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PubMed1987

Evaluating the survival of cancer cases detected by screening.

Early detection of cancer by screening advances the date of diagnosis, but may or may not affect survival. To assess the survival benefit associated with early detection, one must estimate the distribution of time survived post lead-time, that is, after the unknown date when clinical diagnosis would have occurred in the absence of screening. One can then compare the adjusted survival of screen-detected cancer cases to other groups of cases not diagnosed by screening. This paper describes a model for the survival of screen-detected cases, with a hazard function that depends on an individual's lead time, the duration of preclinical disease, and the time since diagnosis. The model is fitted to the ten year survival data from the 132 screen-detected cases of breast cancer in the well-known HIP (Health Insurance Plan of Greater New York) study. Comparison with the survival of several groups of cancer cases not detected by screening (interval cases arising clinically in persons previously screened, cases among persons who refuse screening, and cases among randomized controls not offered screening) yields various estimates of benefit. Use of the interval cases for comparison gives an estimate of about 21 breast cancer deaths prevented among 20,166 women screened in the HIP study; use of the data from the randomized controls gives an estimate of about 25 prevented deaths. The former estimate derives from the screened group of women only, and so the same method of evaluation may also be applied to community screening programmes and other situations that do not entail randomization.

Actuarial Analysis↗

PubMed1982

[Value of screening for early detection of urological tumors (author's transl)].

Screening for early cancer detection is of value if (i) appropriate tests are available, (ii) the detected tumor can be treated, and (iii) the treatment improves the quality of life or the mortality rate of the patients. It is demonstrated whether carcinomas of the prostate and urinary tract, renal cell carcinoma, penile carcinoma and testicular tumors satisfy these conditions. Screening for early cancer detection may be indicated in prostatic and urinary tract carcinomas. The clinical examination should include the male genitalia. The indication for sonography of the kidneys to detect renal cell carcinomas is investigated at the moment. Instruction to perform self-examination of the testes should be given to all males older than 20 years.

Adenocarcinoma↗

PubMed1991

Nurses' practice of breast cancer screening and early detection: results of a pilot survey.

Nursing has a professional responsibility to participate in cancer screening and early detection. Nurses represent the largest professional group in the health care workforce and are presently an underutilized potential resource for implementing breast cancer screening and early detection. Development of a reliable and valid instrument which could be used to evaluate the effectiveness of mechanisms designed to increase nursing's role in breast cancer screening and early detection is needed. The questionnaire tested in this pilot study represents an initial attempt at fulfilling this need. This questionnaire in its present form may be used to evaluate the results of intervention studies aimed at increasing nurses' practice of breast cancer screening and early detection. For example, the questionnaire could be used as an evaluation tool to examine the effectiveness of educational programs regarding breast cancer screening and early detection. It may also be used as an outcome measure to evaluate change in practice activities such as the effect on nursing practice of including questions on the nursing history and assessment form related to BSE, clinical breast exam and mammography. Results of nursing action in breast cancer screening and early detection could have a significant impact on the achievement of the NCI's year 2000 goal of a 30% reduction in breast cancer mortality.

Adult↗

PubMedDate not supplied

Early- and middle-aer components to clicks as response indices for neonatal hearing screening.

Early- and middle-component-averaged electroencephalic responses (AER) to monotic clicks at 60, 40 and 20 dB normal hearing level were elicited from 18 carefully selected normal neonates. Grand-composite AERs of the responses from all 18 babies showed stimulus-related configurations at all three stimulus levels. AERs for individual babies were more frequently identified as stimulus-related when poststimulus activity beyond 10 ms was included in response-identification procedures than when only the first 10 ms was observed.

Audiometry↗

PubMed1997

Ubiquitin is physiologically induced by interferons in luminal epithelium of porcine uterine endometrium in early pregnancy: global RT-PCR cDNA in place of RNA for differential display screening.

