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PubMed1996

Physiologic (intraindividual) variation of serum prostate-specific antigen in 814 men from a screening population.

OBJECTIVES: We measured the intraindividual variation of prostate-specific antigen (PSA) in the serum of healthy men screened for prostate cancer. METHODS: We used a fully automated PSA assay system (ACS: 180 assay) to evaluate a screening population of 814 men (mean age, 63.3 years; range, 50 to 79 years) without documented prostate cancer or prostate surgery. A second blood sample was drawn 15 to 183 days after the first specimen (mean, 80 days). RESULTS: In the ACS PSA ranges of 0 to 7.2 ng/mL, 7.3 to 17.9 ng/mL, and 18.0 ng/mL or greater (O to 4 ng/mL, 4 to 10 ng/mL, and 10.0 ng/mL or greater by the Tandem-R assay), the mean coefficient of variation of the first and second blood drawn was 20%, 12%, and 10%, respectively. In 435 men whose first blood samples were measured twice for PSA difference (interassay or run-to-run variation), the intraindividual variation in the range of 0 to 7.2 ng/mL was significantly larger than the interassay variation, which was also true the 7.3 to 17.9 ng/mL range. In the range of 0 to 7.2 ng/mL, 251 of 695 (36%) showed a 20% or greater relative increase and 69 of 695 (10%) showed a 1.3 ng/mL (0.75 ng/mL by the Tandem-R assay) or greater absolute increase of PSA at the second blood sample. CONCLUSIONS: We conclude that in the low ranges of PSA concentrations, one should consider the possibility of substantial intraindividual variation when interpreting serial PSA measurements.

Aged↗
PubMed2004

No substantial psychological impact of the diagnosis of Type 2 diabetes following targeted population screening: The Hoorn Screening Study.

AIMS: To examine the impact of the diagnosis of Type 2 diabetes on psychological well-being and perceived health status in subjects who participated in a targeted population-screening programme. METHODS: This study was conducted within the framework of a screening project in the general (aged 50-75 years) Dutch population. The final study population consisted of 259 subjects with a high-risk score on the Symptom Risk Questionnaire; 116 of whom were subsequently detected with Type 2 diabetes and 143 who were non-diabetic. The impact was assessed approximately 2 weeks (shortly) and 6 and 12 months after the diagnosis, using the 12-item Well-Being Questionnaire (W-BQ12) and the Medical Outcomes Study Short Form 36 (SF-36), respectively. Analyses of co-variance (ancova) were used. RESULTS: Approximately 2 weeks after the diagnosis, no significant mean differences were found on either the W-BQ12 or the SF-36, between the screening-detected Type 2 diabetes subjects and the non-diabetic subjects. Six months after the diagnosis, we found lower scores in the screening-detected Type 2 diabetes subjects compared with the non-diabetic subjects on the SF-36 dimensions Role Physical (mean difference (95% CI); -8.2 (-16.2; -0.1); P = 0.046) and Role Emotional (mean difference (95% CI); -7.9 (-15.3; -0.5); P = 0.038). One year after the test results, no significant mean differences were found between both groups on either instrument (W-BQ12; SF-36). CONCLUSIONS: The diagnosis of Type 2 diabetes has no substantial adverse or positive effect on psychological well-being and perceived health status, shortly, and 6 and 12 months after the diagnosis.

Aged↗
PubMed2001

The accuracy of antenatal ultrasound in the detection of facial clefts in a low-risk screening population.

OBJECTIVES: To evaluate the accuracy of prenatal ultrasound in the detection of facial clefts in a low-risk screening population and to report on the outcome of these pregnancies. DESIGN: We retrospectively reviewed antenatal ultrasound records from the obstetric ultrasound department, postnatal records from the regional craniofacial unit and autopsy reports of fetuses over 16 weeks' gestational age from the regional pathology department over a 5-year period (1993-97). Cross-referencing between the three data sets identified all cases of facial clefts. RESULTS: Out of 23 577 live and still births, 30 had facial clefts; four were excluded from the study. Of the remaining 26 cases, 10 had associated major anomalies. There were 19 live births and seven terminations. Six of the seven terminations had other major abnormalities. Our detection rate for cleft lip and palate was 93% and the detection rate for isolated cleft palate was 22%. Isolated cleft lip was detected in 67% of cases. The overall detection rate for facial clefts was 65%. CONCLUSION: From our results and a review of the literature it is clear that before standards can be set we need to define which facial clefts are sonographically demonstrable. Our data provide information for effective counseling and setting of standards for clinical practice.

