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S M Moss

Publications and source records attributed to S M Moss.

At least 55 records · Page 3Linked to original sources
PubMed1996

Randomised controlled trial of faecal-occult-blood screening for colorectal cancer.

BACKGROUND: There is growing evidence that faecal-occult-blood (FOB) screening may reduce colorectal cancer (CRC) mortality, but this reduction in CRC mortality has not been shown in an unselected population-based randomised controlled trial. The aim of this study was to assess the effect of FOB screening on CRC mortality in such a setting. METHODS: Between February, 1981, and January, 1991, 152,850 people aged 45-74 years who lived in the Nottingham area of the UK were recruited to our study. Participants were randomly allocated FOB screening (76,466) or no screening (controls; 76,384). Controls were not told about the study and received no intervention. Screening-group participants were sent a Haemoccult FOB test kit with instructions from their family doctor. FOB tests were not rehydrated and dietary restrictions were imposed only for retesting borderline results. Individuals with negative FOB tests at the first screening, together with those who tested positive but in whom no neoplasia was found on colonoscopy, were invited to take part in further screening every 2 years. Screening was stopped in February, 1995, by which time screening-group participants had been offered FOB tests between three and six times. Screening-group participants who had a positive test were offered full colonoscopy. All participants were followed up until June, 1995. The primary outcome measure was CRC mortality. FINDINGS: Of the 152,850 individuals recruited to the study, 2599 could not be traced or had emigrated and were excluded from the analysis. Thus, there were 75,253 participants in the screening group and 74,998 controls. 44,838 (59.6%) screening-group participants completed at least one screening. 28,720 (38.2%) of these individuals completed all the FOB tests they were offered and 16,118 (21.4%) completed at least one screening but not all the tests they were offered. 30,415 (40.4%) did not complete any test. Of 893 cancers (20% stage A) diagnosed in screening-group participants (CRC incidence of 1.49 per 1000 person-years), 236 (26.4%) were detected by FOB screening, 249 (27.9%) presented after a negative FOB test or investigation, and 400 (44.8%) presented in non-responders. The incidence of cancer in the control group (856 cases, 11% stage A) was 1.44 per 1000 person-years. Median follow-up was 7.8 years (range 4.5-14.5). 360 people died from CRC in the screening group compared with 420 in the control group-a 15% reduction in cumulative CRC mortality in the screening group (odds ratio=0.85 [95%; CI 0.74-0.98], p = 0.026). INTERPRETATION: Our findings together with evidence from other trials suggest that consideration should be given to a national programme of FOB screening to reduce CRC mortality in the general population.

Adenoma↗
PubMed1996

Monitoring the performance of breast screening programmes: use of indirect standardisation in evaluating the invasive cancer detection rate.

Close monitoring of data from individual programmes is required to evaluate the potential of the breast screening programme to reach the Health of the Nation target of 25% reduction in breast cancer mortality in the invited age group by the year 2000. This paper outlines the use of indirect age standardisation techniques to compare the performance of individual programmes in terms of their invasive cancer detection rates. Expected invasive cancer detection rates are calculated by applying data from the Swedish two county study to estimated England and Wales background incidence rates for different age strata. If the national programme overall meets these targets then the required mortality reduction should be achieved. The same method can be used by other (national) screening programmes by applying the relevant background incidence figures to produce internationally comparable data.

Age Factors↗
PubMed1996

Monitoring the performance of breast screening programmes: allowing for geographical variation in breast cancer incidence.

Among the myriad of problems associated with evaluating the performance of individual screening programmes in the National Health Service breast screening programme is that of correcting for background breast cancer incidence in the catchment areas of individual programmes. The background incidence will affect not only the expected cancer detection rate at screening, but also the interval cancer rates. This paper proposes a method that can be used to correct for background incidence. The method can be used either to correct the crude cancer detection rate or the age adjusted cancer detection rate using a measure such as the standardised detection ratio. Variation in background incidence and age distribution of screened women are the two major factors affecting the expected cancer detection rate for individual screening programmes. Control of these two variables should allow more effective evaluation of individual screening programme performance.

Aged↗
PubMed1996

A comparison of two view and one view mammography in the detection of small invasive cancers: results from the National Health Service breast screening programme.

OBJECTIVE: To examine the effect of using two view mammography in comparison with one view mammography in the detection of small (< 15 mm) invasive cancers. SETTING: Screening programme data from National Health Service breast screening programme (NHSBSP). METHODS: Data were collated from all screening programmes in the United Kingdom on standard "Korner" returns (KC62 forms) for the screening year 1 April 1994 to 31 March 1995. The comparison of invasive cancer detection rates by programmes using one and two view mammography with indirectly age standardised invasive cancer detection rates. RESULTS: Programmes using two views for women attending their prevalent screen (first screen) in the NHSBSP detected 3% more non-invasive/microinvasive cancers, 7% more large invasive cancers (> or = 15 mm), and 42% more small invasive cancers (< 15 mm) than programmes using one view mammography. CONCLUSIONS: The success of the screening programme depends largely on the ability of individual programmes to detect small invasive cancers. The results suggest that the benefit of using two view mammography is largely in the increased detection of these cancers.

