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PubMedDate not supplied

Multiple marker screening for Down syndrome--whom should we screen?

BACKGROUND: The multiple marker test highlights the complexities of an expanding number of genetic tests that family physicians can offer to their patients. Many concerns surround the use of the multiple marker test, including a poor understanding of the test by physicians and patients, limited sensitivity, increased anxiety among women, and the risks of amniocentesis in patients who have false-positive results. METHODS: An online search of the medical literature was used to select English-language articles addressing the burden of suffering from Down syndrome, and efficacy, cost-effectiveness, and psychological effects of screening. RESULTS AND CONCLUSIONS: Down syndrome occurs in 0.99 per 1000 births, and the risk increases with age. Between 10% and 20% of infants die in the first year, predominantly from heart defects. Special education, the move away from institutionalization, and more employment opportunities have improved the outlook for these persons. The multiple marker test has an overall detection rate for Down syndrome of 56% with a 7% false-positive rate. A laboratory cutoff ratio of 1:190 is the most efficient for optimizing the detection rate and minimizing the false-positive rate. Limited screening to women older than 30 years appears most cost-effective, reducing losses of normal fetuses secondary to amniocentesis and the number of pregnant patients requiring pretest counseling. The family physician needs to inform the patient of the nature, purpose, and risks of screening including the psychological effects. Pretest counseling should be nondirective.

Adolescent↗

PubMed1999

The reliability and validity of a screening Questionnaire for 13 DSM-IV Axis I disorders (the Psychiatric Diagnostic Screening Questionnaire) in psychiatric outpatients.

BACKGROUND: The purpose of this study was to examine the reliability and validity of a new multidimensional screening instrument for 13 DSM-IV Axis I disorders. METHOD: The Psychiatric Diagnostic Screening Questionnaire (PDSQ) is a 90-item self-administered questionnaire that screens for 13 DSM-IV disorders in 5 areas (eating, mood, anxiety, substance use, and somatoform disorders). A consecutive series of 500 psychiatric outpatients completed the PDSQ immediately before their intake evaluation. Seventy-four patients completed the scale a second time less than a week after the initial administration, and 51 patients completed a booklet of questionnaires that included established measures of the same symptom domains assessed by the PDSQ. RESULTS: The PDSQ subscales achieved moderate-to-high levels of internal consistency (mean Cronbach's alpha coefficient = 0.82) and test-retest reliability (mean correlation coefficient = 0.84). Subscale scores were significantly associated with blind clinical diagnoses, and individual PDSQ items correlated much more highly with their own subscale than with other subscales. The PDSQ subscales were much more highly correlated with established measures of the same symptom domain (mean correlation coefficient = 0.72) than with measures of other types of psychopathology (mean correlation = 0.17). CONCLUSION: The PDSQ is a reliable and valid measure of multiple DSM-IV disorders that is brief enough to be incorporated into routine clinical outpatient practice without disruption, yet lengthy enough to be a psychometrically sound instrument.

Adolescent↗

PubMed1999

Biomolecular-chemical screening: a novel screening approach for the discovery of biologically active secondary metabolites. III. New DNA-binding metabolites.

Based on the chemical screening technique, biomolecular-chemical screening has been developed which makes use of two-dimensional TLC analysis of microbial extracts and combines thin-layer chromatography (RP-18) with binding studies towards DNA. In the first dimension the metabolites of the crude microbial extract are separated, and in the second dimension binding properties towards DNA are analysed. An initial screening program with 500 microbial extracts prepared by solid-phase extraction with XAD-16 resin resulted in 17 samples which contained metabolites with significant DNA-binding behavior. Fermentation, isolation and structural characterization led to already known metabolites [phenazine-1,6-dicarboxylate (1), phencomycin (2), 11-carboxy-menoxymycin B (3), soyasaponine I (4), and (8S)-3-(2-hydroxypropyl)-cyclohexanone (5)], as well as to new secondary metabolites. Fermentation of the producing organisms of the new DNA-binding metabolites, ent-8,8adihydro-ramulosin (6). (2R,4R)-4-hydroxy-2-(1,3-pentadienyl)-piperidine (7), (5R)-dihydro-5-pentyl-4'-methyl-4'-hydroxy-2(3H)-furanone (8), and seco-4,23-hydroxyoleane-12-en-22-one-3-carboxylic acid (9), as well as isolation, structural characterization, and physico-chemical properties are reported.

Chromatography, Thin Layer↗

PubMed1996

[Screening tests for dementia: agreement between CST14 and ADS3 is incomplete (Cognitive Screening Test and Amsterdam Dementia Test)].

