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PubMedDate not supplied

Changing cytologic detection rates for cervical intraepithelial neoplasia and invasive cancer in a population lacking a mass screening program.

The secular trends in the detection rates for cervical intraepithelial neoplasia (CIN) and invasive carcinoma were evaluated for a population lacking a mass screening program. For the period from 1980 through 1987, 185,659 Papanicolaou smears from 176,511 women were examined. The average annual age-adjusted detection rate for invasive cervical cancer declined from 3.7 x 10(-3) in 1980 to 1.4 x 10(-3) in 1987. The rate of cytologic findings consistent with CIN 3 and verified by histology increased from 0.7 x 10(-3) to 2.6 x 10(-3), and the rate of findings consistent with CIN 1 and CIN 2 increased from 4.3 x 10(-3) to 7.2 x 10(-3). The yield of Papanicolaou smear diagnoses consistent with CIN 3 was substantial (more than one case per 1,000) for women up to 60 years old, but was insignificant for older women.

Adult↗

PubMed1977

Recommendations for screening programs for congenital hypothyroidism: Newborn Committee of the American Thyroid Association.

The newborn committee of the American Thyroid Association recommends establishment and expansion of screening programs for congenital hypothyroidism because of the high frequency of the disease (1/5000 to 1/6000 births), the difficulty in making a clinical diagnosis and the fact that the disease is easily curable. The regional approach for such a program is recommended, and the Quebec experience with measurement of thyronine and thyrotropin concentrations by means of filter-paper blood spots can serve as a model.

Congenital Hypothyroidism↗

PubMed1983

Employee rubella screening programs in Arizona hospitals.

One year after voluntary guidelines on rubella screening of hospital employees were issued by the Arizona Department of Health, a survey of 68 members of the Arizona Hospital Association was conducted, with an 81% response. Some form of employee rubella screening was present in only 49% of responding hospitals. Of the screening hospitals, 70% of programs had a mandatory aspect for selected employees. Administrative logistics, cost, problems encountered, and the quality and coverage of the program varied substantially among the different hospitals. Fewer than half of the screening hospitals had programs for physicians, students, or volunteers. Verbal histories of immunization or serological tests, although notoriously unreliable, were accepted by 14% of the screening hospitals. Half of the nonscreening hospitals plan to implement programs in the future. Reasons given for not establishing rubella screening programs include cost, no pediatric or obstetric service, liability issues, high turnover, and no previous case of rubella in an employee. Three hospitals (all screening) reported they had had a case of rubella in an employee. The data suggest slow partial compliance with recommendations for rubella screening in hospitals.

Adolescent↗

PubMed1998

Cervical cancer screening among low-income women: results of a national screening program, 1991-1995.

OBJECTIVE: To evaluate the results of cervical cytology screening in the National Breast and Cervical Cancer Early Detection Program and to compare the findings with results from other screening programs. METHODS: We analyzed data on 312,858 women aged 18 years and older who received one or more Papanicolaou smears, and follow-up if indicated, from October 1991 through June 1995 at screening sites across the United States providing comprehensive National Breast and Cervical Cancer Early Detection Program services. RESULTS: Of the women screened, more than half were 40 years or older; slightly less than half (44%) were of racial and ethnic minorities. During the first screening cycle, 3.8% of Papanicolaou tests were reported as abnormal (squamous intraepithelial lesion [SIL] or squamous cell cancer); proportions of abnormals decreased with increasing age. The age-adjusted rate of biopsy-confirmed cervical intraepithelial neoplasia (CIN) II or worse among women screened was 7.4 per 1000 Papanicolaou tests; rates of CIN were highest among young women, but cancer rates peaked among women in their 50s and 60s. The percentages of first screening cycle-Papanicolaou tests interpreted as high-grade SIL and squamous cell carcinoma associated with biopsy-confirmed CIN II or worse (the positive predictive value) were 56.0% for CIN II/III and 3.7% for invasive cancer. Of the 150 invasive cancers diagnosed, 54.0% were classified as local disease. CONCLUSION: Observed results emphasize the duality of cervical neoplasia-CIN in younger women and invasive cancer in older women. This finding points to the importance of reaching both younger and older women for cervical cancer screening.

