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PubMed1997

Free and total prostate-specific antigen in a screened population.

OBJECTIVES: To determine whether the ratio of free to total (F/T) prostate-specific antigen (PSA) can differentiate between men with prostate carcinoma or benign conditions in a screened population. SUBJECTS AND METHODS: Total and free serum PSA (measured using Delfia PSA assays, Abbott IMx and Hybritech Tandem E methods) were determined retrospectively in 1726 men aged 55-77 years, in whom 67 prostate carcinomas were detected by screening with a digital rectal examination, transrectal ultrasonography, and total serum PSA level. Predictors for a positive biopsy result were estimated as a function of total PSA, free PSA and the combination of both. RESULTS: There was an excellent correlation between the Delfia ProStatus, the Abbott IMx and the Hybritech Tandem E assays. Compared with the total serum PSA level, the F/T ratio improved the specificity significantly only in those men with a total PSA of > or = 7 ng/mL. Using the information given by the total and free PSA values, a maximum sensitivity of 75% at a specificity of 74% was obtained for the whole PSA range from 4 to 10 ng/mL; the maximum sensitivity was 79% with a specificity of 71%. CONCLUSION: The optimal mathematical combination of free and total serum PSA improves the specificity of total serum PSA level in detecting prostate carcinoma more than the does the F/T PSA ratio.

Aged↗

PubMed2002

Current international developments in population screening for colorectal cancer.

Pilot programmes for screening for colorectal cancer in average-risk individuals using faecal occult blood testing are planned to commence in Australia in 2002. The National Cancer Control Initiative was interested to compare Australia's progress in this area with that of other countries. Information on programmes or pilot programmes for colorectal screening in average-risk individuals was sought by letter, fax or email from cancer organizations, government departments and professional bodies in 55 countries worldwide. Based on the responses received (32 replies), no country was identified as having an active programme for colorectal screening for the general population based on the characteristics of identification of eligible subjects, active recruitment and integrated screening and follow up, which would allow determination of the participation rates, detection rate and outcomes such as the stage distribution of cancer. In the United Kingdom a pilot programme is under way to test the feasibility and acceptability of screening for colorectal cancer in the general population using faecal occult blood testing. In Finland, health authorities have agreed that the evidence is sufficient to embark on a pilot programme, and Canada, the Netherlands, Denmark and Switzerland are considering pilot programmes. From our enquiries, in countries using a planned approach, only the UK appears to be ahead of Australia. The British pilots have commenced earlier and are larger and have a shorter time frame than the Australian pilots.

Aged↗

PubMed1989

Population screening for cervical cancer in The Netherlands. A report by the Evaluation Committee.

A programme of population-based screening for cervical cancer in three adjacent regions in the Netherlands is described. The target female population aged 35-54 was 370,000. Screening was performed three times with intervals of three years during the period 1976-84. The total numbers of histologically proven abnormalities were 406, 1025 and 215 for severe dysplasia, carcinoma in situ and invasive carcinoma respectively. Detection rates were highest in the more urbanized regions and they fell from 3-5 per 1000 in the first to less than 2 per 1000 in the third screen. Specificity of screening was high enough to reach a predictive value of a positive test of 80% in the first screen and of 60-70% in the second and third screen. Population-based cervical cancer registries enabled the investigators to calculate the sensitivity of screening; if defined as the percentage of invasive cancers appearing within three years of cytological test result showing less than severe dysplasia, sensitivity was 60-70%. Further cytological follow-up of cytological smears with moderate dysplasia could be shown to increase sensitivity to about 80%. A case-control study showed that screening protects against a diagnosis of invasive cervical cancer (odds ratio 0.22 with 95% Cl 0.07-0.69) within the next five years. Prognosis of cervical cancer detected early is generally good. Survival statistics from the programme compare favourably with those from the 'normal care' system. Still, the stage distribution of the latter category has much improved over the last decades, probably due to introduction of the cervical spatula in general practice in 1975. Cost-effectiveness studies and future government health policy are discussed.

Adult↗

PubMed2002

[The benefit of population screening for breast cancer; an advisory report from the Health Council of the Netherlands].

