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PubMed2000

[The current state of the diagnostics of breast diseases in Lombardy].

PURPOSE: The SIRM study group for senology in Lombardy set the following goals: to quantify the number of radiologist working in public radiology centers and in private credited hospitals in Lombardy; to quantify the number of radiologists working in diagnostic senology and the mean time they devote to this field; to survey the diagnostic equipment used for senology purposes and check its adequacy. MATERIAL AND METHODS: We considered 58 centers of senology diagnostic imaging in the radiology departments of general hospitals in 8 Lombardy provinces. First we evaluated the screening programs for early breast cancer detection carried out with clinical mammography. All data were evaluated with reference to female residents aged 40 to 69, to the average adherence rates reported in the literature, to the protocols adopted in different centers relative to the examination frequency. Mammography was always associated with a physical examination and then the patient was submitted to radiological investigations to make the final diagnosis. The form we used for data report is summarized in Table I. RESULTS: In the centers for diagnostic senology we surveyed in 1998, in all 182,724 mammograms, 58,686 breast US examinations and 7,097 needle biopsies for cytology or microhistology were performed; 35.5% of the female population which should have been screened actually underwent the examination and 32.6% of them was also submitted to breast US, while 3.88% underwent FNAB. Sixty-three mammographic units and 62 US units were operated by 152 radiologists. An average 2,900 radiographic investigations per mammographic unit were performed yearly. Each radiologist reported an average 1,202 mammograms a year. Refer to the tables for detailed data reporting by province. Thirty-six per cent of radiologists presently reads more than 1,500 breast examinations a year. The radiologists working in diagnostic imaging in senology devote an average 20% of their working time to this field. As for the technical adequacy of mammographic and US equipment relative to some reference levels reported in detail in the paper, only 42% of the former and 48% of the latter were up to standards. DISCUSSION AND CONCLUSIONS: Despite the massive work done in the field of senology, the estimated needs of the female population have not been met yet, given the increased demand for senologic examinations and women's growing awareness of the need of early breast cancer diagnosis. The answer to this problem lies in a political health care policy that should promote the current clinical programs increasing both instrumental and human resources. Alternatively screening programs could be planned on a regional basis, with the pro of reaching a larger female population and that of a more homogeneous methodological approach. Our data indicate that breast cancer detection is best achieved with clinical and screening tools: the former can be easily promoted in a short time and could thus make our first goal, while the latter, which is more complex, could be implemented later. Thus, a growing clinical activity could make a very good basis for high quality breast screening programs. Finally, it is necessary to guarantee high quality standards for equipment, methods and training of medical and nonmedical staff.

Adult↗

PubMedDate not supplied

[Cryptosporidium parvum (Apicomplexa: Sporozoa, Coccidia)--the optimization of a technic for isolating a large number of oocysts].

The Waldman e. a. (1986) method of separation of Cryptosporidium spp. oocysts from feces by using a percoll discontinuous density gradient appeared a method of choice for obtaining large numbers of oocysts of C. parvum free of fecal contamination. Feces of 7-12 day old calves, spontaneously infected with C. parvum, were concentrated and purified by the above technique. The purified oocysts were shown to be infectious by inoculation of 6-9 day old rats with an average dose of 20,000 oocysts per animal. The rats shed oocysts after 4 days. At necropsy on day 4 postinoculation, the pattern of endogenous development appeared normal, when examined on frozen sections of fresh tissue, using the Bright cryostat, stained with hematoxylin and eosin. Samples of the clean sediment, presumably containing only oocysts of C. parvum, were smeared and stained with carbol fuchsin after Ziehl-Neelsen, and with gentian violet after Sidorenko (1988). With the latter technique, an intense gentian violet staining screened all the constituents of the smear, except the oocysts, which being "negatively stained" looked as small transparent spheres 4-5 mkm in diameter. But of special interest was the reaction of the smeared organisms with carbol fuchsin. Some organisms stained dark red and had a variable number of dark granules, seemingly on the surface; whereas others stained light reddish, if at all, and appeared as transparent spheres. It does not seem unlikely that the sediment, resulting from the final step of percoll separation, may contain, besides oocysts, some other endogenous stages (meronts, gamonts, thin-walled oocysts) that appeared in the lumen of the intestine because of an intense flow of diarrheal fluid during cryptosporidiosis. Unlike the thick walled oocysts, other endogenous stages are not covered with protective walls and thus fail to absorb acid fast staining. Segmented meronts were obviously observed on the rat fecal smears 96 hours after infection. This observation enables us to propose that newly infected hosts-recipients may obtain, with diarrheal fecal masses of infected donors, not only sporulated oocysts, but also some earlier developmental stages. Merozoites, released from the segmented meronts, could start in the intestine asexual rounds, thus shortening the resulting prepatent period. Fluctuations in prepatent period duration are characteristic of Cryptosporidium spp., and the above observation may be one of its explanations.

