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PubMed1976

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

In Finland, the organized mass screening program for the early detection of cervical cancer covers, with few exceptions, all women between the ages of 30 and 55 every fifth year. On the basis of material originating from the Finnish Cancer Registry it was estimated that the probability for a woman aged 30-59 to experience frankly invasive cervical cancer was 0.010 before the screening program, and 0.002 after the first screening. The corresponding probability estimate was 0.022 for pre-invasive lesions subjected to operative treatment. On the assumption that the same relationship applies beyond this age group it was estimated that from 28-39% of the pre-invasive cases progress to invasive cervical cancer, and that 21% of the frankly invasive cases are preceded by a pre-invasive stage of shorter duration than the time period between the screenings, or have no preclinical stage.

Adult↗

PubMedDate not supplied

Effects of news events on response to a breast cancer screening program.

An opportunity to examine the effects of significant, widely reported events on participation in a breast cancer screening program was presented when countrywide public attention was called to breast cancer by reports of the breast surgery of the wives of President and Vice President of United States. These events occurred in September and October 1974 while a breast cancer screening program was underway in the health Insurance Plan of Greater New York. The research design of this program permitted measurements to be made of the participation of the plan's members in the screening before, during, and after these famous mastectomies and of the participants' characteristics during different periods of the research program. In late 1974, when there was great mass media emphasis on breast cancer, participation rates in the breast cancer screening program increased significantly. In the study periods immediately following, however, participation rates declined to previous levels. The increase in Participation rates in late 1974 was fairly uniform among all demographic groups, whether classified by age, education, income, race, or religion. In addition to increases in the participation rate associated with the events of late 1974, there was also an increased tendency among women who were screened to respond readily to mailed invitations to appear for screenings. This increase insensitivity to efforts to win their participation was more pronounced among those groups that this study and other studies have shown are more likely to participate in preventive health programs and to respond more readily to request to participate.

Age Factors↗

PubMed1990

Sociomedical factors affecting participation in screening program on cerebro- and cardio- vascular disease.

In 1984 the Public Health Bureau of Nagoya City began a new health check-up program to encourage citizens aged 40 years to have a medical examination. The rate of participation was 46.6% greater than that of the previous program; however, at about 16%, it was still low. From the survey in Moriyama Ward following results were suggested. Housewives and female part-time workers who had not had a health examination during the previous year showed participation rates of 32.7% and 42.4%, respectively. It would seem that the low rate of participation in the health examination program conducted in the metropolitan area by the municipal Public Health Bureau is due to the existence of many medical care facilities, and the fact that 64.6% of men and 52.6% of women had undergone a medical examination in the year preceding the program. Total screening rates became 69.7% in males and 66.0% in females. Participation rates of 32.7% and 42.4% were achieved by unemployed women and by women with part-time employment, respectively, who had no experience of screening in the previous year. Total screening rates were 63.7% for the unemployed women and 82.1% for the part-time women.

Cardiovascular Diseases↗

PubMed1992

Improving future preventive care through educational efforts at a women's community screening program.

Cervical cancer mortality continues to be a significant problem in the United States. Pap Test screening programs have been effective in attracting high risk women, but the impact of these programs on subsequent health care has seldom been explored. This follow up study examined the impact of a cervical cancer screening and education program on preventive health behaviors of New Hampshire women in the 24 months following the screening program. A mailed survey was sent to a random sample of 750 women from program participants to evaluate both their recent preventive health care practices and to identify perceived barriers to obtaining preventive health services. Of these, 71.1 percent responded. Survey responses of the original program participants were linked to each subject's previous answers to the same questions asked 24 months earlier. A comparison group was derived by asking follow up study participants to identify a female acquaintance within five years of her age. Seventy-four percent of the comparison group responded. Survey responses of original program participants were then compared to those of the comparison group. Results indicate that women who participated in the original Project received significantly more preventive health care services in the two years since the Project than in the two years prior to it. Women in the comparison group received more Paps and clinical breast examinations than women in the participant group, perhaps because all participants had received a Pap test two years before. Having a regular health care provider was the most significant characteristic associated with obtaining indicated preventive services. An important contribution of community screening programs may be to encourage women to establish a regular source of care.