A recent Cochrane review does not nullify the evidence supporting the practice of mammographic population screening for breast cancer for women aged 50 years and over. Thus concludes the Health Council of the Netherlands in an advisory report to the Dutch Government. A central feature of the Cochrane review is the conclusion that breast-cancer mortality is an unreliable outcome that is biased in favour of screening. The Health Council finds this conclusion too extreme and does not support the view that breast-cancer mortality must be replaced by overall mortality as an outcome. The Health Council does agree with the view that the use of disease-specific mortality as the only endpoint renders cancer-screening trials subject to bias. Therefore, careful attention should be paid to total cancer mortality, other important causes of death, and overall mortality.

Breast Neoplasms↗

PubMed2000

Cardiovascular disease and risk factors in persons with type 2 diabetes diagnosed in a large population screening: the Nord-Trøndelag Diabetes Study, Norway.

OBJECTIVE: To study cardiovascular status and risk factors in persons with newly diagnosed type 2 diabetes and controls in a large population. DESIGN: Case-control study. SETTING: Population screening. SUBJECTS: The screening of 74 499 individuals (88.1%), aged 20 years and older, in Nord-Trøndelag County, Norway, during 1984-86 detected 428 persons with undiagnosed diabetes according to the 1980 WHO criteria, of whom 205 attended a clinical follow-up examination assessing cardiovascular status and risk factors. METHODS: For each of 205 cases, one control person matched by age and sex underwent the same clinical examination. Lipids, body mass index, waist/hip ratio, blood pressure, pulse rate, blood pressure medication, kidney function, cardiovascular disease, family history and lifestyle were recorded. RESULTS: At the screening prior to the diagnosis of diabetes, those with diabetes reported poorer general health, less physical activity, more siblings with diabetes and more frequent use of antihypertensive medication. They had higher body mass index, systolic and diastolic blood pressure and pulse rate compared with controls. At the clinical evaluation, diabetics had higher urine albumin levels, increased waist/hip ratio, and higher total cholesterol/HDL cholesterol ratios than the controls. They also reported a greater incidence of angina pectoris and had more ECG changes. CONCLUSIONS: Diabetics presented with more cardiovascular risk factors, angina pectoris and ECG changes than the controls, and they had an established metabolic syndrome more often than controls. These results suggest that prevention of cardiovascular disease in diabetics requires earlier diagnosis of the diabetes.

Adult↗

PubMed1991

Population screening for colorectal cancer, the goals and means.

The causes of colorectal cancer are complex and in most cases obscure, making primary prevention impossible at present. Secondary prevention by finding and treating early asymptomatic cancers may possibly reduce mortality from this very common cancer. Results from conventional treatment have changed little during recent decades and are unsatisfactory, with more than half of the patients dying from the disease. The incidence has increased during recent years in many countries, making it vital to evaluate possible benefits from screening. This review considers different methods of screening for colorectal cancer and includes an overview of continuing European controlled randomised trials with the faecal occult blood test, Haemoccult-II. No final evaluation is possible, but advantages and drawbacks of different strategies are discussed. Assuming that the goal of reducing mortality is achieved, several other problems remain unsolved: the organisation of screening, the training of doctors in endoscopy, cost benefit and cost effectiveness all of which will have to be solved before a population screening can be recommended. Present screening tools are not ideal and we have to continue the search for better markers of early colorectal cancers and even possible precursors like adenomas.

Barium Sulfate↗

PubMed2003

Multiple measures of carcinoma extent versus perineural invasion in prostate needle biopsy tissue in prediction of pathologic stage in a screening population.

