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PubMed1988

[Significance of mammography study in the detection of 2,511 breast cancers 1977 to 1987].

The relation between the way of cancer detection and tumor stage was studied in 2511 cases of breast cancers patients. 85.0% of those patients discovered cancer by themselves. 12.7% of the carcinomas were detected through the screening program (used in FRG). It was found that there exists a clear dependence between the tumor stage and the kind of diagnosis finding. When the breast carcinoma was detected by the patient herself--in spite of attending regularly the above mentioned screening program--it showed that 16.1% had a small, favourable tumor up to 1.0 cm, in 39.8% a rest-tumor and in 48.1% axillary metastases were found. In cases diagnosed through the screening program the number of small carcinomas amounted to 21.4%, a rest-cancer frequency was 30.5%, and the axilla was afflicted in 25.6%. When the tumor was detected only on account of mammography, 47.7% of the women had a small tumor up to a size of 1.0 cm and 89.7% of the patients had no axillary metastases. The results of the study show that the sensitivity of palpation and inspection is insufficient in the search for breast carcinomas. By including the mammography the efficiency of the screening programs is significantly improved. A routine mammography as a part of the screening program on the one hand makes the diagnosis "no cancer" more reliable, and the earlier detection of breast cancer on the other hand statistically renders the chances of healing significantly more favourable.

Breast Neoplasms↗

PubMed1979

Urine screening of arrestees as a source of drug abuse indicator data.

The National Institute on Drug Abuse (NIDA) recently sponsored a study which examined the utility of jail urine screening programs as a source of drug abuse indicator data. During the study, short-term urine screening programs were set up in the central jail facilities of four urban counties. To determine whether jail urine screening programs have the capacity to detect patterns of drug use not readily detectable through existing indicators, the urinalysis findings for each county were compared with data generated by the DAWN and CODAP systems. The results of the study suggest that jail urine screening programs can be useful as a supplement to existing sources of information on drug use patterns in local communities.

Dextropropoxyphene↗

PubMed2002

Costs and benefits of different strategies to screen for cervical cancer in less-developed countries.

BACKGROUND: About 80% of cervical cancers occur in less-developed countries. This disproportionate burden of cervical cancer in such countries is due mainly to the lack of well-organized screening programs. Several cervical cancer screening strategies have been proposed as more cost-effective than cytology screening. We compared the costs and benefits of different strategies and their effectiveness in saving lives in a less-developed country. METHODS: We used a population-based simulation model to evaluate the incremental societal costs and benefits in Thailand of seven screening techniques, including visual inspection of the cervix after applying acetic acid (VIA), human papillomavirus (HPV) testing, Pap smear, and combinations of screening tests, and examined the discounted costs per year of life saved (LYS). RESULTS: Compared with no (i.e., not well-organized) screening, all strategies saved lives, at costs ranging from 121 US dollars to 6720 US dollars per LYS, and reduced mortality, by up to 58%. Comparing each strategy with the next least expensive alternative, VIA performed at 5-year intervals in women of ages 35-55 with immediate treatment if abnormalities are found was the least expensive option and saved the greatest number of lives, with a cost of 517 US dollars per LYS. HPV screening resulted in similar costs and benefits, if the test cost is 5 US dollars and if 90% of women undergo follow-up after an abnormal screen. Cytology (Pap smear) was a reasonable alternative if sensitivity exceeds 80% and if 90% of women undergo follow-up. Compared with no screening, use of a combination of Pap smear and HPV testing at 5-year intervals in women of ages 20-70 could achieve greater than 90% reduction in cervical cancer mortality at a cost of 1683 US dollars per LYS, and VIA could achieve 83% reduction at 524 US dollars per LYS. CONCLUSIONS: Well-organized screening programs can reduce cervical cancer mortality in less-developed countries at low costs. These cost-effectiveness data can enhance decision-making about optimal policies for a given setting.

Acetic Acid↗

PubMed2002

The effect of a church-based breast cancer screening education program on mammography rates among African-American women.

This study examines the effectiveness of breast cancer screening education programs on mammography rates among African-American women 40 years of age and over. We conducted two types of educational programs in community settings, primarily in African-American churches. Three-month follow-up interviews were used to determine whether women who participated in programming were more likely to get a mammogram if they had not had a mammogram in the last year. Our results demonstrate that the educational programs significantly increased the likelihood of getting a mammogram when compared to a control group that received no educational programming. Further, we found that the programs were effective for motivating breast cancer screening in housing projects as well as in the churches, and that the effectiveness of the programs remained even when we controlled for socioeconomic status, depression, and age.

