Role of the nurse in the multiphasic screening program.
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Multiphasic Screening↗
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A clinically effective breast cancer screening program can be cost-effective, too.
The logistics of complying with current American Cancer Society breast cancer screening recommendations in a large health maintenance organization, serving more than 50,000 women age 40 or older, are described. An alternative screening approach estimated to be at least as health-effective as the American Cancer Society recommendations has been developed and appears to solve the problem and is financially feasible. Cost-effectiveness depends on optimal use of mammography and health-care personnel resources. The authors show how the start-up and maintenance costs of an organized program can be offset by future cost savings resulting from reduced long-term disability in patients diagnosed at Stages 0-1 as opposed to Stages 2 and later. Careful selection of the delivery model before implementation can make a breast cancer screening program cost-effective as well as health-effective.
Adult↗
Cytometric characterization and clinical course of breast cancer diagnosed in a population-based screening program.
A randomized controlled trial evaluating mammographic screening was started in two Swedish counties in 1977. In one of these, Ostergötland county, the authors performed static cytofluorometry on 161 cancers detected at the second and third screening rounds, 50 interval cancers, and 219 cancers appearing in the nonscreened control group during the same time period. The median follow-up time was 42 months. No difference in mean S-phase was found between screening and control group cancers, but interval cancers, appearing between two screenings, had increased mean S-phase levels (P = 0.01) compared to both of the other groups. A high S-phase fraction was associated with distant recurrence in both node-negative and node-positive tumors. Aneuploid tumors were more often found in the control group (67%) and among interval cancers (72%) than among screening detected cancers (55%, P = 0.02). In Cox's multivariate analysis, including all patients, the lymph node status, tumor size, estrogen receptor content, and S-phase all contributed independent prognostic information about the clinical course. DNA ploidy predicted the outcome in simple but not in multivariate Cox's analysis. When analyzing screening-detected cancers separately, only the S-phase significantly predicted distant recurrence in multivariate analysis. In tumors with local recurrence, a high S-phase implicated an increased, although not statistically significant, risk for distant recurrence. Survival with metastatic disease was significantly influenced by the S-phase level (P = 0.002). The authors conclude that S-phase fraction provides valuable kinetic information related to the clinical outcome for all stages of the disease and serves as a prognostic factor in screened populations, which have tumors predominantly in early stages.
Adult↗
Consumer choice and the National Bowel Cancer Screening Program.
The opportunity for informed choice in screening is limited.
Australia↗
[Local screening program for prostate cancer].
OBJECTIVE: By massive screening of men between 50 and 75 years of age, to find those of them that are in the early stage of the carcinoma of the prostate and evaluate the usefulness of applying this method nationwide. PATIENTS AND METHODS: 183 male Pleven citizens between 50 and 75 years of age underwent clinical examination, digital rectal examination (DRE) and serum prostate-specific antigen (PSA) determination. Those with suspicious DRE or PSA > 4 ng/ml underwent further examinations: transrectal ultrasonography (TRUS) and biopsy. The sensitivity and specificity of these tests were determined. RESULTS: The mean age of the patients was 63.66 years. Six of them (3.28%) had suspicious DRE while PSA was > 4 ng/ml in 10 (5.46%) patients. Biopsy proved cancer in 2 (1.09%) patients. We needed 6 biopsies to prove one cancer. PSA had the highest sensitivity (100%), while DRE had the highest specificity (97.8%). CONCLUSION: Because of its high sensitivity, PSA could be used for massive screening of the carcinoma of the prostate. However, the low percent (1.09%) of the new-found patients with cancer and the relatively high price of the investigation leave this question open for the time being.
Aged↗
A community screening program for Helicobacter pylori saves money: 10-year follow-up of a randomized controlled trial.
