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PubMed1992

Screening mammography program delay recommended by Manitoba working group: issues for radiology.

UNLABELLED: Assignment: A working group, appointed by government, examined the advisability of implementing a mammography screening program and prepared a cost analysis. ANALYSIS: Present Manitoba activity (45,695) is a mixture of clinical mammography (10,000) and unorganized screening, mammographies (35,695) at an annual screening cost of $2.8 million. Canadian policy reports, program descriptions in other countries and critical reviews were analyzed. A steady-state clinical and financial model was constructed. A controlled screening program enrolling 80% of women 50-69 years will cost $2.6 million per year plus $0.65 million new clinical costs limited to 4 years. Recommendations; Six were made: delay implementation awaiting more evidence of benefit, discourage use in asymptomatic women under 50 years, develop information programs for women and health professionals, establish an advisory group and participate in research directed to a eventual decision.

Adult↗

PubMed1994

Interval breast cancers in the Screening Mammography Program of British Columbia: analysis and classification.

OBJECTIVE: Interval cancers in an annual mammography screening program are defined as cancers detected within 12 months after a mammographic screening in which findings are considered normal. Our objective was to analyze interval cancers for histologic type, tumor size, staging, and histologic grade. A classification for interval cancers is presented. Detection of interval cancers is an integral part of quality control and is required for the establishment of sensitivity rates for screening mammography, a necessary part of implementing the recommendations for breast cancer screening. MATERIALS AND METHODS: A total of 47,583 mammographic screening examinations of 38,219 women were available for review for the period of July 1988 to March 1991. Linkage with the provincial population-based cancer registry provided identification of all interval cancers of the breast. Histologic analysis of breast cancers was provided by an internationally recognized breast cancer pathologist who interpreted the specimens twice. RESULTS: A total of 207 breast cancers were detected at mammographic screening (true-positive cancers) during the first 33 months of the program, and 37 interval cancers were identified during the 33 months of screening plus a 12-month interval. Blinded review by three radiologists experienced in screening mammography resulted in classification of 21 of 37 cases as true interval cancers and 16 cases as misses. No interval cancers were missed because of poor mammographic technique. The sensitivity of screening mammography was 85%, 63% for patients less than 50 years old and 89% for patients more than 50 years old. The specificity was 93% for all patients (both younger and older than 50 years). CONCLUSION: The availability of a population-based cancer registry in the province of British Columbia makes an accurate determination of interval cancers and sensitivity rates possible. These data are essential for quality analysis, program planning, and education of radiologists in screening mammography. There were more true interval cancers than misses, and histologic analysis demonstrated that the majority of interval cancers were in stages I and II.

Adult↗

PubMed1997

Perspectives on a state enacted hearing screening assessment program in the newborn population.

OBJECTIVE: A review of the early performance of Ohio's statewide infant hearing screening program was performed to provide insight as to the impact of the current medical and socioeconomic climate on its implementation. BACKGROUND: In March 1988, the State of Ohio enacted a law that required universal screening of newborn children for hearing loss through a program known as the Infant Hearing Screening and Assessment Program (IHSAP). The program design consisted of a universally applied high-risk questionnaire followed by a screening auditory assessment for those who fail. Although the value of such a program engendered little early public debate, the institution of such a program represented a significant challenge from a public health perspective. STUDY DESIGN: The program performance was analyzed using data from the index population of 160,000 live births per annum and hospital surveys. RESULTS: The questionnaires were found to be failing twice the number of newborns as originally projected, whereas completion rates and compliance were excellent. The assessment arm was plagued with poor compliance rates and limited resources. Lack of resources for effective data management has prevented an accurate evaluation of the program's sensitivity and specificity. CONCLUSION: IHSAP performance is being hampered by poor assessment follow-up and resource limitations, both in terms of screening equipment and habilitative follow-up services for infants identified as hearing impaired. The reasons for these problems are discussed in relation to existing legislative guidelines and medicoeconomic realities.

Audiology↗

PubMed2000

Midwives' descriptions of their familiarity with cancer: a qualitative study of midwives working with population-based cervical cancer screening in urban Sweden.