Abnormalities, Multiple↗
PubMed2002

Correlation between inflammatory cells (T and B lymphocytes, macrophages) in prostate biopsies and elevated PSA levels in a PSA screening population.

OBJECTIVES: To investigate the relationship between inflammatory cells in prostate biopsies and total serum prostate-specific antigen (PSA) levels in a screening population. METHODS: In the study, transrectal ultrasound-guided prostate biopsy specimens from 49 patients were assessed. All patients undergoing biopsy had elevated serum PSA levels (as defined by the biopsy criteria of the Tyrol PSA Screening Project) and/or abnormal findings on digital rectal examination. The prostate biopsy specimens were histologically negative for carcinoma. Immunohistologic characterization of the inflammatory cells was performed using CD3, CD4, and CD8 antibodies for the detection of T lymphocytes, CD20 antibodies for B lymphocytes, and CD68 antibodies for macrophages. The percentage of inflammatory cells and their distribution in stromal and glandular tissue was estimated using morphometric methods. RESULTS: Inflammatory cells in the stroma contained significantly larger numbers of T lymphocytes than B lymphocytes and macrophages. T lymphocytes were also predominant in the glandular region. A significant positive correlation was found between the relative volume (vol%) of macrophages and total PSA levels (P <0.05) and a significant negative correlation between the percent free PSA levels and the relative volumes of T and B lymphocytes. CONCLUSIONS: The results indicate a significant positive correlation between total PSA levels and macrophages and a significant negative correlation between percent free PSA levels and T and B lymphocytes. No statistically significant correlation was found between total serum PSA levels and the presence of inflammatory cells in the stromal and glandular compartment. Additional studies are needed to compare the amount and types of inflammatory cells with the stage and grade of prostate cancer in positive biopsies and radical prostatectomy specimens.

Adult↗
PubMed2004

Comparison of total, complexed and free prostate-specific antigens and their ratios in the detection of prostate cancer in a non-screened population.

BACKGROUND: The role of prostate-specific antigen (PSA) isoforms in the detection of prostate cancer in a non-screened population in the UK remains to be determined. METHODS: Consecutive patients undergoing diagnostic transrectal ultrasound-guided biopsy of the prostate were studied. Prior to biopsy, a blood sample was obtained and total, complexed and free PSA concentrations measured. RESULTS: Of the 171 patients included in the study, 103 were found to have prostate cancer. There were significant differences in total and complexed PSA concentrations and in the ratio of free-to-total PSA (all P <0.001) between patients with prostate cancer and those with benign disease. Receiver operating characteristics (ROC) curve analysis showed that the corresponding areas under the curves were similar. Restricting the analysis to the 77 patients who had total PSA concentrations between 2 and 10 micro g/L, ROC curve analysis showed that total and complexed PSA concentrations failed to discriminate between benign and malignant disease. In contrast, the areas under the ROC curve were greater for the free-to-total ratio (P = 0.033). CONCLUSION: These results show that in patients with total PSA concentrations between 2 and 10 micro g/L, the free-to-total PSA ratio was superior to total PSA concentration in discriminating between patients with benign and malignant disease.

Biomarkers↗
PubMed1996

Population screening for cystic fibrosis.

In the 7 years since the cystic fibrosis (CF) gene has been cloned, many experimental trials of population screening for CF heterozygotes have been reported. Targeting young adults near reproductive age has shown that the method in which screening is offered is a major determinant of acceptance rates: personal invitations produce high rates of acceptance, whereas offers made by mail or leaflet produce disappointing results. In contrast, trials of screening during pregnancy have been more satisfactory. Two models have been tested. In sequential screening, women are screened first and their partners are tested only if the women are found positive for CF alleles. This can lead to anxiety during the period when women who have tested positive await their partner's results. In couple screening both partners agree to be treated as a unit and are reported to be "high risk" only if both results are positive. In all other situations, the results are reported to be negative. Couple screening has turned out to be efficient, trouble-free, and consumer-friendly and may be the method of choice for integration into routine health care.