BACKGROUND & AIMS: Population screening and treatment of Helicobacter pylori has been advocated as a means of reducing mortality from gastric cancer, as well as dyspepsia and dyspepsia-related resource use. Previous programs have failed to demonstrate a significant effect on mortality or resource use, but follow-up was only for 1 or 2 years. We aimed to determine the effect of screening for H pylori on dyspepsia and dyspepsia-related resource use over 10 years. METHODS: H pylori-positive individuals, aged 40-49 years, enrolled in a community screening program, randomized to eradication therapy or placebo in 1994, were sent a validated dyspepsia questionnaire by mail 10 years later, and primary care records were reexamined. Consultation, referral, prescribing, and investigation data related to dyspepsia were extracted. United Kingdom costs were applied to derive total cost per person (1 pound = 1.8 dollars). RESULTS: Of 2324 original participants, 1864 (80%) were traced and contacted. Of these, 1086 (47%) responded, and 919 (40%) agreed to a review of their primary care records. There was a 10-year mean saving in total dyspepsia-related costs of 117 dollars per person (95% confidence interval [CI] = 11 dollars-220 dollars, P = .03) with eradication therapy. Those symptomatic at baseline showed a nonsignificant trend toward resolution of symptoms at 10 years with eradication therapy (relative risk of remaining symptomatic, 0.89; 95% CI: 0.77-1.03). CONCLUSIONS: There were significant reductions in total dyspepsia-related health care costs. The savings made were greater than the initial cost of H pylori screening and treatment.
Adult↗
Evaluation of a nurse-based hypertension management program: screening, management, and outcomes.
This article reports the experience of patients with elevated blood pressure scheduled to be seen in a nurse-based hypertension management program in a large multispecialty group practice. The hypertension management program is a screening and follow-up program designed to improve the measurement and management of patients' blood pressure with standardized protocols. The cohort for this study of the effectiveness of the hypertension management program consisted of 200 patients with elevated blood pressure (140 referred directly for management and counseling, 60 entered through screening). At entry, only 17% of the patients had blood pressure within controlled limits (< 140/90 mm Hg). One year after entry in the management phase of the program, systolic pressure had decreased an average of 6.20 mm Hg (P < 0.01), and 44% of patients had blood pressure within controlled limits (P < 0.001). These results suggest that the use of standardized screening techniques using multiple measurements helps to ensure that patients will not be unnecessarily treated. Furthermore, patients who entered the program successfully lowered their blood pressure and maintained the reduction over time.
Blood Pressure↗
Clinical assessment of three hemoglobin screening programs on a selected population.
Through three related programs, 9,675 individuals were screened for hemoglobinopathy. The studied population was predominantly black (58%) and male (91%). Identified were 333 variants (3.4%), 90.7% of them in blacks. Two hundred occurred in hospitalized patients. Laboratory results were entered in medical charts in all but three instances. Annotation of the abnormality by a physician in the progress notes, discharge summary, or final coded diagnosis was made in 14.4% of the reviewed records. This included 46.7% of 15 patients with clinically manifested disease related to the hemoglobinopathy.
Anemia, Sickle Cell↗
Development of a screening program for tardive dyskinesia: feasibility issues.
This report is part of a feasibility study focused upon developing a valid and reliable method of screening for tardive dyskinesia. The research questions concerned establishing the validity and reliability of the procedure, the acceptability of the procedure to the subjects, and the characteristics of the subjects with scores that exceeded more than a minimal level. Sixty patients were screened in four randomly selected psychiatric aftercare homes. A 12-hour training program was developed to prepare the raters. The interrater reliability achieved for total score using the Abnormal Involuntary Movement Scale (AIMS) was .90, p less than .01, and the validity of the examination was achieved and maintained at an 80-percent agreement level between the nurse raters and a study expert. Thirty percent of the population had scores exceeding minimal symptoms for tardive dyskinesia. The screening program was acceptable to the subjects. A program of training for professional-level raters is described, which is applicable to many settings.
Adult↗
Evaluation of a clinic-based screening program for lung cancer with a case-control design in Kanagawa, Japan.
A case-control study was performed in Kanagawa Prefecture, Japan, which introduced lung cancer screening, by family physicians, to determine if this program was effective. The subjects were persons who died from lung cancer, restricted to those between 40 and 74 years old at death, and National Health Insurance (NHI) holders. A total of 193 lung cancer deaths meeting the criteria were selected for the case group. Three controls for each case were selected at random from living NHI holders matched by residence, gender and year of birth (+1 year). Smoking adjusted odds ratios were calculated using a multiple logistic regression model. The odds ratios of dying from lung cancer for screening participants within 12 months compared with non-participants was 0.535 which was statistically significant (95% CI, 0.337-0.850). The odds ratio in the 12-24-month period before diagnosis was 0.638 (0.302-0.967), which was also significant. The results demonstrated that screening for lung cancer by family physicians can reduce the lung cancer mortality, and that a clinic-based screening program by family physicians is effective.
