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PubMed2001

[Phenotypic expression of a mutation in MEN 2A documented in a family in the western part of Sweden].

A missense mutation at codon 618 of the RET proto-oncogene is a rather unusual cause of multiple endocrine neoplasia 2A. We report the phenotypic expression of this specific RET mutation in a large Swedish family. The family was mapped back to the 18th century. Since 1971 the family has been included in a biochemical screening program, and since 1994 has undergone genetic screening. Twenty-seven individuals were found to have medullary thyroid carcinoma (MTC). Eighteen were detected by screening. The incidence of pheochromocytoma (4%) and hyperparathyroidism (7%) was low. Five individuals died of MTC, but of these none had been included in the screening program. One patient underwent prophylactic thyroidectomy after positive genetic screening. MTC tumor aggressivity differed markedly between gene carriers. The screening program shows that the clinical aggressivity of MTC can be mitigated by early and adequate surgical intervention.

Female↗

PubMed2000

Separation of drug enantiomers by capillary electrophoresis in the presence of neutral cyclodextrins.

This is a selected review, highlighting our results obtained in an extended screening program ("The German-Chinese Drug Screening Program"), with a focus on a set of original data obtained with heptakis(2,3,6-tri-O-methyl)-beta-cyclodextrin (TM-beta-CD) as the chiral solvating agent (CSA). The enantioseparation of 86 drugs by capillary zone electrophoresis in the presence of this CSA was successful for 47 drugs. The migration separation factors (alpham) and the migration retardation factors (Rm) were compared with those found for native beta-cyclodextrin (beta-CD). The patterns thus obtained were also compared with those observed for hexakis(2,3,6-tri-O-methyl)-alpha-CD (TM-alpha-CD) and octakis(2,3,6-tri-O-methyl)-gamma-CD (TM-gamma-CD), respectively. From the statistical data, it can be concluded that there is a remarkable influence of the analyte structure on the electrophoretic data. A substructure 4H was found in the analyte structure that has a significant influence on the analytes' behaviour. Thus, analytes bearing the substructure 4H do not only have a strong affinity to the CDs but also a high rate of success of chiral separation in all systems reviewed. In light of this, the different ring sizes of native cyclodextrins (alpha-, beta- and gamma-CD) readily explain their behaviour towards a limited test set of chiral drugs. Sterical considerations point to the significance of side-on-binding versus inclusion in the cavity of the host. In addition to the findings from the screening program, numerous references to the literature are given.

Cyclodextrins↗

PubMed2004

Attorney-directed screenings can be hazardous.

BACKGROUND: The history of occupational health screenings indicate that they are often necessary to protect the health and interests of workers. However, medical screenings for asbestos and other occupational diseases which are organized and funded by attorneys may result in serious adverse outcomes to those screened. METHODS: We report a case of death that appears to have been heavily influenced by an attorney-initiated and -directed screening program. RESULTS: While well-run medical screening programs are essential to disease detection in workers, attorney-run and corporate screenings can be fraught with ethical and practical problems. Screenings have been used by corporations to identify workers with occupational illness in order to terminate their employment and avoid legal liability. Screenings can also be used to motivate workers to stop smoking and implement workplace controls. However, these screenings must be conducted responsibly. CONCLUSIONS: Although this is only one case it illustrates the gravity and potential danger of attorney-directed screening programs.

Aged↗

PubMed1990

Screening mammography program of British Columbia.

In an attempt to diagnose breast carcinoma as early as possible, a government-funded screening mammography program in British Columbia discovered 29 malignancies in the first 7,100 women screened. The program was carefully planned by a group consisting of representatives of all appropriate constituents. The screenees have demonstrated the anticipated increased frequency with increasing age and risk factors; in addition, the frequency of diagnosis is markedly lower in screenees who have had mammograms within the 2 previous years. Exclusive of equipment costs, amortization, and data processing, the cost per study is $33.81 (Canadian), resulting in a cost of $8,277.62 for each case diagnosed. This includes, for each study, an administrative fee of $1.00 as well as $1.00 devoted to continuing education for the reading radiologists. The success of the program has resulted in encouragement from the Health Ministry to expand rapidly throughout the Province, including use of a mobile van in more remote areas. Continued monitoring and peer review will ensure standard quality control in all of the screening facilities.