Adult↗

PubMedDate not supplied

Evaluation of the Quebec Public Information Campaign and Human Immunodeficiency Virus (HIV) Antibody Screening Program directed to persons transfused between 1978 and 1985.

This study aimed to determine the number and characteristics of the blood recipients tested for HIV infection as a result of the provincial HIV antibody screening program (directed to persons transfused between 1978 and 1985 and their contacts) and to estimate the rate of HIV seroprevalence among them. All physicians in the province of Quebec were provided with a special prescription form for HIV testing of eligible patients. Over a six-month period, a total of 6,348 special prescription forms were used. The HIV seroprevalence was 0.13% (95% confidence interval: 0.04% to 0.2%). We estimated an increase of 16.5% (12,061 tests) in the number of HIV tests related to the program. These results were consistent with those found by similar programs elsewhere in Canada but less than expected. Multiple strategies, including direct notification of transfusion recipients, particularly pediatric patients, are probably necessary to reach infected blood recipients still unaware of their infection.

Adolescent↗

PubMed1989

A prenatal diagnostic center's first-year experience with the California alpha-Fetoprotein Screening Program.

The University of California Davis Medical Center has offered secondary and tertiary care to pregnant patients with abnormal maternal serum alpha-fetoprotein levels since the start of the California alpha-Fetoprotein Screening Program in April 1986. In our first year of involvement with this method of prenatal screening, 452 patients were referred to our center for further evaluation and follow-up of either high or low maternal serum alpha-fetoprotein levels, as determined by the standard multiple of the median adjusted for maternal weight, race, and presence of insulin-dependent diabetes mellitus. This article presents the first-year results of our clinical experience. Information is presented concerning medical complications, screening and diagnostic test results and their confirmation, clinical procedures performed, and postpartum follow-up reports. Findings of pregnancy outcomes associated with low and high alpha-fetoprotein levels are presented and discussed.

Adult↗

PubMed1995

Major differences in cardiovascular risk indicators by educational status. Results from a population based screening program.

All people aged 30-59 years living in one primary health care center's catchment area were invited to participate in a population based screening program. A total of 2642 people (68%) participated. An overall risk index for having a heart attack within 5 years (Ps) was calculated based on diastolic BP, smoking status, total cholesterol, and age. Other risk indicators registered were Body Mass Index, and physical activity. A highly significant association between education level and age-adjusted overall risk index for both men (p = 0.001) and women (p < 0.001) was found. Also Body Mass Index, total cholesterol, smoking status, and, for women, diastolic blood pressure showed similar significant variation with education level with higher education associated to lower risk. These findings imply the possibility of a great variation in the "risk" of receiving pharmacological treatment for one's CVD risk factors.

Adult↗

PubMed2005

Evaluation of a screening program for diabetic retinopathy in a primary care setting Dodia (Dépistage ophtalmologique du diabète) study.

OBJECTIVES: The aim of this observational study was to evaluate the screening for diabetic retinopathy (DR) using eye fundus photography taken by a nonmydriatic camera and transmitted trough the Internet to an ophthalmological reading centre, as compared to a dilated eye examination performed by an ophthalmologist. METHODS: A total of 456 and 426 diabetic patients were included by two different groups of primary care physicians (PCPs), 358 being screened with the non-mydriatic camera (experimental group) and 320 with dilated eye fundus exam (control group). RESULTS: The proportion of screened patients for whom PCPs received a screening report within the 6-month follow-up period was 74,1% for the experimental group and 71,5% for the control group. Screening for DR was negative in 77,6% of patients with eye fundus photographs vs 89,6% with dilated eye examination. DR was diagnosed in 62 patients (17,3%) with eye fundus photographs versus 31 with dilated eye examination (10,4%). Referral to an ophthalmologist was required in 59 reports of patients with photographs (16.5%), 23 of them due to high grade DR. Finally, the non-mydriatic camera was found of little inconvenience by patients. CONCLUSION: The telemedical approach to DR screening proved to be effective in providing primary care practitioners with information about their patient's eye status. This screening method allowed to identify patients requiring prompt referral to the ophthalmologist for further complete eye examination. In conclusion, this study provided successful results of DR screening using fundus photography in primary care patients, and strongly supports the need to further extend this screening program in a larger number of French sites.

Diabetes Mellitus, Type 1↗

PubMed1998

Differences between African American and Caucasian men participating in a community-based prostate cancer screening program.