Breast Neoplasms↗
PubMed1995

Effect of retesting with dietary restriction in Haemoccult screening for colorectal cancer.

OBJECTIVES: To determine the detection rate, false positive and false negative rates associated with a policy of retesting with dietary restriction after an initial positive Haemoccult screening test for colorectal cancer, in order to compare the cost effectiveness of such a policy with the alternative, in which all subjects with a positive test would proceed directly to diagnostic colonoscopy. METHODS: Over four years in a large randomised control trial in Nottingham 35,260 subjects had a mean of 1.5 screening rounds each at two-yearly intervals, and were followed up for a minimum of 27 months. During this period subjects with positive screening tests were asked to repeat the test with dietary restrictions. Estimates of costs of the initial screening and of diagnostic colonoscopy were used to estimate the cost for each cancer detected by the different policies. RESULTS: 1209 subjects had a positive initial screening test and 1033 (85.4%) completed the retests. Four hundred and ninety nine subjects were investigated and 89 cancers detected. In the 710 subjects with negative retests six interval cancers were diagnosed in the two years after screening. If these had been detected by screening under a policy of immediate colonoscopy, test sensitivity would have been improved from 53.6% to 57.2% (P = 0.02), but the cost for each cancer detected would have increased from pound 773 to pound 1509. CONCLUSION: Retesting with dietary restrictions reduces costs and maximises the benefit of limited colonoscopy resources, but results in a small but significant reduction in test sensitivity compared with a policy for immediate colonoscopy.

Colonoscopy↗
PubMed1995

Results from the NHS breast screening programme 1990-1993.

OBJECTIVE: To present results from the NHS breast screening programme (NHSBSP) for the three year period 1990 to 1993, and to examine the extent to which interim targets are being met. METHODS: Data have been collated from all screening programmes in the United Kingdom on standard "Korner" returns, supplemented for the year 1991/92 by data from the radiology quality assurance programme. Most of the data refer to the prevalent screening round, but some data on rescreening are also available. RESULTS: The total cancer detection rate at prevalent screens was 6.0/1000, 18% being in situ cancers; the detection rate of invasive cancers < or = 10 mm in diameter was 1.3/1000, but data on size were missing for 12% of cancers. Referral rates were significantly lower for programmes using two view mammography at the prevalent screen than for those using single view, and cancer detection rates were significantly higher. For prevalent screens over the three year period, 70% of programmes had a referral rate of < or = 7%, 87% had a benign biopsy rate of < or = 5/1000, and 79% had a cancer detection rate of > or = 5/1000. By contrast, only 30% of programmes appeared to meet the target detection rate of > 1.5/1000 for invasive cancers < or = 10 mm in diameter. CONCLUSIONS: While the majority of interim targets are being met by the NHSBSP, the rate of detection of small invasive cancers requires careful monitoring. Collection of more accurate data on size of cancers and interval cancer rates will give a better indication of progress towards the target mortality reduction.

Aged↗
PubMed1994

Observer variability in the histopathological reporting of abnormal rectal biopsy specimens.

AIMS: To study the consistency of reporting of abnormal rectal biopsy specimens, especially in the differentiation of inflammatory bowel disease from other causes of abnormality. METHODS: Sixty rectal biopsy specimens were identified from patients presenting with bloody diarrhoea. These were then circulated to the 11 consultant pathologists in the study who filled in a proforma with a list of 12 diagnostic categories and 22 features. RESULTS: Forty one of the 60 cases were examples of inflammatory bowel disease. In 33 of these cases nine or more pathologists had made the diagnosis. Further categorisation into ulcerative colitis and Crohn's disease showed better recognition of ulcerative colitis. In the 19 cases of non-inflammatory bowel disease recognition of pseudomembranous colitis and solitary rectal ulcer syndrome was good, but the results were poorer in the case of infective colitis. CONCLUSION: The findings suggest that a group of consultant pathologists can differentiate between inflammatory bowel disease and other causes of an abnormal rectal biopsy specimen and can also recognise pseudomembranous colitis and solitary rectal ulcer syndrome satisfactorily.

Biopsy↗
PubMed1994

Survival of patients with breast cancer diagnosed in the United Kingdom trial of early detection of breast cancer. United Kingdom Trial of Early Detection of Breast Cancer Group.

