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PubMed2004

Breast carcinoma diagnosis, treatment, and prognosis before and after the introduction of mass mammographic screening.

BACKGROUND: The introduction of breast carcinoma screening leads to early detection and is believed to reduce mortality and increase the proportion of patients for whom breast-conserving surgery is possible. METHODS: In 1992, a population-based mammographic screening program was introduced in the Dutch city of Tilburg and its surroundings; the program achieved total coverage in 1996. The authors examined the effects of this screening program by investigating disease stage, treatment, and survival among women diagnosed with breast carcinoma at a teaching hospital in Tilburg during the periods 1985-1991 and 1992-1999. RESULTS: Between January 1, 1985, and December 31, 1999, 1400 patients were diagnosed with breast carcinoma. Among patients ages 50-69 years, the proportion of TNM Stage I breast carcinoma increased from 24% in 1985-1991 to 45% in 1992-1999 (P<0.001). The proportion of patients age <50 years with invasive breast carcinoma who underwent breast-conserving surgery decreased from 45% to 33% (P=0.011). Among patients ages 50-69 years, the overall survival rate during the period from 1992 to 1999 was significantly greater than the corresponding rate during the period from 1985 to 1991 (P=0.0009). Even after adjustments were made for tumor stage and patient age, a slight reduction in mortality risk was observed in this age group. No difference in stage distribution or prognosis was found among patients age <50 years or among patients age > or =70 years. Of the 168 invasive malignancies found in patients ages 50-69 years between 1997 and 1999, 68 (40%) were detected by the screening program, 47 (28%) were interval malignancies, and 53 (32%) were detected in nonparticipants or in women who did not participate in 1 or more screening rounds. Patients with screen-detected tumors had a much more favorable prognosis than did patients with interval malignancies (P=0.0018) or patients with clinically detected breast carcinoma (P<0.0001). CONCLUSIONS: Between 1992 and 1999, after the introduction of breast carcinoma screening, improved prognosis and more favorable tumor stage were observed among patients ages 50-69 years. Even after the screening program was fully implemented in 1996, the majority of invasive malignancies still were detected between screening rounds or in patients who did not participate in the program.

Adult↗

PubMed2001

Neonatal screening and long-term follow-up of phenylketonuria: the French database.

BACKGROUND: In France, neonatal screening of phenylketonuria (PKU) started in 1966. A national association was created in 1978 in order to organise the neonatal screening program and to control the efficacy of the screening and patients' follow-up. AIMS: To evaluate the results of the French PKU screening program in terms of hyperphenylalaninaemia epidemiology, efficacy of the screening procedure, management and outcome of the patients. STUDY DESIGN: The national database has been filled-up first with the answers to questionnaires that were sent each year by the PKU patients' physicians, and second with the results of an additional inquiry, which was set up in 1994 in order to investigate diagnosis, treatment, and school outcome of all French PKU patients. RESULTS: PKU was diagnosed in 81.6% of patients with hyperphenylalaninaemia (HPA), non-PKU HPA in 17.2% and cofactor deficiency in 1.1%. From 1980, incidence of PKU has been stable: 1 per 17,124 live births. Sensitivity of the screening procedure was 99.3%. Age at diet initiation regularly decreased to reach 14 days as a median in 1996. Until 1990, median age at diet discontinuation was 6 years of age. Later, strict diet was continued longer (at least, up to 8-10 years). PKU patients who entered to secondary school at normal age were characterised by an earlier age at diagnosis and at diet initiation and a later age at diet discontinuation, compared to those who entered 1 year or more behind normal age. CONCLUSION: These data confirm the benefit of a nationwide organised screening program. They emphasise the importance of an early neonatal diagnosis and diet initiation in PKU patients and are consistent with the benefit of a longer period of strict diet in childhood.

Child↗

PubMedDate not supplied

What lay health advisors do: An evaluation of advisors' activities.

