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PubMedDate not supplied

Coorscreen: a low-cost, on-site mammography screening program.

SETTING: Coors Brewing Company is a self-insured corporation of 10,600 employees located in Golden, Colorado. Management has long believed in the value of a healthy workforce and has instituted ongoing health and wellness programming since 1981. PROGRAM DESIGN: Coorscreen was started in September 1985 to create an ongoing awareness of breast cancer screening and prevention for all female employees, spouses, and retirees and to lower the health care costs for the company through early detection of breast cancer. PROGRAM IMPACT: From 1985 through 1993, 12,210 mammograms were completed on 3729 employees, spouses, and retirees. The participation rate was 83%. Forty-seven malignant conditions were confirmed during the first 8 years. Pathology reports confirmed 43 early detections (10 employees) and four late detections (two employees). The 10 cases of malignant disease detected early among employees cost an average of $12,388 in terms of direct medical costs, short-term disability, temporary replacement, and ongoing benefits. The two cases detected late among employees cost an average of $143,398. Among spouses, cases of malignant disease detected late have cost an average of $69,230 more than cases detected early. On the basis of early detection for 10 employees and 26 spouses, the total savings are estimated to be $3,110,000. DISCUSSION: The Coorscreen program cost savings for the first 8 years were $3,110,080 because of the lower cost of early versus late detection. Total screening and procedural costs to the company have equaled $668,690. Thus the company has realized a total cost savings of $2,441,190.

Adult↗
PubMed1998

Development and implementation of a breast and cervical cancer screening program in urban and rural Alaska.

Early detection of breast and cervical cancers represents the single best strategy to effect the reduction of associated morbidity and mortality. The State of Alaska identified a need to establish a service delivery system which would assure the availability of breast and cervical cancer screening services for women who are low income, under- and uninsured, and from racial/ethnic minorities. In March 1995 the Alaska Breast and Cervical Cancer Early Detection Program (AK-BCCEDP) began funding breast and cervical cancer screening services through the Centers for Disease Control and Prevention, National Breast and Cervical Cancer Early Detection Program. The purpose of AK-BCCEDP is to establish a comprehensive service delivery strategy which includes screening, tracking, referral, follow-up, public education, quality assurance, surveillance, coalition building/partnering, and evaluation. During the first year of services (March 1, 1995, to February 29, 1996) 651 women were screened for breast and cervical cancer. Higher than expected numbers of breast cancer were detected. Of the 651 women screened, four were diagnosed with invasive breast cancer and three were diagnosed with high-grade squamous intraepithelial lesions.

Adolescent↗
PubMed1996

Evaluation of the American Academy of Dermatology's National Skin Cancer Early Detection and Screening Program.

BACKGROUND: Increasing incidence and mortality rates from cutaneous melanoma are a major public health concern. As part of a national effort to enhance early detection of melanoma/skin cancer, the American Academy of Dermatology (AAD) has sponsored an annual education and early detection program that couples provision of skin cancer information to the general public with almost 750,000 free skin cancer examinations (1985-1994). OBJECTIVE: To begin to evaluate the impact of this effort, we determined the final pathology diagnosis of persons attending the 1992-1994 programs who had a suspected melanoma at the time of examination. METHODS: We directly contacted all such persons by telephone or mail and received pathology reports from those who had a subsequent biopsy. RESULTS: We contacted 96% of the 4458 persons with such lesions among the 282,555 screenings in the 1992-1994 programs. We obtained a final diagnosis for 72%, and the positive predictive value for melanoma was 17%. Three hundred seventy-one melanomas were found in 364 persons. More than 98% had localized disease. More than 90% of the confirmed melanomas with known histology were in situ or "thin" lesions (< or = 1.50 mm thick). The median thickness of all melanomas was 0.30 mm. The 8.3% of AAD cases with advanced melanoma (metastatic disease, regional disease, or lesions > or = 1.51 mm) is a lower proportion than that reported by the 1990 Surveillance, Epidemiology and End Result Registry. The rate of thickest lesions (> or = 4 mm) and late-stage melanomas among all participants was 2.83 per 100,000 population. Of persons with a confirmed melanoma, 39% indicated (before their examination) that without the free program, they would not have considered having a physician examine their skin. CONCLUSION: The 1992-1994 free AAD programs disseminated broad skin cancer educational messages, enabled thousands to obtain a free expert skin cancer examination, and found mostly thin, localized stage 1 melanomas (usually associated with a high projected 5-year survival rate). Because biases impose possible limitations, future studies with long-term follow-up and formal control groups should determine the impact of early detection programs on melanoma mortality.

Adult↗
PubMed1990

Results of a screening program for C-cell disease (medullary thyroid cancer and C-cell hyperplasia).

