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PubMed2002

Annual PSA tests are not necessary for men with a PSA level below 2 ng/mL: findings of the Imari prostate cancer screening program.

BACKGROUND: Annual changes in prostate specific antigen (PSA) levels detected by the Imari prostate cancer screening program were evaluated to establish a more efficient and cost-saving screening system, especially for men with low PSA levels. METHODS: Prostate specific antigen-based annual mass screenings for prostate cancer were conducted for men aged 60-69 in the Imari district, Saga, Japan. Between 1992 and 2000, 1822 men had their PSA levels tested. A total of 4661 PSA tests were conducted. Changes in PSA levels over the following 1 to 5 years were analyzed in men with PSA levels of 3 ng/mL or less, a range in which the detection rate of prostate cancer would seem to be negligibly low. RESULTS: The overall detection rate of prostate cancer between 1992 and 2000 was 0.73%. The detection rate in men with a PSA level between 3.1 and 3.9 ng/mL, and between 4 and 9.9 ng/mL was 1.6% and 8.3%, respectively. Of 4661 determinations of PSA, 2553 (54.8%) were found to be < or = 1 ng/mL, 1273 (27.3%) were between 1.1 and 2 ng/mL, and 401 (8.6%) were between 2.1 and 3 ng/mL. Four hundred and thirty-four men (9.3%) had PSA levels > or = 3.1 ng/mL, with possible indications for prostate biopsy. Of the men tested, 1.4% with an initial PSA level of < or = 2 ng/mL and 22.3% with an initial level between 2.1 and 3 ng/mL had a PSA level of > or = 3.1 ng/mL after 1 year. Almost the same rate of PSA increase was observed between the two PSA tests conducted at 2 to 5-year intervals. Of the men tested, 2.2% with an initial PSA level of < or = 2 ng/mL, and 21.9% with an initial level between 2.1 and 3 ng/mL, had a level of > or = 3.1 ng/mL after 5 years. CONCLUSION: Levels of PSA in men with an initial level below 2 ng/mL remained stable for up to 5 years. Levels of PSA in 97.8- 98.8% of men remained below 3 ng/mL after 1 to 5 years. In contrast, 18-35.3% of men with an initial PSA level between 2.1 and 3 ng/mL showed PSA progression to 3.1 ng/mL or more within 5 years. Our present data suggest that annual PSA testing is not necessary for men with a PSA level below 2 ng/mL. Prostate specific antigen testing could therefore be conducted at longer intervals in such individuals.

Age Factors↗
PubMed1995

A missense mutation in a patient with guanosine triphosphate cyclohydrolase I deficiency missed in the newborn screening program.

A patient with guanosine triphosphate cyclohydrolase I deficiency passed the newborn phenylketonuria screening program. The characteristic clinical phenotype developed in a 5-month-old patient; elevated plasma phenylalanine, undetectable urinary pterins, and absence of the enzyme activity in a liver biopsy were present. A point mutation that results in an amino acid substitution from methionine to isoleucine at position 211 was proposed to be the cause for this new phenotypic expression of guanosine triphosphate cyclohydrolase I deficiency.

Base Sequence↗
PubMed2002

In vivo toxicity screening programs using metabonomics.

Metabonomics is an emerging technology that enables rapid in vivo screening for toxicity, disease state, or drug efficacy. The technology combines the power of high-resolution nuclear magnetic resonance (NMR) techniques with statistical data analysis methods to rapidly evaluate the metabolic "status" of an animal. Complimentary to other profiling technologies like proteomics and genomics, metabonomics provides a fingerprint of the small-molecules contained in a given biofluid through the time course of a study. This article reviews the steps in implementing a metabonomics-based screening program from study design through data analysis. While metabonomics is still a relatively new technology in comparison to the other "omics", published results from metabonomics studies demonstrate its potential impact in the drug discovery process by enabling the incorporation of safety endpoints much earlier in the drug discovery process, reducing the likelihood (and cost) of later stage attrition.

Algorithms↗
PubMed2003

Risk factor-based selective screening program for gestational diabetes mellitus in Siriraj Hospital: result from clinical practice guideline.