Nurse-midwives are responsible for taking Papanicolaou (Pap) smears in Swedish population-based cervical cancer screening programs. A research project examining the screening program from the perspective of different stakeholders includes an interview study of 21 midwives working in Stockholm. This article explores the way the midwives describe cancer-related knowledge and aspects of screening, contrasting this with relevant findings from a substudy of 66 healthy women participating in screening. A semistructured interview guide with open-ended questions was used to investigate ideas about benefits and risks in the screening program, risk factors for cervical cancer, the reliability of the test itself, sources of information/knowledge relevant for cervical cancer screening, and the manner in which the midwife described her role in the screening program. The transcripts of the audiotaped interviews were analyzed thematically using a team approach. The interviewed midwives showed a great deal of consensus in their descriptions of lacking familiarity with cervical cancer and its prevention and treatment. The midwives said they lack recent education and knowledge, often avoiding use of the word "cancer" with women attending screening. It seems that the midwives experienced little professional guidance in discussing cancer-related issues with women attending the screening program. In this study, they appeared to rely on personal knowledge, values, and experience instead.

Adult↗

PubMed1989

[Evaluation of the effectiveness of a premarital program for HIV infection screening].

The effectiveness of premarital screening program for HIV infection is discussed, in relation to hypothetical objectives: improvement of individual health, prevention of transmission of HIV infection and estimate of prevalence among sexually active population. Taking into account validity of screening test, natural history of HIV infection, availability of effective early treatment and possible social outcomes, the hypothesis of lack of effectiveness of this program is held.

Acquired Immunodeficiency Syndrome↗

PubMed1986

Descriptive epidemiology of missed cases of phenylketonuria and congenital hypothyroidism.

We conducted a structured telephone survey of state public health laboratory directors of neonatal screening programs to determine the extent of the problem of missed cases of phenylketonuria (PKU) and congenital hypothyroidism. A total of 76 missed cases were reported--43 PKU and 33 congenital hypothyroidism. We looked at the following characteristics of the missed cases: the stage at which the miss occurred, which included specimen collection, laboratory procedures, or follow-up; the size of the program; the type of screening program; the age of the infant at the time of screening; and any legal action that resulted from the miss. The 76 missed cases probably represent an underascertainment of the true number, yet we believe that our data provide an overview of some of the problems associated with mass neonatal screening. There was one missed case of PKU for every 70 cases detected, and one missed case of congenital hypothyroidism for every 120 cases detected; in other words, two congenital hypothyroidism cases were missed for every 1 million infants screened. Regarding the stage of screening in which the miss occurred, 14% occurred during specimen collection, 45% during the laboratory procedures stage, 16% during follow-up, 11% were the result of biologic variation, and in 14% the stage could not be identified. We conclude that neonatal screening programs have been highly successful but that there may be additional safeguards to be developed, tested, and implemented when practical.

Clinical Laboratory Techniques↗

PubMedDate not supplied

[Program of hearing loss early detection in newborn infants in Cantabria. Results of the first year of activities].

AIMS: To report the findings in the first year of follow-up of the Cantabrian Program to screen newborn babies for congenital permanent hearing loss. METHODS: The study population consisted of infants born during a year period in Cantabria (Spain). Universal hearing screening by transient evoked otoacoustic emissions (TEOAE) in 2 stage protocol was performed. Infants with failure scores in these 2 stages and those with risk factors for hearing loss were referred for diagnostic evaluation with auditory brainstem response. Hearing aids were recommended for those infants who had bilateral hearing loss and referrals to infant speech and language rehabilitation. RESULTS: Out of the 4117 eligible babies, 3987 were studied. One hundred and ten (2.6) had risk factors for hearing loss, 3.5% were referred for audiological assessment and 1.2/1000 were diagnosed as having a permanent hearing loss. The false-positive rate was 0.72% after the two-stage screening procedure was performed. Positive predictive value for permanent hearing loss was 10%. CONCLUSIONS: During the first year working with the Cantabrian Screening Program for congenital permanent hearing loss in newborn babies, the most part of the proposed aims have been achieved.

Age Factors↗

PubMed1980

Hospital-based cancer detection programs for the community.