Animals↗

PubMed1988

The different types of alpha-thalassemia: practical and genetic aspects.

From May 1985 to October 1987, 1,564 Southeast Asians living in Hawaii were screened for hereditary anemias. Microcytosis was determined by electronic red cell indices and morphology; iron deficiency was ruled out by normal red cell distribution width and normal protoporphyrin levels; Hb E was determined by electrophoresis; beta-thalassemia (thal) heterozygotes were identified by raised Hb A2 on column chromatography. alpha-Thalassemia heterozygotes were diagnosed by exclusion. Family studies helped identify or confirm diagnoses, especially for the alpha-thal-2 heterozygotes (-alpha/alpha alpha) and homozygotes (-alpha/-alpha). Provisional diagnoses are being checked by DNA analyses. Iron deficiency prevented detection of possibly coexisting alpha-thalassemias in 97 individuals. Technical problems included the obscuring of standard criteria for recognizing the alpha-thal variants by the presence of Hb E or beta-thal. In such cases, alpha-thal could only be detected by family studies or DNA analyses. Problems with hemoglobin (Hb) electrophoresis included Hb H migrating beyond the edge of the strip if incubation was not closely monitored, and difficulty in detecting the small amounts of unstable Hb Constant Spring. DNA analyses also had limitations, since the nondeletion alpha-thalassemias would not be detected by routine Southern blotting. DNA analyses suggested that about 50% of presumed alpha-thalassemias were alpha-thal-2 (-alpha/alpha alpha) variants, and a corresponding number of alpha-thal-2 variants were among the apparent normals. Gene frequencies in the unselected Lao subjects were approximately 0.2 for Hb E, at least 0.1 for (-alpha), usually a rightward (alpha -3.7) type, 0.04 for (-), and 0.01 for a beta-thal. Multistep screening for the alpha- and beta-thalassemias was an effective and efficient strategy.

Asia, Southeastern↗

PubMed1997

Competitive oligonucleotide single-base extension combined with mass spectrometric detection for mutation screening.

A rapid, robust and widely applicable mutation detection scheme not requiring radioactivity or gel-based detection is introduced. It is a single-tube, competitive oligonucleotide single-base extension (COSBE) reaction using a pair of primers with the 3'-terminal base complementary to either the normal or mutant allele. Upon hybridization and addition of a polymerase and the nucleotide triphosphate corresponding to the next base after the primer, only those primers properly annealed (i.e., no 3'-terminal mismatch) are extended; products are resolved by molecular weight shifts as determined by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (single-scan spectrum acquisition < < 1 s). For the cystic fibrosis delta F508 polymorphism, 28-mer "normal" (N) and 30-mer "mutant" (M) primers generate 29-mer (N + I) or 31-mer (M + 1) products for homozygotes and both for heterozygotes. Since primer and product molecular weights are relatively low (< 10 kDa) and the mass difference between these are at least that of a single approximately 300-Da nucleotide unit, a low-resolution mass spectrometer is suitable for such measurements.

Alleles↗

PubMed1996

Computed radiographic absorptiometry and morphometry in the assessment of postmenopausal bone loss.