A clinical practice guideline for the screening and diagnosis of gestational diabetes mellitus (GDM) is currently implemented at Siriraj Hospital. During the year 2000, a total of 9325 pregnant women were screened for clinical risk factors during their first antenatal visits, and 3770 had at least 1 risk. After the 50 g glucose challenge test and 100 g oral glucose tolerance test, GDM was diagnosed in 235 women. The incidence of GDM was 6.2 per cent (95% CI 5.5-7.1) among high-risk pregnant women, and 2.5 per cent (95% CI 2.2-2.9) of all pregnant women. Significant risk factors identified from the present study were family history of DM (adjusted OR 1.86, 95% CI 1.38-2.51), age > or = 30 years (adjusted OR 2.41, 95% CI 1.72-3.39), history of unexplained intrauterine fetal death (adjusted OR 4.30, 95% CI 2.04-9.04), and obesity (adjusted OR 2.83, 95% CI 1.88-4.25). The risk of developing GDM also increased when more than 1 clinical risk factor was identified. The results support the value of this screening program for GDM. Every obstetrician should be aware of the need to screen for GDM in every pregnant woman and a similar program should also be introduced to other settings.

Adult↗
PubMed1999

The Icelandic and Nordic cervical screening programs: trends in incidence and mortality rates through 1995.

BACKGROUND: The objective of cervical cancer screening is to lower the incidence and mortality rates of the disease. This study evaluates the effectiveness of cervical screening and the UICC and EC screening recommendations based on the Nordic screening experience. METHODS: The study analyzes the features of the Icelandic and the Nordic screening programs and the observed trends in the incidence and mortality rates in these countries through 1995. RESULTS: Organized screening started in all the Nordic countries soon after 1960 and had nation-wide coverage in all these countries, except in Denmark (45% coverage in 1991), by around 1973 but in Norway screening was only spontaneous up to late in 1994. Up to 1985 the target age group and screening interval were most intensive in Iceland, followed by Finland, Sweden and Denmark. All countries except Finland lowered the lower age limit and intensified the screening intervals after 1985. Through the period 1986-1995 the reduction in both the mortality and the incidence rates was greatest in Iceland (mortality: 76% and incidence: 67%) and Finland (73% and 75%, respectively), intermediate in Sweden (60% and 55%, respectively) and Denmark (55% and 54%, respectively), and lowest in Norway (43% and 34%, respectively). The age-specific incidence in the 20-29 age group has been increasing since 1971 in all the Nordic countries, except in Finland, where the yearly registered age-specific incidence has been increasing in the targeted 30-54 age group since 1991. In Iceland screening has greatly affected the rate of all stages of squamous cell carcinoma, but not the rate of adeno- and adenosquamous carcinomas. In fact the rate of adenocarcinoma has been increasing. CONCLUSIONS: Organized screening is more effective than spontaneous screening in reducing the risk of cervical cancer. Although differences in environmental, biological and ethnic factors may call for different screening strategies, screening should preferably start soon after age 20 with a screening interval of 2-3 years.

Adult↗
PubMed2004

Retrospective study of a pioneer antenatal screening program with 8,477 pregnant women in Brazil.

PURPOSE OF INVESTIGATION: To analyze the results of a statewide screening program inaugurated in 2002 in Mato Grosso do Sul, METHODS: Retrospective audit of the screening results of 8,477 pregnant women for 11 diseases in 19 tests. Local health centers of the Brazilian Unified System of Health/State Program of Pregnant Protection (SUS/PEPG) and central reference processing laboratories, both in and out of state were involved. Pregnant women were referred to the program by medical staff principally at local health centers, between November 2002 and February 2003. Primary screening with filter-paper blood samples was carried out with positives being resampled and sera appropriately tested. RESULTS: The detailed test results are given below; the most frequent diseases serodiagnosed were hepatitis B, syphilis, HIV and Chagas' disease. One case of maternal phenylketonouria (PKU) was encountered. CONCLUSION: The diagnosis of 11 diseases of importance for mothers and their offspring provides an epidemiological profile of Brazil, but must be matched by opportunities to elaborate new control strategies and improve health care during pregnancy.