Experimental screening programs have demonstrated the efficacy of screening procedures for cervical, breast, and colorectal cancers but there has not been widespread application of such screening projects to programs suited to community health care facilities. Here, we illustrate how this may be accomplished by use of outpatient facilities, cancer screening clinics in hospitals, or periodic short-term community screening programs. The objective is cancer control through screening and detection programs characterized by application of demonstrated detection procedures, reliance on existing hospital resources, use of minimally invasive screening procedures, promotion targeted to high-risk groups, collaboration with community volunteer organizations, and emphasis on serving persons not already receiving such routine detection services. This paper presents results on the hospital monitoring of Pap smear screening of outpatients and the yield from experience with the community screening program. It also describes the various cancer control activities of an ongoing hospital-based cancer screening clinic.

Adult↗

PubMedDate not supplied

BOEL screening: a program for the early detection of communicative disorders. Preliminary reports from a study on 1,000 Finnish infants.

Programs for infant screening of communicative disorders should cover the need for information about the development of attention functions--auditory, visual and tactile at an age when the child is on the doorstep of speech acquisition, i.e. before 1 year of age. BOEL is a new screening test, constructed to cheek the capacity of giving priority to signals for hearing, sight and motor attention in infants around 8 months of age. The child's innate program to follow an interesting signal, grasp it and investigate it with his mouth, turn his head after it, and smile responsively is tested with the help of two visual stimuli and four sound sources, ranging between 4 000 and 12 500 Hz. BOEL is meant to be used within the routine health check-ups of, for example, well-baby clinics.

Child Behavior↗

PubMed1981

Maternal serum alpha-fetoprotein screening: a report of the Forsyth County project.

A pilot screening program for the prenatal detection of neural tube defects has been conducted in Forsyth County, North Carolina. During the first 2 years of the program, 3,476 women were screened by quantitating levels of maternal serum alpha fetoprotein. Three neural tube defects and one case of multiple congenital anomalies with severe gastroschisis were detected as a result of the screening program. Outcome of pregnancy has been monitored in this group of women and no false negatives have been reported. No false positive amniotic fluid alpha-fetoprotein values were observed and no normal fetuses were aborted. Data gathered from this screening program again document the validity of maternal serum screening. The method of implementing a program for the prenatal decision of neural tube defects in urban areas is discussed.

Amniotic Fluid↗

PubMed1996

Economic impact of treatment of HIV-positive pregnant women and their newborns with zidovudine. Implications for HIV screening.

OBJECTIVES: To estimate the economic impact of (1) treating pregnant women who are human immunodeficiency virus (HIV)-positive with zidovudine and (2) voluntary screening programs for pregnant women for HIV infection and offering treatment with zidovudine to those found to be HIV-positive. MAIN OUTCOME MEASURES: Number of cases of pediatric HIV infection and costs of screening, zidovudine treatment, and pediatric HIV infection treatment. DESIGN: Health care costs associated with treatment of HIV-positive pregnant women and their newborns are estimated as the costs of zidovudine and its administration and the reduction in costs of treating pediatric HIV infection. The lifetime costs of pediatric HIV infection are derived from the published literature. Estimates of the reduction in maternal-to-fetal transmission rates are taken from the AIDS [acquired immunodeficiency syndrome] Clinical Trials Group (ACTG) Protocol 076. Costs of a voluntary screening program include costs of screening tests and counseling. Sensitivity and threshold analyses are performed to determine the impact of changes in input parameter values including zidovudine treatment costs, efficacy of treatment, costs of pediatric HIV infection, prevalence of HIV infection in pregnant women, screening test sensitivity and specificity, and pregnancy termination rates on the results. RESULTS: Assuming transmission rates are reduced from 25.5% to 8.3% as found in the ACTG 076 trial, treatment costs of $104,502 for 100 HIV-positive pregnant women and their newborns are offset by the reduction of $1,701,333 associated with fewer cases of pediatric HIV infection for a net savings of $1,596,831. The sensitivity and threshold analyses show that overall cost savings from treatment of HIV-positive pregnant women and their newborns are achieved for a wide range of possible maternal treatment costs, efficacy rates, and lifetime pediatric HIV treatment costs. In the base-case analysis for the voluntary screening program, overall cost savings are seen when HIV prevalence rate among pregnant women is greater than 4.6 per 1000. However, this threshold prevalence rate is sensitive to changes In parameter value-especially pediatric HIV treatment costs, counselling costs, efficacy of treatment, and years of additional HIV treatment for the pregnant women. CONCLUSIONS: Offering zidovudine treatment to pregnant women known to be HIV-positive will decrease the number of cases of pediatric HIV infection and reduce health care costs. Voluntary screening programs for pregnant women will further decrease the number of cases of pediatric HIV infection. The effect of a screening program on health care costs varies according to HIV prevalence and the costs associated with the screening program.