Aged↗

PubMed2006

Infant hearing screening at immunization clinics in South Africa.

OBJECTIVE: Benefits of early identification and subsequent intervention for hearing loss are not accessible to infants in developing countries like South Africa. There are no systematic screening programs and traditional platforms for newborn hearing screening, such as well-baby and intensive care nurseries, do not provide sufficient coverage due to the high incidence of births at home or in primary healthcare facilities. Primary healthcare structures, in the form of immunization clinics, have been proposed as an alternative screening platform. The current study, therefore, investigates a hearing screening program implemented at two immunization clinics in a representative South African community. METHODS: The two clinics in the current study were selected by a convenience sampling method in a community representative of large sections of the population. The hearing screening program was conducted over a 5-month period, and enrolled 510 infants (0-12 months of age). The screening protocol included Distortion Product Oto-Acoustic Emissions (DPOAE) and a high frequency probe tone (1000 Hz) tympanogram. Referral was based on one or both ears referring the DPOAE screen. Follow-up screening and diagnostic evaluations were scheduled for referred subjects. RESULTS: Coverage with DPOAE amounted to 95% of the sample ears (93% of sample subjects) compared to tympanogram coverage amounting to 94% (93% of sample subjects). OAE pass rates were 93% for the sample ears with neonatal ears indicating a higher pass rate of 95% compared to 92% for infant ears (5-52 weeks of age). Eighty-seven percent of the sample ears indicated peaked tympanograms indicative of normal middle-ear functioning and neonatal ears presented with an increased incidence of peaked tympanograms (92%). A highly significant association between the DPOAE and high frequency tympanometric result was found. Follow-up screening appointments were scheduled for 68 subjects (14% of screened sample). Only 40% returned for the second follow-up and 44% for the third follow-up. CONCLUSIONS: Immunization clinics indicate promise as infant hearing screening platforms, but identification of only bilateral hearing losses may be warranted initially to keep referral rates acceptably low. In addition to this efficient tracking systems are necessary to ensure acceptably high follow-up return rates are reached over time.

Acoustic Impedance Tests↗

PubMedDate not supplied

Primum non nocere and the quality of evidence: rethinking the ethics of screening.

BACKGROUND: Screening is different from investigation, and these differences have important implications in the assessment of screening programs. METHODS: I review the differences between screening and investigation and the implications of these differences derived from a consideration of the four ethical principles of beneficence, nonmaleficence, autonomy, and distributive justice. RESULTS: Because most of the harms of screening fall on the healthy and because screening is initiated by physicians, nonmaleficence takes ethical precedence over beneficence. Issues related to cost and consent are also approached differently in screening compared with investigation, and both take on greater ethical importance. I contend further that these ethical implications require that screening programs be backed up by better evidence than is the usual case for investigative medicine. I suggest an outline for the appropriate assessment of screening programs and for the ethical responsibilities of those involved in screening. CONCLUSIONS: Many current medical screening practices are not concordant with our ethical principles and should be reassessed.

Ethics, Medical↗

PubMed2004

Evaluating organized breast cancer screening implementation: the prevention of late-stage disease?

The objective of our study was to evaluate organized breast cancer screening implementation by measuring the association between screening program enrollment and late-stage disease. Our setting was a health plan using mailed mammography reminders to women ages > or = 40. We conducted yearly cross-sectional summaries of mammography experience and late-stage (regional or distant Surveillance Epidemiology and End Results Reporting (SEER) stage) breast cancer occurrence for all of the health-plan women ages > or = 40 (1986-1998). We estimated the odds of late-stage breast cancer among health-plan and surrounding community women because it was too early to compare changes in mortality. We also estimated the odds of late-stage disease (1995-1998) associated with program enrollment and mammography screening among health-plan women. We found that mammography-within-two-years increased within the health plan from 25.9% to 51.2% among women ages 40-49 and from 32.9% to 74.7% among women ages> or = 50. Health-plan late-stage rates were lower than those in the surrounding community [ages 40-49: odds ratio (OR), 0.87; 95% confidence interval (CI), 0.77-0.99; ages 50-79: OR, 0.86; 95% CI, 0.80-0.92] and declined parallel to the community. Among health-plan cancer cases, women ages > or = 43 who were enrolled in the screening program and who had at least one program mammogram were less likely to have late-stage disease compared with the women not enrolled in the program (OR, 0.31; 95% CI, 0.16-0.61) but the odds of late-stage was also reduced among program-enrolled women not receiving program mammograms (OR, 0.45; 95% CI, 0.21-0.95). We concluded that enrollment in organized screening is associated with increased likelihood of mammography and reduced odds of late-stage breast cancer. Addressing the concerns of un-enrolled women and those without mammograms offers an opportunity for further late-stage disease reduction.