PURPOSE: Since the 1970s, health promotion and disease prevention programs that rely on lay health advisors have proliferated, making it important to ascertain the levels and types of activity that can reasonably be expected from such advisors. This report describes the activities of lay health advisors participating in a program to increase mammography screening by older African American women and shares lessons that the authors learned about evaluating advisors' activities. DESCRIPTION OF STUDY: Between September 1994 and January 1996, 144 lay health advisors, associated with the North Carolina Breast Cancer Screening Program, were asked to complete, on a periodic basis, a standardized, self-administered activity report that asked about group presentations in the past 3 months and one-on-one contacts in the past week. Eighty-five advisors submitted one or more reports. The authors tabulated responses for lay health advisors overall, for those turning in one or more reports, and for those reporting a specific type of activity. RESULTS: The responses showed that North Carolina Breast Cancer Screening Program lay health advisors made approximately one group presentation every 3 months and had one to three individual contacts per week. Group presentations were commonly in churches and homes, and focused on who needs a mammogram, how then, and where to get one. During one-on-one encounters, advisors primarily encouraged women to get mammograms or discussed fears about mammograms. CLINICAL IMPLICATIONS: Information about lay health advisor activities serves several important purposes. Such information allows programs to identify the types of messages that lay health advisors transmit and the number of contacts they make, while also identifying the groups that are more and less difficult to reach, and the topics and locations favored by advisors and the women they contact. Activity data may indicate what resources or other support the advisors need, whether in-service training is necessary, and how to enhance the recruitment and training of additional lay health advisors.

Black or African American↗

PubMedDate not supplied

Can severe neonatal jaundice be prevented by neonatal screening for glucose-6-phosphate dehydrogenase deficiency?--a review of evidence.

An evidence-based approach is used to evaluate the neonatal screening program for glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. The primary consideration to include G-6-PD deficiency (G-6-PDD) in neonatal screening program was the public health burden of G-6-PDD-associated neonatal jaundice (G-6-PDDANJ) in the target population. However, the prevalence of G-6-PDD per se cannot be the sole index of the public health burden of G-6-PDDANJ. In more developed areas, G-6-PDDANJ is no longer a major public health problem. Further, most cases with G-6-PDDANJ in more developed areas are not precipitated by any identifiable icterogenic agents, and therefore not preventable by avoidance education. In less developed areas, however, G-6-PDDANJ is still a big public health burden and requires intervention. In this study, the effectiveness of neonatal screening programs for G-6-PDD to prevent severe neonatal jaundice(NJ) has been shown based on historical comparison, but the results may be confounded by other temporal factors. G-6-PDDANJ usually occurs in the first week after birth. Prompt need for G-6-PD screening results precludes it from incorporation into other existent neonatal screening programs (i.e., for PKU), and from centralization of laboratory work. The efficacy, adverse effects and cost-effectiveness of this mass screening program need further study.

Cost-Benefit Analysis↗

PubMedDate not supplied

Community prostate cancer screening.

Health promotion and cancer prevention, including screening, are two important aspects of cancer care. However barriers exist to patients receiving recommended cancer screening procedures. One way to overcome these barriers is through the use of community cancer screening programs. This article presents a prototype of a community prostate cancer screening program. The program planning, staffing, promotion, cost and finance, and follow-up activities are explained. Furthermore, examples of communication tools and follow-up protocol, and results of 4 years of community screening programs are described. Recommendations for future community screening give insight for program improvement.

Community Health Services↗

PubMedDate not supplied

Systematic screening for Chlamydia trachomatis: estimating cost-effectiveness using dynamic modeling and Dutch data.

OBJECTIVE: To estimate the cost-effectiveness of a systematic one-off Chlamydia trachomatis (CT) screening program including partner treatment for Dutch young adults. METHODS: Data on infection prevalence, participation rates, and sexual behavior were obtained from a large pilot study conducted in The Netherlands. Opposite to almost all previous economic evaluations of CT screening, we developed a dynamic Susceptible-Infected-Susceptible (SIS) model to estimate the impact of the screening program on the incidence and prevalence of CT in the population. SIS models are widely used in epidemiology of infectious diseases, for modeling the transmission dynamics over time. Subsequently, a predictive decision model was used to calculate the complications averted by the screening program. Cost-effectiveness was expressed as the net costs per major outcome averted (MOA) and was estimated in the baseline analysis and in sensitivity analysis. RESULTS: The overall prevalence decreased from 1.79% to 1.05% as a result of the screening program directed at both men and women. The program costs were mainly offset by the averted costs, although not fully. Resulting net costs per MOA were 373 euro sin the baseline analysis. Sensitivity analysis showed that partner treatment and sending a reminder are important aspects improving cost-effectiveness. Additionally, restricting the screening to women only was estimated to save costs. CONCLUSIONS: Our cost-effectiveness analysis shows that the Dutch society has net to pay for the prevention of CT-complications through screening young men and women. One could argue although that 373 euros per MOA presents a reasonable cost. A screening program consisting of screening women only should always be adopted from a pharmacoeconomic point of view. Our dynamic approach appreciates better the specific characteristics of an infectious disease, such as CT.

Adult↗

PubMed1994

[Economic evaluation of screening for neuroblastoma].