AIDS Serodiagnosis↗

PubMedDate not supplied

Waiting for a diagnosis after an abnormal screening mammogram. SMPBC diagnostic process workgroup. Screening Mammography Program of British Columbia.

BACKGROUND: Women with abnormal screening mammograms require diagnostic assessment and experience anxiety until a diagnosis is established. This report evaluated the timeliness of diagnosis after an abnormal screening mammogram in the Screening Mammography Program of British Columbia (SMPBC). METHODS: Information on diagnostic interventions following an abnormal screen (N = 10,314) provided through 11 regional SMPBC services between January 1, 1993 and June 30, 1994 were abstracted and analyzed. RESULTS: The median time from abnormal screen to diagnosis was 3.4 weeks with regional variation of 2.0 to 4.7 weeks; 10% waited 8.7 weeks or longer. For the 19% of women proceeding to open biopsy, the median diagnostic interval was 7.1 weeks with regional variation of 4.6 to 9.3 weeks; 10% waited 13.1 weeks or longer. INTERPRETATION: After an abnormal screening mammogram, women waited many weeks for a definitive diagnosis, especially those proceeding to open biopsy. Opportunities for process improvement were identified.

Breast Neoplasms↗

PubMed1995

Cost-effectiveness model for colon cancer screening.

BACKGROUND & AIMS: The relative efficacy and effectiveness of different colon screening programs has not been assessed. The purpose of this analysis was to provide a model for comparing several colon screening programs and to determine the key variables that impact program effectiveness. METHODS: Five screening programs were compared: annual fecal occult blood test (FOBT) alone, flexible sigmoidoscopy, flexible sigmoidoscopy and FOBT combined, one-time colonoscopy, and air-contrast barium enema. Key variables were adjusted for sensitivity analyses. Cost-effectiveness was defined as the cost per cancer death prevented. RESULTS: FOBT alone prevents fewer cancer deaths than the other programs. The addition of flexible sigmoidoscopy to the FOBT increases the rate of cancer prevention. One-time colonoscopy has the greatest impact on colorectal cancer mortality, largely because of assumptions that cancer would be prevented in most patients who undergo polypectomy. FOBT alone is the most cost-effective of the programs, but the cost is sensitive to several key variables. CONCLUSIONS: The model shows key variables that impact the cost-effectiveness of colon screening programs. Compliance is an important determinant of effectiveness of all of the screening programs. Future study should be focused on methods of patient education that improve patient compliance with screening.

Aged↗

PubMed2005

[Economic evaluation of the new national breast cancer screening programme in France: application to the Bouche-du-Rhone district].

The purpose is to measure the costs of the new national breast cancer screening programme in France and to compare these with those of the previous programme in the Bouches-du-Rhône district. Direct screening costs and costs related to diagnosis and assessment were collected. Costs are presented by screening period, by organisms involved in the screening program and by corresponding phase within the screening process. The total cost of the screening program total cost has increased from 5587487 euros to 9345469 euros between the two campaigns. The main reasons are the investment costs in the new screening program, the increase in the target population and the increased fee for programs. This study presents a first estimate of the costs related to the new national breast cancer screening program. Results of this study may help to guide future decisions on the further development of breast cancer screening in France.

Adult↗

PubMed1994

Screening and treatment of asymptomatic bacteriuria in pregnancy prevent pyelonephritis.