The capacity of perineural invasion by carcinoma in prostate needle biopsy tissue to independently predict pathologic stage in radical prostatectomy tissues remains uncertain. We sought to determine, in a prostate specific antigen-based screening population, the ability of needle biopsy histologic grade, tumor extent, and perineural invasion to independently predict pathologic stage and margin status in the whole prostate gland. Perineural invasion, Gleason grade, percentage Gleason pattern 4/5 carcinoma, and multiple measures of needle biopsy tumor extent, including number of positive cores, percentage of positive cores, total percentage of carcinoma, greatest percentage of carcinoma in a single core, and total carcinoma length in millimeters, were captured for 215 men from a prostate specific antigen-based screening program diagnosed with prostate cancer in a median of six procured needle biopsy cores. Pathologic stage and surgical margin status were evaluated in corresponding completely embedded radical prostatectomy specimens. A logistic regression model was used to relate the endpoints of extraprostatic extension by carcinoma and/or positive margins to needle biopsy tissue findings. In univariate analyses, total percentage of carcinoma (p = 0.003), greatest percentage of carcinoma in a single core (p = 0.004), total tumor length in millimeters (p = 0.009), and fraction of positive cores (p = 0.02) were all significantly associated with extraprostatic (pT3) carcinoma, whereas all five measures of carcinoma extent in needle biopsy tissue were related to positive margins. Correlation coefficient determinations showed that all five measures of needle biopsy carcinoma extent were highly interrelated. In multivariate analyses, total percentage of carcinoma was significantly related to pathologic T stage (p = 0.003) and positive margins (p = 0.0002). In a multivariate model with the radical prostatectomy whole gland endpoint of either pT3 disease or positive margins, fraction of positive cores (p = 0.00001) was the only variable with significant predictive value. Perineural invasion by carcinoma in needle biopsy tissue was detected in 11% of cases. Neither presence nor absence of perineural carcinoma nor number nor percentage of positive nerves related to pathologic stage in univariate or multivariate analyses. Amount of carcinoma in prostate needle biopsy tissue, using multiple measurements but not perineural invasion, is a significant histologic attribute predictive of pathologic stage and margin status for men with prostate specific antigen screening detected prostatic carcinoma. Reporting of several measures of carcinoma extent in needle biopsy tissue is recommended.

Adult↗

PubMed1992

Inexpensive population screening for abnormal cells from the uterine cervix and valid results using the vaginal cytopipette.

Women who have not accepted an invitation by their own general practitioner to have a smear test, or for whom voluntary population screening projects are unavailable because of lack of public funds, may be at increased risk of malignant cervical changes. Such women may be offered self-testing by a cytopipette on the basis of the present analysis of abnormal cell counts and cell density on the cytological slides. As one link in a prophylactic study using the cytopipette, 107 women with abnormal cell findings were reinvited for simultaneous sampling by irrigation smear and by ordinary technique. The cytological findings indicate that the two methods are equal in recovery of abnormal epithelium, provided that the scanned quantity of cells is increased fourfold in the irrigation smear method, this quantity being distributed over two specimens each with double cell density and giving at least 1800 squamous epithelial cells per visual field (125:1) or a total of approximately 10(6) epithelial cells in each cytological specimen. Under these conditions the two sampling methods have the same predictive value.

Cell Count↗

PubMed2002

Albuminuria and renal insufficiency prevalence guides population screening: results from the NHANES III.

BACKGROUND: A number of screening criteria, applied either at a single point in time or serially, can be used for the purpose of identifying individuals at risk of end-stage renal disease (ESRD). This study focused on two such criteria measured on a single occasion, proteinuria and renal insufficiency, and examined their prevalence in a sample representative of the adult U.S. non-institutionalized population. Such knowledge guides the utility of population screening to prevent ESRD. METHODS: The prevalence of albuminuria (microalbuminuria and macroalbuminuria from a random urine albumin-to-creatinine ratio) and renal insufficiency [glomerular filtration rate (GFR) estimated from serum creatinine] was determined in different age categories in various adult screening groups in the cross-sectional Third National Health and Nutrition Examination Survey (NHANES III). RESULTS: A total of 14,622 adult participants were included in the analysis. In the general population, 8.3% and 1.0% of participants demonstrated microalbuminuria and macroalbuminuria, respectively. To identify one case of albuminuria, one would need to screen three persons with diabetes mellitus, seven non-diabetic hypertensive persons, or six persons over the age of 60. When albuminuria and renal insufficiency were considered together, it was clear that these tests were identifying different segments of the population; 37% of participants with a GFR less than 30 mL/min/1.73 m2 demonstrated no albuminuria. Non-albuminuric renal insufficiency was most evident in the ages of 60 to 79; 34% of diabetics, and 63% of non-diabetic hypertensives with a GFR less than 30 mL/min/1.73 m2 demonstrated no albuminuria. CONCLUSIONS: Albuminuria is prevalent, and when considered together, screening tests of albuminuria and renal insufficiency measured on a single occasion identify different segments of the population. The prevalence of albuminuria and renal insufficiency in populations of interest should be considered, as this knowledge has implications for the effectiveness of screening.

Adult↗

PubMed2000

Correlation of prostate-specific antigen before prostate cancer detection and clinicopathologic features: evaluation of mass screening populations.