Adult↗
PubMed2000

Population screening for hemochromatosis: a comparison of unbound iron-binding capacity, transferrin saturation, and C282Y genotyping in 5,211 voluntary blood donors.

Early diagnosis and treatment of hemochromatosis is essential to prevent organ damage. Screening strategies to detect early hemochromatosis include testing for iron overload and/or genetic testing. Voluntary blood donors numbering 5,211 were screened with unbound iron-binding capacity (UIBC), transferrin saturation (TS), and genetic testing for the C282Y mutation of the HFE gene. The study found 16 C282Y homozygotes (1 in 327), 69 compound heterozygotes, 371 simple heterozygotes, and 4,755 normals. There were 5 men and 11 women homozygotes with a mean age of 42, range 28 to 57. Mean UIBC (24 +/- 7 microL) and TS (48% +/- 17%) in homozygotes were significantly different from compound heterozygotes, simple heterozygotes, and normals (ANOVA). Only 3 homozygotes had an elevated serum ferritin. Family studies found an additional 4 iron-loaded homozygotes. Optimal thresholds were < or =28 micromol/L for UIBC and > or =46% for TS. Receiver operating characteristic (ROC) curve analysis showed an area under the curve for UIBC of 0.93 (0. 85-1.0, 95% confidence interval), and for TS of 0.83 (0.7-0.95). Screening with UIBC to preselect those for genotyping is a cost-efficient strategy for population screening for hemochromatosis.

Adult↗
PubMed1989

Effect of body mass and other factors on serum liver enzyme levels in men attending for well population screening.

Alcohol abuse is usually regarded as the most likely cause of elevated serum liver enzyme values in those attending for well population screening, but we have found increased body weight to be an important contributing factor. We have measured serum levels of alanine amino-transferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transferase (GGT) in approximately 21,000 men attending for routine health screening, and related these to behavioural factors such as alcohol consumption, cigarette smoking, exercise level and obesity. The levels of all three enzymes were positively correlated with levels of alcohol consumption. Decreasing levels of physical activity were associated with increases in mean ALT and GGT levels. Cigarette smoking showed only a weak effect on ALT and AST, which became non-significant after multivariate statistical analysis, but increasing consumption of cigarettes was associated with increased mean levels of GGT. In contrast, all three enzymes showed marked increases in mean levels with increasing body mass index (BMI). The effect of obesity was particularly important in the case of ALT: the prevalence of increased ALT values in obese subjects (BMI greater than or equal to 31 kg/m2) was more than eight times that in those with normal weight (BMI less than or equal to 25 kg/m2), even after allowing for the confounding effect of alcohol consumption. This study is concerned solely with male subjects, but we hope to extend the analysis to females in the near future.

Adult↗
PubMed1987

Epidemiology of intraocular pressure in a population screened for glaucoma.

This study evaluated the association between intraocular pressure and various sociodemographic characteristics, ocular findings, and cardiovascular risk factors in a population screened for glaucoma. A total of 2594 subjects older than 40 years residing in three urban areas of southern Israel participated. Of those screened 6.1% had a raised intraocular pressure (IOP greater than or equal to 21). The mean IOP increased with age, was higher among persons born in Africa or Asia than those born in Europe or America, higher among myopes than hypermetropes and among those with an enlarged cup-disc ratio (CDR). Analysis of variance tests indicated that refractive status, CDR, age, country of birth, and diabetes were each independently associated with IOP. In addition, associations between raised intraocular pressure and age, country of birth, myopia, CDR, diabetes, and glaucoma in the family were found.

Adult↗
PubMed2006

Population screening for colorectal cancer.

Each year in the UK, around 16,000 people die from colorectal cancer. At disease presentation, around 55% of people have advanced cancer that has spread to lymph nodes, metastasised to other organs or is so locally advanced that surgery is unlikely to be curative (Dukes' stage C or D). Overall 5-year survival for colorectal cancer in the UK is around 47-51% (compared to 64% in the USA), but only 7% at most in those presenting with metastatic disease. These facts underlie the current introduction of national bowel screening programmes in the UK. Here we assess the role of screening of the general population in reducing mortality from colorectal cancer. We do not consider the screening arrangements needed for high-risk populations, including those with inflammatory bowel disease or a strong family history of colorectal cancer.