OBJECTIVE: To examine the survival of patients with breast cancer diagnosed in different centres and by different methods in the United Kingdom trial of early detection of breast cancer, in order to investigate the contribution of different factors to the previously observed reductions in breast cancer mortality. SETTING: A non-randomised trial of the early detection of breast cancer, in which women aged 45-64 in two districts were offered annual screening for seven years, women in a further two districts were offered education about breast self examination (BSE), and those in four districts formed a comparison group. METHODS: Patients with breast cancer are classified according to the type of centre, method of detection, and attendance for BSE education. Univariate and multivariate survival analyses are carried out, including tumour size, dissemination status, and use of adjuvant treatment as additional variables. RESULTS: In the univariate analysis, patients with breast cancer who are non-attenders for screening have a significantly worse prognosis than those in the comparison centres. Patients whose cancer is detected by mammography have the best survival rate. The inclusion of size and dissemination status in the multivariate analysis explains only about one third of the improved prognosis in these cases. There is a significant difference between prognosis in the two BSE centres. CONCLUSIONS: The use of prognostic factors as recorded in this trial to predict breast cancer mortality may be inadequate.

Analysis of Variance↗
PubMed1993

National Health Service breast screening programme results for 1991-2.

OBJECTIVES: To report the results of the NHS breast screening programme for the year March 1991 to April 1992. DESIGN: A report of statistics was derived from Körner (K62) returns and from the radiology quality assurance programme. MAIN OUTCOME MEASURES: Detection rates for breast cancer and small (< or = 10 mm diameter) invasive cancer, benign biopsy rates, and recall and acceptance rates. RESULTS: The acceptance rate for screening across the United Kingdom was 71.3%. The referral rate for further investigation was 6.2% (regional 4.3-9.0%). The breast cancer detection rate was 6.2 cancers per 1000 women screened (5.1-9.0) and the detection rate of invasive cancers < or = 10 mm was 1.4/1000 (1.0-2.3). 72% of screening programmes reached the target 70% acceptance rate, and 95% of programmes achieved a recall rate of less than 10%. 75% of programmes had a cancer detection rate of more than 5/1000, but only 32% had a detection rate for invasive cancers < or = 10 mm of more than 1.5/1000. CONCLUSIONS: Overall, the results of the screening programme for the year 1991-2 can be regarded as extremely satisfactory, given the size and complexity of the operation.

Aged↗
PubMed1993

Interval cancers and sensitivity in the screening centres of the UK trial of early detection of breast cancer.

The incidence rates of interval cancers following a negative breast screen in two screening centres which offered women aged 45-64 annual screening by mammography and/or clinical examination are examined. Sensitivity of screening is estimated by comparing the incidence rate of interval cancers with that expected in the absence of screening, and the results are compared with those from alternative methods of calculating sensitivity. The incidence rate of cancers diagnosed within 12 months of a negative screen by mammography plus clinical examination was reduced by 70% for women aged 45-54, and 84% for women aged 55+. There is no indication from this that sensitivity in the UK trial was substantially lower than in other studies which have achieved larger reductions in mortality.

Breast Neoplasms↗
PubMed1993

Breast self-examination programmes in the trial of early detection of breast cancer: ten year findings.

Programmes of education in breast self-examination with specialist clinics for self-referral were introduced in two health districts around 1980. Combining the results from the two centres showed no reduction in mortality from breast cancer over the following 10 years but the mortality was low in one of the centres whilst in the other it was higher than in four geographically separate comparison centres in which there was similar careful monitoring of breast cancer incidence and mortality. Because this was not a randomised controlled trial and lacked a uniform treatment protocol, biases may be responsible for the differences observed, but it is also possible that BSE education with annual reinforcement contributed to the breast cancer mortality reduction seen in one district. The overall conclusion however is that the value of breast self-examination remains unproven.

Age Factors↗
PubMed1992

A case-control evaluation of the effect of breast cancer screening in the United Kingdom trial of early detection of breast cancer.

