Search PubMed⌕ Search

Biomedical subjects

J Melia

Publications and source records attributed to J Melia.

At least 37 records · Page 2Linked to original sources
PubMed1998

Screening for prostate cancer: the current position.

Prostate cancer is a significant and increasing health problem in the UK and elsewhere, and there is considerable interest in the potential for screening. Of the currently available screening tests, measurement of serum levels of prostate specific antigen appears the most promising. However, despite evidence that screening can detect asymptomatic early stage disease, there is, as yet, no evidence that mortality from prostate cancer can be reduced. There are concerns that screening may result in considerable over-diagnosis of non-progressive or slowly developing disease, and the effectiveness of radical treatment of localised disease, which itself will cause some morbidity, remains a subject of debate. Population screening should not currently be recommended. Randomised controlled trials are in progress to assess the effectiveness of screening, but these will take many years to produce results.

Biomarkers, Tumor↗
PubMed1996

The evaluation of diagnostic and prognostic criteria and the terminology of thin cutaneous malignant melanoma by the CRC Melanoma Pathology Panel.

Sections from 95 skin lesions excised at pigmented lesion clinics in England and Scotland were studied by eight histopathologists in order to evaluate consistency in the use of histopathological terms for features of diagnostic and prognostic importance for cutaneous malignant melanoma. The level of agreement (kappa) amongst the panel improved after discussion and re-definement of criteria for several features. These included, architectural and nuclear atypia, pagetoid infiltration and radial and vertical growth phases. A high level of agreement was achieved for an overall benign or malignant diagnosis (kappa = 0.77) but use of more specific terms such as benign naevi with atypia and melanoma < or = 0.76 mm thickness, was associated with only an intermediate level of agreement. Of the original diagnosis of melanoma, 17% were re-classified by the panel as benign with atypia and 2% reported to be benign were judged to be melanoma. This reflected the high proportion of borderline lesions in the study. The use of standardized diagnostic criteria with precise definitions has been shown to improve consistency in diagnosis and it is recommended for general application. From this should emanate more reliable incidence figures for thin melanoma, and improved understanding of the nature of these early lesions, to the benefit of patient and clinician alike. The poor concordance in distinguishing severe dysplasia in the junctional component of melanocyte proliferations from melanoma in situ and superficial dermal invasion improved only modestly despite intensive efforts. Since melanoma in situ and severe dysplasia cannot be distinguished by objective measurements and since their clinical management is the same, the panel suggests that attempts to separate them in diagnostic reports should be discontinued and they could both be referred to as melanocytic intraepidermal neoplasia (MIN). If it becomes accepted that dermal invasion without a vertical growth component can also be managed identically to MIN, then this invasive radial phase may be appropriately referred to as microinvasion and linked to MIN for the purposes of clinical management.

Biopsy↗
PubMed1995

Problems with registration of cutaneous malignant melanoma in England.

The aim of the study was to assess the completeness and accuracy of cancer registration for cutaneous malignant melanoma. The study was conducted in seven health districts in England and one health board in Scotland from 1987 to 1989 with a total resident population of 3.6 million. Records from pigmented lesion clinics and pathology laboratories collected during the Cancer Research Campaign's health education programme to promote the early detection of melanoma were matched with cancer registrations from a total of five regional cancer registries. In England 74% out of a total of 642 cases of invasive malignant melanomas (ICD 172) and 44% out of a total of 155 in situ melanomas (ICD 232) had been registered compared with 96% and 100% respectively in Scotland. A significantly higher proportion of late-stage cases was found among registered than among non-registered cases in England (P < 0.001). In all registries the majority of superficial spreading in situ melanomas were miscoded as invasive cases. The annual incidence of invasive malignant melanoma in the English study areas was found to be seven per 100,000 in men and 11 per 100,000 in women, similar to that reported in Scotland. The registries are best at recording thick or late-stage melanomas. As the skin cancer target for Health of the Nation depends on monitoring trends in the incidence of malignant melanoma, future improved ascertainment of cases and changes in the type of cases being registered must be taken into account.

England↗
PubMed1995

Early detection of cutaneous malignant melanoma in Britain.

A multidisciplinary approach to research has been one of the hallmarks of Walter Holland's outstanding career in medical research. Studies arising from evaluation of the Cancer Research Campaign's health education programme for the early detection of cutaneous malignant melanoma were reviewed at Walter's Festschrift because they illustrate the importance of the multidisciplinary approach and raise issues about medical screening which has been a special interest of Walter's The programme took place in 1987 in seven areas of England and Scotland with a target population of 3.6 million. The main aim of the evaluation study is to investigate the effect of the programme on mortality from melanoma. Interim effects on awareness about melanoma, workload and incidence rates of melanoma by stage are reviewed. The importance of collaboration between dermatologists, epidemiologists, histopathologists and health education specialists has been essential. However, the effectiveness of high profile campaigns alone to promote early detection of melanoma is uncertain and future initiatives should be evaluated in randomized controlled trials.

Adult↗
PubMed1995

Sunburn and tanning in a British population.

