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PubMedDate not supplied

[Cost-benefit analysis of a mammography screening program extended to all the national territory].

A cost-effectiveness analysis has been conducted in order to evaluate effects and costs of a nationwide mammographic breast cancer screening programme compared with no screening in a 30 years period. The analysis includes seven different phases of breast cancer, from the screening programme itself to the treatment of terminal illness. The estimates use italian published data and field studies. The calculations were performed with the Miscan computer simulation package: a programme providing for the screening of women aged 50-69 at two years intervals might be expected to result in a 1,650 deaths prevented and 14,500 years of life gained each year. The overall net costs of the programme were assessed at between 2,893 and 3,212 thousand million lire, the cost per life saved between 59.8 and 66.4 million lire and the cost per life-year gained between 6.6 and 7.3 million lire (between 10.7 and 11.5 million lire with a 5% discount rate, an estimate lower than that of German programme). The analysis produces important information for the Italian policy debate over mammography and it also contributes to the development of economic evaluation in our country.

Aged↗
PubMed1988

Natural history of adenocarcinoma-large cell carcinoma of the lung: conclusions from screening programs in New York and Baltimore.

A mathematical model of the progression kinetics of lung cancer was described and used to shed light on the natural history of adenocarcinoma and large cell carcinoma of lung from data collected in screening studies of male smokers by the Memorial Sloan-Kettering Cancer Center and The Johns Hopkins Medical Institutions. In both programs, estimates of the mean duration of early-stage adenocarcinoma or large cell carcinoma of lung ranged upward from 4 years, and estimates of the probability of detecting it in early-stage disease ranged downward from .16. The probabilities of curing early-stage disease through surgical treatment were found to be at most .52 and .13 in the New York and Baltimore studies, respectively. These estimates led to the conclusion that expected reduction in mortality from adenocarcinoma and large cell carcinoma of lung as due to annual x-ray screening from age 45 to 80 years is not greater than 18% in New York and 5% in Baltimore.

Adenocarcinoma↗
PubMed1998

A community outreach lead screening program using capillary blood collected on filter paper.

OBJECTIVE: To test whether a method of fingerstick blood sample collection onto filter paper could be used as an alternative screening method in the field in settings where environmental lead contamination is a high risk. METHOD: Members of the Pediatric Mobile Team of Children's Hospital of Michigan, Detroit, collected paired venous and capillary blood samples from 120 children, aged 6 months to 6 years, who presented for services at any of 7 sites located in decaying neighborhoods of older sections of Detroit. All samples were analyzed for lead content by graphite furnace atomic absorption spectrometry. RESULTS: When filter paper samples with blood lead levels of 0.48 micromol/L (10 microg/dL) or higher were compared with matched venous samples, the concordance coefficient was 0.96. The sensitivity and specificity of the filter paper samples relative to the venous samples for a cutoff of 0.48 micromol/L (10 microg/dL) or higher were 94% and 99%, respectively, with a positive predictive value of 97%. However, at a cutoff of 0.72 micromol/L (15 microg/dL), the sensitivity and specificity dropped to 75% and 98%, respectively, with filter paper samples underreporting blood lead values. At any cutoff point (0.48, 0.72, or 0.96 micromol/L [10, 15, or 20 microg/dL]), the filter paper method was highly specific for lead. CONCLUSIONS: Capillary filter paper sampling is an accurate and practical alternative to venous sampling for blood lead screening using 0.48 micromol/L (10 microg/dL) as the cutoff. The filter paper method predicts levels of 0.72 micromol/L (15 microg/dL) or higher less well. The cause of divergent values above 0.72 micromol/L (15 microg/dL) is not clear. Environmental contamination of capillary filter paper, however, does not seem to be an explanation.

Capillaries↗
PubMed1990

Cytometric and histopathologic features of tumors detected in a randomized mammography screening program: correlation and relative prognostic influence.

Cytometric determination of S-phase fraction and ploidy type was performed on 430 tumors detected within a randomized trial of mammographic screening. The results were compared to several histopathologic features. A high S-phase fraction was estimated in tumors with a high grade of malignancy and other histopathologic findings related to rapid tumor progression, including lack of tubule formation, a high mitotic index, marked nuclear pleomorphism, multifocal cancer growth, tumor emboli in lymphatic and blood vessels, tumor necrosis, and inflammatory reaction. DNA aneuploidy was correlated with a high malignancy grade, frequent mitoses, a high degree of nuclear pleomorphism, vascular invasion, necrosis, and the presence of noninvasive ductal carcinoma. Both cytometric variables were inversely related to the degree of elastosis. Positive nodes, large tumor size, DNA aneuploidy, a high S-phase fraction, high grade of malignancy, lack of tubule formation, as well as high mitotic index and pleomorphism, presence of multifocal cancer, and vascular invasion, predicted a significantly shorter distant recurrence-free interval after a median follow-up time of 46.6 months. Elastosis and the presence of estrogen and progesterone receptors indicated favorable prognosis. In the multivariate analysis, only lymph node status, tumor size, S-phase fraction, and multifocal growth pattern had independent prognostic value.