Prostate cancer is a major contributor to morbidity and mortality in the male population, but public awareness of the cancer has been reported as minimal. We evaluated the effectiveness of an educational prostate cancer screening program on 944 men in a midwest urban community. Digital rectal examinations and PSA blood tests were provided at no charge to participants with a grant from the Michigan Department of Community Health. An educational intervention that stressed the importance of prostate cancer early detection and treatment was conducted before screenings. A brief questionnaire administered before and after the videotape and screenings, targeted both knowledge and attitudes concerning prostate cancer. Pre-test results revealed that African American men were significantly (t = 3.7, P = .00) less likely then white men to correctly identify early symptoms of prostate cancer and the basic components of a prostate checkup. Following program involvement, scores significantly improved in all areas and differences were no longer significant between the races. Racial differences were also found for screening preferences and modes of reaching men to participate in screening. African American men were twice as likely as white men to choose private appointments over mass screening (OR = 2.2, P = .00). Radio reached the most African Americans (25%) while newspaper reached the most Caucasians (34%). The decreased level of knowledge among African Americans regarding prostate etiology and clinical factors highlights the need for educational programs to target minority populations. The need for discretion also applies by providing minority-favored access with screening through private appointments.

Adult↗

PubMed1997

Axillary node dissection in patients with breast cancer diagnosed through the Ontario Breast Screening Program: a need for minimally invasive techniques.

OBJECTIVE: To determine the role of axillary node dissection by studying patient and tumour characteristics of invasive breast cancer through the Ontario Breast Screening Program (OBSP). DESIGN: A retrospective evaluation. SETTING: The London, Ont., branch of the OBSP. PATIENTS: Three groups of women seen were studied: 50 women with screen-detected breast cancers, which were palpable and detected by the nurse-examiner, 62 women with occult screen-detected breast cancers and 353 age matched women with invasive breast cancer from the LRCC prospective database, who served as controls. MAIN OUTCOME MEASURE: The proportion of involved axillary nodes within the 3 groups based on patient and tumour characteristics. RESULTS: Twenty-five (22.3%) of the 112 women had screen-detected tumours less than 1 cm in dimension, but only 1 had an involved axillary node. Twelve (19%) of the 62 women with occult screen-detected tumours had involved lymph nodes compared with 17 (34%) of the 50 women with palpable screen-detected cancers (NS). In the control group tumour dimension less than 1 cm versus 1 cm or larger had a marked effect on the probability of axillary node involvement (12.5% v. 40.7%, p = 0.001). In the palpable screen-detected group 3 times as many women with outer quadrant or central lesions had involved nodes as those with inner quadrant lesions (38% v. 12%) and for those with a family history of breast cancer almost twice as many had involved axillary nodes. In occult screen-detected patients there was more nodal involvement in patients aged 60 years or less than in those older than 60 years (35% v. 10%, p = 0.042); only 4 of 41 patients older than 60 years had involved nodes at surgery. A significant difference in nodal involvement was found with respect to high or intermediate grade versus low grade lesions in the occult group (44% v. 12%, p = 0.033). In the control group, tumour grade (intermediate and high [45.3%] v. low [20.0%]) and hormone replacement therapy (HRT) (current or recent use [56.5%] v. no use [34.5%]) were significant findings (p < 0.001 and p = 0.005 respectively). CONCLUSIONS: Women older than 60 years with tumours smaller than 1 cm had a low probability of nodal positivity (0% to 8.7%), but there is insufficient information in this group to give a 95% or better prediction of nodal status at the time of surgery. Studies of minimally invasive techniques such as sentinel node biopsy are needed in this group to minimize surgical morbidity in these women who, as a result of early diagnosis, have an excellent long-term outlook.

Age Distribution↗

PubMed1990

Referral policy and positive predictive value of call for surgical biopsy in the Florence Breast Cancer Screening Program.

