RESULTS: Altogether, 65.4% of the study group reported cost-related factors as barriers to participation; 37.9% cited either scheduling concerns, fear, or embarrassment; and 36% cited misinformation issues about either screening recommendations, effectiveness of treatment, or disease presentation. CONCLUSIONS: Strategies to increase participation in Pap smear screening clinics may include increasing availability of free or low-cost screening examinations, increasing time efficiency and scheduling flexibility of examinations, and making efforts to mitigate the fear and embarrassment associated with the exam.

Adult↗
PubMed1998

[Cancer of the cervix uteri: analysis of the cost-benefit and efficacy of opportunistic screening versus organized screening].

Cervical cancer is the fourth cancer in women. It is the first malignancy for which mass population screening has been demonstrated to significantly reduce the mortality due to this disease. In Belgium, the mortality associated to cervical cancer decreased from 6 to 4 per 100,000 women-years from 1955-1959 to 1985-1989. European recommendations regarding cervical cancer screening are to perform a cervical smear each three years in women aged 25 to 65 years. In Belgium, while the Flemish region has decided to organize the cervical cancer screening according to the European recommendations, the screening in the French part of the country is essentially opportunistic. In this short review, the cost/benefit of the organized screening versus the opportunistic screening is discussed.

Adult↗
PubMed1998

Cervical cancer screening: knowledge of own screening status among women aged 20-29 years.

BACKGROUND: Studies have shown that accuracy of self-reported screening for cervical cancer is not optimal. In order to improve women's knowledge of their screening status and in broader terms improve communication between patient and doctor the risk groups who require special attention with regard to information have to be identified. The purpose of this study was to identify lifestyle and socio-demographic determinants for denying screening when in fact it had been performed. METHODS: A case-control study among 7,763 women aged 20-29 years from Copenhagen. Data were obtained by means of a personal interview using a standardized questionnaire and from a computerized pathology registry. Determinants for not knowing own screening status were identified using multiple logistic regression analysis. RESULTS: In all, 13% of the women could not state correctly that they had been screened for cervical cancer. The major determinant was younger age (adjusted odds ratio: 5.8, for women aged 20-22 years compared with women aged 26-29 years). Other determinants included few Pap smears, increasing years since last Pap smear, no previous abnormal Pap smear, lower education, never having used oral contraceptives, and current smoking. CONCLUSIONS: Knowledge about own screening status is not optimal in Denmark. Our study shows that doctors have to be extra careful with information to the youngest women and to certain other groups.

Adult↗