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Tumor characteristics and detection method in the MRISC screening program for the early detection of hereditary breast cancer.

In the MRISC study, women with an inherited risk for breast cancer were screened by a 6-month clinical breast examination (CBE) and yearly MRI and mammography. We found that the MRISC screening scheme could facilitate early breast cancer diagnosis and that MRI was a more sensitive screening method than mammography, but less specific. In the current study we investigated the contribution of MRI in the early detection of breast cancer in relation to tumor characteristics. From November 1999 to October 2003, 1909 women were included and 50 breast cancers were detected, of which 45 were evaluable and included in the current study. We compared the characteristics of tumors detected by MRI-only with those of all other (non-palpable) screen-detected tumors. Further, we compared the sensitivity of mammography and MRI within subgroups according to different tumor characteristics. Twenty-two (49%) of the 45 breast cancers were detected by MRI and not visible at mammography, of which 20 (44%) were also not palpable (MRI-only detected tumors). MRI-only detected tumors were more often node-negative than other screen-detected cancers (94 vs. 59%; P=0.02) and tended to be more often <or=1 cm (58 vs. 31%; P=0.11). MRI was more sensitive than mammography for a wide spectrum of invasive tumor characteristics i.e., size, nodal status, histology, grade and ER status. Half of the breast cancers detected in this study were visible by MRI only and these tumors were smaller and significantly more often node-negative than other screen-detected tumors, suggesting that MRI makes an important contribution to the early detection of hereditary breast cancer.

Breast Neoplasms↗

[Medullary thyroid carcinoma. Results of a family screening program].

During a ten-year period (1975-85) 56 patients with medullary carcinoma of the thyroid were under treatment. A family screening programme discovered such a tumour in the offspring of a 47-year-old female patient and her 56-year-old sister. In four of seven offspring from three lines of this family ultrasonography revealed changes in the thyroid. Positive preoperative pentagastrin test with stimulation of calcitonin as tumour marker resulted in the histological diagnosis of thyroid carcinoma.

Calcitonin↗

Efficacy of a hospital based cytology screening program.

From 1976 to 1986, a total of 117,471 women attending gynecologic outpatient departments of six hospitals in Delhi, India, were screened cytologically. The cytodiagnosis revealed 30,399 (25.9%) normal finding, 84,889 (72.3%) inflammatory changes, 1910 (1.6%) dysplasia of various grades and 213 (0.2%) malignant lesions. Of the 213 cases detected as malignant, clinical suspicion of cervical cancer was not present in 125 women (58.7%). Histologically malignancy was confirmed in 192 women (90.1%) of the 213 cytologically diagnosed malignant cases. The diagnosis revealed 94 (49.0%) as carcinoma in situ and the rest of the cases were invasive lesions. This was in contrast to only 5.2% (10/194) of cases with carcinoma in situ seen at the cancer clinic during 1983-1986 in one of the major collaborating hospitals of Delhi. The analysis of data according to age revealed that median age at detection of mild/moderate, severe dysplasia, carcinoma in situ (CIS) and invasive cancers was 34.0, 37.9, 38.6, and 47.8 years, respectively, indicating a latency period of one and a half decade from the onset of precursor lesions to invasive disease. Mass population screening in our country is not feasible in the near future and this may be true also for other developing countries. In its absence cytological screening of patients attending hospitals and maternity homes can give a large yield of early cervical cancers, which are curable.

Adult↗

Newborn screening for cystic fibrosis: evaluation of benefits and risks and recommendations for state newborn screening programs.