The agreement between two screening tests for the detection of dementia was tested by comparing a 14-item orientation questionnaire (Cognitive Screening Test or CST14) and the short version of the Amsterdam Dementia Screening Test (ADS3: Visual Memory, Orientation and Fluency. All 106 consecutive patients (71% female) of a psychogeriatric day care center were tested in two sessions. Their mean age was 77,7 (range 52-89). Taking the advised cutting-scores into account, we found consistent results for 74% of the patients (95%-confidence interval: 65%-82%): 60 patients were positive for dementia on both tests, and 18 were negative. For 28 patients the results were inconsistent, in that more patients scored in the impaired range for ADS3 than for CST14.

Aged↗

PubMed1996

Screening for dementia: Cognitive Assessment Screening Test (CAST).

The Cognitive Assessment Screening Test (CAST) is a self-administered paper-and-pencil test that can be used to screen geriatric patients for dementia. The test is composed of three one-page sections; Part A has 10 simple questions; Part B has five more demanding questions, and Part C has 13 self-report questions. Parts A and B determine whether cognition falls within the normal range or below the threshold for dementia. Part C assesses the patient's perception of a decline in memory and competence. Designed for office use, the CAST requires minimal examiner time and little training or experience to administer. This test is as sensitive and specific as other relatively brief screening instruments for dementia.

Aged↗

PubMedDate not supplied

The effect of Medicare reimbursement for screening mammography on utilization and payment. National Cancer Institute Breast Cancer Screening Consortium.

OBJECTIVE: In January 1991, Medicare extended its mammography benefit to reimburse for breast cancer screening mammograms. In 1991 and again in 1993, the National Cancer Institute Breast Cancer Screening Consortium (BCSC) conducted a survey to test the hypothesis that this benefit would increase mammography use among women over the age of 65. METHODS: The authors analyzed data on non-Hispanic white women ages 65 to 74 living in 11 geographic areas targeted by the BCSC for an earlier study--six that had received cancer screening educational interventions and five control subsites--to measure the impact of the newly adopted Medicare benefit on the use of mammography and use of Medicare to reimburse mammography costs. RESULTS: The data show little overall increase between 1991 and 1993 in reported mammography use among respondents to the survey. However, in six intervention and five control subsites there was an increase in the percentage of women who reported using public payment sources to at least partially reimburse the cost of mammograms. In three intervention subsites, the increase from 1991 to 1993 in the percentage of women using public sources of payment was greater than in the corresponding control subsites. CONCLUSIONS: These findings suggest that public health interventions are more likely to succeed when educational promotion accompanies a financial benefit.

Aged↗

PubMed2000

Coordination and management of a large multicenter screening trial: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial.

The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial is a large and complex multi-institutional, multifaceted organization with a 20-year horizon. The implementation of the trial began with the creation of an organizational structure that supports strong leadership, cooperation, and effective communication among the trial collaborators including an operational framework for the development, review, and pretest of instruments, data collection, and management procedures; the setting of high-quality standards for training of trial staff; and the development of a comprehensive assessment plan for evaluation of all trial activities. This paper describes the process and methods used in the coordination and management of the PLCO trial. These include the role of the steering committee and its subcommittees and working groups, the establishment of regular and ad hoc communications among collaborators, the training of screening center coordinators and examiners, the PLCO manual of operations and procedures, and the development and implementation of a comprehensive quality assurance plan.

Colorectal Neoplasms↗

PubMed2005

Impact of the introduction of organised screening for cervical cancer in Turin, Italy: cancer incidence by screening history 1992-98.

After an organised cervical screening programme was introduced in Turin in 1992, the age-adjusted cervical cancer incidence ratio in 1992-98 was 0.81 (95% confidence interval (CI) 0.59-1.09) for invited vs not invited women and 0.25 (95% CI 0.13-0.50) for attenders vs non attenders. An organised screening programme can further reduce cervical cancer incidence in an area where substantial spontaneous activity was previously present.

Female↗

PubMed2004

[Limited value of prenatal risk group screening for heart abnormalities. Time for a general screening?].

544 fetuses at increased risk of cardiac malformations were examined by echocardiography from gestational week 14 to 40 (median 21), during the period January 1989-March 2002. A heart defect was diagnosed in 70 fetuses. Three false positive diagnoses and eight false negative diagnoses occurred (sensitivity 89 % and specificity 99 %). Seven were terminated (three with trisomy, two with concomitant diaphragmatic hernia and two with single ventricles) and eight died in utero. 22 of 52 liveborn infants died during the neonatal period. Fetal arrhythmia was diagnosed in 30 cases of which eight died prenatally. This risk group screening identified only 3.3 % of all infants with heart defects born during the study period. The ambition to diagnose a greater proportion prenatally would require a general screening program. In order to guarantee a high quality of specialized fetal cardiology service, referrals should be centralized to only a few units in the country.