Adolescent↗
PubMedDate not supplied

A supermarket cardiovascular screening program: analysis of participants' solicitation of follow-up care.

We conducted a cardiovascular screening program in 54 supermarkets in the province of Québec, Canada to determine cardiovascular risk factors, including total cholesterol, blood pressure, tobacco use, height, weight, and physical activity levels. A 10-minute debriefing counseling session followed. Of the 3,432 screening participants 18-74 years of age, 2,420 participated in a nutrition study, consisting of answering a brief questionnaire before the screening. Three months after the screening, 1,293 individuals returned the posttest nutrition questionnaire sent to them by mail. We report follow-up care activity for low-risk and high-risk individuals for respondents of the posttest nutrition questionnaire. Overall, 53% of respondents reported seeing a physician within three months after the screening to discuss their blood cholesterol or blood pressure results, and the percentage ranged from 25% for individuals with normal cholesterol (< or = 199 mg/dL) and normal blood pressure (< 140/90 mm Hg) to 83% for individuals with high cholesterol (> or = 240 mg/dL) and high blood pressure (> or = 140/90 mm Hg). Respondents who saw a physician following the screening were more likely to be (1) those on medication at the time of the screening for high blood cholesterol and high blood pressure, (2) older individuals, (3) those found to have high blood cholesterol and high blood pressure values during the screening, (4) women, and (5) individuals with a lower level of education. Seventy-nine percent identified as having high blood cholesterol during the screening reported that their blood cholesterol was remeasured. The majority of high-risk participants and their physicians took appropriate follow-up action.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1997

Prostate volume and cancer in screening programs.

BACKGROUND: Prostate cancer screening is studied in a randomized trial in Antwerp, Belgium. The case group receives three screening tests (DRE, TRUS, and PSA). Intermediate evaluation shows that only 1/3 of the biopsy results is positive (35/125). The proposed analysis identifies variables that determine the biopsy outcome. METHODS: Multiple logistic regression analysis is used to regress biopsy results (n = 125) by age (60-74), PSA, PSA-D, prostate volume, TRUS, and DRE. Continuous variables are transformed into quartile values. Robustness of the outcome is tested with ROC and sensitivity analysis on age. RESULTS: Biopsy outcomes are best explained (82.3%) by PSA, DRE, and DRE related to volume. Volume is more sensitive than age to explain the biopsy result. PSA-D, instead of PSA, does not procure more precise information when a high PSA cut-off level is used. Restricting the analysis to the 60-70-year-old age group shows that volume is more sensitive. ROC-analysis confirms the findings. CONCLUSIONS: When performing prostate cancer multitest screening among a wide age range, the use of uniform screening criteria is difficult to accept due to differences in prostate volume. Logistic regression analysis is an appropriate method to identify cut-off levels for prostate volume.

Aged↗
PubMed1981

Clinical experience with a screening program for gestational diabetes.

Screening for abnormal glucose metabolism was carried out in 2,077 pregnant women. Historical or clinical risk factors for gestational diabetes were present in 959 women (group 1). The remaining 1,118 patients composed group 2. A 50 gm oral glucose load and a 1-hour serum glucose determination with a threshold of 150 mg/dl were used as a glucose challenge screening test (GCT). Patients with an abnormal GCT underwent an oral glucose tolerance test (GTT). Group 1 patients underwent screening at the initial clinic visit or when the clinical risk factor was first recognized, with repeat screening at 28 to 32 weeks if the initial testing was normal. Group 2 patients were screened at 28 to 32 weeks. In group 1, 69 patients (7.2%) exhibited an abnormal GCT and 14 (1.5%) demonstrated an abnormal GTT. In group 2, 68 patients (6.1%) exhibited an abnormal GCT and 16 (1.4%) demonstrated an abnormal GTT. These incidences are not statistically different. The estimated costs per patient screened and per case of gestational diabetes detected were $4.75 and $328.96, respectively.

Blood Glucose↗
PubMed2004

Estimating the cumulative risk of a false-positive test in a repeated screening program.