Though neuroblastoma, a cancer occurring in children, is infrequent, several countries run screening programs to detect it early since advanced stages show high mortality rates. The aim of this study is to propose a non empirical medico-economic evaluation model for the screening program for neuroblastoma, adaptable to various contexts. A marginal cost-effectiveness analysis was performed. The effectiveness and cost criteria were respectively the number of children who do not die from neuroblastoma and the cost of the screening programs, together with the cost of the treatments. The major parameters of the model were: size of target population, incidence, over-incidence rate, compliance rate, test sensitivity, distribution of cases and mortality rates according to the stage of the disease. The aim of the model was to determine, within a specific context (fixed parameters), the cost of an additional life saved, or less pragmatically to calculate the threshold values for the parameters for which the screening program for neuroblastoma is worthwhile (ie marginal cost equal to zero). We illustrate this model presentation with simulations elaborated from the neuroblastoma screening program performed in the Rhône area, France.

Child, Preschool↗

PubMed1997

Screening for thyroid abnormalities among immigrants to Israel from the former USSR.

The exposure of some former Soviet citizens to radiation following the 1986 Chernobyl disaster has raised the question of the need to enroll these individuals in screening programs for thyroid abnormalities upon their immigration to Israel. Since screening programs have many drawbacks, and screening for thyroid disease has never been shown to decrease mortality or to improve survival, we are of the opinion that the establishment of thyroid screening programs will do more harm than good. The timely diagnosis of the very small excess in benign and malignant thyroid disease to be anticipated among the immigrants can be achieved in the community by the primary care physician armed with specific knowledge of the risks and the initial diagnostic approaches to suspected thyroid disease as well as information on the availability of specialist backup.

Emigration and Immigration↗

PubMed1982

So-called interval cancers of the breast. Pathologic and radiologic analysis of sixty-four cases.

Within a population-based breast cancer screening programs, 209 cancers were detected by regular mammographic screening. Additionally, 66 cancers were discovered between two consecutive screenings after one, two, or three negative screening examinations (interval cancers). The study group consisted of 25,920 women who have been participating since 1975 in a breast cancer screening program in Nijmegen, the Netherlands. In this program, single view mammography (lateromedial projection) was administered as the sole screening examination every two years. Physical examination was not part of the screening program. All previous histologic and radiologic material from 64 of those "interval" patients was available and was reviewed. In 19 of the 64 patients, direct or indirect signs of tumor were seen on the previous screening mammogram on review (observers error). In four cases the site of the tumor lay outside the imaging field (technical error). In 41 cases, no signs of tumor could be seen on the mammograms even on review. By calculated tumor doubling times, 20 of these 41 cases were probably too small to be detected at the last screening ("real" interval cancers). However, 21 cases were probably large enough but were somehow masked from radiologic detection. The mean reasons for this "masking" proved to be: 1) dense breast, 2) poorly outlined tumor mass of diffuse infiltrative type, mainly invasive lobular carcinomas, and 3) intraductal localization. The authors suggest that women with dense breasts be screened more frequently, using more views and modalities and with broader criteria for advising surgical biopsy. They also note that in general the two-year interval between screenings is probably longer than the optimal interval.

Aged↗

PubMed2005

Screening for cervical carcinoma.

BACKGROUND: Differences exist between defined groups of women in their attendance to screening programs for cervical carcinoma. Data from the screening organization in the southwest Netherlands were used to evaluate differences between subpopulations to get information to improve the screening procedure. METHODS: Between 1998 and 2001, a total of 251,446 women had been invited to participate in the screening program. The ethnic background of all invited women was documented. Both the results of Papanicolaou tests and the reason women did not participate were stored in a data base that was matched with the invitation data base. The resulting data set was analyzed with regard to participation rates and results of screening in relation to age, ethnic background, and socioeconomic status. RESULTS: Overall participation was 55.7%. Women who were born in The Netherlands participated at a rate of 56.8%, whereas women who were born in other Western countries participated at a rate of 45.3%. The participation rate for women who had a Moroccan background was as low as 35.9%. The prevalence of high-grade squamous intraepithelial lesion was 6.2 times higher among women in the younger age groups compared with women in the oldest age group. Women with low socioeconomic status were 1.5 times more likely to have high-grade squamous intraepithelial lesions. Women from The Netherlands Antilles had greater percentages of both low-grade and high-grade squamous intraepithelial lesions (1.6 and 3.0 times more frequent, respectively) compared with women who were born in The Netherlands. CONCLUSIONS: Although cervical screening is free of charge in The Netherlands, participation rates differed greatly between ethnic groups and between women from different socioeconomic strata. Abnormalities were found more often in women who were not born in The Netherlands and in women with lower socioeconomic status. In these groups, attendance at the screening program was lower compared with the attendance of women who were born in The Netherlands.