The best method for the diagnosis of osteoporosis and assessment of fracture risk is currently considered to be bone densitometry. The most commonly used dual-energy X-ray absorptiometry (DXA) methods may sometimes not predict bone mass accurately in every skeletal site, are expensive and not widely available. The recent development of computed analysis of a plain radiograph of the hand might provide a practical, inexpensive and rapid method for evaluation of bone mineral status. In this study we evaluated 20 healthy premenopausal and 660 postmenopausal women. In 36 of these subjects a second evaluation was carried out after 2 years of therapy with calcium supplements. The internal and external diameters of the second metacarpal and the metacarpal and ultradistal radial bone density were evaluated using a technical device developed in our laboratory and marketed by NIM, Verona, Italy (Osteoradiometer). The radiographic images, captured by a video camera, were digitized and studied by computed analysis. In 150 subjects bone density at the level of the lumbar spine, femur, and ultradistal and proximal radius was also measured by DXA techniques. Both external (D) and internal (d) diameters increase significantly with age and years since menopause (YSM), whereas metacarpal index (D--d/D) and metacarpal and ultradistal radial bone density decrease significantly with age and YSM. The ratio between metacarpal bone mineral content and the cortical area (volumetric metacarpal bone density) did not change with age. Significant correlations were found between radiometric findings and DXA measurements. The best correlation coefficients were between bone density measured at the level of the ultradistal radius by DXA and radiographic absorptiometry. In the 2-year follow-up study, a 4.9% and 6.2% decline in radial metacarpal bone density respectively were observed, but the difference was statistically significant only for the latter. In conclusion, computed radiogrammetry is closely correlated with all DXA measurements and may be useful in screening of large populations, providing a simple, inexpensive and sufficiently precise method for evaluation of bone mineral status. Further studies are warranted for assessing the accuracy of radiogrammetry for longitudinal investigations and its capacity to predict fracture risk.

Absorptiometry, Photon↗

PubMed2002

Does virtual colonoscopy have a major role in population-based screening?

In summary, technical advances in the performance of VC are occurring at a very rapid pace. These technical improvements will undoubtedly improve the polyp detection rate and reduce false-positive and false-negative examinations. The concept of VC is clearly attractive and the general public is enamored with everything that has an association with virtual reality. As other articles in this issue have revealed, there are many techniques in development to help stratify patients at risk for colon cancer. As we begin to focus our health care resources on those at highest risk, the less need there is for inexpensive, broadly based screening techniques. Clearly, those patients at high risk for having polyps are better served by colonoscopy because of its therapeutic potential. That being said, in the view of this author, if a virtual preparation can be achieved and the cost of VC can be kept relatively low, then this technique will become part of our mainstream clinical practice. If an immaculate colon preparation must be performed and if the costs reflect standard abdominal and pelvic CT rather than a special reduced cost for VC, then it is doubtful that there will be any significant impact from this technology

Colonic Polyps↗

PubMed2002

[Stereotaxic breast biopsy techniques have become the standard of care for mammographically suspicious lesions].

An optimal technique for the evaluation of nonpalpable, suspicious mammographic lesions should have a low technical failure rate, no false-negative results and should remove the lesion completely. Since most of these lesions are benign, the procedure should be carried out in an outpatient setting without general anesthesia. Cancer is missed in 2.6% of cases with excisional biopsy following needle localization. Furthermore, 50-83% of these patients undergo a second surgical intervention for definitive surgical treatment. In contrast, the rate of missed cancers is less than 0.7% following stereotaxic core or large-core biopsies. However, using these techniques, discordant results and histologic high-risk lesions need to be recognized and reexcized. The cost-effectiveness of stereotaxic vacuum-assisted core biopsy has been demonstrated. Stereotaxic breast biopsy techniques such as vacuum-assisted core biopsy and large-core biopsy for suspicious mammographic lesions have low false-negative rates and result in few histologic underestimations.

Biopsy↗

PubMed1998

Cross-cultural adaptation of the hearing handicap inventory for the Elderly-Screening Version (HHIE-S) for use with Spanish-speaking Mexican Americans.