Arrhythmias, Cardiac↗

PubMedDate not supplied

Comparison of screen-film and full-field digital mammography in Japanese population-based screening.

PURPOSE: To investigate how the greater contrast of full-field digital mammography (FFDM) affects the detection of suspicious lesions in Japanese population-based screening. MATERIALS AND METHODS: Screen-film mammography (SFM) and FFDM were performed in 480 women aged 50 years or more. A set of mediolateral oblique views was obtained with each modality. All mammograms were independently double-read. The five-scale category assessment and type of finding using the Breast Imaging Reporting and Data system (BI-RADS) nomenclature were given. Intraobserver variance, recall rates, and positive predictive value were calculated. RESULTS: The findings between the two modalities were discordant. kappa-values for each reader were 0.619 and 0.385, respectively. Almost half of the microcalcifications were called with both modalities. The detection of masses was less concordant between the readers (27%). The masses were detected more frequently with FFDM (73%). Other findings were only detected with one modality. The recall rate was not significantly different (2.9% with SFM vs. 4.2% with FFDM; p=0.253). The positive predictive value was not significantly different (14% with SFM vs. 10% with FFDM; p=0.69), either. Two patients with breast cancer were detected with both modalities. CONCLUSION: Recall rates and positive predictive value were not significantly different between SFM and FFDM. Cancers were detected with both modalities.

Breast Neoplasms↗

PubMedDate not supplied

[Ambulatory geriatric screening--an overview. II: Evaluation of the effectiveness and current recommendations for screening implementation].

Geriatric screening detects many problems previously unknown to the primary health care physician. In spite of this, a valid judgement can only be made if the effectiveness of the induced intervention is proven. Prospective studies evaluating these screening-induced interventions show diverse results. Nevertheless, international task forces conclude from the evidence of existing studies that there are areas which are effective, efficacious, and enhance the quality of life. It remains a continuing task for research to develop geriatric assessment instruments as well as to set up objective guidelines of intervention in these areas.

Aged↗

PubMed1990

Transvaginal sonography as a screening method for ovarian cancer. A report of the first 1000 cases screened.

From November 1987 to April 1989, 1000 women 40 years or older underwent screening vaginal sonography at the University of Kentucky Medical Center (Lexington, KY). Patients included in this investigation were all asymptomatic and had no known pelvic abnormalities. Each ovary was measured in three planes and ovarian volume was calculated using the prolate ellipsoid formula. The upper limit of normal for ovarian volume was 18 cm3 in premenopausal women and 8 cm3 in postmenopausal women. In patients with normal scans, mean ovarian volumes decreased from 6.8 cm3 to 3.0 cm3 with menopause. Thirty-one patients (3.1%) had abnormal vaginal sonograms and 24 underwent exploratory laparotomy. All patients undergoing surgery had ovarian or fallopian tube tumors with dimensions identical to those predicted by ultrasound. Histologic diagnoses of these tumors included the following: adenocarcinoma, one, serous cystadenoma, eight; endometrioma, six; and cystic teratomas, two. Vaginal sonography was performed easily and without complications, and was well accepted by patients. All patients with normal sonograms have been rescreened annually and none have subsequently developed ovarian cancer. Further clinical trials to determine the efficacy of vaginal sonography as a screening method for ovarian cancer are indicated.

Adult↗

PubMed1991

Sputum occult blood screening for lung cancer. Stage II screening of 14,431 subjects.

Sputum occult blood screening (SOBS) for lung cancer was performed in outpatients with suspected lung cancer. A total of 1011 patients were seen. Among them, 604 patients were found to be negative for SOBS, and 407 were found to be positive. The false-negative rate was 3.97% (24 of 604), and the opposite positive rate was 19.65% (80 of 407). A total of 14,431 normal subjects over 40 years of age were screened by SOBS. In the series, 1942 specimens were found to be positive. Among the 1942 patients, 31 were found to have definite cancer cells.

Adult↗

PubMed2003

A feasibility study of the use of the AutoPap screening system as a primary screening and location-guided rescreening device.