The authors evaluate the referral rates and the predictive value (PV) of call for diagnostic work up or biopsy in a population based breast cancer screening program in the 1979-1986 period. The presence of mammographic abnormalities either benign or suspicious proved to be the only reliable referral criterion (recall rate = 7.9%, recall PV = 3.8%, biopsy call PV = 39%). When mammography was normal the presence of breast complaints other than pain or of a radiologically dense breast were aspecific referral criteria, and since the latter was abandoned, (a) referral rates dropped especially in younger women, (b) referral or biopsy PV improved, whereas (c) cancer detection rate was almost unaffected. Younger age was associated with higher referral rates and with lower PV of both referral or biopsy. Whenever comparison with previous examination was possible, mammography accuracy was higher; this explains the decrease in referral rates and the increased predictivity observed at further rounds with respect to first screening round.

Adult↗

PubMed2002

Changes in breast cancer incidence and stage distribution in Modena, Italy: the effect of a mammographic screening program.

OBJECTIVE: Assessing changes in breast cancer (BC) incidence and stage distribution in the District of Modena, Italy, during the period 1992-1998, and their relationship to a mammographic screening program launched in 1995. METHODS: Demographic, clinical, and pathological data of all BC cases reported to the population-based Modena Cancer Registry between 1992 and 1998 were collected and linked to the screening database. RESULTS: A total of 3429 women were diagnosed with BC in the District of Modena between 1992 and 1998. In this period the incidence rate increased by 15.7% (from 134.3 in 1992 to 155.4 per 100,000 in 1998). The increase began in 1995 and exclusively included women aged 50-69; the incidence rose by 30.4%. Moreover, the rise was confined to early tumors, with more than half (54%) of all cases reported in 1998 diagnosed as stage 0 or I disease, compared with 42% in 1992. Screen-detected tumors were significantly smaller (13.2 mm) than other tumors diagnosed in women aged 50-69 (18.5 mm), with 46% of screen-detected tumors smaller than 10 mm. Overall, a decline in the average tumor diameter was shown (from 20.2 mm in 1992-1994 to 18 mm in 1996-1998). CONCLUSIONS: Our data confirm that mammographic screening leads to an increase in the incidence of early-stage BC cancers.

Aged↗

PubMed1986

Tuberculin reactivity in United States and foreign-born Latinos: results of a community-based screening program.

Because of the concern that we were underestimating the prevalence of tuberculosis within the Latino community in San Francisco, we undertook a community-based screening program directed largely towards recent immigrants. Of 1,871 intermediate-strength (5 TU) tuberculin tests applied and read, 37 per cent of the reactions were greater than or equal to 10 mm. Significant reactions were found in 53 per cent of foreign-born persons compared to 7 per cent of those born in the United States. Persons older than 20 years of age were more likely to have significant reactions compared to younger Latinos. Among the foreign-born, the frequency of significant reactions was not influenced by the length of stay in the US or a history of BCG (bacille Calmette-Guérain) vaccination. Two foreign-born children were found to have current tuberculosis. The prevalence of tuberculin reactors among US-born Latino children was 3 per cent, which suggests that undetected transmission of tuberculosis may be occurring. We conclude that Latino immigrants should be systematically screened for tuberculosis.

Adolescent↗

PubMed1996

Evaluation of a lead screening program in Houston, Tex.

Universal screening for childhood lead poisoning is widely debated. Our purpose was to compare screening results at three pediatric clinics within Houston and to evaluate the effectiveness of screening according to published criteria. The clinics were chosen for their geographic and socioeconomic diversity. Children between 6 months and 6 years of age were tested, and the results were classified according to current guidelines. We screened 864 children. Results between sites were significantly different, P = 0.002. No children with blood lead levels greater than 0.45 mumol/L (9 micrograms/dL) were identified at Clinic C compared to 76 (8.8%) from Clinics A and B, but no site had children with levels greater than or equal to 2.20 mumol/L (45 micrograms/dL). The prevalence of childhood lead poisoning can vary even within the city. If regional screening is to replace universal screening, statewide as well as citywide data are needed to identify high-risk areas. This could be done by clinic site, zip code, or census track data with a minimum of 3000 children.

Child↗

PubMed1979

Review of Metabolic Screening Program of Children's Hospital, Vancouver, British Columbia. 1971--1977.

