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PubMed1986

Evaluation of the effect of Papanicolaou screening in Sweden: record linkage between a central screening registry and the National Cancer Registry.

Development of in-situ or invasive carcinoma of the uterine cervix was studied among 930,127 women reported to a Swedish Central Screening Register through a record linkage between that Register and the National Cancer Registry. The relative protection against cervical cancer after one negative smear, calculated on incidence level prior to screening, is 14.5 for the first year and drops to 3.4 five years after the screening. The relative protection after two or more negative smears is considerably higher for the first three years but for the years following drops to the same level as after one negative smear.

Adenocarcinoma↗

PubMed1986

A community-based program of colorectal screening in an asymptomatic population: evaluation of screening tests and compliance.

The incidence of colorectal cancer in Ashkenazi Jews is two to three times higher than in non-Ashkenazis. For a community colorectal screening program 1339 asymptomatic Ashkenazis over 40 yr old were asked to participate. Of these 1012 (75%) took Hemoccult II kits [fecal occult blood tests (FOBT)], and 614 (46%) personally returned them. Screenees were interviewed regarding family and personal medical history. Fourteen persons (2.3%) had positive tests, in whom colonoscopy revealed two with cancer (Dukes' B,C) and two with a greater than 2 cm polyp. The remaining 600 persons were invited for flexible sigmoidoscopy (FS) but only 287 (48%) appeared. The mean depth of insertion of the instrument was 50.3 cm (range 30-120), but was poorer for women. FS identified lesions in 28 (9.7%) persons: three had Dukes' A carcinomas and 25 had less than 2 cm adenomatous polyps. Significantly more women than men accepted FOBT, but among those completing FOBT, there was no difference by sex for use of FS. Middle-aged persons (50-69 yr) found screening more acceptable than young or older persons. Among screenees who agreed to undergo FS, a significantly larger fraction had a first relative with colon cancer, or a personal history of colon or female genital neoplasia, compared to those not agreeing to FS. There were no differences in screenees with relatives with noncolon cancer. Eighty-eight couples completed FOBT and were invited for FS. The decision whether or not to participate was made for both members in 81 (92%) couples. In conclusion, effective screening programs have to take into consideration compliance patterns of the target population.

Adult↗

PubMed1985

[Studies of screening, detection and mortality rates in mass screening for uterine cervical cancer in Shimane prefecture].

To assess the value of mass-screening for uterine cervical cancer, we compared data obtained from a "model area" with findings obtained from the whole of Shimane Prefecture. The factors given attention were: Screening ratio, detection ratio and mortality directly related to cancer of the uterine cervix. These data were obtained from 1976-1980. The results are as follows: Screening ratio and mortality rates were 35.7% and 7.8% respectively, in the model area and 8.4% and 11.5% respectively, in Shimane Prefecture. Four years after setting up the "model area", the mortality rate for uterine cervical cancer reached zero. The ratio of cancer detection in the "model area" was 0.204%, that is about twice that in Shimane Prefecture. The ratios of detection of severe dysplasia, carcinoma in situ and infiltrative carcinoma were higher in the "model area" than in Shimane Prefecture. Detection of severe dysplasia and carcinoma in situ was significantly high in the "model area". Therefore, to reduce the mortality rate for cervical cancer, the CAI should be over 350.

Adult↗

PubMed1985

Screening for endometrial carcinoma by endouterine aspiration cytology with analysis of tumor markers in the aspirates. Development and application of a new screening technique.

A new endometrial aspiration technique for office screening of endometrial carcinoma without an anesthesia was studied. In patients without apparent signs of cervical canal stenosis, all of whom were 50 years of age or older, the aspiration attempt was successful in 96%. The aspirates were used for cytologic study and tumor marker assays. The results indicate that screening for endometrial carcinoma should be based on the determination of biochemical tumor markers in the uterine fluid. Lactate dehydrogenase (LD) is recommended as a primary marker, determined as total LD and as LD isoenzyme activity. Endometrial cytology is recommended as a supplementary screening technique in selected cases.

Aged↗

PubMed1983

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↗

PubMed1984

Simplified models of screening for chronic disease: estimation procedures from mass screening programmes.

The performance of a screening programme depends on a number of parameters, which may need different types of information for their estimation. In this paper, two characteristics of interest, the sojourn-time distribution and the sensitivity, are considered, and estimation procedures, based on data which should be available from a mass screening programme, are proposed. The methods are applied to published data from the HIP breast cancer screening project, to which a negative exponential distribution for the sojourn-time distribution fitted better than the other families of distribution considered.