Colonography, Computed Tomographic↗
PubMed2003

Living with achondroplasia: attitudes toward population screening and correlation with quality of life.

OBJECTIVES: Since the discovery of the gene that causes achondroplasia, population-wide prenatal screening for this condition has become a possibility. This study sought to assess attitudes toward screening for achondroplasia and correlation with quality of life in a population of individuals affected with achondroplasia and first-degree relatives. METHODS: Surveys were collected from 189 individuals affected with achondroplasia and 136 average-statured first-degree relatives. RESULTS: While 87% of all respondents would support the use of prenatal screening by affected parents at risk of having a fetus with the homozygous, lethal form of achondroplasia, 29% would support general population prenatal screening for achondroplasia. Attitudes supporting general population screening were more likely to be held by those people with less education, who were affected with achondroplasia, who supported abortion, and who believed that achondroplasia is a serious condition without any accompanying advantages (p<0.01). Those respondents who felt positively toward offering the prenatal test for individuals at risk for homozygous achondroplasia were more likely to have lower mean quality of life scores and to support abortion in general (p<0.05). CONCLUSION: These data suggest that opinions about prenatal screening are heterogeneous within this study population and are related to individuals' experiences and perceptions of the condition. Future research is needed to assess attitudes toward population screening and quality of life in communities of individuals affected with genetic conditions, both to support policy decisions and to inform the education and counseling provided in the prenatal setting.

Achondroplasia↗
PubMedDate not supplied

Promoting participation in a population screening program for breast and cervical cancer: a randomized trial of different invitation strategies.

AIMS AND BACKGROUND: Attendance level has been identified as a major determinant of cost-effectiveness of organized screening programs. We tested the effectiveness of 4 different invitation systems in the context of an organized population screening program for cervical and breast cancer. METHODS: Women eligible for invitation--8385 for cervical and 8069 for breast cancer screening--listed in the rosters of 43 and 105 general practitioners (GP), respectively, who had accepted to collaborate in the program, were randomized to 4 invitation groups: Group A--letter signed by the GP, with a prefixed appointment; Group B--open-ended invitation, signed by the GP, prompting women to contact the screening center to arrange an appointment; Group C--letter (same as for group A), signed by the program coordinator, with a prefixed appointment; Group D--extended letter (highlighting the benefits of early cancer detection) signed by the GP, with a prefixed appointment. Assignment to the interventions was based on a randomized block design (block=GP). RESULTS: Assuming Group A as the reference, the overall compliance with cervical cancer screening was reduced by 39% in Group B (RR=0.61; 95% CI, 0.56-0.68) and by 14% in Group C (RR=0.86; 95% CI, 0.78-0.93); no difference was observed for Group D (RR=1.03; 95% CI, 0.95-1.1). The response pattern was similar for breast screening (Group B: RR=0.71; 95% CI, 0.65-0.76; Group C: RR=0.87; 95% CI, 0.81-0.94; Group D: RR=1.01; 95% CI, 0.94-1.08). CONCLUSIONS: Personal invitation letters signed by the woman's GP, with preallocated appointments, induce a significant increase in compliance with screening. Efficiency can be ensured through the adoption of overbooking, provided that attendance levels are regularly monitored.

Adult↗
PubMed1985

Population screening for breast cancer by mammography in The Netherlands. Expectations, early results, negative effects and conditions for large-scale screening.

Recent publications have shown clearly that screening by mammography is the only method of reducing breast cancer mortality substantially. This can only be achieved, however, by regular annual screening of all women over 40 years of age. An efficiently organized screening program that guarantees optimal mammographic quality should be developed in order to avoid negative effects of population screening such as false-positive and false-negative reports.

Adult↗
PubMed1988

Prevalence of genital HPV infections in a regularly screened population in The Netherlands in relation to cervical cytology.