Adult↗

PubMedDate not supplied

The experience and satisfaction of women attending breast cancer screening.

PURPOSE/OBJECTIVES: To determine women's satisfaction and experience with breast cancer screening and associated factors. DESIGN: Exploratory, descriptive design. SETTING: One center of the Ontario Breast Screening Program, a province-wide breast cancer screening program. SAMPLE: Nonprobability sample of 315 asymptomatic women, age 50 years or older, with no previous history of breast malignancy. METHODS: Data were collected from the entire sample of 315 women immediately postscreening using a self-report questionnaire and from a subgroup of 256 women by telephone interview at three weeks post-screening. MAIN RESEARCH VARIABLES: Satisfaction with and intentions and anxiety regarding breast cancer screening. FINDINGS: Overall, women reported a high level of satisfaction with their screening experience, including respect for privacy, encouragement to ask questions, and provision of information. Two areas of concern that participants identified were mammogram discomfort and fear about radiation risks. At the postscreening interview, women reported that breast screening had relatively little impact on social or physical aspects of their lives, but it did have a positive effect on certain emotional issues, such as their feelings of reassurance, well-being, and relaxation. CONCLUSION: Since the degree of satisfaction that participants in health services report has been shown to influence attendance patterns, assessing breast screening programs from the perspective of attendees is necessary. Such assessment can identify areas of satisfaction and concern and, thus, provide information for developing interventions aimed at promoting recruitment and retention. IMPLICATIONS FOR NURSING PRACTICE: As health educators, nurses play an important role in providing breast cancer screening information to women. As well as being knowledgeable about screening guidelines and the benefits of screening, nurses also must recognize women's concerns about radiation risks and pain or discomfort with the procedure and be prepared to provide teaching and support for these women.

Aged↗

PubMed1995

Screening for diabetic retinopathy. Initiation and frequency.

A screening program for diabetic eye disease was established in Iceland in 1980. Diabetics involved in the screening program have a low prevalence of blindness, 1% in type 1 and 1.6% in type 2. We examined ways to make the screening program more efficient by identifying subgroups at low risk of developing eye disease that require treatment and therefore need less frequent screening. We studied whether diabetic eye disease screening programs may be trimmed by excluding children and examining diabetics without retinopathy biannually. Our results indicate that diabetic children under the age of 12 years do not need regular screening for eye disease. Biannual examinations seem to suffice in type 1 and 2 diabetic patients without retinopathy. However, in a setting where the eye clinic is located apart from the diabetes clinics, biannual examinations present practical problems which could result in a less effective screening for diabetic eye disease.

Adolescent↗

PubMed2003

Delivering equitable care: comparing preventive services in Manitoba.

OBJECTIVES: This study examined preventive care delivered in Manitoba during the 1990s by 3 different methods -childhood immunizations (by physicians and public health nurses under a government program), screening mammography (through a government program introduced in 1995), and cervical cancer screening (no program). METHODS: Longitudinal administrative data, an immunization monitoring system, and Canadian census databases were used. RESULTS: Cervical cancer screening rates remained static and showed strong socioeconomic differences; childhood immunization rates remained high with small socioeconomic gradients. The introduction of the Manitoba Breast Screening Program resulted in rising rates of screening and vanishing socioeconomic gradients. CONCLUSIONS: Manitoba government programs in childhood immunization and screening mammography actively helped the provision of preventive care. Organized programs that target population groups, recognize barriers to access, and facilitate self-evaluation are critical for equitable delivery.

Adult↗

PubMed1990

[General aspects of secondary prevention and possible interventions applicable to squamous carcinoma of the upper respiratory-digestive tract].

The authors report some aspects of secondary prevention, including screening programs. General standards for screening programs are first analyzed; standards including a) definition of the problem and its social importance; b) tumor natural history; c) diagnostic test characteristics; d) therapeutic possibilities; e) evaluation of results. The problem of selective screenings are then discussed as they attempt to reduce costs and maximize benefits.

Carcinoma, Squamous Cell↗

PubMed1997

[Programs of early detection of breast cancer and access of mammography in Spain].