Adult↗

PubMedDate not supplied

Stereopsis testing in a preschool vision screening program.

We conducted a preschool vision screening study using stereopsis testing with the Random Dot E and Lang stereotests as a complement to visual acuity measurement. Over 6000 children were screened. Stereopsis testing at a threshold of 600 seconds of arc was cognitively easier for the children than visual acuity measurement. At this threshold there was no effect on reducing the rate of visual acuity overreferrals, but ten children with abnormal binocular vision were detected who were not referred by visual acuity criteria. Though a large number of children passed only one of the two stereotests, there was no significant difference in their degree of difficulty. Stereopsis testing with these two stereotests may be a useful adjunct to preschool vision screening programs though further studies are required.

Child, Preschool↗

PubMed1988

Comprehensive vision screening program: Illinois' approach.

This article discusses a statewide vision screening program that utilizes trained and certified vision screening technicians under the auspices of the Department of Public Health. Public Act 81-174, the Child Vision and Hearing Test Act, mandates periodic vision screening of children using accepted and approved instruments and standards. The program receives consultation from the Children's Vision Services Advisory Committee, consisting of optometrists, ophthalmologists and others in health and education programs. Topics addressed include: training and certification of technicians; screening, referral and follow-up; program summary of statewide screening statistics of 1.2 million children for fiscal year 1985, etc.

Adolescent↗

PubMed1978

Mammographic parenchymal patterns as risk indicators for incident cancer in a screening program: an extended analysis.

In a screening program of self-referred women, different mammographic parenchymal patterns were related to significantly different rates for developing breast cancer. The risk of cancer detection subsequent to a negative mammographic examination was 7.6 times greater for women in the highest parenchymal risk class compared with the lowest, an increase in risk comparable to that of a personal history of breast cancer and greater than that reported for any other combination of historical risk factors. These differences are qualitatively similar to, but of a lesser magnitude than, those in previous reports which were based on symptomatic women with previous negative mammograms. Data suggest this difference in risk is inherent between parenchymal patterns, rather than indicating difficulty in identifying small cancers in dense breasts. Findings of differential parenchymal risk, coupled with other risk factors, may lead to concentrating mammographic screening on a smaller segment of the population, thus improving the benefit-to-cost ratio.

Adult↗

PubMedDate not supplied

Survey of departments of health about PKU screening programs.

Mailed questionnaires were used to examine the success of PKU (phenylketonuria) screening programs that were operated by departments of health and to examine differences between these programs. Of 55 departments, 44 were returned and 42 departments reported they had a PKU detection program. Thirty-eight respondents considered the PKU detection program to be effective, and 31 respondents indicated that the entire program cost $60,000 or less per year. The answers and comments on the questionnaires showed a generally positive view of the effectiveness about the value of the treatment program in general were also positive. However, a few departments indicated that more clinical evidence and experience were needed to fully evaluate the overall merits of PKU detection and screening programs.

Costs and Cost Analysis↗

PubMed1988

Pharmacy-based screening program for tardive dyskinesia.

An ongoing screening program using pharmacists to detect tardive dyskinesia (TD) was developed, and a pharmacy-based prevalence survey of TD in chronic hospitalized psychiatric patients was undertaken to determine the extent of abnormal involuntary movements. The results show that older patients and women in particular are at higher risk for developing abnormal movements. Higher doses of neuroleptics were used in non-TD patients, indicating a possible masking effect caused by these drugs. By using a standardized rating method such as the Abnormal Involuntary Movement Scale, pharmacists can and should be utilized in the surveillance of TD.

Adolescent↗

PubMedDate not supplied

[Automatic perimetry in screening programs].