In the authors' Medullary Screening Clinic, medullary thyroid cancer (MTC) or C-cell hyperplasia (CCH) has been identified in 26 relatives of 12 apparently "sporadic" patients from 56 families in which calcitonin (CT) testing has been performed. The interpretation of stimulated test results was sometimes difficult: elevated basal levels without a significant increase after the injection of secretagogues; basal levels in the normal range with considerable increases after stimulation but not exceeding two or three times the upper limit of normal; elevated basal or stimulated CT levels that slowly decreased to normal or near-normal levels over relatively short periods of time. The latter results suggest the possibility of CCH disappearing spontaneously in some patients.

Adolescent↗
PubMedDate not supplied

[Assessment of HPV detection assays for use in cervical cancer screening programs].

OBJECTIVE: Detection of high-risk human papillomavirus types (HPV) infection is an important tool in the screening of cervical cancer and triage of cytological abnormalities. The different techniques for detection of this cancer need to be contrasted and validated for use in population screening. MATERIAL AND METHODS: Cervical cell samples were collected from 166 women attending a dermatology clinic in Oviedo (Spain). We evaluated the performance of three different assays for VPH detection. The methods utilized were 1) In-house PCR-EIA using LI consensus primers MY09/ MY11, 2) A PCR-reverse line blot hybridization (PCR-LBH) that uses LI consensus PGMY primers. 3) Hybrid Capture 2. All assays were performed blinded. The kappa statistic was used to test for global agreement between assay pairs. RESULTS: HPV DNA was detected in 24,7%, 25,3% and 29,5% of the women, respective to the assay. The overall agreement between the in-house PCR, PCR-LBH and HC2 was (73.5%) with all kappa values between assay pairs exceeding 0.56 (p<0.001). CONCLUSION: The three HPV assays were equally accurate in estimating high-risk HPV prevalence and HPV-related lesions. The method for HPV detection must be decided depending on the goals of the search (screening, follow-up or molecular studies).

DNA Probes, HPV↗
PubMed1990

Detection of glaucomatous visual field defect using a screening program of Humphrey Field Analyzer.

To evaluate its clinical efficacy, we report the results of Armaly central field screening test in comparison with those of central 30-2 threshold test of Humphrey Field Analyzer. In 83 cases of normotensives, ocular hypertensives, and glaucoma patients with open-angle or narrow-angle enrolled in this study, a total of 143 eyes were examined. Fifty-four out of 61 patients (88.5%) and 73 out of 81 eyes (90.1%) with visual field defects were detected by the Humphrey Field Analyzer screening test. Eight eyes out of 81(9.9%) with visual field defects detected by the screening test were confirmed as false positive. All points of false positive were solitary, which tended to occur more frequently on superior visual field. A false negative of eight eyes out of 62 (12.9%) detected by the screening test was confirmed by the threshold test, which was more frequent on superior field and shown to be located more peripherally from the fixation point. There was no significant difference in either central sensitivity or age of the false positive and negative.

Adult↗
PubMed1994

Cost-effectiveness analysis for evaluation of screening programs: hereditary hemochromatosis.

A significant body of research over the last 10-20 years supports the hypothesis that screening for hereditary hemochromatosis (HH) may be cost-effective, given the low-cost, low-risk therapeutic options available for most homozygous individuals. The factors that confound a straightforward test of this hypothesis include the fact that the disease is not fully penetrant and that, to achieve the anticipated life-year gains, therapy must be instituted before disease complications become irreversible. Recent articles and editorials, as well as practice guidelines prepared by the College of American Pathologists, recommend screening for HH with transferrin saturation and ferritin testing, and with percutaneous liver biopsy for those with positive laboratory test results. Patients at risk would be treated with phlebotomy for life and monitored with ferritin testing. We present a cost-effectiveness analysis that evaluates the efficacy of using a screening strategy to accomplish the desired healthcare goals.

Adult↗
PubMed1977

[Results of a mass screening program of cervix carcinoma of the city of Wismar].

From 1.10.1974 to 29.2.1976 in Wismar a cervical cancer screening on computerbase was performed. The participation of the female population (20 to 65 years) was relative high, with 74,9%, results are discussed. In 12702 investigations 12 cases of dysplasia (severe degree), 41 carcinomata in situ and 14 cases of invasive cervical cancer were revealed.

Adult↗
PubMed1998

Who gets lost: follow-up of suspect results in a newborn screening program

Objective. To determine reasons for and adequacy of follow-up testing of suspect results of metabolic screening in infants born in Alberta in 1992. Study Design. Of 42 392 live births, 41 553 infants were deterministically matched using birth registry data. Infants requiring repeat analyses were determined from notes made on the screening report. Characteristics of infants needing repeat screening, and obtaining a repeat screen results, were determined by logistic regression using variables from the birth registry and the screening record. Results. A total of 1375 infants required repeat screening. Infants with unsatisfactory samples were more likely to be born in a smaller community, of low birth weight, and to have the sample obtained after 7 days of age. Infants with biologically suspect results were more likely to be of low birth weight, to die in week 1 of life, and to be born in a large hospital. Repeat analyses were found for 663 infants. Boys, infants from smaller communities, and low birth weight infants were more likely to have the required repeat screening. Infants of single mothers were less likely to undergo repeat screening. Conclusions. The results of this study demonstrate the need for a clear, time-oriented protocol of follow-up of newborn metabolic screening results.