Breast Neoplasms↗

PubMed1975

[Organization of mass-screening for early detection of cervical cancer and its precancerous conditions. I. report: Demonstration of a computer assisted mass-screening program (Model Rostock) (author's transl)].

Gynecological mass-screening leads to a decrease of prevalence and incidence of cervical cancer and precancerous conditions. In Rostock a program for early detection of cervical cancer was developed. Organization, application of computer in this model and the expenses of a computer assisted mass-screening-program are discussed. In order to facilitate comparison between various centers, a generally accepted classification and terminology of colposcopic, cytologic and histologic findings are essential. First epidemiological results of Rostock's women are demonstrated to characterize the screened population.

Costs and Cost Analysis↗

PubMed1994

To screen or not to screen: cancer of the prostate.

Prostatic cancer is a leading cause of mortality in Australian males and yet screening programs are accorded a low priority by the health professions. Literature to date suggests that there are strong cultural taboos to the effective implementation of a national screening program. Comparisons are made with screening programs for breast and cervical cancer, currently available to Australian women.

Australia↗

PubMed1994

[Screening of newborn infants for cystic fibrosis. A combined analysis of immunoreactive trypsin and delta F508 mutation--a screening without false positive results].

A total of 1081 blood screening cards taken from newborn babies, were anonymously selected for cystic fibrosis (CF) screening by quantitation of immunoreactive trypsin (IRT, Delfia) and by delta F508 mutational analyses using polymerase chain reaction followed by a time resolved fluorescence hybridization assay (Delfia). The IRT values showed a log normal distribution and were significantly higher in girls than boys and in 28 carriers compared with 1052 normals. In 12 newborns, corresponding to 1.02%, an IRT concentration greater than 70 micrograms/l was found. One of these was a delta F508 homozygote with an IRT concentration of 380 micrograms/l. delta F508 mutational analyses showed 1052 normals, 28 heterozygotes, and one homozygote, i.e., a carrier frequency of this mutation for delta F508 of 1:39. In future newborn CF-screening programmes we therefore recommend Delfia IRT followed by Delfia delta F508 analyses for IRT values greater than 70 micrograms/l.

Cystic Fibrosis↗

PubMed1993

[Reference standards in the performance of a mammographic screening program. Results of the screening program in the province of Florence, 1992].

The authors report the results of the Florence District program for the year 1992. 11,033 subjects were examined. Attendance rate (64.4%) was significantly related to age (42-49 = 71.0%; 50-59 = 66.7%; 60-70 = 58.5%). Recall rate to diagnostic assessment was 2.09% (mammographic abnormalities = 199, subjective symptoms other than pain = 32) and was related to age (42-49 = 3.12%; 50-59 = 1.65%; 60-70 = 1.77%). According to the results of diagnostic assessment 53 surgical biopsies (0.48%) were recommended and performed. The biopsy rate was also related to age (42-49 = 0.2%; 50-59 = 0.4%; 60-70 = 0.7%). Forty-seven carcinomas were detected in 46 subjects (benign/malignant biopsy ratio = 0.13). Cancer detection rate was 0.42% and changed significantly with age (42-49 = 0.13; 50-59 = 0.36; 60-70 = 0.68%), as well as the observed/expected cancer ratio (42-49 = 0.89; 50-59 = 2.03; 60-70 = 2.98). Detected cancers were nonpalpable in 57% of cases. Pathologic staging was pTIS in 2 cases, pT1a in 5, pT1b in 17, pT1c in 17, pT2 in 5, and pT4b in one case. Six of 47 (12.8%) cancers involved axillary nodes. A preliminary estimate of screening cost yielded a total cost of Lit. 397,671,000 for the year 1992--i.e., Lit. 36,000 per examined subject and Lit. 8,461,000 per detected cancer. The results are compared with reference standards for the evaluation of screening performance provided by the national breast screening program in the United Kingdom.

Adult↗

PubMed1993

Prenatal screening for hepatitis B surface antigen. Is universal screening necessary?