OBJECTIVE: To cross-culturally adapt the Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S) for use with older Spanish-speaking Mexican Americans. SUBJECTS AND SETTING: Two different samples were used. First, a convenience sample of 100 older community-dwelling Mexican American men and women in San Antonio, Texas, was used to test technical equivalence of the Spanish and English language versions of the HHIE-S. Second, a neighborhood-based sample of older Mexican Americans was used to establish conceptual (n = 433) and criterion equivalence (n = 381) of the two HHIE-S language versions. METHODS: Independent forward and back translations were done to create a Spanish language version of the HHIE-S. In the convenience sample, subjects were administered the English and Spanish HHIE-S in random order on separate days. In the neighborhood sample, the HHIE-S was given on one occasion in the language of the subject's preference. Depressive symptoms were assessed using the Geriatric Depression scale to see if the two language versions of the HHIE-S were similarly associated with depression (conceptual equivalence). Hearing impairment was assessed using the Welch-Allyn Audioscope to see if the two language versions were similarly associated with an audiometric measure for hearing loss (criterion equivalence). RESULTS: In the convenience sample, the overall mean (SD) Spanish and English HHIE-S scores were 6.2 (8.7) and 6.2 (9.3), respectively (P = 1.00). Total scores of the English and Spanish versions were highly correlated (r = .89), and regression analysis indicated that the two language versions gave nearly identical results. In the neighborhood-based sample, men had higher HHIE-S scores than women (OR 2.0, 95% CI = 1.3-3.5). Having depressive symptoms (OR 3.2, 95% CI = 1.9-5.5) or hearing impairment (OR 6.1, 95% CI = 3.5-10.5) was associated with higher HHIE-S scores. After adjustment for gender, depressive symptoms, and/or hearing impairment, the language of interview was not associated with HHIE-S score. CONCLUSION: We have developed and tested a Spanish translation of the HHIE-S that yields equivalent results to those obtained with the English version in bilingual Mexican Americans. The Spanish HHIE-S presented here is suitable for clinical use and research studies involving older Mexican Americans.

Aged↗

PubMed1998

Population-based mammographic screening in Singapore: what are participants' views?

Mammographic screening for breast cancer has been shown to be an effective tool for reducing mortality from the disease in many studies in the West, if high technical quality and acceptance by the target population are achieved. The objective of the Singapore Breast Screening Project was to determine if the same results could be obtained among local women by inviting a random sample of 69,500 women aged 50 to 64 years for a screening mammogram over two years. To date, the compliance rate among the women invited has been 41.7%. The objective of the present substudy was to determine participants' views on the accessibility and acceptability of organised mammographic screening. Of the three hundred women interviewed, 85% were satisfied with the information given prior to the visit, while 67% needed to change the original appointment given. The majority were satisfied with aspects of the visit such as waiting time, privacy and explanation given during the test. However, 35.1% reported at least moderate discomfort during mammography. A substantial proportion (39.7%) of attenders felt that there was very little hope of cure even if cancer was detected early. When asked the most important reason for attending, most indicated they had taken the opportunity for a free check-up to be assured they were well. Almost all (95.7%) reported a willingness to be screened again, but most would not be willing to pay for a mammogram at the current rates.

Appointments and Schedules↗

PubMed2005

Diffusion and dissemination of evidence-based dietary strategies for the prevention of cancer.

OBJECTIVE: The purpose was to determine what strategies have been evaluated to disseminate cancer control interventions that promote the uptake of adult healthy diet? METHODS: A systematic review was conducted. Studies were identified by searching MEDLINE, PREMEDLINE, Cancer LIT, EMBASE/Excerpta Medica, PsycINFO, CINAHL, the Cochrane Database of Systematic Reviews, and reference lists and by contacting technical experts. English-language primary studies were selected if they evaluated the dissemination of healthy diet interventions in individuals, healthcare providers, or institutions. Studies of children or adolescents only were excluded. RESULTS: One hundred one articles were retrieved for full text screening. Nine reports of seven distinct studies were included; four were randomized trials, one was a cohort design and three were descriptive studies. Six studies were rated as methodologically weak, and one was rated as moderate. Studies were not meta-analyzed because of heterogeneity, low methodological quality, and incomplete data reporting. No beneficial dissemination strategies were found except one that looks promising, the use of peer educators in the worksite, which led to a short-term increase in fruit and vegetable intake. CONCLUSIONS AND IMPLICATIONS: Overall, the quality of the evidence is not strong and is primarily descriptive rather than evaluative. No clear conclusions can be drawn from these data. Controlled studies are needed to evaluate dissemination strategies, and to compare dissemination and diffusion strategies with different messages and different target audiences.