Journal Article↗
PubMed1989

NJ skin cancer screening program.

Free skin cancer detection and prevention programs have been conducted throughout the United States. The New Jersey experience is outlined. Over 9,500 patients have been screened by a volunteer force of professionals. Patient education, an integral part of the program, stresses self-examination, recognition, and prevention of common cutaneous malignancies.

Humans↗
PubMed2004

A nationwide population screening program for diabetes in Brazil.

OBJECTIVES: In 2001, persons throughout Brazil who were 40 years old or older were invited to participate in community screening for diabetes as part of the Brazilian Ministry of Health's Plan for the Reorganization of Care for Arterial Hypertension and Diabetes Mellitus. This report describes the overall participation rate and positivity rate of the screening campaign, as well as factors associated with the level of participation among the municipalities in Brazil. METHODS: Screening test positivity was defined as a fasting glucose of > or = 100 mg/dL or a casual glucose of > or = 140 mg/dL. Screening data were obtained from the Ministry of Health and were analyzed for each municipality. RESULTS: Out of the 5 561 municipalities in Brazil, 5 301 of them (95.3%) participated and reported results. Of the 30.2 million persons in the target population, 22.1 million of them (73.0%) were tested, and 3.5 million of the persons tested (15.7%) were positive. Higher odds of a high population participation rate (> or = 80%) were seen in municipalities that were of small size (risk ratio (RR) = 5.0, comparing extremes), were located in the North region of the country (RR = 1.8), were located outside of a metropolitan region (RR = 1.4), and had a higher proportion of their population who had completed elementary school (RR = 1.2) (P < 0.05). There was a parallel increase in glucose testing nationwide during and immediately after the campaign, presumably in part for diagnostic confirmation of cases identified during screening. CONCLUSIONS: The massive response to the campaign attests to the potential that this type of program has to raise diabetes awareness and to set the stage for capacity-building at the primary care level.

Adult↗
PubMed2005

[Economic analysis of a screening program for diabetes mellitus in Brazil].

OBJECTIVE: Diabetes mellitus is a common disease and costly public health concern and an expressive number of affected individuals have undiagnosed diabetes mellitus. In 2001, the Brazilian Ministry of Health conducted a national diabetes screening campaign. The purpose of this study was to estimate the yield and economic impact of this screening strategy. METHODS: Based on positive screenees (fasting glucose >100 mg/dL or nonfasting >140 mg/dL) probable new cases of diabetes were estimated and a decision analytic model was built up. Primary and secondary data were used to estimate screening cost (in Brazilian Reais, R$) and yield (new cases of diabetes detected), assuming a single-payer-perspective. Sensitivity analyses were performed. RESULTS: Assuming a prevalence of undiagnosed diabetes mellitus of 4.8%, probable new cases of diabetes were 518,579 (23 new cases per 1,000 subjects screened), considering that 33% of positive-screening individuals underwent confirmatory glucose testing. The cost per new case of diabetes diagnosed would be R$89. The results were sensitive to percentage of confirmatory tests performed. CONCLUSIONS: The costs of nationwide community screening in Brazil were significant, however, in absolute terms lower than those described by other countries.

Adult↗
PubMedDate not supplied

[Adherence to the screening program for HBV infection in pregnant women and application of the immunoprophylaxis protocol in babies born to HBV carrier women].

The aim of the study was to evaluate the frequency of the screening for HBV infection in pregnant women and the application of immunoprophylaxis in newborns to HBV carrier women. The study, carried out in 2001 for 2 months, involved 1596 pregnant women consecutively recruited in public and private hospitals of the Sardinia. Information has been collected by a questionnaire: 90.5% of the women underwent HBV screening during pregnancy and 2.6% of them were found positive to HBsAg test. Among the newborns to HBsAg carrier mothers, 89.2% received the immunoprophylaxis protocol (specific immunoglobulin and the first dose of vaccine within 24 hours from birth). Two variables resulted statistically associated with the lack of adherence to HBV screening: the original family size of women (more than 4 members in the household) and the delivery in a private hospital. These findings point out a satisfactory adherence to HBV screening during pregnancy and the application of immunisation protocol in most of the newborns to HBsAg carrier mothers. However, the increase of information programs turned to the population is required to reach the total application of the prevention tools available in Italian public health.

Adult↗