Adult↗

PubMed1991

Logistical implementation of cholesterol screening at the worksite. Appointment versus walk-in approach.

Worksite cholesterol screening programs providing initial cholesterol screening, dietary consultation, and follow up evaluation are an excellent way to assist individuals to know their cholesterol. Two methods for implementation of cholesterol screening at the worksite include walk-in and appointment. These methods can be tailored to accommodate any worksite population. Guidelines for planning, implementation, follow-up, and evaluation of cholesterol screening programs are discussed.

Appointments and Schedules↗

PubMed1999

The Next Step Trial: impact of a worksite colorectal cancer screening promotion program.

BACKGROUND: The Next Step Trial was a randomized trial of worksite colorectal cancer screening promotion and nutrition interventions for automobile industry employees at increased risk of colorectal cancer. Interventions were tested at 28 worksites with 5,042 employees. This report describes results of the screening promotion intervention. METHODS: Worksites randomized to the control group received a standard program including rectal examination, fecal occult blood testing, and flexible sigmoidoscopy. Intervention worksites received an enhanced program (i.e., standard program plus an educational booklet/telephone call). Compliance (i.e., completion of all recommended screening examinations) and coverage (i.e., completion of at least one screening examination), the primary and secondary outcomes, were measured over 2 years. RESULTS: In the 2 years prior to baseline, 61% of employees had been screened. After random assignment, baseline differences in several employee characteristics and worksite screening procedures were detected, including more past history of screening in control worksites. After adjusting for differences, we found modest, but higher, compliance and coverage in intervention compared with control worksites (odds ratio [95% confidence limits] = 1.46 [1.1-2.0] and 1.33 [1.1, 1.6], respectively). CONCLUSIONS: Adding a personally tailored behavioral intervention to a standard colorectal cancer screening program can promote continued employee participation in screening as measured by compliance. Further research is needed to assess intervention effects in other populations.

Automobiles↗

PubMed1996

Baltimore Vision Screening Project.

PURPOSE: This study estimates the prevalence of common visual disorders (amblyopia, strabismus, refractive errors) in a group of inner-city school children. In addition, the study addresses the issue of access to care for vision-screening programs, specifically for children with recognized difficulties in obtaining routine medical care. METHODS: School children from an inner-city elementary school were enrolled into a prospective vision-screening program combining the identification arm (screening) and diagnostic/treatment arm (ophthalmic examination). The screening consisted of Snellen E optotypes presented at a 10-foot test distance. Each child failing the vision screening was examined by an ophthalmologist at the school using standard protocol. This allowed the authors to examine all children identified through the vision-screening program. RESULTS: Six-hundred eighty children were screened during the 1993 to 1994 school year. Eleven percent (76) failed the vision screening and were examined, 68 of whom failed the ophthalmic examination. The estimated prevalence of visual morbidity was as follows: amblyopia, 3.9%; strabismus, 3.1%, and refractive errors, 8.2%. CONCLUSION: Amblyopia, strasbismus, and refractive errors were found in relatively high frequencies for this population sample of inner city children. These findings underscore the necessity of comprehensive vision-screening programs that integrate follow-up care. Children with limited access to specialized eye care must be provided with a mechanism for obtaining these services.

Amblyopia↗

PubMed1987

Mass screening for cervical cancer in Ostfold county of Norway 1959-77.