Congresses as Topic↗

PubMed1995

Clinical predictors of HIV-1 infection among preschool children in Dar es Salaam, Tanzania.

Seroprevalence of HIV-1 infection was determined in children aged between eighteen months and five years, attending maternal and child health (MCH) clinics in Dar es Salaam, Tanzania. A total of 889 children were eligible for the study, however seven children could not be enrolled because their mothers/guardians absconded and blood could not be drawn from 21 children due to refusal of mothers/guardians and from another 12 children due to technical reasons. Therefore, the participation rate was 95.5%. Of the 849 children screened, 14 (1.65%) were found to have IgG anti HIV-1 antibodies in their sera. The main clinical features found in children with symptomatic HIV-1 disease were weight loss, generalized lymphadenopathy, recurrent fevers, and prolonged diarrhoea. The utility of clinical features suggestive of HIV-1 infection (according to CDC classification) in identifying HIV-1 infection in children was evaluated and found to have high sensitivity (100%), specificity (96.9%) and negative predictive value (100%), but a low positive predictive value (35%). Marked variations in progression to symptomatic phase were noted, whereby some relatively young children had progressed to symptomatic phase (CDC class P-2A), while some older children were still in the asymptomatic stage (CDC class P-1 C). None of the symptomatic HIV-1 infected children presented with neurological disease, severe opportunistic infections, or malignancies. Although reduced mid-upper arm circumference and weight-for-age were associated with HIV seropositivity, these clinical parameters had low positive predictive values compared to the CDC classification.

Child, Preschool↗

PubMed1979

Clinical comparison of computed tomography and lymphangiography for detection of retroperitoneal lymphadenopathy.

The advantages of CT scan over lymphangiography are numerous and significant. The accuracy of CT scan was virtually identical to lymphogram for the detection of para-aortic lymph node involvement; however, CT provides a better means of assessing the true extent of disease. In such cases it is possible to determine whether the neoplastic process involves retroperitoneal structures such as the kidneys, ureters, pancreatic region, hilum of the liver, or the major vessels. Moreover, this excellent definition permits accurate follow-up assessment of therapy. Finally, CT is a noninvasive examination and does not require significant technical expertise, and the examination is easily reproducible following any time period from the initial examination. Finally, although we have not specifically discussed biopsy procedures, the CT scan is an excellent means for guiding biopsy procedures even for retroperitoneal abnormalities, perhaps precluding the necessity for laparotomy in order to provide histologic diagnosis of disease (Fig. 11). The disadvantages of CT are several. Of course, the acquisition of CT equipment is expensive and the cost effectiveness has not yet been proven. The most significant disadvantage is its inability to resolve or detect neoplastic disease within normal-sized lymph nodes. This was not a significant problem in our series, because our series contained only a few cases of suspected metastatic disease as opposed to lymph node neoplasms. The advantages of lymphography have been discussed by other authors. Because of the better spatial resolution of lymphograms, it is possible by proper interpretation to distinguish between neoplastic disease and lipogranulomatous changes. In a few cases in our series, this did not prove to be true; however, this may have been due to deficiencies in our interpretations (two cases of lymphoma were called positive for neoplasm, but proved to be lipogranulomatous changes by biopsy). Secondly, surveillance films may be easily and cheaply obtained to detect recurrences of disease. In addition, lymphography also provides the opportunity for biopsy of lymphoma masses, but to date this has only been accomplished by skinny-needle biopsy aspirations and not by large core biopsy techniques. After reviewing the literature and evaluating our data, we believe that several recommendations are appropriate with respect to the roles of computed tomography and lymphography. We agree with the previously stated concept that CT should be used for screening for lymphoma; however, we disagree that lymphograms have a greater advantage over CT in the biopsy-proven cases of lymphoma. Rather we believe that CT is better suited than lymphography for those cases with biopsy proven lymphoma. CT is better able to accurately localize the lymph node masses for surgeons if the surgical approach is desired and better able to define the extent of the disease throughout the abdomen. As a result of this it is capable of providing a better follow-up for therapy...

Biopsy, Needle↗

PubMed2000

Clinical trial of telepathology as an alternative modality in breast histopathology quality assurance.