Prenatal screening for hepatitis B is now recommended as a universal practice in Canada. This study questions whether that policy should apply outside large urban centres. We studied women delivering babies at the Royal Victoria Hospital in Barrie, Ont. Of 1216 women, results of HBsAg screening were available for 716; only two women, both from a high-risk group, were HBsAg positive. If selective screening is used, physicians must question patients carefully to ensure that women at risk are identified and tested.

Carrier State↗

PubMed1996

Screening for congenital adrenal hyperplasia: the Delfia Screening Test overestimates serum 17-hydroxyprogesterone in preterm infants.

OBJECTIVE: To compare 17-hydroxyprogesterone (17-OHP) levels measured by quantitative serum radioimmunoassay (RIA), including an extraction step, and by screening fluoroimmunoassay (FIA) on blood spots in preterm infants. METHODS: Subjects were 39 healthy infants born at less than 31 weeks' gestational age. Each infant had weekly blood sampling, and RIA and FIA were performed on each sample. RESULTS: Two hundred twenty-seven samples were taken at 28 to 41 weeks' postconceptional age. Mean +/- SD 17-OHP measured by RIA was 11.4 +/- 11.1 nmol/L (0.4 +/- 0.4 micrograms/dL), and decreased over time. Mean +/- SD 17-OHP measured by FIA was 38.96 +/- 37.3 nmol/L, greater than 17-OHP (RIA). Log(delta FIA-RIA) was inversely related to postconceptional age (R2 = .39). CONCLUSION: Screening FIA of blood spots overestimates levels of 17-OHP in preterm infants and should not be used to determine the likelihood of congenital adrenal hyperplasia in this population. We have abandoned FIA screening for congenital adrenal hyperplasia in infants weighing less than 1500 g.

17-alpha-Hydroxyprogesterone↗

PubMed1996

Recent progress in the prevention of osteoporosis. To screen or not to screen?

Screening can be defined as: "Early detection of an asymptomatic condition which might develop to a symptomatic disease if not detected and treated". The purpose of a screening programme for osteoporosis is to identify individuals at risk and consequently to intervene in order to prevent future fractures. The principles of a screening test were outlined by William and Jungner in a WHO publication from 1968 (1). The 10 principles are still valid.

Economics, Medical↗

PubMed1997

[Value of lung filter, asymmetric film-screen technique and digital storage screen radiography in diagnosis of coin lesion].

AIM: To evaluate the image quality of an asymmetric film-screen combination (a-FSC), a conventional screen-film combination (FSC) at speed class 200, a lung filter, and digital luminescence radiograms in detecting pulmonary nodules. METHODS: Detail perception studies were carried out with an anthropomorphic phantom. The image systems were exposed under standardised conditions with 125 kVp. The systems' perception efficiency was evaluated on the basis of 12.240 single observations with ROC analysis. RESULTS: In the overall evaluation the a-FSC and the filter achieved equally high assessments of 0.878 +/- 0.018 and 0.860 +/- 0.21 respectively (p > 0.05). The 200 speed FSC and the storage phosphor screen radiograms did not differ significantly. In the mediastinum all the tested systems were clearly superior to the 200 speed FSC (p < 0.05). In the lung fields on the other hand the 200 speed system was given a higher assessment of 0.866 +/- 0.026. The a-FSC had slight advantages over the lung filter and the digital imagining modes (p > 0.05). CONCLUSIONS: The a-FSC and digital luminescence radiograms provide significantly more diagnostic information in the mediastinum, together with high detail detectability in the lung fields and without requiring additional dosage.

Humans↗

PubMed1998

Recommendations for cervical screening 1997. Members of the Working Party on Cervical Screening.

The Ministry of Health and the Cancer Society of New Zealand invited a working group to review the 1991 recommendations on cervical screening. No major changes have been suggested but minor modifications have been made with regard to recent literature. All women who have ever had intercourse should be offered a three yearly cervical smear test from age 20 to age 69. If it is a woman's first smear or there is a gap of five or more years since her last one, the second smear should be taken in one year's time. Women who have had a hysterectomy for a benign condition, with complete removal of histologically normal cervical epithelium and a normal smear history, do not require further screening. Women who are immunocompromised may require more frequent screening. The cervical smear will be part of the investigation of women with signs and symptoms of cervical cancer. It is not sufficiently sensitive, however, for a negative result to override clinical concern. Such women should be referred for gynaecological assessment irrespective of the smear result.

Adult↗

PubMed1998

Down syndrome screening in Singapore--the effectiveness of a second trimester serum screening policy modelled on 29,360 pregnancies in KK Women's and Children's Hospital.

