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PubMed2003

[Epidemiologic reasons for screening programs in the national health service].

The author describes the current health state of the Hungarian population in terms of cancer mortality and morbidity. Based on the comparative analysis of national and international, mainly European, data he describes the unfavourable Hungarian indices trying to identify their causes and the possible breaking free from them, as well. The greatest potential lies in the organised, continuous screenings within the frame of "Johan Béla National Programme of the Decade of Health". Since tumour diseases pose severe and alarming problems in national health care the reduction of extremely high mortality in three tumour localisation (cervix uteri, breast and colorectum) by regular screenings is absolutely justified.

Europe↗
PubMed2001

Results of a screening program for prostate cancer in patients scheduled for abdominoperineal resection for colorectal pathologic findings.

OBJECTIVES: Because of the difficulty of accessing the prostate for tissue sampling after surgical removal of the rectum and obliteration of the anus, we started an early detection program for prostate cancer in all men scheduled for abdominoperineal resection. METHODS: Twenty consecutive men were screened for prostatic adenocarcinoma before planned abdominoperineal resection for colorectal pathologic findings. Patients were 48 to 77 years old (mean 66.9). Screening included serum prostate-specific antigen determination and digital rectal examination. Those patients with suspicious findings underwent transrectal ultrasound-guided sextant biopsies of the prostate. RESULTS: One patient was excluded because of a prior history of prostate cancer. Six (31.6%) of the remaining 19 patients demonstrated elevated prostate-specific antigen levels (greater than 4.0 ng/mL); two of these patients also had an abnormal digital rectal examination. Transrectal ultrasound and prostate biopsies in these 6 patients revealed prostatic adenocarcinoma in 3 patients (50% of those undergoing biopsies or 15.8% of those screened). The 13 patients who did not undergo prostate biopsies had prostate-specific antigen levels from 0.4 to 2.4 ng/mL (mean 0.9) and normal prostate glands according to the digital rectal examinations. CONCLUSIONS: Screening for prostate cancer in men 50 years old or older with 10 years or longer life expectancy before they undergo abdominoperineal resection detects a significant number of prostatic malignancies and should be encouraged.

Adenocarcinoma↗
PubMedDate not supplied

Pap smear screening in women under 30 in the Norwegian Coordinated Cervical Cancer Screening Program, with a comparison of immediate biopsy vs Pap smear triage of moderate dysplasia.

OBJECTIVE: Top provide population based estimates of Pap smear screening results among women under 30 and to compare the outcomes of 2 triage options for women under 30 with a moderate dysplastic Pap smear: immediate biopsy vs. Pap smear follow-up. STUDY DESIGN: All Pap smears, histologically verified cervical intraepithelial lesion (CIN) 2/3 and invasive cervical cancer in 1999-2002 from women in Norway under 30 in 2000-2002 were analyzed. Due to different triage recommendations in different laboratories, 836 women under 30 with a moderately dysplastic Pap smear were recommended for immediate biopsy, while 109 were recommended for a Pap smear within 6 months. Risk estimates for triage outcome were estimated by multinominal logistic regression. RESULTS: The prevalence of squamous intraepithelial lesion was highest around 20 years. The first moderate dysplasia was diagnosed at age 16, as was CIN 2/3. Of the women with Pap smear triage, one third were diagnosed with a CIN 2+ lesion, one third had a normal outcome, while the last third were in uncertain state 12 months later. Among those recommended for immediate biopsy, nearly 70% were diagnosed with a CIN 2+, thus having odds of 4.2 (95% CI 2.5-7.1) higher than did women with Pap smear triage of being diagnosed with CIN2+ 12 months later. CONCLUSION: The choice of triage has a profound impact on the proportion of young women diagnosed with CIN 2+ after a moderately dysplastic Pap smear.

Adolescent↗
PubMed2002

[Abuse of women is a public health problem. All female patients over the age of 14 should be part of a routine screening program].

Abuse does not appear to be restricted to a specific sociodemographic group of women, nor to a specific period in their lives. Screening for domestic violence provides an opportunity not only to disclose family abuse but also to take action to improve the safety and health of these women. All routine health care of women should incorporate direct questions about abuse, psychological as well as physical and sexual. Staff should be trained in how to integrate routine enquiries about abuse into their daily practice.

Adolescent↗
PubMed1983

Data from an alpha-fetoprotein pilot screening program in Maine.

In Maine, maternal serum alpha-fetoprotein (AFP) values equaled 2 or more multiples of the median in 4.8% of screened women. Between 2.0 and 2.9 multiples of the median repeat maternal serum AFP testing and sonography were comparable as the next diagnostic step; at 3 multiples of the median or higher sonography was superior. Sonography moved dates back in only ten singleton viable pregnancies with maternal serum AFP elevations; three of these had open fetal defects. Among singletons, all five anencephaly cases, one of two open spina bifida lesions, and all three open ventral wall defects were identified. Three closed singleton neural tube defects and two open spina bifida defects in twins were not detected. Nineteen of 36 multiple gestations had maternal serum AFP 2 or higher multiples of the median. In singletons, maternal serum AFP of 3 or higher multiples of the median indicated a thirtyfold increased risk for fetal death and a sevenfold increased risk for birth weight under 2500 g.

Congenital Abnormalities↗
PubMed1979

Experience of a sickle cell screening program in Baltimore.