Early in the course of pregnancy, at the preimplantation stage, the pig embryo is likely to exert a paracrine effect on the tissue intended to receive it, via the secretion of interferons. Our observations show that trophoblastic interferons induce an increase of some mRNAs in the epithelial cells of the gilt endometrium, which would illustrate this phenomenon. The increase of four mRNAs, whose corresponding cDNAs are dD1, dD2, dD3 and dD4, has been examined in this study. The method used is similar to Northern blot analysis except that mRNAs in the blot are replaced by cDNAs produced from total cellular poly(A)+ mRNAs by global reverse-transcription polymerase chain reaction (RT-PCR). Northern blot hybridization requires a considerable quantity of starting material--which we estimate in this study to be several million porcine endometrium cells--whereas the RT-PCR-based method gives comparable results starting with only a few cells--about 200. Using this method, the differential nature of dD1, dD2, dD3 and dD4 was shown. dD2 and dD3 correspond to genes already identified as interferon-induced: the beta2-microglobulin and Finkel-Biskis-Reilly murine sarcoma virus-associated ubiquitously secreted protein (FAU). dD1 corresponds to a still unidentified gene. dD4 encodes for the porcine UbA52 ubiquitin. Up to now, the increase in ubiquitin mRNA as a result of interferon effect has not been reported and is discussed in view of recent publications.

Amino Acid Sequence↗

PubMedDate not supplied

Prostate cancer: screening and early detection.

BACKGROUND: Despite more than a decade of prostate-specific antigen (PSA)-based screening, the proven impact of screening on mortality due to prostate cancer continues to be controversial. METHODS: A literature review of issues pertaining to the epidemiology, screening, early detection, and mortality as they relate to prostate cancer was conducted. Included in the review are PSA refinements, controversies of screening, and organization guidelines. Finally, recent reports of mortality rates in the post-PSA era are presented for discussion. RESULTS: Prostate cancer mortality rates have begun to decline for the first time since statistics have been recorded. The recent decline in age-adjusted mortality rates from prostate cancer is significant, and this decline appears to be earlier than would have been predicted. This finding, coupled with the dramatic decline in metastatic disease, implies that PSA-based screening may be responsible for a significant portion of this improvement in mortality. CONCLUSIONS: The cost of prostate cancer screening appears to be acceptable. Randomized studies of PSA-based screening are currently ongoing, although the results may not be available for a decade. Currently, the best evidence is derived from population-based studies that appear to show a benefit to prostate cancer screening.

Biopsy↗

PubMed2000

Screening for early prostate cancer: what is the problem?

Screening has been applied to normal populations to detect early cancers. Prostate cancer is very common and can be detected at an early stage. Screening has not been introduced in the UK for this disease and the possible reasons for this are discussed. There is a strong case for evaluation of screening programmes for this disease.

Humans↗

PubMedDate not supplied

Vision screening requirements under 52 Early and Periodic Screening Diagnosis and Treatment (EPSDT) Programs.

A 1979 survey of vision screening requirements in 52 Early and Periodic Screening Diagnosis and Treatment (EPSDT) programs revealed that 17 percent of the programs had no requirements, and 17 percent required only distance visual acuity testing. An additional 25 percent required distance vision and ocular muscle-fusion tests only, and the remaining programs required various combinations of three or more tests. Fewer than two-thirds of the programs with requirements had referral criteria for the tests. The ages at which initial testing was required also varied among the programs. The differences in requirements were not related to the demographic, socioeconomic, and other variables analyzed in this study. Programs with specific referral criteria, however, had a higher percentage of referrals for vision screening than those without such criteria. Because of the variability in vision screening standards and referral criteria observed among the programs, the authors conclude that national standards are needed.

Adolescent↗

PubMed1997

Discussion of the controversies associated with prostate cancer screening.

Early detection of prostate cancer through screening seems to provide the best hope of control or possibly cure of the disease. Unfortunately, controversy and confusion surround the screening guidelines. Specifically, the controversy involves whether the screening of asymptomatic men, particularly those under age 50, should be recommended. To date, there have been no randomised clinical trials which have demonstrated that screening for prostate cancer reduces mortality or increases life expectancy. The lack of evidence regarding the benefits of prostate screening and the risk of adverse effects make it important for clinicians to provide information to interested patients regarding the possible consequences before they take part in screening endeavours. Other health care professionals must be proactive in becoming informed about the entire prostate screening issue.

Aged↗

PubMed1977

Cancer: prevention, screening and early diagnosis.

The priniciples for setting up early detection and screening programmes are set out. Outlines are given of procedures available, at the time of the writing, in respect of some commonly occurring cancers; these sites being the lung, the female breast, the large bowel and the uterine cervix. The family doctor's role in the field of cancer is an important one. Some aspects for this role are discussed.