BACKGROUND: We studied availability to mammography among Spanish women aged 40 to 70 years, variation in use of the mammography by autonomous community, and the situation and importance of breast cancer screening programs among other factors, in the access to mammography. SUBJECTS AND METHODS: A cross-sectional population survey was conducted in 1994 in a sample of 3,218 women. A questionnaire was used to collect data on the variable access (receipt of at least one mammogram in the last 2 years) as well as different access-related variables. Information on breast cancer screening programs was collected by contacting the responsible institutions. We considered that a program had total coverage if it included all the municipalities in the province and partial if it did not include all municipalities. RESULTS: Twenty-eight percent of women had performed a mammogram. This proportion varied among autonomous communities (AACC) from 11.5 to 73.8%. Breast cancer screening programs existed in 8 AACC. The multivariant analysis revealed an association between access to mammography and the existence of a screening program, especially when the later had total coverage (OR = 7.64; 95% CI = 5.24-11.10). An association was also found between access to mammography and physician-related factors, place of residence and attitudes of women toward mammography. CONCLUSIONS: Less than one third of women aged 40-70 have performed a mammography in the last 2 years, and this proportion varies among AACC. Gynecologist visits and the existence of breast cancer screening programs are fundamental factors in the access to mammography in Spain.

Adult↗

PubMed2006

[Pathological characteristics in screening versus clinically-detected breast cancer].

We report pathological characteristics of screen detected breast cancers versus breast cancers diagnosed outside the official breast screening program. The breast cancer screening program was organised in the county of Haute-Vienne and a pathological record was established in the Association de dépistage des cancers du sein (ADCS 87). Three hundred and thirty three cases were recorded in 50 to 74 years-old women who had been screened (74 were interval cancers), six hundred and eighty seven in 50 to 74 years-old women without screening and three hundred and fifteen in women under 50. No difference in ductal carcinoma in situ or histological type was noted but tumor size and lymph node involvement presented significantly more favorable prognosis in screen detected breast cancers. This study confirms the potential benefit of screening in breast cancer.

Aged↗

PubMed2000

Ten years of breast screening in the Screening Mammography Program of British Columbia, 1988-97.

OBJECTIVES: To evaluate 10 years outcomes of the Screening Mammography Program of British Columbia (SMPBC) and determine if breast screening targets were being achieved among women aged 40-80+ years. SETTING: Organised breast screening programme in British Columbia, Canada. METHODS: Rates of participation, abnormal referral, cancer detection, and interval cancer were calculated for asymptomatic women receiving an SMPBC mammography from 1988-97. RESULTS: 895,849 screening mammographies were provided to 335,433 women. 51.3% of women were age 50-69 years. Abnormalities were identified on 57,454 screens (6.4%) from which 3304 cancers were detected. Abnormal call rates were higher on first (9.8%), compared with subsequent screens (4.4%) and declined with age: 7.7% at age < 40 to 5.4% for age 70-79 years. Cancer detection rates were higher on first (5.0 per 1000) compared with subsequent screens (2.8 per 1000) and increased smoothly with age from 1.4 to 8.2 per 1000 from age < 40 to age 80 years and older. Twenty per cent of cancers were non-invasive. The median size of invasive cancers was 14 mm and 81% had no axillary lymph node metastases. The 12 month interval cancer rate was 0.6 per 1000 and did not vary significantly with age or screening history. The prevalence to expected incidence ratio was 3.1 for women age 50-79 years. CONCLUSION: Across a broad range of ages, surrogate indices of screening mammography success have been achieved in a population based, North American, organised breast cancer screening programme.

Adult↗

PubMed2003

[Visual screening to discover ophthalmologic disorders in children].

PURPOSE: [corrected] To report the frequency of common childhood ocular disorders in a pediatric population. To address the issue of access to care for vision screening programs. METHODS: Prospective vision screening for a period of 2 years (February 2001-February 2003) which enroll 254 children from 3 villages (Cepleniţa, Vlădeni, Aroneanu) sponsored by World Vision Romania. The study asses refractive errors, strabismus, amblyopia and other ocular abnormalities. RESULTS: The mean age was 8.09 +/- 2.88 with the following distribution: preschool 19%, first grade 56%, second grade (over 10 years of age) 25%. Refractive errors requiring correction were observed frequently in this group of children (especially mild hyperopia, small myopia, astigmatic refractive errors). Strabismus was identified în 7.87% of cases and amblyopia în 11.42% (1/3 of cases mild and severe). CONCLUSIONS: The frequency of common visual disorders in this population sample was larger than previously published studies. In poor economic subgroups the first ophthalmologic examination was performed after school age. Access to care is an integral part of any vision screening program. We are trying to highlight the importance of effective follow-up programs for all children especially those with limited resources for health care.

Adolescent↗