BACKGROUND: The prevalence of sunburn and tanning, and associated attitudes were investigated in a national sample of adults in Great Britain. METHODS: A randomly selected cross-sectional sample of 2025 adults aged 16 or over living in England, Scotland and Wales were interviewed in October 1993 in the Office of Population Censuses and Surveys Omnibus Survey. RESULTS: The response rate was 77 per cent. Thirty-seven per cent reported at least one episode of sunburn in the past 12 months, the highest frequencies being found in young age groups, in those with skin that tans poorly (p < 0.001), and in those who specifically tried to tan in this period (p < 0.001). Sunbathing was the most frequent activity associated with most severe episodes of sunburn, and occurred most frequently at the beginning of the summer, 46 per cent of episodes occurring abroad. Thirty-three per cent had tried to tan in the past 12 months, the proportion being highest in younger age groups and women (p < 0.001). Among those with severe sunburn more men (34 per cent) expected to burn when trying to tan than women (17 per cent). CONCLUSIONS: The results provide background information with which to develop and evaluate primary prevention initiatives for skin cancer. These should take into account the strong association between sunburn and the desire to tan, particularly in young adults and men.

Adolescent↗
PubMed1995

Cancer Research Campaign health education programme to promote the early detection of cutaneous malignant melanoma. I. Work-load and referral patterns.

From 1987 to 1989 a campaign to promote the early detection of cutaneous malignant melanoma was conducted in the areas of seven health authorities in England and Scotland (total population 3.6 million). Data were collected on 17,155 patients attending pigmented lesion clinics (PLCs) in each study area during the campaign. After a dramatic rise in PLC referral rates in the first month of the campaign the average monthly referral rate among the target population in the study period settled to an average of 13 per 10(5), a twofold increase compared with the pre-campaign period. Over 85% of patients at all PLCs were seen within 4 weeks of referral from their general practitioners. The melanoma to non-melanoma detection ratio was (1:33). The organization of future early detection initiatives needs careful review and planning, in order to improve their effectiveness in all sections of the population, and to enable health services to cope with the increased work-load.

Adult↗
PubMed1995

Cancer Research Campaign health education programme to promote the early detection of cutaneous malignant melanoma. II. Characteristics and incidence of melanoma.

The effect on the detection and characteristics of melanoma, resulting from the Cancer Research Campaign's health education programme to promote the early detection of melanoma in the general population, was studied from 1987 to 1989. The seven study areas in England and Scotland yield a target population of 3.6 million. Data were collected from local clinic-based registers, pathology laboratories, and the cancer registries. The average annual incidence rates of melanoma were seven and 12 per 10(5) in males and females, respectively, age-standardized to England and Wales, 1988. These rates are similar to the national figures for Scotland, where there is a national melanoma register, but higher than those reported by the English and Welsh cancer registries. The incidence was significantly higher in females than males (P < 0.001), and increased with age. Fifty-three per cent and 65% of cases in males and females, respectively, were thin (Breslow thickness < or = 1.5 mm), similar to the national figures from Scotland. No significant decrease in the incidence of late-stage tumours was found in either sex as a result of the campaign. Because of difficulties with ascertainment of cases in England, the main evaluation will focus on future trends in mortality rates for melanoma.

Adult↗
PubMed1994

Meeting The Health of the Nation target for skin cancer: problems with tackling prevention and monitoring trends.

The White Paper The health of the nation challenges us to halt the rising incidence and mortality from skin cancer. Means of achieving this include various approaches to educating the public and modifying sun exposure and promotion of early detection of cancers. Some initiatives can be organized locally but others require national coordination. Evaluation of the impact on health and the cost of preventive programmes is important because the effectiveness of health education packages and campaigns that aim to reduce the incidence or death from skin cancer has yet to be proved. As the majority of skin cancers do not metastasize, it is on melanoma that efforts to improve registration should be focused. Cancer registries have particular difficulty in monitoring the incidence of skin cancer where treatment is simply excision. Improved ascertainment and a shift towards early diagnosis will cause artefactual increases in incidence. Investigation of the trends will therefore require careful interpretation.

Bias↗
PubMed1994

Investigating changes in awareness about cutaneous malignant melanoma in Britain using the Omnibus Survey.

Awareness about cutaneous malignant melanoma and sun protection was investigated in a national sample of 3961 adults. Awareness about malignant melanoma seems to have increased in England since the mid-1980s but it is lower in men, the under 25s, the elderly, those without a partner and the poorer socioeconomic groups. As mortality rates for melanoma are higher in elderly men than other age-sex groups, the possibility for improved awareness and prevention needs to be explored further within this group. Most people in the survey knew about sun protection. Further primary prevention initiatives should be monitored, using markers for behaviour such as the incidence of sunburn, as the potential benefits of a reduced incidence of skin cancer might not be seen for up to 20 years.

Adolescent↗
PubMed1993

Purchasing services for end stage renal failure: the potential and limitations of existing information sources.

Renal replacement therapy services already consume considerable health service resources and, as patient stock levels rise and unmet need continues to be identified, the pressure to spend more on renal services will increase. Purchasers of services must decide how to respond to these pressures, and a clear assessment of need and the effectiveness and efficiency of services are key issues when contracts are being developed for such services. This paper reports an examination of the quality and potential of information currently available from routine data sources to support the contracting process. The results expose gaps in current knowledge and identify areas for future research. Locally, purchasers should consider surveying their population to identify the incidence of renal disease, including the reasons for any unmet need. Nationally, research is required to investigate the following: the relationship between ethnicity and the development of renal disease; the criteria for allocating patients to the alternative treatment modalities; and the treatments in terms of their costs and cost-effectiveness.

Age Factors↗