OBJECTIVES: Although prostate-specific antigen (PSA) has become the reference standard for prostate cancer diagnosis, few reports have examined the long-term changes in PSA values before the diagnosis of prostate cancer in a large number of subjects. We investigated serial PSA levels and related values before prostate cancer diagnosis in a mass screening population and analyzed the values in an attempt to discover some values useful in clinical diagnostic science. METHODS: We performed mass screening for prostate cancer in 9671 subjects from 1986 to 1998. The initial screening method was measurement of prostatic acid phosphatase from 1986 to 1991 and measurement of PSA from 1992 to 1998. As a result, 303 cases of prostate cancer were diagnosed. For all the cases diagnosed before 1991, we measured the serum PSA value in preserved frozen serum. RESULTS: The prostate cancer detection rate was 3.1% among all subjects observed during the 13-year period. By measurement of the PSA level using frozen serum during the pre-PSA era, we found that 62% of patients demonstrated a PSA abnormality for more than 1 year (average 2.8) before prostate cancer diagnosis. Prostate cancer that was diagnosed within 1 year after a PSA value became abnormal was not associated with bone metastasis. Concerning the relationship between PSA velocity (PSAV) and clinical stage, the proportion of Stage B cancer was 86% in the subjects whose PSAV level before diagnosis was 0.18 ng/mL/yr or less and it was only 29% in those with PSAV levels of 4.5 ng/mL/yr or more. Only 3 (3.5%) of 86 patients with prostate cancer with PSAV levels of 4.4 ng/mL/yr or less had bone metastasis, and 2 of those 3 patients had poorly differentiated adenocarcinoma. CONCLUSIONS: Although a total of 62% of patients had an abnormal PSA level more than 1 year before prostate cancer diagnosis, no patients with prostate cancer who were diagnosed within 1 year after the PSA level became abnormal had bone metastasis. Among patients who have undergone mass screening twice or more, a clinically useful indicator of the lack of bone metastasis would be a period between the detection of PSA levels of 4.1 ng/mL or more but not more than 10 ng/mL and prostate cancer diagnosis of less than 1 year and a diagnosis of well or moderately differentiated adenocarcinoma or a PSAV of 4.4 ng/mL/yr or less and a cancer diagnosis of well or moderately differentiated adenocarcinoma.

Adult↗

PubMed1994

Screening flexible sigmoidoscopy in a low-risk, highly screened population.

BACKGROUND: The efficacy of screening flexible sigmoidoscopy in patients with a prior history of a negative screening sigmoidoscopy has not been previously studied. METHODS: Charts from 866 consecutive asymptomatic patients undergoing baseline or rescreening flexible sigmoidoscopy were reviewed. Any previously screened patient with a history of polyps was excluded from the study. Findings on sigmoidoscopy, including size, location, and histopathology of lesions and number of prior examinations, if any, were recorded. RESULTS: Polyps were found in only 12 of 866 patients (1.4%). The effect of prior screening was significant. Ten of 414 (2.4%) patients who had not undergone prior screening sigmoidoscopy were found to have polyps. In contrast, only two of 452 (0.4%) patients who had undergone prior screening were found to have polyps. CONCLUSIONS: Screening flexible sigmoidoscopic examinations provided a low positivity yield in this study, a finding that is likely explained by the exclusion of previously screened patients with a history of polyps and by the significant number of previously screened patients. The relation between the prevalence of lesions and the patients' previous examination statuses suggests that multiple screenings for asymptomatic, low-risk patients at 3- to 5-year intervals as recommended by the American Cancer Society may be unnecessary.

Aged↗

PubMed1998

Population screening for neonatal liver disease: a feasibility study.

BACKGROUND: Extra-hepatic biliary atresia and several other causes of neonatal liver disease carry high mortality and morbidity rates, especially if not treated early in life. Despite professional recommendations, delayed referral of infants with prolonged jaundice continues to be a significant problem. One approach to reducing the age of referral and diagnosis is population screening to detect significant conjugated hyperbilirubinaemia as an index of liver dysfunction. METHODS: To investigate this possibility, and to provide reference data on bilirubin and its conjugated and unconjugated fractions in a normal newborn population, 1157 neonates were anonymously tested (median age 7 days, range 4-28 days) using surplus plasma from routinely collected neonatal screening specimens, using dry slide chemistry. RESULTS: Of 2310 specimens received, 50% were suitable for analysis. The remainder were either haemolysed or insufficient (10% and 40% of the total, respectively). Total bilirubin concentrations ranged from 9 to 428 micromol/l and conjugated bilirubin from 0 to 175 micromol/l, although the latter was rarely increased to more than 30 micromol/l (2.5th-97.5th percentile ranges 15-285 micromol/l and 0-18 micromol/l, respectively). The range of the percentage of conjugated bilirubin was 0-57% (2.5th-97.5th percentile; range 0-20%). CONCLUSION: An increased conjugated bilirubin, expressed as a concentration or as the percentage of the total bilirubin, could be used as a specific marker to screen for liver dysfunction in neonates. This approach has the potential to improve the age of referral and the prognosis of infants with neonatal liver disease.