Australia↗

PubMed1988

[Mass screening for early lung cancer by the Miyagi method].

Mass screening for early detection of lung cancer has been in practice from 1982. Up to 1985, 583,549 persons-years have been screened. Screening was done by examining miniature X-rays taken of the chest for all those tested, and by sputum cytology for those thought to be high-risk, 34,044 persons-years. Heavy smokers over 50 years of age comprised much of the high-risk cases and persons evidencing hemoptysis. In a total of 207 detected cases of lung cancer, 120 cases were found by chest X-ray only, 69 cases were uncovered by sputum cytology only, and 18 cases were discovered by both X-ray and cytology. In one hundred and forty-four cases the cancers were resected and in 69 cases the cancers were determined to be in an early stage.

Female↗

PubMed2001

Breast cancer: screening and early detection.

A comprehensive program for breast cancer screening and early detection has a number of components. First, an understanding of the magnitude of the breast cancer problem and the natural history of breast cancer is essential. Appropriate screening guidelines must be identified and adopted into practice. Screening recommendations must be promoted actively. While breast cancer screening guidelines can be applied broadly to the general population, patients who are at increased risk must be identified through formal risk assessment. For those at increased risk, earlier screening and prevention strategies can be recommended. Physicians must be prepared to manage the abnormalities identified in screening and make appropriate referrals for treatment. Finally, patients identified with cancer must be staged accurately, as this staging will determine the prognosis.

Breast Neoplasms↗

PubMed1996

Controversies in prostate cancer screening. Analogies to the early lung cancer screening debate.

The current debate regarding early detection and aggressive treatment of prostate cancer is fueled by the absence of controlled studies defining the risks and benefits of prostate cancer screening, and by the lack of adequately powered trials demonstrating the benefit of curative treatment for early-stage prostate cancer. Pending the results of clinical trials in 10 to 15 years, advocates of early detection of prostate cancer with digital rectal examination and prostate-specific antigen have compared prostate cancer screening with the effective strategy of breast cancer screening, implying that prostate cancer screening should similarly reduce cancer mortality. They have also cited the high burden of disease, the acceptable operating characteristics of digital rectal examination and prostate-specific antigen, a stage shift among cases detected by screening, and the theoretical curability of early-stage disease as sufficient reasons to proceed with screening. These arguments, however, are reminiscent of earlier arguments in favor of lung cancer screening with chest x-ray examination and sputum cytology, a practice ultimately proven ineffective in clinical trials. We reviewed published articles on lung and prostate cancer screening and identified many parallels. While prostate cancer screening may one day prove effective, analogies between the current prostate cancer screening controversy and the older lung cancer screening debate should inject some caution regarding widespread dissemination of prostate cancer screening without experimental evidence that such screening does more good than harm.

Clinical Trials as Topic↗

PubMed1999

[Screening and early diagnosis of primary liver cancer].

OBJECTIVE: To investigate the value of screening for early diagnosis of primary liver cancer (PLC). METHODS: A total of 18,816 persons, who were high-risk population of PLC, were divided randomly to allocated screening group and control group. In the screening group every individual was checked up by serum AFP test and ultrasound every 6 months but those in the control group were not. RESULTS: Eighty-six patients with PLC were detected in the screening group, while 51 patients with PLC occurred in the control group. In patients from the screening group 60.5% were in the early stage, 45.3% of them were with small liver cancer. However, in the control group the figures were 0 and 0 respectively. In the screening group, 57 patients with PLC were detected by follow-up screening every 6 months, 77.2% patients of this series were in the early stage. However in the screening group the other 29 patients with PLC were detected by screening but they were not followed up every 6 months. Early-stage patients were only 27.6% in this series. CONCLUSION: This suggests mass screening, especially continual screening every 6 months in fixed population can diagnose PLC early.

Humans↗

PubMed1986

Scientific basis of screening in early detection.

The basis of screening for cancer is related to the natural history of the disease, to the screening test, to the treatment of preinvasive lesions, and to the application of a screening program at a population level. It is not only the test but the total program that should be valid, ie, detect both those having a preinvasive abnormality and those being healthy. The only reliable indicator on the efficacy of a screening program is the reduction in the mortality from the cancer subjected to screening. The reduction in mortality should be assessed by a randomized preventive trial. There are several examples on inconclusive evidence stemming from observational studies and based on indicators other than mortality.