Adult↗
PubMed2006

Psychosocial factors associated with the adherence to a colorectal cancer screening program.

BACKGROUND: Although colorectal cancer (CRC) is one of the most commonly diagnosed cancers and a major cause of cancer related mortality, very little is known about why screening adherence rates are low. First-degree relatives of CRC patients are the largest group of individuals at increased risk of CRC. Psychosocial factors related to CRC screening adherence were examined in a sample of siblings of individuals diagnosed with CRC. METHOD: To identify psychosocial factors related with participation in cancer screening examinations, 90 siblings of CRC patients were recruited. Adherence to screening by fecal occult blood test, flexible sigmoidoscopy and colonoscopy was the relevant factor. Sociodemographic variables, health locus of control (HLOC), perceived social support, knowledge about CRC and coping strategies were independent measures. RESULTS: Significant differences were found in age, gender, retirement status, knowledge of sibling's illness, HLOC-powerful others, coping strategies (positive thinking, blaming others, seeking social support), perceived social support types (listening, affective, material) and social support sources (friends, work colleagues and health staff). Using stepwise logistic regression, the strongest predictor of adherence was knowledge of sibling's illness. CONCLUSIONS: The findings suggest that effective strategies to increase participation in CRC screening may include efforts to improve knowledge of sibling's illness, material social support and advice from health staff.

Aged↗
PubMed1983

Lung cancer detected during a screening program using four-month chest radiographs.

Ninety-two lung cancers were detected in the Mayo Lung Project in patients undergoing chest radiography every four months for screening. Fifty patients had a peripheral nodule, 16 had a perihilar nodule, 20 had hilar or mediastinal enlargement, and six had pneumonitis. The peripheral cancers grew slowly. Ninety per cent were visible in retrospect for months or even years. Despite this, 70% of the peripheral cancers were classified as postsurgical American Joint Committee (AJC) Stage 1. The central cancers grew rapidly, usually presenting as hilar or mediastinal enlargements after normal findings on the previous radiograph obtained four months earlier. Most were classified as AJC Stage 3 tumors.

Adenocarcinoma↗
PubMed2001

[Screening for breast cancer on basis of individual risk assessment for women ineligible for the national population screening program].

For healthy women, without malignancies in their personal histories, a positive family history for breast cancer is the single indication for individual breast surveillance outside the population screening. Management of women is based on individual risk assessment. A cumulative risk of 20% and more, as a result of a positive family history, will in practice be an indication for breast surveillance. This threshold is not evidence-based yet, nor are data available on the benefits of this surveillance efficacy. When a personal cumulative risk of more than 30% exists to develop breast cancer, a consultation with a clinical geneticist involved in a family cancer clinic should be offered. Surveillance of women with a high-risk cumulative risk should preferably be included in a prospective study design. Only in this way will data about compliance and the estimates of different ways of surveillance become available. There is no convincing evidence that population screening for women aged 40-49 years does lead to important mortality reduction in combination with a good balance between pros and cons for the women involved. Women in the age category 50-75 years, with breast cancer in their personal histories, who are not followed anymore, should be informed by their specialist about participating (again) in the population breast screening. There is no evidence of mortality reduction as a result of breast self-examination nor of palpation performed by a physician. However, awareness of the own body can be useful for early recognition of breast abnormalities; it may reduce the delay between the first recognizable symptom and the subsequently initiated therapy.

Adult↗
PubMed1994

Hearing loss: an educational and screening program for African-American and Latino elderly.

This article describes a study that tested the effectiveness of culturally sensitive educational material on hearing loss and performed mass screenings to evaluate the prevalence of hearing impairment among urban African-American and Latino seniors. Bilingual information booklets on hearing loss were mailed to households and senior centers in 45 census tracts with high concentrations of minority elderly. Seniors were invited for hearing evaluations and were screened using a handheld audioscope. Subjects with hearing impairment were referred for specialized testing and later telephoned to assess subsequent care. Four hundred thirty-three persons (3.14%) responded to three mailings, typically by presenting for a hearing evaluation. Responses to a brief questionnaire indicated a high degree of learning about hearing loss. Of the 296 seniors screened, 174 demonstrated abnormal hearing, but only 26% obtained further testing. Barriers to follow-up care included problems with finances, transportation, and illness.

Black or African American↗