Bilirubin↗

PubMed2002

A nation-based population screening for azoospermia factor deletions in Greek-Cypriot patients with severe spermatogenic failure and normal fertile controls, using a specific study and experimental design.

Y chromosome microdeletions in the azoospermia factor (AZF) locus have been associated with spermatogenic failure. The frequency of AZF deletions is estimated to be about 10-18% in subgroups of idiopathic azoospermia and severe oligospermia, whereas the deletion frequency is estimated to be about 1.5-10.6% in the general population. Patient selection criteria as well as experimental and study design are the major factors that influence the deletion frequency. We designed a nation-based population screening with a well-defined study and experimental criteria to answer, first, what is the deletion frequency in a study population of high risk for Y deletion in the Greek-Cypriot origin and second, if there are any differences in the deletion frequency in the investigated specific subgroup of patients from different geographic/ethnic origin. Eighty Greek-Cypriot patients who met the selection criteria were included in this study as well as 50 fertile control males. The sample size is quite large when compared with the size of the population. All samples were collected from all districts of the island of Cyprus as the population is of the same religious, geographic and ethnic origin. All patients and controls had detailed clinical information and at least two semen-analysis reports based on World Health Organization standards. Samples with abnormal karyotypes, obstructive azoospermia or oligospermia with >2 x 106/mL were excluded from this study. The experimental design required a referral team and laboratory to undertake the responsibility to collect all the samples, all clinical and laboratory information, isolate DNA and carry out all tests, data analysis and interpretation. In our study, Y chromosome microdeletions have been found in patients with spermatogenic failure. Under the specific patient selection criteria and experimental design, the overall frequency is 5%, while among azoospermic patients it is 12.5%. In the subgroups of patients with idiopathic cause it is 5.9% and in idiopathic azoospermia it is 14.3%. No variation in the overall deletion frequency or the specific subgroups deletion frequency were found, as compared with frequencies found in patients from different geographic/ethnic origin.

Case-Control Studies↗

PubMed1992

Cost savings in mass population screening for colorectal cancer resulting from the early detection and excision of adenomas.

The widely-accepted hypothesis of a development sequence from colorectal adenoma to carcinoma is felt by clinicians to legitimate adenoma excision during routine colonoscopic investigation. Using published data on adenoma development, and adenoma prevalence data derived from the Nottingham colorectal cancer screening trial, the number of carcinomas prevented by early excision as a result of screening is predicted. The cost-effectiveness of early excision is then evaluated with reference to the expected treatment costs saved. These cost savings are found to represent a discount on the overall costs of mass population screening for colorectal cancer.

Adenoma↗

PubMed2002

Hospital costs and benefits of screening for abdominal aortic aneurysms. Results from a randomised population screening trial.

OBJECTIVES: to analyse the hospital costs and benefits of screening older males for abdominal aortic aneurysm (AAA). MATERIALS AND METHODS: in 1994 a hospital-based screening trial of 12 658 65-73-year-old males was started. AAA >5 cm were referred for surgery. The remaining AAA were offered annual scans. Those with aortic ectasia were rescreened at 5 yearly intervals. AAA-operations and hospital AAA-related deaths were researched. The costs of screening, surveillance, and treatment were also registered. RESULTS: the attendance rate was 76%; of whom 191 (4.0%) had AAA. Mean observation time was 5.13 years. Sixty in the screened and 41 in the control group were operated (p=0.06), of which 7 and 27 respectively were operated as an emergency (p<0.001), and 6 and 19 respectively died due to AAA (p=0.009). The costs per scan were 83.50 DKK, 81 400 DKK per emergency operation (71 485 DKK after screening), and 117 000 DKK per emergency operation. The cost per prevented hospital death was 67 855 DKK, equivalent to approximately life year saved approx. 7540 DKK (GBP1=12 DKK). CONCLUSION: screening appears to reduce hospital AAA mortality and to be cost-effective.