The goal of screening tests for a chronic disease such as cancer is early detection and treatment with a consequent reduction in mortality from the disease. Screening tests, however, might produce false positive and false-negative results. With an increasing number of screening tests, it is clear that the risk of a false-positive screen, a finding with potentially significant emotional, financial, and health costs, also increases. Elmore et al. (1998, New England Journal of Medicine 338, 1089-1096), Christiansen et al. (2000, Journal of the National Cancer Institute 92, 1657-1666), and Gelfand and Wang (2000, Statistics in Medicine 19, 1865-1879) investigated this problem under the somewhat unrealistic assumption that the choice of making the decision to drop out at the kth screen does not depend upon the results of the earlier k - 1 screens. In this article we obtain sufficient and necessary conditions for their assumption to hold and use one of them to provide a method for testing the validity of the assumption. A new model which does not depend on their assumption is introduced. The maximum likelihood estimator of the cumulative risk of receiving a false-positive screen under the new model is derived and its asymptotic normality is proved. The extension of the new model by incorporating covariate information is also considered. We apply our testing method and the new model to data from the breast cancer screening trial of the Health Insurance Plan of Greater New York.

Adult↗
PubMed2003

Human papillomavirus DNA testing as an adjunct to cytology in cervical screening programs.

Our objective was to review current large studies of human papillomavirus (HPV) DNA testing as an adjunct to the Papanicolaou test for cervical cancer screening programs. We analyzed 10 large screening studies that used the Hybrid Capture 2 test and 3 studies that used the polymerase chain reaction test in a manner that enabled reliable estimates of accuracy for detecting or predicting high-grade cervical intraepithelial neoplasia (CIN). Most studies allowed comparison of HPV DNA and Papanicolaou testing and estimates of the performance of Papanicolaou and HPV DNA as combined tests. The studies were selected on the basis of a sufficient number of cases of high-grade CIN and cancer to provide meaningful statistical values. Investigators had to demonstrate the ability to generate reasonably reliable Hybrid Capture 2 or polymerase chain reaction data that were either minimally biased by nature of study design or that permitted analytical techniques for addressing issues of study bias to be applied. Studies had to provide data for the calculation of test sensitivity, specificity, predictive values, odds ratios, relative risks, confidence intervals, and other relevant measures. Final data were abstracted directly from published articles or estimated from descriptive statistics presented in the articles. In some studies, new analyses were performed from raw data supplied by the principal investigators. We concluded that HPV DNA testing was a more sensitive indicator for prevalent high-grade CIN than either conventional or liquid cytology. A combination of HPV DNA and Papanicolaou testing had almost 100% sensitivity and negative predictive value. The specificity of the combined tests was slightly lower than the specificity of the Papanicolaou test alone, but this decrease could potentially be offset by greater protection from neoplastic progression and cost savings available from extended screening intervals. One "double-negative" HPV DNA and Papanicolaou test indicated better prognostic assurance against risk of future CIN 3 than 3 subsequent negative conventional Papanicolaou tests and may safely allow 3-year screening intervals for such low-risk women.

Cervix Uteri↗
PubMed1999

[Participation factors in a occupational health colorectal cancer screening program].

A colorectal cancer screening campaign by Hemoccult test was carried out from January 1993 to December 1994 in collaboration with the company doctors of employees ages 45 and older in the companies of the Lot department of France. Of the 1311 employees to whom the test was offered, 811 actually had the test done, representing a rate of participation of 61.9%. Participation varied from 48.1% to 72.7% depending on the company doctor, and was higher for large companies. Managers participated less than other employees. People who never visit a dentist, who had not seen their doctor for over a year or who never give blood participated less than others. Thus, even though company doctors can play a true role by favouring the participation of general employees, their action is limited by the weak participation of people who already have little contact with the health care system.

Aged↗
PubMed2001

[Referrals to clinical mammography in a county without screening program].