Adult↗

PubMedDate not supplied

Recruitment of underserved women for breast cancer detection programs.

PURPOSE: The purpose of this correlational, nonexperimental study was to survey a sample of uninsured/underinsured women entering a no-cost, state-funded breast cancer screening program to identify factors that might enhance existing recruitment strategies and adherence to breast cancer screening. OVERVIEW: Inadequate access to breast cancer screening contributes to the high morbidity and mortality that have been documented in low-income American women with breast cancer. Two hundred and four participants in a no-cost cancer screening program at the Johns Hopkins Oncology Center's East Baltimore Community Health Program in Maryland were surveyed by telephone to identify methods to enhance recruitment strategies. The survey solicited information in areas such as demographics, healthcare practices, and recruitment sources. Knowledge about breast cancer and its treatment, perceived control over health matters, and the practice of preventive measures were low in this group. Based on the data obtained, recruitment strategies better tailored to this population were developed and implemented. CLINICAL IMPLICATIONS: Recruiters and clinicians must understand that for impoverished women, day-to-day survival takes precedence over most other issues. The possibility of a condition that may cause illness or death 10 to 20 years from now is of less importance than obtaining food, clothing, and shelter today. This program demonstrates that services such as transportation and child care are important elements of care for this population. Culturally sensitive recruitment strategies, personalized care, and vigilant follow-up are important requisites to breast cancer screening programs. A multidisciplinary team effort is critical in bringing together the elements required for a successful screening program.

Adult↗

PubMed1993

Occupation as a risk identifier for breast cancer.

OBJECTIVES: Breast cancer mortality may be reduced if the disease is detected early through targeted screening programs. Current screening guidelines are based solely on a woman's age. Because working populations are accessible for intervention, occupational identification may be a way of helping to define and locate risk groups and target prevention. METHODS: We used a database consisting of 2.9 million occupationally coded death certificates collected from 23 states between 1979 and 1987 to calculate age-adjusted, race-specific proportionate mortality ratios for breast cancer according to occupation. We performed case-control analyses on occupational groups and on stratifications within the teaching profession. RESULTS: We found a number of significant associations between occupation and frequency of breast cancer. For example, white female professional, managerial, and clerical workers all had high proportions of breast cancer death. High rates of breast cancer in teachers were found in both proportionate mortality ratio and case-control analyses. CONCLUSIONS: These findings may serve as in an aid in the effective targeting of work-site health promotion programs. They suggest that occupationally coded mortality data can be a useful adjunct in the difficult task of identifying groups at risk of preventable disease.

Adult↗

PubMed1998

Genetic screening and ethics: European perspectives.

Analysis and comparison of genetic screening programs shows that the extent of development of programs varies widely across Europe. Regional variations are due not only to genetic disease patterns but also reflect the novelty of genetic services. In most countries, the focus for genetic screening programs has been pregnant women and newborn children. Newborn children are screened only for disorders which are treatable. Prenatal screening when provided is for conditions for which termination may be offered. The only population screening programs for adults are those for thalassaemia carrier status in Cyprus, Greece and Italy. Social responses to genetic screening range from acceptance to hostility. There is a fundamental tension between individual and community in the debates in various European countries about implementation of screening programs. Opposition to genetic screening is frequently expressed in terms of arguments about "eugenics" with insufficient regard to the meaning of the term and its implications. Only a few countries have introduced explicit legislation on genetic screening. Legislation to address discrimination may provide more safeguards than legislation protecting genetic information itself.

Adult↗

PubMed1997

Prevalence and genotypes of alpha- and beta-thalassemia carriers in Hong Kong -- implications for population screening.