1. Between 1971 to 1977, 74,521 urines, collected on filter paper and mailed in, were screened by the Metabolic Screening Program of the Children's Hospital. These represented 45.9% of live births in B.C. hospitals were the program has been available. The mean age of the infants was 4.4 weeks. Urines were examined by chromatography with ethyl acetate-pyridine-water for sugars. 1423 (2.13%) had an abnormal pattern necessitating a repeat urine card. A persistent abnormality was noted in 167 (0.22%) and from these a liquid urine sample was obtained for two dimensional amino acid chromatography and/or a repeat sugar chromatography. 2. In 47 (0.06%) of these a definite metabolic abnormality was confirmed. These included cases of Iminoglycinuria (8), Hartnup trait (4), Nonketotic hyperglycinemia (2), Histidinemia (1), Cystathioninuria (5), Argininosuccinic aciduria (1), Maple Syrup Urine Disease (1), Diabetes Mellitus (1), Renal glycosuria (1) and Persistent galactosuria (3). 201 infants had a slight increase of cystine and/or lysine, and 19 of these were documented to be heterozygous for cystinuria.

Amino Acids↗

PubMed1977

Mass screening program for prostatic diseases with transrectal ultrasonotomography.

A special chair-type apparatus for transrectal ultrasonotomography was developed in our laboratory 3 years ago. We did a mass screening program for prostatic disease, using this equipment as the primary study in the system. The 132 apparently normal men evaluated ranged in age from 40 to 76 years (mean 55.0). The 48 patients suspected of having prostatic disease underwent secondary studies, consisting of the usual urological examinations. Prostatic disease was detected in 24 cases, including 18 cases of benign prostatic hyperplasia. Thus, the model program revealed an extraordinarily high prevalence of latent prostatic disease among apparently normal older men.

Adult↗

PubMed1986

Total or near total thyroidectomy versus limited resection for radiation-associated thyroid nodules: a twelve-year follow-up of patients in a thyroid screening program.

Controversy continues regarding the extent of thyroidectomy appropriate for patients with radiation-associated thyroid nodules. The incidence of cancer in this group of patients is more than 50% when near total or total thyroidectomy is done and all thyroid tissue is serially sectioned and examined. Tumor multicentricity is common. Is total or near total thyroidectomy warranted in all of these patients? A prospective study and follow-up program of 2118 patients with prior low-dose head and neck irradiation who entered into a thyroid screening program allowed us to examine how the extent of thyroidectomy influenced the clinical course of these patients. Near total or total thyroidectomy was performed in 59 patients (36 had cancer), and limited thyroid resection, that is, lobectomy or less, was done in 78 patients (four of whom had cancer). During follow-up, only three patients have developed recurrent cancer; two had near total thyroidectomy and one had total thyroidectomy at first operation. Two patients with limited thyroid resection have had reoperation for new thyroid nodules, both of whom had benign nodules. We conclude that although limited thyroid resection may leave occult malignancies in unresected thyroid tissue, there is no significant difference in outcome between patients with limited resection and those with near total or total thyroidectomy after a 12-year follow-up of the program. Significant differences in cancer recurrence rats may occur with longer follow-up.

Follow-Up Studies↗

PubMed1988

[Prenatal detection of open neural tube defects in a mass screening program by determination of alpha-fetoprotein concentration in maternal serum].

A partially automatized ultramicroencymimmunoassay developed by the GDR and Cuba should be tested in a mass screening for the prenatal detection of open neural tube defects by measurement of maternal alphafetoprotein concentration (MS-AFP). In the screening program 24,271 pregnant women were included (Berlin/District of Schwerin). In 18,144 patients AFP-concentration in maternal serum was measured as a routine procedure in the care for all pregnant women of the district of Schwerin. The time of MS-AFP determination in this connection was limited from 15th to 18th completed gestational week. 1986 already in 84.9 per cent of all pregnant women of the district of Schwerin MS-AFP concentration could be measured in early pregnancy. The detective rate of open neural tube defects among 24,271 tested pregnant women was 86.1 per cent. AFP concentration was expressed in ng/ml and the "cut off" was set at 2.0 MOM. Infants born with open neural tube defects were reduced by 75 per cent under the conditions of MS-AFP screening. Better results are possible in connection with a progress in the qualification of the following diagnostic steps, if MS-AFP-levels are elevated. Not unexpected and unspecific MS-AFP-elevation was found in connection with twin pregnancies and a higher risk of abortion and the delivery of infants with very low birth-weight less than 1,500 g. A general MS-AFP-screening is recommended for prenatal detection of open neural tube defects all over the country.

Anencephaly↗