Adult↗
[Results of monitoring the year 2002 of the Hungarian breast cancer screening program].
AIM: The aim of the study is to analyse the regional and time range characteristics of the breast cancer screening programme and the utilization of health services related to the programme. METHODS: The data derive from the database of the National Health Insurance Fund Administration containing routinely collected financial data. The patients include all the women having mammography screening in the year of 2002 (N=314,395). In the time range analysis the starting point (T0) was the time of the mammography screening identified with the outpatient code "42400 mammography screening". We calculated the average delay between the time of mammography screening (time=T0), further diagnostic (time=T1) and therapeutic (time=T2) procedures. For the calculation of the average period spent from the time of mammography screening we used the median value instead of arithmetic mean. RESULTS: According to our data 17,303 women had ultrasound examination in axilla (T1 median value: 20 days) and 23,249 women had ultrasound examination in breast (T1 median value: 26 days). Among the women having mammography examination in 2002, 906 had chemotherapy (T2 median value: 83 days), while 1364 patients had radiotherapy (T2 median value: 136 days). The T2 median value of subtotal and total mastectomy was 43-47 days and 50-53 days respectively, while the T2 median value of breast operations because of non-malignant causes was 57 days after mammography screening. The total annual cost of organised breast cancer screening programme, including the cost of mammography examination, the cost of further diagnostic examination and surgical, radio- and chemotherapy treatment of recalled women, was 2,242 billion Hungarian forints (8,968 million euros) in 2002. CONCLUSION: We observed significant regional differences, which result in large discrepancies in the equity. We can assume that these differences can be reduced by better organisation and the more consistent application of professional guidelines.
Breast Neoplasms↗
The worth of a screening program: an application of a statistical decision model for the benefit evaluation of screening projects.
A statistical decision model is applied to the benefit evaluation of screening projects to derive an expression which provides upper and lower limits for average benefits in terms of prevalance rates of screen positives and negatives, and the average cost of screening and referral. Possible applications of such a technique are discussed and a numerical example is given.
Bayes Theorem↗
Three impedance screening programs on a cohort of seven-year-old children. Can serial impedance screening reveal chronic middle ear disease?
In an unselected cohort of 387 seven-year-old children 90% got all 9 planed tympanometries in the first year at school. The results from these 348 children had been analysed in three different impedance screening models, as 3 consecutive screening series, each comprising two or three tests with an interval of 4 to 8 weeks. The specificity of the ASHA and Nashville models were too low, about 70%, there were too many false positive cases. Therefore a new impedance screening model, was constructed. It had about the same sensitivity (80%) and a fare better specificity (95%) than the ASHA and Nashville models. The predictive value of a positive test was 15% in the ASHA and Nashville models but three times better (48%) in the Hirtshals model. The Hirtshals model had a referral rate of 9% compared with the 32-36% in the ASHA and Nashville models. The frequencies of retesting were 31% in the ASHA model, 52% in the Nashville model and 45% in the Hirtshals model.
Acoustic Impedance Tests↗
How effective are "community" stroke screening programs at improving stroke knowledge and prevention practices? Results of a 3-month follow-up study.
BACKGROUND AND PURPOSE: Community stroke screening is a commonly used prevention strategy to identify and educate those at risk. Although the goal of this approach is to reduce the overall occurrence of stroke, its long-term benefit remains unknown. The purpose of this study was to determine whether attendance of a stroke screening changes knowledge or prevention practices in persons at risk for stroke 3 months later. METHODS: A stroke screening event was held following the National Stroke Association guidelines, with health screening, counseling, and education. Knowledge about stroke was measured by a questionnaire before and after the event. At 3 months, attendees identified at risk for stroke were contacted by telephone to determine their retained knowledge and any specific actions taken as a result of the health counseling. RESULTS: At 3 months, 78 persons were contacted. Knowledge of stroke warning signs increased from 59% to 94% after screening but decreased to 77% at 3 months. At 3 months, 73% had done nothing to change their health practices. CONCLUSIONS: Community stroke screening has modest effects on health behavior, knowledge of stroke risk factors, and warning signs.