BACKGROUND: The thalassemias are common in southern China. We determined the prevalence of heterozygous carriers of these genetic disorders in Hong Kong and assessed the feasibility of a community-based screening program. METHODS: An educational and screening program for the thalassemias was carried out in three high schools with a total of 2420 students. Seventy-five percent of the students agreed to undergo screening, which consisted of blood counts, hemoglobin electrophoresis, serum ferritin measurements, and DNA analyses. RESULTS: Of the 1800 blood samples tested, 150 (8.3 percent) had microcytosis (mean corpuscular volume, <80 microm3). Ninety students (5.0 percent) were carriers of alpha-thalassemia, of whom 81 (4.5 percent) were carriers of the Southeast Asian type of deletion, in which both alpha-globin genes on the same chromosome 16 are deleted. Sixty-one students (3.4 percent) were carriers of either beta-thalassemia or the mutation coding for hemoglobin E. Six students were carriers of both alpha- and beta-thalassemias. On the basis of these figures, the estimated numbers of pregnancies in Hong Kong in which the fetus is at risk for homozygous alpha-thalassemia and beta-thalassemia major or intermedia are 145 and 80 per year, respectively. In Hong Kong the actual numbers of women referred for prenatal diagnoses of these disorders are approximately 95 and 40 per year, respectively. CONCLUSIONS: Despite the availability of hospital-based screening and prenatal diagnosis for many years in Hong Kong, many women carrying fetuses at risk for thalassemia are not referred for genetic counseling. A community-based program of education, screening, and counseling is needed in Hong Kong and southern China.

Adolescent↗

PubMed2005

Synthesis, in vitro-antimycobacterial activity and cytotoxicity of some alkyl alpha-(5-aryl-1, 3, 4-thiadiazole-2-ylthio)acetates.

A new series of alkyl alpha-[5-(5-nitro-2-furyl)-1, 3, 4- thiadiazole-2-ylthio] and alpha-[5-(1-methyl-5-nitro-2-imidazolyl)-1, 3, 4-thiadiazole-2-ylthio]acetates (6a-e, 6f-j) were synthesized and evaluated against Mycobacterium tuberculosis as part of the TAACF (Tuberculosis Antimicrobial Acquisition and Coordinating Facility) TB screening program. Primary screening was conducted at the single concentration of 6.25 microg/mL against M. tuberculosis H(37)Rv in BACTEC 12B medium using a broth microdilution assay, the Microplate Alamar Blue Assay (MABA). The minimum inhibitory concentration (MIC) was determined for compounds demonstrating >90 % growth inhibition in the primary screening. Seven compounds were efficient antimycobacterial agents showing MIC values ranging from 0.78 to 6.25 microg/mL. Among nitrofuran derivatives, methyl (6a), ethyl (6b), and benzyl (6e) esters displayed a good antituberculosis activity (MIC=0.78-3.13 microg/mL) and the others were inactive. In the nitro imidazole series, methyl (6f), ethyl (6g), propyl (6h) and butyl (6i) esters showed significant activity against M. tuberculosis while benzyl (6j) ester was inactive. Also, active compounds were screened by serial dilution to assess toxicity to a VERO cell line. A varying degree of toxicity was observed in nitrofuran and nitroimidazole derivatives (IC(50) = 2.3 - >10 microg/mL).

Acetates↗

PubMed1992

Simultaneous spectrophotometric determination in solid phase of aspirin and its impurity salicylic acid in pharmaceutical formulations.

We report the simultaneous determination of aspirin and its hydrolysis product, salicylic acid, in solid phase by fluorescence spectrophotometry. Aspirin is often the most labile component in a combination-type analgesic compound. Therefore, its stability is often the initial concern in any formulation-screening program. Preliminary screening of a large number of potential formulations can be arduous, because most current methods of analysis generally consist of several steps: extractions or column separations followed by UV, colorimetric, or gas-liquid chromatographic assays. The method proposed here is quite suited to large numbers of assays because it is not time consuming, it is straightforward, and it is not subject to interference from the substances present in the pharmaceutical formulations. In addition, the method is nondestructive, not dependent on the sampling procedure, and, above all, quite sensitive.

Aspirin↗

PubMed1990

Screening strategies to inhibit the spread of AIDS.

In this paper we explore the costs and benefits of screening programs for the human immunodeficiency virus (HIV). Because of the low prevalence rate of the virus among the general population, the cost per detected case of a program to screen the population at large is very high. We show how this cost changes with the prevalence rate, and how screening high risk groups reduces the cost per detected case. Screening has little point, however, unless there are follow-up activities to reduce the continued spread of the virus. To this end, we present a modeling framework for determination of optimal policy alternatives after screening.

Acquired Immunodeficiency Syndrome↗

PubMed1980

Mutagenicity of constituents identified in pulp and paper mill effluents using the Salmonella/mammalian-microsome assay.