Telepathology is a potential alternative to conventional histopathology. A clinical trial using a robotic telepathology system was conducted to assess the clinical and technical utility and effectiveness of telepathology in the U.K. breast screening pathology quality assurance program. Eighty-seven cases of breast disease were chosen at random from a series of 192 cases from the U.K. Breast Screening Pathology National Quality Assurance Scheme (NEQAS) collection. There were 20 benign, 23 carcinoma in situ (CIS), and 44 invasive malignant cases. The diagnostic accuracy of telepathology (TP) compared with conventional light microscopic (LM) diagnosis was 98.8%; this included a single case deferred for LM examination. The figure was similar when compared with expert consensus diagnosis (CD). In invasive tumor typing, TP accuracy was 95.4% (42/44 cases), the difference being attributable to slide color fading and would have had no impact on patient management. The accuracy of TP versus LM and expert consensus in tumor grading was 91.3% for carcinoma in situ (21/23 cases), a discordance with no relevance to patient management. TP grading of invasive tumor compared with LM diagnosis, had an accuracy of 86.4% (38/44) with a clinically significant accuracy of 97.7% (43/44). The time taken for TP diagnosis averaged 3.9 minutes per case by the end of the study. This data demonstrates that telepathology diagnostic accuracy is comparable to conventional microscopy and may therefore be envisaged as an alternative to conventional light microscopy for more rapid proficiency testing in breast screening (and perhaps other) quality assurance schemes.

Biopsy↗

PubMed1999

Screening for HBV, HCV and HIV genomes in blood donations: shortcomings of pooling revealed by a multicentre study simulating real-time testing.

This study was undertaken in order to determine whether screening of viremic blood donations by testing of pooled donor samples could constitute a technically feasible transfusional safety measure. A pilot study of real-time simulation, on a day-to-day basis, of screening of three viral genomes (hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV)) was conducted by five French Blood Centers on plasma samples collected from blood donors and studied within undiluted samples and within sample pools of various sizes. This study was carried out within time conditions compatible with the release of platelets. For the detection of HCV and HIV genomes, the five laboratories achieved a sensitivity that decreased with the size of the sample pool. Four were successful in detecting all undiluted samples. In the 1/10 diluted samples, four failed to detect one HIV or HCV sample. In the 1/100 diluted samples, all laboratories failed to detect one or more HIV or HCV samples. For HBV genome, no participating laboratories detected all of the samples of the panel, even undiluted samples, and the sample pooling considerably affected sensitivity. The improvement and standardization of assays needs to be attained, and training of laboratories appears to be a step crucial for routine screening of viral genomes in blood donations.

Blood↗

PubMed2003

[Virtual colonography].

Recent technical developments in computed tomography (CT) and magnetic resonance imaging (MRI) have made a virtual presentation of the colon possible. The results of clinical investigations comparing virtual colonography and conventional colonoscopy up to now are promising. Virtual colonography is a potential tool for colorectal carcinoma screening in the future, but it still has an unsatisfactory sensitivity for the detection of small and flat lesions and exposes the patient to substantial doses of ionizing radiation. Recent investigations using ultra-low-dose (< 2 mSv) multislice CT colonography show promising results. Magnetic resonance (MR) colonography as a radiation-free modality is the technique of the future. Although encouraging results using virtual MR colonography for the detection of colorectal polyps have been reported, the sensitivity of detecting small polyps (</= 10 mm) and flat lesions is poor. Main reason is the limited spatial resolution in MRI of the colon. The potential role of virtual colonography in the prevention of colorectal cancer is not yet clear. Larger studies with asymptomatic persons at average risk are needed, and further improvements in the detection of flat and very small (< 5 mm) lesions need to be achieved before advocating the use of virtual colonography for routine colorectal cancer screening.

Adenoma↗

PubMed2002

A breast cancer screening programme operating in a liberal health care system: the Luxembourg Mammography Programme, 1992-1997.