Aged↗

PubMed2000

Population screening in hereditary hemochromatosis.

Hemochromatosis is a common autosomal recessive condition found in the homozygous state in 1/200-1/400 people of northern-, central-, and western-European origin. It causes increased iron storage, which may lead to liver cirrhosis, liver cancer, heart disease, arthritis, and diabetes in many but not all affected adults, with a higher frequency in males. The condition is easily treated by repeated venesections without side effects but is frequently overlooked. Population screening of adults using iron indices alone or combined with DNA testing has therefore been recommended, but a consensus conference in 1997 recommended that such screening be deferred, owing to uncertainty regarding the extent of clinical disease that may develop in individuals detected by such programs. There was also concern that DNA screening results might be used for discrimination in insurance and occupational settings. Screening family members of patients with evidence of definite iron loading, however, is accepted by all observers. Because serious complications may be overlooked, a more aggressive stance toward case detection in the adult population has been advocated by some observers, realizing that unnecessary treatment might occur. Because additional information regarding the spectrum of clinical disease in homozygotes in now accumulating, a consensus conference in the near future is suggested to consider appropriate policies.

Adult↗

PubMed2005

Computed tomographic virtual colonoscopy computer-aided polyp detection in a screening population.

BACKGROUND & AIMS: The sensitivity of computed tomographic (CT) virtual colonoscopy (CT colonography) for detecting polyps varies widely in recently reported large clinical trials. Our objective was to determine whether a computer program is as sensitive as optical colonoscopy for the detection of adenomatous colonic polyps on CT virtual colonoscopy. METHODS: The data set was a cohort of 1186 screening patients at 3 medical centers. All patients underwent same-day virtual and optical colonoscopy. Our enhanced gold standard combined segmental unblinded optical colonoscopy and retrospective identification of precise polyp locations. The data were randomized into separate training (n = 394) and test (n = 792) sets for analysis by a computer-aided polyp detection (CAD) program. RESULTS: For the test set, per-polyp and per-patient sensitivities for CAD were both 89.3% (25/28; 95% confidence interval, 71.8%-97.7%) for detecting retrospectively identifiable adenomatous polyps at least 1 cm in size. The false-positive rate was 2.1 (95% confidence interval, 2.0-2.2) false polyps per patient. Both carcinomas were detected by CAD at a false-positive rate of 0.7 per patient; only 1 of 2 was detected by optical colonoscopy before segmental unblinding. At both 8-mm and 10-mm adenoma size thresholds, the per-patient sensitivities of CAD were not significantly different from those of optical colonoscopy before segmental unblinding. CONCLUSIONS: The per-patient sensitivity of CT virtual colonoscopy CAD in an asymptomatic screening population is comparable to that of optical colonoscopy for adenomas > or = 8 mm and is generalizable to new CT virtual colonoscopy data.

Adenomatous Polyps↗

PubMed1994

A reassessment of fasting plasma glucose concentrations in population screening for diabetes mellitus in a community of northern European ancestry: the Wadena City Health Study.

In current clinical and research practice, the determination of diabetic status depends largely on plasma glucose levels 2 h after the ingestion of a standard 75-g glucose load, the oral glucose tolerance test (OGTT). The OGTT, however, remains inconvenient, not highly reproducible, and costly, especially for large-scale studies and population screening tests. Fasting plasma glucose (FPG) determinations are convenient, reliable, and valid measures of glucose intolerance, but the currently prescribed cut-off point of 140 mg/dl (7.8 mM) lacks sensitivity. We evaluated the reliability and validity of fasting plasma glucose (FPG) values compared with other measures of hyperglycemia for a diagnosis of diabetes in a population-based study of carbohydrate metabolism in Wadena, Minnesota, a community of predominantly northern European ancestry. As a part of this effort, a random sample of Wadena adults, stratified by age and gender, plus all known, previously diagnosed diabetics participated in 2 days of baseline testing and were followed prospectively and retested 5 years later. Cross-sectional analyses of baseline data are presented in this article. Diabetic status was ascertained by administering a standard OGTT according to National Diabetes Data Group (NDDG) specifications. Sensitivity and specificity levels obtained when using a FPG cut-off point of 6.4 mM were 95.2% and 97.4%, respectively. In study subjects with no known diagnosis of diabetes, the FPG cut-off point of 6.4 mM performed reasonably well with a sensitivity and specificity of 67.7% and 97.4%, respectively. (ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