About 300 compounds have been reported in the literature as constituents of pulp-mill effluent. Previously, in our screening program, 10 resin acids identified in effluent were examined for potential mutagenicity in the Salmonella/mammalian-microsome assay. Neoabietic acid was the only resin acid which was found to be mutagenic. Now, a program to screen for mutagenicity of 48 additional compounds, belonging to chemical classes of chlorinated aliphatic and aromatic hydrocarbons, phenols, aldehydes, quinones, and carboxylic acids, has been completed. Only 2 of these compounds, tetrachloropropene and pentachloropropene, were found to be mutagenic, showing dose-related increases in His+ reversion mutations, in the standard Salmonella test. Metabolic activation with a preparation of Aroclor 1254-induced liver homogenate (S9) greatly reduced the mutagenic responses of these 2 compounds. Modifications of the Salmonella test for volatile mutagens enabled the detection of the mutagenicity of 3 additional chlorinated aliphatic hydrocarbons dichloromethane, dichloroethane and trichloroethane.

Animals↗

PubMed1989

Preliminary estimates of the virtually safe dose for tumors obtained from the maximum tolerated dose.

The purpose of this paper was to examine the correlation between the maximum tolerated dose (MTD) and the low-dose estimate of the virtually safe dose (VSD) for animal carcinogens. Chronic bioassay results from the National Cancer Institute/National Toxicology Program carcinogenesis screening program were used. Estimates of the VSD were obtained by linear low-dose extrapolation for which an adequate dose-response relationship existed at the same tumor site in the same sex for both rats and mice. Estimates of the VSD were compared with the MTD for 69 tumor sites from 38 chemicals for rats and mice. The MTDs ranged from high to low toxicity (1 ppb to 4.4% in the diet). The overall geometric mean of the ratio of the MTD to the VSD corresponding to a maximum estimated risk of 10(-6) was 3.8 x 10(5). Of the 138 cases, only 3 cases were more than a factor of 10 from the mean ratio. This suggested that a quick estimate of the VSD could be obtained by dividing the MTD, obtained from a subchronic study, by 400,000. Further, if the human exposure is less than 10(-7) X MTD, the estimated risk is likely to be negligible even if the chemical is a carcinogen. It may not be worthwhile to conduct a chronic bioassay for the purpose of demonstrating a negligible risk, if the chemical is likely to be carcinogenic, unless the human exposure is extremely low.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1990

Screening hospital admissions from the emergency department for occult carbon monoxide poisoning.

Because cases of unrecognized carbon monoxide (CO) poisoning have been described among patients admitted to the hospital with other diagnoses, screening hospital admissions with carboxyhemoglobin testing has the potential for preventing morbidity among patients as well as among their cohabitants. Carboxyhemoglobin levels were obtained on 753 patients admitted to the hospital from the emergency department over a 3-month period during the winter. Patients in whom CO poisoning was diagnosed in the emergency department prior to admission were excluded. The mean carboxyhemoglobin level was 2.52% +/- 1.85%; there was no significant difference in mean carboxyhemoglobin among patients with medical, surgical, neurological, and psychiatric admission diagnoses (F = 1.17; df = 3,746; P = .32). Two patients (0.3%; 95% confidence limits, 0.04% to 1.1%) from the entire admission cohort, and one of 20 patients (5%; 95% confidence limits, 0.3% to 26.9%) admitted with seizures, had carboxyhemoglobin levels greater than 10%. The carboxyhemoglobin levels of the two patients were only marginally elevated, with levels of 10.9% and 11.3%. The cost of the carboxyhemoglobin screening program was $2.26 per patient result, or approximately $2,100 over a 3-month winter heating season. A program for screening emergency department admissions with carboxyhemoglobin testing, although feasible in terms of cost, detected few cases of unrecognized CO poisoning.

Adolescent↗

PubMed1996

Breast arterial calcifications: association with diabetes mellitus and cardiovascular mortality. Work in progress.