The national breast cancer screening programme in Luxembourg, the Mammography Programme (MP), was launched in 1992. Its primary goal was to set up an organised breast cancer screening with biennial invitation-reinvitation of women 50-64 years, 2-view mammography, technical quality assurance, double-reading procedures and close monitoring of performance. In 1994, the decision was taken by health authorities to only reimburse screening mammograms done within the MP. We evaluated the performance of 3 screening rounds that took place in 1992-1997. In 1992, 4,815 women had opportunistic screening and 4,790 attended the MP. In 1997, 861 women had opportunistic screening and 8,603 attended the MP. In 1997, the participation rate in the MP reached 50%. The referral rate in the MP was 10% for initial screening and 5% for subsequent screening. Echographic examinations accounted for 71% of referrals. Per 1,000 screened women, biopsy and cancer rates were 18.0 and 8.0 for initial screening and 10.3 and 5.8 for subsequent screening. Twenty-one percent of the breast cancers diagnosed in screened women were interval cancers. The age-adjusted proportion of tumours >20 mm was 56.1% before 1992, 45.1% for women not (yet) screened by the MP, 27.0% for interval cancers, 26.6% for initial screening and 12.0% for subsequent screenings. Tumour size distribution was similar to that observed in the Dutch Breast Cancer Screening Programme, 1990-1993, except that in the latter programme, no difference was observed between initial and subsequent screening. The Luxembourg experience shows that in a liberal health care system, a policy of organising the screening process by reimbursing only those mammograms done within the context of the organised screening programme can drastically reduce opportunistic screening. Further efforts in the Mammography Programme will aim at increasing participation and look at ways to decrease referrals to echography.

Aged↗

PubMed1994

An evaluation of cervical screening in general practice.

OBJECTIVES: To identify the technical practices of general practitioners (GPs) in relation to Papanicolaou (Pap) smear screening, and the differences in screening practices between male and female practitioners; to determine the cellular content of smears taken; and to correlate screening practices and demographic variables with smear results. DESIGN: During February-May 1992, a sample of Melbourne GPs filled in a questionnaire concerning their screening practices, and the results were correlated retrospectively with results of Pap smears taken in March and October 1991. SETTING: Melbourne metropolitan general practice. PARTICIPANTS: One hundred and seventy-nine GPs (72% participation rate among eligible practitioners) from a sample obtained from the register of the Medical Board of Victoria. RESULTS: Female doctors took significantly more smears than male doctors. An opportunistic approach to cervical screening was most commonly practised, with the patient being asked to ring for her results and the practice staff only contacted her if the result was abnormal. Only 43% of doctors indicated the use of a specific reminder system when rescreening was due. Endocervical cells were present in 79% of smears. The presence of endocervical cells was found to be related to the year of a doctor's graduation (with both very recent and older graduates [pre-1960s] having lower endocervical cell rates), and to be positively correlated with more postgraduate training. CONCLUSIONS: Our study suggests that further education and training in cervical screening is needed for some GPs, in particular, male doctors, graduates of less than four or greater than 20 years, and those without postgraduate training.

Adult↗

PubMed2007

Identification of nucleated red blood cells in maternal circulation: a second step in screening for fetal aneuploidies and pregnancy complications.

BACKGROUND: Identification of fetal nucleated red blood cells (NRBCs) in maternal circulation can facilitate non-invasive prenatal diagnosis, but technical difficulties still exist. An increase in the number of circulating NRBCs, however, could indicate fetal aneuploidies or pregnancy complications. MATERIALS AND METHODS: The number of NRBCs was determined from 20 mL peripheral blood in 351 women in the second trimester of pregnancy after isolation by magnetic cell sorting (MACS) with anti-CD71 antibody and identification with May-Grunwald/Giemsa staining. RESULTS: An average of eight NRBCs (range 1-12) were identified among 282 women with chromosomally normal fetuses. In cases known to carry aneuploid fetuses the mean number was 35 (range 7-113), but when the fetus had trisomy 21 (n = 17) an average of 71 NRBCs were identified. Among 26 carriers of beta-thalassemia, 42 NRBCs (range 22-158) were isolated. In pregnancies with abnormal Doppler findings in both uterine arteries (n = 20), 15 NRBCs (range 2-75) were isolated. CONCLUSION: Determining the number of NRBCs in maternal circulation could represent an additional screening step for fetal aneuploidies, as long as the anemic status of the mother is taken into consideration. However, more cases with abnormal Doppler results must be investigated before this test is used for in the prediction of pregnancy complications.

Adult↗