In November 2003, CDC and the Cystic Fibrosis Foundation cosponsored a workshop to review the benefits and risks associated with newborn screening for cystic fibrosis (CF). This report describes new research findings and outlines the recommendations of the workshop. The peer-reviewed evidence presented at the workshop supports the clinical utility of newborn screening for CF. Demonstrated long-term benefits from early nutritional treatment as a result of newborn screening for CF include improved growth and, in one study, cognitive development. Other benefits might include reduced hospitalizations and improved survival. Mixed evidence has been reported for pulmonary outcomes. Newborn screening in the United States is associated with diagnosis of CF a median of 1 year earlier than symptomatic detection, which might reduce the expense and anxiety associated with workup for failure to thrive or other symptoms. Certain psychosocial risks for carrier children and their families (e.g., anxiety and misunderstanding) are associated with newborn screening. Exposure of young children to infectious agents through person-to-person transmission in clinical settings, although not an inherent risk of newborn screening, is a potential cause of harm from early detection. Involving specialists in CF care and infection control, genetic counseling, and communication can minimize these potential harms. Although screening decisions depend on a state's individual resources and priorities, on the basis of evidence of moderate benefits and low risk of harm, CDC believes that newborn screening for CF is justified. States should consider the magnitude of benefits and costs and the need to minimize risks through careful planning and implementation, including ongoing collection and evaluation of outcome data.

Algorithms↗

[Preliminary results of a mass screening program for colorectal cancer].

The Digestive Tumours Registry of Burgundy set up a study to assess acceptability and results of colorectal cancers screening using the Hemoccult test. A total of 95,000 people, aged 45 to 74, were included, 55,000 in 1988 and 40,000 in 1989. The aim of this paper is to report the results of the first screening process in the population tested from January to July 1988, i.e. 27,421 subjects. Information on colorectal cancer was mailed to all homes in the screening areas and a news campaign was organized. During the first 4 months, the general practitioners (GPs) either prescribed the test which was then reimbursed (Autun area), or gave it free to their patients (other areas). After that phase, the test was mailed to all subjects who had not consulted their GP, and a second letter was sent 1 month later when the test had not been sent back. A total of 14,603 subjects performed the Hemoccult test (53.3 percent). Acceptability was higher in those areas there the test was initially given free by the GPs (57.3 percent) than in those where it was prescribed (40.0 percent). Acceptability was higher in women (55.8 percent) than in men (50.6 percent). A total of 57.8 percent of the performed tests were done during the medical offer phase, 29.1 percent after mailing and 13.1 percent after the recall letter. There was a positive test in 340 subjects (2.3 percent) and 288 (84.7 percent) had colonic investigations, a colonoscopy in 99 percent of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗

Results of a vision screening program: an initial study.

BACKGROUND: More than 100 children between the ages of 5 and 13 years (grades K through 6) were screened with the New York State Optometric Association vision screening battery. METHODS: A comparison between regular and special education referral rates was performed. Two groups of tests were established: acuity testing and functional testing. A comparison of the failure rates of these two groups was also analyzed. RESULTS: This study revealed that although the referral rate between the two populations showed no statistical difference, the particular "group" of tests failed differed significantly. CONCLUSIONS: Although no conclusions can be drawn from these numbers as the sample was not varied enough, further screenings in different geographical and socioeconomic areas need to be performed to determine the validity of this trend.

Adolescent↗

[Attitudes and knowledge of primary care physicians about community breast cancer screening programs].

OBJECTIVE: To find the view of Primary Care doctors in relation to the need for a community programme of breast cancer screening, its effectiveness and the criteria underlying its application. DESIGN: Crossover study. SETTING: Municipal districts of Ciutat Vella and Sant Martí, Barcelona. PARTICIPANTS: General Practitioners (GPs) in the programme. INTERVENTION: A self-filled questionnaire. The questions sought the level of agreement with 11 statements concerning: importance as health problem, effectiveness of the programmes, target population and role of GP. Results were compared for: year of graduation, sex and type of centre. MEASUREMENTS AND MAIN RESULTS: Of 140 doctors, 110 (78.6%) replied. There was majority agreement with all the statements, especially so in: "Breast cancer is one of the three main causes of death in women in Barcelona"; "screening of 50-64-year old women should be recommended"; and "GPs must recommend screening to their patients". CONCLUSION: The replies to the questionnaire indicated agreement with the programme's basic orientation, except for including 40 to 49-year old women in the programme, which the programme did not propose. Hopefully, this consensus will help Primary Care professionals become involved in the screening programme.

Adult↗