This work has studied the use of automatic perimetry in glaucoma screening programs. Subjects with suspicious glaucoma were selected on the basis of tonometry and direct ophthalmoscopy. Visual fields were analyzed using the G1 program of the Octopus 500 E automatic perimeter. A prevalence of 3.49% of glaucoma was observed in persons above 40 years old. This represents a higher incidence in comparison to other studies. The inclusion only of those subjects with suspicious glaucoma for automatic perimetry has resulted in a more precise and earlier diagnosis of glaucoma without unduly prolonging the duration of the study. Undoubtedly, automatic perimetry can improve both the reliability of the diagnosis and incidence of glaucoma in screening programs. Moreover, this does not necessarily mean more prolonged or costly studies.

Adult↗

PubMed1985

What participants understand about a maternal serum alpha-fetoprotein screening program.

We investigated the knowledge of pregnant women participating in a maternal serum alphafetoprotein (MSAFP) screening program for the detection of neural tube defects (NTDs) in the fetus. Women participating in the screening program scored higher on two knowledge tests than a comparison group of pregnant women who were not offered screening. However, there were substantial gaps in the knowledge base of women in the program, as measured by one of the tests. Women did not misinterpret a negative test result to mean that the test had identified a potential problem with the fetus; instead, there is a suggestion that they tended to interpret a negative result too positively, as an assurance that the baby was healthy in all respects.

Adult↗

PubMedDate not supplied

Developing a breast cancer screening program for Chinese-American women.

The Chinese, like other minority groups, often underuse cancer screening services because of language, cultural, and economic barriers. Nonattendance reduces the probability that cancer will be detected in its earliest and often most curable form. To improve use of cancer screening services among Chinese-Americans, a community-based coalition organized a one-day demonstration cancer awareness and screening program--the Breast Cancer Screening Day for Chinese Women. More than 100 women, many of whom did not speak English, attended the program. Six abnormal mammograms required follow-up and one breast cancer was detected. The planning process used to develop this successful project is described as are suggestions to improve future screening programs for ethnic minorities.

Adolescent↗

PubMed1991

Results of a prenatal screening program for the human immunodeficiency virus in a cross-sectional population.

A prenatal screening program for antibody to the human immunodeficiency virus (HIV) was examined prospectively in a cross-sectional population. Routine screening was performed on 3,241 women during the first trimester. Serum samples yielding repeatedly positive results on an enzyme-linked immunosorbent assay (ELISA) (n = 6) were subjected to confirmatory Western blot testing. All the specimens were determined to be false positive with atypical banding regions not consistent with HIV-1 infection. This false-positive rate was higher than in previous reports of screening programs in low-risk populations (P less than .005). Since antibody to HIV may not be detectable for several months after infection, we serially tested 984 of the women in different trimesters of pregnancy to determine whether repeat testing would yield seroconversion undetected at the first screening. No patient who initially tested negative on the ELISA tested positive later in gestation. We therefore recommend that routine screening be performed only once during pregnancy, preferably in the first or early second trimester, in the general population.

Adolescent↗

PubMed1992

A successful breast cancer screening program.

A private, low-cost mammography screening program in Charlotte, North Carolina, has grown from one to four fixed sites in the past 6 years and now screens more than 25,000 women annually. An ongoing medical audit of the program shows that the percentage of patients with breast cancer with positive lymph nodes has decreased from 29% to 13%, and the percentage of minimal cancers found has increased from 31% to 52%. Compliance for regular screening has remained at approximately 50% for the past 2 years. Means of increasing compliance to desired levels are discussed.

Breast Neoplasms↗

PubMed1990

Survey of performance of cervical cytopathology laboratories and of screening programs in Italy. National Working Group for Quality Assurance in Cytohistopathology.