PURPOSE: To determine the relationship between breast arterial calcification, diabetes mellitus, and subsequent cardiovascular and noncardiovascular mortality. MATERIALS AND METHODS: A prospective cohort study was carried out in 12,239 women aged 50-68 years who participated in a breast cancer screening program. The screening mammograms were coded for the presence of breast arterial calcification. Diabetes (n = 442) was defined as use of insulin or oral hypoglycemic agents, use of a restricted diet for diabetes, or the presence of glucosuria. Data were available from questionnaires and urine glucose tests. Hazard ratios, which were adjusted for age, smoking, parity, and obesity, were calculated from mortality data after 16-19 years of follow-up. RESULTS: Breast arterial calcification was seen in 9.0% (1,107 of 12,239) of all women and in 15.4% (68 of 442) of the diabetic women. An excess cardiovascular mortality of 40% (hazard ratio = 1.4; 95% confidence interval = 1.1, 1.8) was found for all women with breast arterial calcification. In diabetic women, the presence of breast arterial calcification was associated with a 90% (hazard ratio = 1.9; 95% confidence interval = 1.1, 3.2) increase in cardiovascular mortality. CONCLUSION: Breast arterial calcification represents an independent risk factor for cardiovascular mortality in women over 50 years of age, especially in those with diabetes.

Aged↗

PubMed1989

Pattern of cervical screening utilization in Italy.

The pattern of cervical screening utilization in Italy was analyzed using data from the 1986-1987 National Health Survey on the basis of a sample of 27,455 women aged 20 to 79 randomly selected within strata of municipality of residence and age in order to be representative of the whole Italian population. Overall, about 17% of women aged 20 to 79 were screened per year, for a total of 3.5 to 4 million cervical smears per year. The highest frequency was reported in younger middle age, about one in four women being screened per year in the age groups 30 to 49, and there was a substantial decline above age 50. Cervical smear rates were higher in Northern areas (22%), where mortality from cervical cancer is lower, than in the Centre (16%) and South (11%) of the country. Further, there was a strong positive social class gradient in the utilization of cervical screening, in relation to both education and occupation. In spite of the absence of any organised mass screening program, cervical screening is a relatively common procedure among Italian women. However, this study provides further quantitative evidence of a markedly irrational utilization of non-organized cervical screening, which tends to end up selectively used by the groups in which cervical cancer is less common.

Adult↗

PubMed1996

The social dynamics of genetic testing: the case of Fragile-X.

This article considers a program to screen school children for Fragile-X Syndrome as a way to explore several features of the growing practice of genetic testing in American society. These include the common practice of predictive testing in nonclinical settings; the economic, entrepreneurial, and policy interests that are driving the development of genetic screening programs; and the public support for genetic testing even when there are no effective therapeutic interventions. Drawing from research on popular images of genetics, I argue that cultural beliefs and expectations, widely conveyed through popular narratives, are encouraging the search for diagnostic information and enhancing the appeal of genetic explanations for a growing range of conditions.

Attitude to Health↗

PubMed2001

Performance of recommended screening tests for undiagnosed diabetes and dysglycemia.

OBJECTIVE: To evaluate the performance, in settings typical of opportunistic and community screening programs, of screening tests currently recommended by the American Diabetes Association (ADA) for detecting undiagnosed diabetes. RESEARCH DESIGN AND METHODS: Volunteers aged > or =20 years without previously diagnosed diabetes (n = 1,471) completed a brief questionnaire and underwent recording of postprandial time and measurement of capillary blood glucose (CBG) with a portable sensor. Participants subsequently underwent a 75-g oral glucose tolerance test; fasting serum glucose (FSG) and 2-h postload serum glucose (2-h SG) concentrations were measured. The screening tests we studied included the ADA risk assessment questionnaire, the recommended CBG cut point of 140 mg/dl, and an alternative CBG cut point of 120 mg/dl. Each screening test was evaluated against several diagnostic criteria for diabetes (FSG > or =126 mg/dl, 2-h SG > or =200 mg/dl, or either) and dysglycemia (FSG > or =110 mg/dl, 2-h SG > or =140 mg/dl, or either). RESULTS: Among all participants, 10.7% had undiagnosed diabetes (FSG > or =126 or 2-h SG > or =200 mg/dl), 52.1% had a positive result on the questionnaire, 9.5% had CBG > or =140 mg/dl, and 18.4% had CBG > or =120 mg/dl. The questionnaire was 72-78% sensitive and 50-51% specific for the three diabetes diagnostic criteria; CBG > or =140 mg/dl was 56-65% sensitive and 95-96% specific, and CBG > or =120 mg/dl was 75-84% sensitive and 86-90% specific. CBG > or =120 mg/dl was 44-62% sensitive and 89-90% specific for dysglycemia. CONCLUSIONS: Low specificity may limit the usefulness of the ADA questionnaire. Lowering the cut point for a casual CBG test (e.g., to 120 mg/dl) may improve sensitivity and still provide adequate specificity.

Adult↗