BACKGROUND: The AutoPap 300 QC system (Tripath Imaging, Inc., Burlington, NC) is an automated device that was designed to screen conventionally prepared cervical smears and, more recently, thin-layer slide preparations. The system has been tested in large clinical trials. METHODS: A total of 14,145 cervical smears obtained from participants in the Florence screening program were eligible for the study. Smears were processed first with the AutoPap system and were classified into three different categories: 1) no further review (NFR), 2) review, and 3) process review (PR). Conventional manual reading was performed by 10 experienced cytopathologists. RESULTS: After AutoPap processing, 2398 smears were classified as NFR (16.9%), and 1818 smears were classified as PR (12.8%). Overall, there were 188 inadequate smears (1.3%) at conventional review and 125 inadequate smears (0.88%) at AutoPap review. Six-month repeat smears were prompted by 330 conventional reviews (2.3%) and by 222 AutoPap reviews (1.56%). Similarly, referral to colposcopy was prompted by 179 conventional reviews (1.2%) and by 147 AutoPap reviews (1.0%). Overall, 32 patients were diagnosed with high-grade cervical intraepithelial neoplasia as a result of assessment. Conventional reading detected 31 patients (28 patients were referred for colposcopy, and 3 patients were referred for repeat cytology), and the AutoPap system detected 30 patients (27 patients were referred for colposcopy, and 3 patients were referred for repeat cytology). CONCLUSIONS: The current experience suggested that conventional reading and AutoPap reading of cervical smears had essentially the same sensitivity, with slightly greater specificity for the AutoPap system. Thus, comparisons of the AutoPap system and conventional reading should focus mainly on cost analysis.

Automation↗

PubMed2004

Screening for distress in cancer patients: the NCCN rapid-screening measure.

The present investigation evaluated the NCCN distress management screening measure (DMSM) in a sample of 68 mixed site cancer patients. The DMSM was administered with the Brief Symptom Inventory (BSI) and the Brief Symptom Inventory-18 (BSI-18). Convergent validity was established by the moderate positive correlation between the DMSM and the BSI and BSI-18 global severity indices (r=0.59, p<0.001 and r=0.61, p<0.001, respectively). Divergent validity was demonstrated by the lower correlations between the DMSM and the BSI subscales suggestive of psychopathology (e.g. paranoid ideation, obsessive-compulsive). Receiver operative characteristic (ROC) analyses demonstrated that the DMSM has moderate ability to detect distress identified by the BSI and the BSI-18 (area under curve=0.74, p<0.001 and 0.80, respectively, p<0.01, respectively). While the ROC curves suggested that the DMSM lacks a single cutoff that maximizes sensitivity and specificity, the use of multiple cutoffs renders the DMSM an effective and very rapid screen for distress among cancer patients.

Adolescent↗

PubMedDate not supplied

Screening for carcinoma of the prostate: efficacy of available screening tests.

Despite the high prevalence and mortality from carcinoma of the prostate, very few prospective, controlled, population-based studies are available to assess the impact of early diagnosis programs. Three screening modalities have been suggested for this tumor: rectal examination, serum tumor markers, and transrectal ultrasound. Prostatic acid phosphatase and prostatic specific antigen have proven to be insensitive and nonspecific in large trials and generally, when elevated, allow diagnosis of metastatic disease. Transrectal ultrasound also suffers from poor specificity. Rectal examination, although insensitive to small tumors (less than 1 ml in volume), has the advantage of possibly detecting tumors of a higher biologic activity. An improved survival has been demonstrated in populations undergoing routine rectal examinations. Further prospective, population-based trials comparing early detection techniques are necessary before mass screening for carcinoma of the prostate can be recommended.

Adenocarcinoma↗

PubMed1990

Screening for congenital hypothyroidism in France. Misdiagnosed cases: collaborative study of screening centres in France.

Misdiagnosed cases of congenital-hypothyroidism (CH) during the first 9 years of the French screening program were analysed. A total of 50 cases were missed (3% of total diagnosed) which represents a severe failure of the system. Failures were caused by technical errors of sample collection or TSH assay (n = 27) or due to normal TSH (n = 22) or T4 (n = 1) concentrations in the newborn blood specimens. We conclude that screening methods should be improved and that physicians should remain alert to clinical signs of hypothyroidism.

Congenital Hypothyroidism↗

PubMedDate not supplied

Selective screening: when should screening be limited to high-risk individuals?

Issues related to selective screening are discussed. The distinction between test accuracy and program accuracy is presented in the context of impact on cost/true case detection, which in turn reflects the gain in specificity and loss in sensitivity for the total target population. When two or more risk factors are combined to define high-risk subjects, a gain in program accuracy and a relative reduction in cost/true case found ensue if there is additive interaction between these risk factors. The author also discusses periodicity of screening and emphasizes the inappropriateness of using the notion of risk for disease occurrence as a criterion to define periodicity.

Costs and Cost Analysis↗