Structure, performance, management, quality control and participation in screening programs of cervical cytology laboratories have been evaluated through a questionnaire sent to all public Italian hospitals, relevant university departments and senior members of relevant scientific associations. Completed questionnaires were received from 276 centers, which gives a response rate of 73%. In this report we concentrate on the need for improvement, but there are a number of centers who have all or almost all the features traditionally associated with good or excellent practice. The main results of the survey are the following. Most of the centers examine relatively few cervical smears, so their workload could be considered too low for maintaining a good level of practice. Six centers examine 3 specimens per woman, about 25% examine 2 specimens, and the rest only 1 specimen. There is a marked variability in filing and storing practices of positive and negative smears and results. Internal quality control is inadequate in most centers, and external quality control is limited to voluntary exchange of dubious or interesting smears. Only half of the centers are involved in screening programs. In 75% of the programs the suggested screening interval is 1 year or even 6 months; only 7 (4.5%) agree with the UICC/IARC recommended interval of 3 years. The target population coverage varies from 10% to 85%, and it is less than 50% in 78% of the programs. Only 6 programs have an active women's call system. The survey has confirmed the need for launching a national program of internal and external quality control. Almost all centers have expressed their interest to take part.

Adult↗

PubMed1990

Results of a repeat television-advertised mass screening program for colorectal cancer using fecal occult blood tests.

The results of a 1987 television-advertised colorectal screening program using fecal occult blood tests (FOBT) are compared with the initial 1986 program (results in parentheses). In the 1987 program, 73,508 fecal occult blood test (FOBT) kits were distributed free of charge, of which 63% were returned for analysis (57,000, 53%). Twenty-five percent of persons from the initial screening participated again in the 1987 program: 1,303 or 2.8% of persons had a positive screen (1,165, 3.9%). The predictive value of a positive screen was 23% for an adenomatous polyp and 8% for colorectal cancer (22%, 8%). Seventy-nine percent of the cancers detected were Dukes A or B or carcinoma in situ (78%). In order to promote a more thorough diagnostic work-up in positive screenes, a suggested diagnostic algorithm for the work-up of a positive FOBT was sent to participating physicians. Despite this, 35% of positive screenees had a diagnostic work-up limited to a repeat FOBT, and/or sigmoidoscopy only (32%). In conclusion, television-advertised mass screening programs consistently enroll large numbers of participants. The rate of compliance (percent of kits returned) and the limited diagnostic evaluation of persons with a positive screen appear to be the major factors limiting the success of our screening program.

Adenocarcinoma↗

PubMed1988

Screening programs for congenital hypothyroidism. How can they be improved?

High-sensitivity neonatal hypothyroid screening tests are used throughout the country. Because of low specificity, primary care physicians are faced with an abundance of false-positive results that challenge the interpreting physician with clinical, economic, and medicolegal considerations. We surveyed 154 physicians caring for Wisconsin-born infants with the highest newborn-screen thyrotropin values in a two-year period. Our results indicated that (1) confirmation of thyroid normalcy is often delayed beyond 6 weeks of age; (2) there is wide variation among physicians regarding therapeutic goals if hypothyroidism is confirmed; and (3) physicians prefer autonomy in the management of congenital hypothyroidism. Modifications in hypothyroid screening programs may include confirmatory tests by a central laboratory (that distributes filter paper with all abnormal results), provision of a management decision tree for primary care physicians, and a one-time subsidy for a visit to a pediatric endocrinologist. We suggest that these modifications may improve the long-term outcome of hypothyroid infants identified by the screening program.

Attitude of Health Personnel↗

PubMed1985

The use of lay readers of chest roentgenograms in industrial screening programs.

A study was conducted to test the feasibility of training lay persons to screen chest x-ray films for professional readers in an industrial screening program and to use the International Labor Office classification of the pneumoconioses for silicosis. With minimal training the lay readers agreed with the professional readers on the presence or absence of silicosis in 72.6% of the films and missed only 3.2% of the silicosis identified by the professional readers. The lay readers were able to identify only 17.1% of the pathology other than silicosis; however, it appeared that they identified some of these conditions as silicosis. Considering this, the lay readers missed only 27.0% of the other pathologies. It was concluded that, with more extensive training, lay persons could be taught to screen chest X-ray films for professional readers in an industrial screening program.

Allied Health Personnel↗