California↗
Clinical outcomes from skin screening clinics within a community-based melanoma screening program.
BACKGROUND: Within a randomized trial of population screening for melanoma, primary care physicians conducted whole-body skin examinations and referred all patients with suspect lesions to their own doctor for further treatment. OBJECTIVE: Our aim was to describe characteristics of skin screening participants, clinical screening diagnoses, management following referral, and specificity and yield of screening examinations. METHODS: Information collected from consent forms, referral forms, and histopathological reports of lesions that had been excised or undergone biopsy was analyzed by means of descriptive statistics. RESULTS: A total of 16,383 whole-body skin examinations resulted in 2302 referrals (14.1% overall; 15.5% men, 18.2% > or = 50 years of age) for 4129 suspect lesions (including 222 suspected melanoma, 1101 suspected basal cell carcinomas [BCCs], 265 suspected squamous cell carcinomas [SCCs]). Histopathologic results were available for 94.8% of 1417 lesions excised and confirmed 33 melanomas (23 in men; 24 in participants > or = 50 years of age), 259 BCCs, and 97 SCCs. The probability of detecting skin cancer of any type within the program was 2.4%. The estimated specificity of whole-body skin examinations for melanoma was 86.1% (95% confidence interval = 85.6-86.6). The positive predictive value (number of confirmed/number of lesions excised or biopsied x 100) for melanoma was 2.5%, 19.3% for BCC, and 7.2% for SCC (overall positive predictive value for skin cancer, 28.9%). LIMITATIONS: Follow-up of participants with a negative screening examination has not been conducted for the present investigation. CONCLUSIONS: The rate of skin cancer detected per 100 patients screened was higher than previously reported and men and attendees older than 50 years more frequently received a referral and diagnosis of melanoma. The specificity for detection of melanoma through whole-body skin examination by a primary care physician was comparable to that of other screening tests, including mammography.
Adult↗
[Risk management in a regional screening program for breast cancer in the region of Lazio, Italy].
In the Lazio Region, it has been put into effect a plan of clinical Risk Management for the Breast Cancer Screening Regional Program (BCSP), involving all of the 12 Local Health Units and the Public Health Agency of Lazio (ASP). Being the BCSP a health care service, it consists of a perfect integration of health care structures, professionals and skills working for the citizens. This program originates from an unexpressed health need and leads to a evidence-based health benefit. The BCSP provides free breast screening for 700,000 women aged between 50 and 69 in the Lazio region; the Public Health Agency carries out the clinical governance of the BCSP The prevention of errors and incidents represents a fundamental basis of governance: it is a contribution to the achievement of efficacy in breast cancer screening. The BCSP deals with screening incidents from a systemic point of view and actively involves several Local Health Units staff going through each step of the whole patient's clinical path, from the identification of the target population, to the oncological treatment of positive cases. The programme is an integration of different tools: literature research, process analysis using the HFMEA methodology and reporting system. The results reached so far are the following: the regional severity rating scale, the regional Master-List of possible adverse events, occurrence and detection rating scale.
Aged↗
[Formulation of a non-related anonymous screening program for HIV].
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Ethics, Medical↗
[Value of neonatal screening for cystic fibrosis. Evaluation of a neonatal screening program including 34,522 neonates (author's transl)].
Screening for cystic fibrosis in 34,522 neonates was done by assaying proteolytic activity in feces samples spread on special filter paper. Infants were considered at high risk for cystic fibrosis if proteolytic activity was significantly decreased and albumin was found in all the fresh stool specimens. Cystic fibrosis was detected in eight infants, most of whom were already hospitalized for respiratory and/or digestive manifestations suggestive of the disease. Six other patients, one of whom was three-and-a-half years-old, were detected after referral by pediatricians. Two false-negative results were recorded, in infants without detectable pancreatic involvement. Given these results, the authors believe that routine neonatal screening for cystic fibrosis is unnecessary. The various etiopathogenetic mechanisms and the possibilities for investigating patients with cystic fibrosis are discussed.
Clinical Enzyme Tests↗