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PubMed2003

Periodic pharyngolaryngoscopy detects early head and neck cancer and improves survival in esophageal cancer.

BACKGROUND: Multiple squamous cell carcinomas (SCCs) frequently arise in the upper aerodigestive tract. The purposes of this study were to identify risk factors for SCC of the head and neck in patients with esophageal cancer (EC) and to investigate the value of periodic pharyngolaryngoscopic screening in detecting early SCCs of the head and neck and improving survival. METHODS: We reviewed the cases of 754 patients with EC treated surgically (n = 545) or nonsurgically (n = 209) from May 1995 to December 1999 in our institution. Of these patients, 541 underwent periodic pharyngolaryngoscopic screening after treatment of EC, whereas 213 did not because of hospital death, dropout from the program, and distance from the hospital. Data were compared between patients in whom SCCs of the head and neck developed synchronously or metachronously (EC + SCC group, n = 70) and patients without SCCs (EC group, n = 684). Survival rates were compared between patients receiving periodic pharyngolaryngoscopy and those followed without endoscopic screening. RESULTS: In the EC + SCC group, younger patients (p < 0.05), male patients (p < 0.05), and patients with a higher alcohol intake (p < 0.01) were more common than in the EC group. The 5-year survival rate was 40.9% in the EC group and 44.8% in the EC + SCC group (p = not significant). The survival rate of patients receiving periodic pharyngolaryngoscopy was significantly higher than that of patients followed without endoscopic screening (p < 0.001). Periodic pharyngolaryngoscopy was effective in detecting early SCCs of the head and neck and was beneficial for patients with EC in stages I to IV. CONCLUSIONS: Periodic pharyngolaryngoscopy can provide early detection of SCCs of the head and neck, which arose in 9.3% of patients with EC. Such screening particularly benefits male patients and heavy drinkers, who are at high risk for multiple SCCs. Periodic pharyngolaryngoscopy may prevent reduced survival resulting from associated SCCs of the head and neck and improve overall survival in patients with EC.

Age Distribution↗
PubMed2006

Progress and prospects on melanoma: the way forward for early detection and reduced mortality.

The public health problem of melanoma is difficult. Recent decades have seen substantial efforts directed at primary prevention, yet the incidence of melanoma continues to increase. Substantial efforts have been devoted to improving treatment, yet melanoma retains a poor prognosis if simple surgical excision is not curative. Early detection has made remarkable progress, however. Five-year relative survival has increased from approximately 80% in 1975 to greater than 90% in 1996. Even so, almost 8,000 Americans are projected to succumb to melanoma in 2005. Because most of these fatal melanomas are visible on the skin surface at a curable phase in their evolution, more can and must be done. To improve the early detection practices of clinicians, we have developed an eight-step Basic Skin Cancer Triage algorithm, which forms the core of a curriculum that we have shown can result in improved skills, attitudes, and practices. We are now in the process of attempting to test a Web-based version of that curriculum in a randomized trial. Skin self-examination also has tremendous potential for contributing to early detection of melanoma. We have tested an intervention to encourage thorough skin self-examination in a randomized trial and found it effective in increasing the performance of this procedure, on increase that is sustained for at least a year, while resulting in only short-term increases in surgical procedures on the skin. Early detection has not yet reached its full potential effect on the public health problem of melanoma and is poised to further reduce melanoma mortality.

Humans↗
PubMed1997

Significance of a single CA 125 assay combined with ultrasound in the early detection of ovarian and endometrial cancer.

We evaluated the utility of a single CA 125 measurement in combination with transvaginal sonography for early detection of ovarian and endometrial cancer in asymptomatic postmenopausal women. A sample of peripheral blood was taken from 1291 apparently healthy postmenopausal women, who were examined by conventional and color Doppler ultrasound for early detection of ovarian and endometrial cancer. Serum CA 125 was determined in all samples 3 years later by the IMx CA 125 assay (Abbott Laboratories, Abbott Park, IL). The cutoff level based on the 99th percentile was 30 U/ml. Elevated values were controlled by repeat sonography and an additional determination of CA 125. Record linkage with the files of the Finnish Cancer Registry was performed 3 1/2 years after the primary sonographic screening. The mean CA 125 concentration was 8.1 U/ml (range 0-1410 U/ml). Fourteen of the 1291 women had a CA 125 level greater than 30 U/ml. None of these had signs of either endometrial or ovarian malignancy in the primary sonography screening. Among the other women three cases of endometrial carcinoma (all stage Ib) and one ovarian carcinoma (stage Ia with borderline malignancy) were detected by sonography. All these patients had a CA 125 value <30 U/ml, the mean value being 11.4 U/ml (range 7.5-16.7 U/ml). During follow-up of 3.5 years, one stage Ia ovarian carcinoma, one abdominal carcinomatosis, and two endometrial carcinomas (both stage Ib) were diagnosed. In these patients the mean value for CA 125 was 12.7 U/ml (range 2.5-30.9 U/ml) at the primary sonography screening. A single CA 125 measurement provides no advantage in the early detection of ovarian and endometrial cancer in asymptomatic postmenopausal women compared with transvaginal sonography. The vast majority of women with an elevated CA 125 value have some reason other than an ovarian or endometrial malignancy for this finding.