OBJECTIVE: The aim was to assess the extent to which selection bias affects a case-control study of breast cancer screening in which attenders and non-attenders for screening are compared. DESIGN: There were two retrospective case-control studies, one estimating the risk of death from breast cancer in women in the screening district relative to those in the comparison district (study A), the second estimating the relative risk for women who had ever been screened compared with women who had never been screened in the screening district alone (study B). For cases and controls in study B, the women's screening history was summarised for the time period from date of entry to diagnosis of the case, or the equivalent time from date of entry for the matched controls. For cases detected by screening, the screen at which cancer was detected was included in the screening history. SUBJECTS: Cases were deaths from breast cancer in women with disease diagnosed after entry to the trial, up to 31 December 1986 or a maximum of seven years from date of entry, in one of the screening districts (Guildford) and one of the comparison districts (Stoke) participating in the UK Trial of Early Detection of Breast Cancer: study A: 198 deaths in Guildford and Stoke; study B: 51 deaths in Guildford only. There were five age matched controls for each case, with length of follow up at least as great as the time from entry to death of the case. MAIN RESULTS: The estimate of the risk of death from breast cancer in the screening district relative to the comparison district from study A was 0.76, thus implying a reduction of 24% in the screening district, similar to that obtained from a cohort analysis of data from the two districts. In contrast, the relative risk in study B for ever v never screened women was 0.51, which, taking the 72% compliance into account, would result in a relative risk of 0.65 for the screening district if there were no selection bias. The risk of breast cancer mortality in the never screened relative to the comparison district was 1.13, despite the fact that incidence rates in the two populations were similar. This suggested that cancers in the never screened group had a particularly poor prognosis, contributing to selection bias. CONCLUSIONS: The possible existence of selection bias should lead to caution in interpretation of the results of case-control studies of the effect of breast cancer screening on mortality.

Breast Neoplasms↗
PubMed1991

Long-term assessment of intracranial pressure using the tympanic membrane displacement measurement technique.

The tympanic intracranial pressure (ICP) measurement technique was used to assess intracranial pressure over several months in two patient populations. In the first study, 43 shunted hydrocephalic children, aged 4-17 years, were tested over a period of 18 months when clinically well. Of these 11 (26%) were later admitted with symptoms suggesting acute shunt blockage. The tympanic ICP measurement correlated with clinical and/or operative findings in 10 cases. In the second study, illustrated by a case report, repeated testing over a period of 5 months in children with chronic symptoms suggestive of periods of increased ICP, demonstrated a correlation between symptoms and ICP and helped influence management decisions. Tympanic ICP measurement in shunted children is a valuable tool in the assessment of acute and chronic shunt malfunction. Serial testing was shown to be clinically useful in the long-term management of these patients as a diagnostic indicator of pressure variation and shunt dysfunction.

Adolescent↗
PubMed1991

Case-control studies of screening.

The application of case-control studies to the evaluation of screening data presents a number of potential problems. In particular, the results are liable to be affected by selection bias. Published case-control studies of breast cancer screening are reviewed in the light of the results of a recent UK study of somewhat different design which attempts to estimate the effect of selection bias. Case-control studies of cervical screening involve additional difficulties, such as the handling of cases of invasive disease diagnosed by screening, and the distinction between diagnostic and screening smears. The extent to which published studies have addressed these is discussed. It is concluded that case-control studies of screening should be interpreted with caution, particularly in situations where comparable data from controlled trials are not available.

Bias↗
PubMed1990

Non-invasive assessment of ventricular shunt function using tympanic membrane displacement measurement technique.

A technique which was originally developed for measuring cochlear fluid pressure, has been under trial for the past two years as a means of assessing ventricular shunt function. The principle of the technique has been reported in previous papers (1, 2, 3) and has been shown to provide a reliable measure of intracranial pressure (ICP) in terms of induced displacement of the tympanic membrane. This study concentrates on the assessment of shunt blockage in spina bifida patients who subsequently underwent shunt revision. The tympanic displacement technique is shown to be of value to this patient group in three respects. Firstly as a research technique to study group-averaged ICP measurements where the ICP needs to be known but invasive measurements cannot be justified. Secondly for assessing shunt dysfunction in individual patients and, finally, in determining the success of shunt revision surgery. The technique was found to be extremely sensitive to relative changes in ICP with shunt revision or any subsequent blockage. The technique is more reliable diagnostically in instances where the patients act as their own controls and a comparison with baseline measurements can be made. Three case reports are illustrated which were selected from those patients tested to emphasise the importance of serial measurements of ICP over period of several days post-revision. The tympanic displacement technique is shown to provide a practical and acceptable method by which this can be undertaken.

Acoustic Impedance Tests↗
PubMed1990

Observer variability in histopathological reporting of transitional cell carcinoma and epithelial dysplasia in bladders.

Sections from 90 urinary bladder biopsy specimens were examined by 11 consultant histopathologists with varying experience to determine the appropriateness of existing pathology terminology. Analysis with kappa statistics showed fair to good agreement in the grading and staging of transitional cell carcinoma. There was also reasonable agreement in the diagnosis of high grade dysplasia in random biopsy specimens from the urothelium adjacent to the neoplasm, but very poor agreement for lesser degrees of dysplasia. It is concluded that the present classification of bladder carcinomata is reliable and that pathologists can determine stage with a high degree of reproducibility and grade with a fair degree of reproducibility.

Carcinoma, Transitional Cell↗