Breast Neoplasms↗

PubMedDate not supplied

Controlled trial of universal neonatal screening for early identification of permanent childhood hearing impairment. Wessex Universal Neonatal Hearing Screening Trial Group.

BACKGROUND: Congenital permanent childhood hearing impairment (PCHI) impairs communication skills and, possibly, mental health and employment prospects. Management within 1 year of birth can alleviate most of its adverse effects. Neonatal screening for this disorder is feasible but its benefit for all babies is disputed. We investigated whether neonatal screening of all babies born in hospital, in addition to the standard health visitor distraction test, would increase the rates of early referral, confirmation, and management. METHODS: Between 1993 and 1996, two teams of four part-time testers and equipment moved between two pairs of hospitals to achieve four periods with neonatal screening and four without neonatal screening, each of 4-6 months' duration. Babies did or did not undergo neonatal screening dependent on during which periods they were born. We used a transient evoked otoacoustic emissions test and, in babies who failed this test, an automated auditory brainstem response test on the same day. We referred babies with positive results for audiological assessment. FINDINGS: 53,781 babies were included in the trial, and 25,609 were born during periods with neonatal screening. Neonatal screening achieved 87% coverage of births, with a false-alarm rate of 1.5%, and an overall yield of 90 cases of bilateral PCHI of 40 dB or more relative to hearing threshold level per 100,000 target population, equivalent to 80% of the expected prevalence of the disorder in the population. 71 more babies with moderate or severe PCHI per 100,000 target population were referred before age 6 months during periods with neonatal screening than during periods without. Early confirmation and management of PCHI were significantly increased. The rate of false-negative results from neonatal screening was significantly lower than that for the distraction test (4 vs 27% p=0.041). INTERPRETATION: Neonatal screening is effective in identification of congenital PCHI early and may be particularly useful for babies with moderate and severe PCHI for whom early management may have the most benefit.

England↗

PubMedDate not supplied

Cancer screening and early detection: managing malpractice risk.

PURPOSE: The purpose of this report is to educate healthcare professionals about the legal risks of conducting cancer screening examinations and necessary risk reduction practices. OVERVIEW: The authors describe the elements of a medical malpractice claim, the healthcare professionals' legal standard of care, theories of malpractice liability, common factors related to missed or delayed diagnoses, malpractice defenses, and risk reduction practices. CLINICAL IMPLICATIONS: Healthcare professionals, including physicians, physician assistants, advanced practice nurses, and social workers, have been shown to be clinically effective in cancer screening, and early detection of many cancers leads to improved long-term survival rates. Healthcare professionals who conduct cancer early detection examinations and counsel patients in cancer screening programs need to be aware of the common legal theories under which lawsuits are brought related to cancer detection examinations. Important steps in reducing the risk of malpractice include developing creative strategies to address the theories of liability in the area of cancer screening and early detection; keeping abreast of changes in national and international cancer screening recommendations; monitoring the literature for approaches to decrease liability; and scrupulously maintaining documentation of all findings and interactions among providers and between providers and patients.

Defensive Medicine↗

PubMed1990

Endoscopic screening of early esophageal cancer with the Lugol dye method in patients with head and neck cancers.

The poor prognosis for esophageal cancer could be improved if lesions were detected at an early stage. To detect early esophageal cancer, endoscopic screening of the esophagus with the Lugol dye method was performed in patients with head and neck cancers who were asymptomatic but regarded as being at high risk for synchronous or metachronous esophageal cancer. Of 178 patients screened, 9 had esophageal cancer (5.1%). Eight of these patients (89%) were at early stages with no lymph node metastasis. Most of the lesions (9 of 13 lesions) were not detectable by barium studies or ordinary endoscopic study. The epidemiologic statistical analysis of the patients confirmed that they had a significantly high observed and expected number (O/E) ratio (39.7; P less than 0.001). These results demonstrate the value of endoscopic screening of the esophagus with the Lugol dye method in patients with head and neck cancers and imply that endoscopic screening with the Lugol dye method may be useful for detecting early esophageal cancer in individuals at risk for other causes.

Aged↗