In 1959, the Norwegian Cancer Society started a research project in Ostfold county to assess the effect of a mass screening program for cervical cancer. The program comprised 5 screening rounds during the period 1959-77. At each screening a clinical gynecological examination was performed in addition to the cytological test. A total of 45,960 women aged 25-59 years at the first screening were invited to participate. The follow-up, which was based on the data base of the Cancer Registry of Norway, lasted until December 31, 1982. For the follow-up period as a whole, the observed incidence and mortality were reduced to 78% and 83% of the expected values, respectively. Through the initial phase of the program there was a cumulation of patients with early-stage disease, while the incidence of advanced disease and mortality were reduced. In the later part of the follow-up period, a decrease in incidence of early and advanced disease as well as in mortality was observed. Women not participating in the screening program had a significantly higher risk of cervical carcinoma than the reference population, and a less favorable stage distribution as well. Among participants in the screening program, the reduction of risk was dependent upon the number of previous negative smears. Women with 5 previous negative smears had a risk of disease which was only 18% of that expected. Problems concerning choice of reference population, migration, attendance rates, sensitivity and specificity of the cytological tests and intervals between screenings are discussed. Also, the probable conversion rates of pre-cancerous lesions to cancer and the health hazards involved in possible over-treatment of pre-cancerous cases which otherwise would have regressed, are considered. A dynamic model is suggested. In order to achieve a reduction of mortality in the short term, the efforts of the program should initially be concentrated on older women. To achieve a reduction of incidence in the long run, younger women should gradually be included. Finally, special efforts should be made to increase attendance rates among high-risk women.

Adult↗

PubMed2003

Urbanization and the incidence of abnormalities of squamous and glandular epithelium of the cervix.

BACKGROUND: The large data bases of the Dutch cervical screening program can be exploited to establish the relation between urbanization and the incidence of abnormalities of the squamous and glandular epithelium, including mild or greater changes of the squamous and glandular epithelium of the cervix. METHODS: Six cytology laboratories in the context of the Dutch cervical screening program screened over 190,000 cervical smears. Urbanization (place of residence) data were derived from postal codes. All smears were coded with the Dutch national coding system, the Dutch national classification system KOPAC, in which squamous abnormalities are coded S4-S9, and glandular cell changes are coded G4-G9. From the scores per 1000 screened women, the relative risk (RR) of living in a large city compared with living in rural areas was calculated. To investigate a trend in incidence in relation to urbanization, the Schaafsma method was used. RESULTS: Of the smears with positive cytology, mild squamous dysplasia (S4) had the highest incidence per 1000 screened women (4.32), and the lowest incidence was found for adenocarcinoma (in situ; G7/G9; RR, 0.07). The RR for urban women ranged from 1.73 for moderate squamous dysplasia (S5) to 7.55 for adenocarcinoma (in situ; G7/G9). For smears with positive cytology for both squamous and glandular abnormalities, the Schaafsma method indicated a significant positive trend. CONCLUSIONS: The incidence of squamous and glandular abnormalities are maximal in women who live in a large city, which, in The Netherlands, is where there also is a population at high risk for human papillomavirus and bacterial vaginosis.

Adenocarcinoma↗

PubMed1996

Tuberculosis screening in medical students.

BACKGROUND AND OBJECTIVES: The Liaison Committee on Medical Education and the Association of American Medical Colleges have issued recommendations for screening medical students for tuberculosis. This report describes the initiation of a tuberculosis screening program at the F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USUHS). METHODS: A screening program was instituted in 1993 that included intradermal purified protein derivative, the "booster phenomenon," inter-reader variability, risk factor analysis, and administrative policy to improve compliance. RESULTS: There were 501 students screened (classes of 1996-1998). Initially, 19 (3.8%) students' tests were classified as positive, and 14 additional students tested positive when tested again 2 months later, due to the booster phenomenon. The subsequent conversion rate was 2.5% for those students who were followed for the next 3 years of medical school. All these students were placed on prevention therapy with isoniazid. No active cases of tuberculosis have been identified since the inception of the screening program. DISCUSSION: Only recently has the importance of screening medical students been emphasized. The USUHS program was designed to address the factors for a successful screening program, such as increased compliance, standardization, and documentation. With modifications according to resources, medical schools can offer an efficient tuberculosis screening program to students, faculty, and staff.

Humans↗

PubMed2000

Colorectal cancer screening 2000: the role of colonoscopy in average-risk individuals.