AIM OF STUDY: To assess the effectiveness of a proposed second trimester Down syndrome serum screening policy in Singapore. METHOD: Auditing the effectiveness of an age-only policy and comparing it against a serum screening policy modelled on the same maternal population of KK Women's and Children's Hospital in 1994 and 1995. RESULTS: KK Women's and Children's Hospital's (KKH) maternal age distribution is similar to the national age distribution of mothers. Sixteen percent (16.7%) of mothers in KKH, in 1994 and 1995, were 35 years or older at delivery. Based on our hospital birth defect registry, 66% (35/53) of Down Syndrome pregnancies occurred in mothers who were 35 years or older at delivery and 43% (23/53) in the oldest 6.5% of mothers (38 years or older at delivery). Using various models on KKH's population structure to estimate the expected number of Down Syndrome livebirths expected, 52%-55% and 34%-36% of Down Syndrome livebirths were expected to occur in the oldest 16.7% and 6.5% of mothers respectively. These simulated figures are much lower than the figures from the data and needs further study, assuming that the Western Down Syndrome risk model to be applicable to our population. The overall uptake of amniocentesis irrespective of gestational age at booking was 28%. In mothers who were 35 years or older at delivery and booked before 22 weeks gestation, the uptake rate of amniocentesis was 49%. There was a substantial difference in the uptake rate when the counselling was done by trained counsellers compared to those who were not. CONCLUSION: We would expect that for a fixed amniocentesis rate of 6.5% and 16.7%, serum screening would be able to detect 71% and 85% respectively of the Down syndrome pregnancies. This is more efficient than figures published from Western populations as our patients are older.

Amniocentesis↗

PubMed1998

Screening for anxiety disorders. Sensitivity and specificity of the Anxiety Screening Questionnaire (ASQ-15).

BACKGROUND: The paper describes the rationale, sensitivity and specificity of the Anxiety Screening Questionnaire (ASQ), a disorder-specific screening instrument for use in primary care. METHOD: Two hundred and fifty subjects sampled from psychiatric, primary care settings and the community, participated in a test-retest reliability as well as a procedural validity study, using the M-CIDI with DSM-IV algorithms as a diagnostic yardstick. RESULTS: The ASQ was found to be easy to administer and acceptable and efficient in terms of sensitivity and specificity for generalised anxiety syndromes. The test-retest item reliability was good to excellent with kappa values of 0.6 or above. As compared with the validity standard, the DSM-IV/CIDI diagnoses caseness sensitivity was generally high (above 82%) for all diagnostic domains covered, whereas the specificity was only high for DSM-IV threshold and subthreshold generalised anxiety disorder. CONCLUSIONS: These preliminary findings demonstrate the usefulness of this anxiety screening questionnaire, constructed closely following the guidelines of specific diagnostic criteria.

Adolescent↗

PubMed2000

Brief screening for family psychiatric history: the family history screen.

BACKGROUND: Brief screens to collect lifetime family psychiatric history are useful in clinical practice and for identifying potential families for genetic studies. METHODS: The Family History Screen (FHS) collects information on 15 psychiatric disorders and suicidal behavior in informants and their first-degree relatives. Since each question is posed only once about all family members as a group, the administrative time is 5 to 20 minutes, depending on family size and illness. Data on the validity against best-estimate (BE) diagnosis based on independent and blind direct interviews on 289 probands and 305 relatives and test-retest reliability across 15 months in 417 subjects are presented. RESULTS: Agreement between FHS and BE diagnosis for proband and relative self-report had median sensitivity (SEN) of 67.6 and 71.1 respectively; median specificity (SPC) was 87.6 and 89.4, respectively. Marked decrease in SEN occurred when a single informant (the proband) reported on a relative (median, 37.5); however, median SPC was 95.8. Use of more than 1 informant substantially improved SEN (median, 68.2), with a modest reduction in SPC (median, 86.8). Test-retest reliability across 15 months resulted in a median kappa of 0.56. CONCLUSIONS: The FHS is a promising brief screen for collecting lifetime psychiatric history on an informant and/or first-degree relatives. Its validity is best demonstrated for major depression, anxiety disorders, substance dependence (alcohol and drug dependence), and suicide attempts. It is not a substitute for more lengthy family history if more detail on diagnosis is required.

Adolescent↗