Although asymptomatic bacteriuria during pregnancy is associated with an increased risk of developing pyelonephritis, the effectiveness of screening programs to reduce this risk is controversial. A sharp reduction in the annual incidence of pyelonephritis (1.8% to 0.6%, P < .001) occurred after the introduction of a program to screen and treat asymptomatic bacteriuria among pregnant women followed at a large teaching hospital. The data provide retrospective and prospective evidence that screening and treatment programs for asymptomatic bacteriuria during pregnancy reduce the risk of pyelonephritis in a population with a moderate to high prevalence of bacteriuria.

Bacteria↗

PubMedDate not supplied

Public health impact of genetic tests at the end of the 20th century.

PURPOSE: To evaluate genetics tests available for clinical, research, and public health purposes in terms of their public health impact as measured by the number of people who could potentially be tested. METHODS: Genetic tests for the 751 inherited diseases or conditions listed in the GeneTests database as of November 2000, were classified on the basis of their use for population-based testing and the prevalence of the disease or condition being tested. The GeneTests database divides the tests into two groups: those offered for clinical use and those available for research only. RESULTS: Of the 423 clinical tests, 51 had potentially greater impact on public health because of their use in statewide newborn screening programs, other population screening programs, or testing for common diseases with a prevalence over 1 in 2,000 people. Among the 328 tests performed for research purposes only, 18 met the criteria for potentially greater public health impact. CONCLUSIONS: Our classification scheme indicated that fewer than 10% of the genetic tests listed in the GeneTests database at the end of 2000 are highly relevant to public health. The majority of genetic tests are used in diagnosis and/or genetic counseling for rare, single-gene disorders in a limited number of people. However, as more tests are being considered for newborn screening, and associations between genes and common diseases are being discovered, the impact of genetic testing on public health is likely to increase.

Databases, Genetic↗

PubMed2006

State newborn screening in the tandem mass spectrometry era: more tests, more false-positive results.

BACKGROUND: The advent of tandem mass spectrometry has made it possible to test newborns for multiple conditions efficiently. It is not known how state newborn screening programs have changed screening practices in response to this technology and how it affects the number of false-positive test results. METHODS: We obtained data from the National Newborn Screening and Genetics Resource Center regarding the screening practices for each of the 50 states, to determine the number of mandated disorders added to state newborn screening panels between 1995 and 2005. Combining these data with reported specificities from the literature and the number of births in each state, we estimated the number of infants who would have received false-positive results through screening with tandem mass spectrometry in 2005. RESULTS: The average state mandated screening for 5 disorders in 1995 (range: 0-8 disorders). Wyoming was the only state that decreased its panel size over the next decade. Kansas and Texas were the only states that did not add disorders to their panels between 1995 and 2005; the average state added 19. Iowa, Minnesota, Mississippi, South Dakota, and Tennessee each added > or = 40 disorders. Assuming that an individual test for a disorder had a specificity of 99.995%, we estimated that approximately 2575 infants would have received false-positive results through screening with tandem mass spectrometry in 2005. If specificity was assumed to be 99.9%, then the number increased to > 51000. CONCLUSIONS: State newborn screening programs have expanded dramatically in the past decade. Because the benefit of such testing may be unclear in some cases and because the number of infants who may receive false-positive results and may be labeled falsely as having disease is potentially sizeable, a more cautious approach is needed.

Blood Chemical Analysis↗

PubMed2002

Evaluation of a community breast screening promotion program.

BACKGROUND: This study reports results of a controlled evaluation of a comprehensive community breast screening promotion program. This program promoted increased use of mammography, clinical breast examination, and breast self-examination through community organization, physician training, and public education. METHODS: The program was conducted in one of three matched Florida study areas, with before and after assessment of breast screening behaviors, beliefs, and perceptions of women ages 40 and older. Baseline measures in 1990 were obtained by combining telephone and household survey data; follow-up measures using similar combined data were conducted with 4,096 women in 1997. RESULTS: . There was no evidence that the breast screening promotion program achieved higher levels of screening among women ages 40 and older in the program area. Mammography use and supportive beliefs and perceptions of mammography increased in all three study areas between 1990 and 1997. CONCLUSIONS: Among factors that may have reduced the differential impact of the program were public attention to breast cancer screening in the late 1980s throughout the U.S., effects of managed care, and limited penetration of a key program component. While the program was well received and served the community, its impact was overwhelmed by temporal trends observed in this study.

Adult↗