To determine the prevalence of human papilloma virus (HPV) genotypes in relation to cervical cytology, 1,290 cervical samples from a regularly screened population of 30-55-year-old women were investigated. Gynaecological specimens, obtained from the cervix, were cytologically classified and screened for the presence of HPVs 6/11 and 16/18 using dot-spot DNA hybridisation. Of the cervical samples containing unequivocally normal cells, 21 of 1,271 (1.6%) were found positive for HPV, and of the cervical samples containing cells with mild dysplasia, 6 of 14 (43%) were found positive for HPV. All five samples containing cells consistent with severe dysplasia or carcinoma in situ were found positive for HPV. Approximately 50% of the HPV-positive samples contained HPV 16 and/or HPV 18 DNA.

Adult↗
PubMed2001

Diagnostic value of radiological breast imaging in a non-screening population.

The aim of this study was to assess the diagnostic performance of breast imaging in the diagnosis of breast cancer in a non-screening population. In a consecutive set of patients referred for mammography in one year, the results of palpation and radiological breast imaging were scored on a 5-point grading scale and linked to pathology as gold standard after a follow up period of one year. The diagnostic performance was studied by logistic regression analysis and ROC-curves. There were 1,944 breast examinations in 1,890 patients and 3,816 breasts. Pathology results reported 118 malignancies in 115 women. With a cut-off point between benign and uncertain benign a sensitivity of 89% and a specificity of 98% was found for radiological imaging. ROC-curves showed a significant increase in diagnostic performance when radiology was added to results of palpation and age (p = 0.007). Radiological imaging tests have a large diagnostic value in the detection of breast cancer in addition to palpation and age. A sensitivity close to 100% could be reached.

Adolescent↗
PubMed1990

A study of baseline risk factors for coronary heart disease: results of population screening in a developing country.

To contribute information on coronary heart disease and its risk factors (information which is still scarce in developing countries), this report is presented on a population screening study done in urban Jakarta, using the MONICA Protocol. A randomly selected sample of 2073 people (25-64 years) from 3 districts (total population 523,000) of Jakarta were examined. The results were as follows: electrocardiogram (ECG) signs of old myocardial infarction were found in 2.7%, and sequelae of stroke in 0.5% of respondents: prevalence of hypertension was found in 14.9%; male smokers were 59.9% (females only 5.9%); mean serum total cholesterol concentrations were 5.2 mmol/L in men and 5.4 mmol/L in women, with 13.4% of all respondents having hypercholesterolaemia (greater than or equal to 6.5 mmol/L); regular alcohol drinkers were only 2.7%. Anti-smoking, anti-hypertension and active physical exercise campaigns already launched many years ago will be boosted, along with the preservation of the traditional low fat diet of the common Indonesian.

Adult↗
PubMed2006

Incidentally discovered thyroid nodules: incidence, and greyscale and colour Doppler pattern in an adult population screened by real-time compound spatial sonography.

PURPOSE: Our aim was to assess the incidence and ultrasound features of thyroid nodules in an adult population screened by means of high-resolution ultrasonography (HRUS) and to evaluate the contribution of real-time spatial compound sonography (CS) in terms of image quality. MATERIALS AND METHODS: A total of 704 consecutive patients (400 women, 304 men) without thyroid disease underwent HRUS and CS examination of the thyroid gland. Number, size, location, echotexture and colour Doppler pattern of detected nodules were assessed. Two radiologists also assessed image quality of the two techniques. RESULTS: Seven hundred and eleven thyroid nodules (size range 0.18-4.1 cm; mean: 1.1 cm) were detected in 233 subjects (33.1%). Of these, 416 (58.5%) were found in 143 women whereas 295 (41.5%) were detected in 90 men. In both genders, the number of detected nodules increased with age, with the highest prevalence in the seventh decade (p<0.001). There were 461/711 (64.9%) thyroid nodules that were hypoechoic, and 449/711 (63.1%) had peripheral vascularity only (p<0.001). Fine-needle aspiration (FNA) revealed no malignancies. CS was graded better than HRUS in 621/711 (87.3%) cases (p<0.001). CONCLUSIONS: The prevalence of benign, small, hypoechoic thyroid nodules with peripheral vascularity was high in our series, thus suggesting a conservative approach. CS provided better image quality compared with HRUS.

Adolescent↗