The hemoglobinopathies constitute a major medical problem in the black community of Baltimore. A sickle cell service should be designed to discover, educate, and, if necessary, treat. Screening is sound preventive medicine and may serve to introduce the patient to the concept of continuing medical surveillance. The prevention of serious complications in patients with the more severe types of hemoglobinopathy should be a basic goal in the program.

Adolescent↗
PubMedDate not supplied

The American College of Radiology's BI-RADS 3 Classification in a Nationwide Screening Program: current assessment and comparison with earlier use.

The Breast Imaging Reporting and Data System allows radiologists to classify lesions as "probably benign-short interval follow-up suggested" (category 3). The purpose of this study is to evaluate the recent use of the category 3 designation in a national cancer detection program. We analyzed data from the National Breast and Cervical Cancer Early Detection Program, a nationwide collaboration between the Centers for Disease Control and Prevention (CDC) and local health agencies that provides cancer screening for low-income, uninsured women. The study population included all women at least 40 years old who had mammograms in the program through September 1999 (n = 826,424). Of the 826,424 mammograms, the percentage classified as category 3 in the initial phase (1991-1996, previously reported, n = 372,760) was 7.7%; of the most recent 453,664 mammograms (1996-1999), 6.0% were given this designation. During the same periods, the percentage of abnormal mammograms decreased from 2.6% to 2.1% and those needing "additional imaging" (category 0) increased from 5.0% to 6.9%. The percentage receiving a category 3, category 0, or abnormal designation decreased with increasing age for each classification. The percentage of category 3 mammograms varied by site from 1.1% to 12.2%. Overall the proportions of category 3 mammograms decreased over time, while requests for additional examinations increased. This suggests that patients were more likely than before to receive additional examinations prior to their final designation. The persistent wide variability in category 3 indicates further education and attention to the use of this category is warranted.

Adult↗
PubMedDate not supplied

Identification of women at increased risk for breast cancer in a population-based screening program.

A multivariate model to assess breast cancer risk was developed by Gail et al. (M. H. Gail, L. A. Brinton, D. B. Byar, D. K. Corle, S. B. Green, C. Schairer, and J. J. Mulvihill, J. Natl. Cancer Inst., 81: 1879-1886, 1989) based on data analysis of the Breast Cancer Detection and Demonstration Project. We evaluated the model's usefulness for assigning women to risk groups for counseling and follow-up by applying it to the 1987 Texas Breast Screening Project data. We identified 3165 women with one or more first-degree relatives affected with breast cancer. The mean risk score for the group was 3.3 (range, 2.7-11.8), indicating a greater than 3-fold elevated risk. The mean risk score for the remaining 27,439 women without affected first-degree relatives was 1.5 (range, 1.24-3.2). Risk perception was found to be a motivator for participation. Women with a risk score greater than 5 perceived themselves to be at high risk for breast cancer. The perception of risk was related to the type of affected first-degree relatives: 80.0% of the women with three affected first-degree relatives and 71.5% of women whose mother and sister were both affected with breast cancer perceived themselves to be at high risk. The Gail model is potentially useful in the clinical setting because women at high risk for breast cancer can be entered into etiological studies, enrolled in primary prevention trials, or referred to programs seeking to improve compliance with screening mammography. The Gail model needs validation, but it is useful for estimating the risk of breast cancer in large populations.

Adult↗
PubMed2006

Single reading with computer-aided detection and double reading of screening mammograms in the United Kingdom National Breast Screening Program.

PURPOSE: To retrospectively determine if the use of a computer-aided detection (CAD) system can improve the performance of single reading of screening mammograms to match that of double reading in the United Kingdom. MATERIALS AND METHODS: Local research ethics committee approval was obtained; informed consent was not required. This study included a sample of 10 267 mammograms obtained in women aged 50 years or older who underwent routine screening at one of two breast screening centers in 1996. Mammograms that were double read in 1996 were randomly allocated to be re-read by eight different radiologists using CAD. The cancer detection and recall rates from double reading and single reading with CAD were compared. Statistical significance and confidence intervals were calculated with the McNemar test to account for the matched nature of the data. RESULTS: Single reading with CAD led to a cancer detection rate that was significantly (P = .02) higher than that achieved with double reading: 6.5% more cancers were detected by means of single reading with CAD than by means of double reading. However, the recall rate was higher for single reading with CAD than for double reading (8.6% vs 6.5%, respectively; P < .001). This was equivalent to relative increases of 15% and 32% in the cancer detection and recall rates, respectively. CONCLUSION: Single reading with CAD leads to an improved cancer detection rate and an increased recall rate.

Breast Neoplasms↗
PubMed2002

[The use of medical services and the utilization rate in screening programs in relation to social class: results of a representative survey in Bavaria].

OBJECTIVES: This article aims to analyse utilisation of medical services and screening programmes in relation to social class. METHODS: 2051 adults in Bavaria were interviewed using computer-assisted telephone interview (CATI) in 1999/2000. Social class was established from the income-adjusted Winkler social category index. Data were standardised by age and sex. If social class differences were found, separate analyses for education and income effects were conducted. RESULTS: Higher education was found to be associated with visits to specialist and vaccinations. The purchase of over-the-counter medication was related to higher education and family income. Frequency of HIV-tests was higher in higher social classes but not related to higher education or better financial situation. Utilisation rates for screening programmes for various types of cancer were similar in all social classes. CONCLUSIONS: The results show that social class differences in health behaviour in Bavaria prevail. Positive health behaviour is often associated with higher education. Compared to earlier findings social class effects on the utilisation of cancer screening appears less pronounced. Preventive measures seem to have reached all social classes to a similar degree.

Adolescent↗