Colorectal cancer fulfills all of the criteria of a disease process that is suitable for a screening program. Several screening tests are effective in preventing mortality from colorectal cancer and are widely recommended. Despite the lack of direct comparisons, there is compelling indirect evidence that programs using colonoscopy as the primary tool are likely to be more effective than programs using fecal occult blood testing or flexible sigmoidoscopy as initial strategies. Colonoscopy-first programs are more expensive initially, but their cost effectiveness may prove to be comparable with the currently recommended programs in certain settings.

Colonoscopy↗

PubMed2006

[Mammography screening in Germany: how, when and why?].

It is well-known from several large randomized trials that regular mammography screening can reduce breast cancer mortality. While in many countries mammography screening programs have been in existence for quite some time, an organized population-based screening program is only now being implemented in Germany. In this review article, the different elements of a mammography screening program and their effect on the cost-benefit ratio are discussed and the planned German screening program is compared to the international programs.

Breast Neoplasms↗

PubMed2005

Proteinuria screening for children.

BACKGROUND: In Japan, urine screenings are performed annually at school for proteinuria and hematuria, but the effectiveness of this practice has not been clarified. METHODS: Urine screening at school was performed, and we investigated the prevalence of urine abnormalities and incidence and the causes of their diseases. Therefore, we studied effectiveness of the school-screening program. RESULTS: The prevalence of urinary abnormalities was 0.52% among elementary school children and 0.75% among junior high school children. The incidence was 0.24% among elementary school children. The school-screening program is effective in early detection of glomerulonephritis, so the number of new end-stage renal disease (ESRD) patients starting treatment has been changing. DISCUSSION: The school-screening program is effective for early detection of glomerulonephritis. In case of generations who underwent the school-screening program, the age that one develops ESRD has been rising year by year, and the number of new ESRD patients starting treatment before 20 years old is lower in Japan than in America. CONCLUSION: The school-screening program in Japan represents a highly effective mass screening technique.

Child↗

PubMed1983

Impact of network organization on head and neck cancer control.

Prior to the Northern California Head and Neck Cancer Network, there had been no organized community effort regarding detection, management, and rehabilitation of head and neck cancers. Organization depended upon endorsement by the newly formed Northern California Cancer Program (NCCP) and membership of major treatment centers. Important developmental steps included financial support, a principal investigator, a representative multidisciplinary Steering Committee and By-laws. The organization established a support staff and subcommittees of volunteer professionals for the following areas: standards of care (state-of-the-art); patient management guidelines; epidemiology and evaluation; pre-treatment conferences; screening programs and dental hygienist training; demonstration of rehabilitation techniques; and professional education. Assessment of the contract period with a baseline year indicated beneficial and progressive standards of care, improved referral patterns, and areas of weakness useful in guiding future educational efforts. Utilizing a large target population of almost 9 million and 72 institutions responsible for more than 80% of the cancer patients yielded data on 1,790 patients that was meaningful and realistic regarding cancer control. The pre-treatment conferences in four different geographic locations are continuing, as well as rehabilitation programs in each area. The cooperative multidisciplinary, multi-institutional efforts developed during the contract are continuing in educational and research programs. Screening programs were shown not to be cost effective.

California↗

PubMed1995

Quality-oriented mass mammography screening.

PURPOSE: To demonstrate the ability of a mass mammography screening program to provide consistently high-quality mammography screening, while at the same time sustain a large volume of patients to keep the cost of mammography low. MATERIALS AND METHODS: A public-funded, mass mammography screening program, begun in 1988, is currently being conducted in five Canadian provinces. For the Screening Mammography Program of British Columbia, complete follow-up data are available for the first 57 months of operation. During that time, the program expanded from one center with five radiologist screeners to 14 centers with 30 radiologist screeners. There were 201,937 examinations performed on 128,325 women, 35% of whom were younger than 50 years. RESULTS: There were 802 cancers detected at an overall rate of 6.2 per 1,000 women (2.8 per 1,000 in women younger than 50 years and 8.1 per 1,000 in women older than 50 years). In the women younger than 50 years, 90 (72%) of the cancers were stage 0 or stage I, and the axillary lymph nodes were involved in 14 (11%). In the women 50 years or older, 496 (73%) of the cancers were stage 0 or stage 1, and the axillary lymph nodes were involved in 97 (14%). CONCLUSION: If quality is carefully controlled, the results of a mass screening program can be either maintained or improved. For both age groups, the prognostic characteristics are similar.

Breast Neoplasms↗