Systematic mammography-screening may reduce the number of unindicated diagnostic mammographies. Six thousand, eight hundred and four women from Rosklde County underwent mammography at the Roskilde County Hospital over a four-year-period. Five hundred and nineteen women were excluded from the study, leaving 6285 women to form the study population. Twenty-four percent of the women had no clinical indication for mammography, 15% of the women had an increased risk of breast cancer, and for 61% of the women there was a clinical indication for mammography. Breast cancer was found in 0.46% of the women undergoing mammography without a clinical indication, in 1.2% of the women belonging to risk-groups, and in 8.9% of the women with a clinical indication for mammography. Biennial screening for breast cancer of 15,394 women (7697 women a year) in the age group 50-69 years could reduce the number of diagnostic mammographies by 338 women a year. Cooperation with GPs in a reduction of unindicated clinical mammographies of women younger than 50 years could reduce the number by a further 171 women. Potential savings in the X-ray-departments is not a weighty argument in favour of introduction of mammography screening.

Adult↗
PubMed1998

Worksite breast cancer screening programs: a review.

1. Breast cancer is a major health problem amenable to secondary prevention for reducing morbidity and mortality. 2. Given the large and increasing numbers of women in the workplace, breast cancer prevention and control measures should be included in workplace health promotion programs. However, despite the increasing prevalence of worksite health promotion programs in the United States, the prevalence of breast cancer programs in the workplace has been decreasing. 3. Despite the limited evaluative research of worksite breast cancer screening programs, a number of important conclusions conducted thus far. 4. Additional scientifically rigorous evaluation studies of worksite health programs for the early detection of breast cancer are needed, and additional innovative workplace programs aimed at increasing breast cancer screening need to be developed.

Adult↗
PubMed1985

Clinical findings in four children with biotinidase deficiency detected through a statewide neonatal screening program.

Four children with biotinidase deficiency were identified during the first year of a neonatal screening program for this disease in the Commonwealth of Virginia. Two unrelated probands were identified among the 81,243 newborn infants who were screened. In addition, two siblings of one of these infants were found to be affected. Both probands had mild neurologic symptoms at two and four months, respectively, and the two older children had more severe neurologic abnormalities, cutaneous findings, and developmental delay at two and three years of age. However, none of the affected children had acute metabolic decompensation. Previous studies have shown that the administration of biotin to affected children can be a lifesaving procedure that can reverse acute symptoms and prevent irreversible neurologic damage. Our findings demonstrate that subtle neurologic abnormalities may appear as early as at two months of age and that developmental abnormalities may occur even in the absence of episodes of overt metabolic decompensation. Since screening and treatment are both inexpensive and effective and the incidence of the disease is well within the range of that of other metabolic diseases for which screening is performed, biotinidase deficiency should be added to the group of metabolic diseases for which screening is done in the neonatal period.

Amidohydrolases↗
PubMed1999

[Cervical cancer screening for high risk women: is it possible? Results of a cervical cancer screening program in three suburban districts of Lyon].

Between november 1993 and october 1996, a cervical screening program was proposed for women 25-65-year-old who tend to have little or no medical supervision, in three suburban districts of Lyon. The data and results of the two last Pap-smears have been collected together with details of gynecological follow-up. Both general practitioners and gynaecologists were actively involved. A total of 3,792 women (12.3% of the target) were registered, with a larger proportion of women over 60 (17.7%). According to the "Consensus of Lille", only 403 women (34.4%) had adequate screening (over 50 y: 25.8%, 35-49 y: 39.4%, 25-35 y: 36.5%) and 2,489 women had inappropriate gynaecological follow-up: no smear for 185 women (4.9%) and inadequate schedule of follow-up visits for 476 others (12.5%). Missing data (date or results of Pap smear) were noted for 1,828 patients (48.2%). The screening procedure for women over 50 years was carried out mainly by general practitioner. Of 3,127 registered smears, 62 positive results were found (2.1%). Of these women, 9 were lost to follow-up and 4 did not have appropriate tests. Others results were: 27 negative further investigations, 9 CIN1, 7 CIN2, 3 CIN3, 1 in situ carcinoma and 2 invasive carcinoma. Despite low participation, this pilot study indicates that a procedure can be established to integrate high risk women in cervical cancer screening programme. Active participation of general practitioners is essential.

Adult↗