CA-125 Antigen↗
PubMed1988

[Early detection of breast cancer in relation to patient and physician characteristics].

Higher participation rates of women in regular examination for early cancer detection (Krebsfrüherkennungsuntersuchung, KFU) are expected to improve the effectiveness of breast cancer screening. In the Federal Republic of Germany the law guaranties yearly examination. The detection of early stages is also intended to make breast conserving therapy possible. In our project "Patient- and physician-related problems of early breast cancer detection" we believed that early detection of breast cancer depends not solely on the participation of women entitled to make use of regular examination. We assumed that it depends also on the diagnostic reliability of the examinating physicians. Therefore, we became interested in the factors that cause early or late diagnosis in patients with malignant and good breast lesions. In order to identify these factors, we asked patients and the examinating physicians for case reports. Our qualitative investigations included 50 patients in the area of Munich and Ulm. We found out that, though most patients participated regularly in the early cancer detection examination, participation had no influence on early or late detection of the disease. The majority of patients included in the study, belonged to the group of women with a high participation rate according to the statistics. In general, examination for early cancer detection failed to recognize breast cancer in symptomless women. Not until the patient presented symptoms breast cancer was diagnosed. Early and late diagnoses followed this pattern. Only the patient with early breast cancer and primary surgery by a gynaecologist retained her breast. The surgeons removed the breast. They did not even consider partial resection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Early detection of prostate cancer. Decreasing the mortality rate.

In conclusion, prostate cancer is a major menace to Western society. Since prostate cancer is asymptomatic in the early stages and no curative therapy exists for the advanced stages, our only hope for decreasing the mortality rate from prostate cancer is through early detection programs. Young men with life expectancies of 15 years or more should participate in early detection efforts. These men should be evaluated diligently, through the combined use of DRE and the newly described age-specific reference ranges. Radical prostatectomy, when performed on a man with a life expectancy of 30 to 35 years who has organ-confined prostate cancer, is an effective treatment for the No. 1 cancer in men today. With limited health care dollars available in the future for the diagnosis and management of prostate cancer, physicians will be forced to become selective with their diagnostic and therapeutic efforts. It is much less expensive to treat a young man with early-stage, curable prostate cancer than to manage an elderly man terminally ill from advanced prostate cancer. Without question, young men will be the target of our early detection efforts and the ones who will benefit.

Adult↗
PubMed1992

Rational targets for the early detection of lung cancer.

The fact that routinely effective treatments for disseminated lung cancer are not available has prompted the search for effective early detection systems. It is important to identify lung cancer while it is still confined to the bronchial epithelium and is potentially curable with local modalities. We have previously reported on an immunologically based assay to identify antigens expressed on shed bronchial epithelial cells. This assay resulted in a statistically significant correlation of immunostaining with the eventual development of lung cancer 2-4 years prior to routine clinical detection. Attempts to further improve this approach require an understanding of the basis for its success. Based on the work of Hakomori and coworkers, this difucosylated Lewis X structure would be a likely marker of carcinogenic transformation of the bronchial epithelium. In fact, an antibody to this structure was useful for sputum immunocytochemistry analysis for early lung cancer detection. Other carbohydrate structures would also be reasonable markers to evaluate for early detection application, based on the known pattern of expression of these structures in fetal, dysplastic, and neoplastic lung tissue. Another antibody used for sputum immunostaining recognizes a 31-kd protein structure; the antibody is not a known member of a likely class of early detection targets. The reported cases of lung cancer missed by the immunostaining approach included principally adenocarcinoma of the lung, suggesting that the addition of a marker(s) of that type of morphologic differentiation should be considered. Markers to dissect the various forms of lung adenocarcinoma are being characterized and are available for evaluation in early detection applications.(ABSTRACT TRUNCATED AT 250 WORDS)

Antigens, Neoplasm↗
PubMed2002

Modeling and optimization in early detection programs with a single exam.

The choice of timing of screening examinations is an important element in determining the efficacy of strategies for the early detection of occult disease. In this article, we describe a flexible decision-making framework for the design of early detection programs, and we investigate the choice of timing when each individual in the screening program is examined only once. We focus on the theoretical relation between the optimal examination time and the distributions of sojourn times in health-related states. Specifically, we derive closed-form solutions of the optimal age using two specifications of utility functions, discuss the effects of natural history and utility specifications on the optimal solution, and present an application to early detection of colorectal cancer by once-only sigmoidoscopy or colonoscopy.

Age Factors↗
PubMed2005

Federal role in early detection preparedness systems.

This report discusses CDC's role in the early detection of threats to public health, including linkage of detection to other preparedness functions, and provides an update on recent progress in improving these capabilities. CDC's role has been fivefold: 1) identifying and adopting information system standards; 2) providing funding; 3) defining critical surveillance functionalities; 4) accelerating Internet-based surveillance systems and electronic reporting of laboratory results; and 5) implementing BioSense, a secure, Internet-accessible, national early detection system that includes syndromic surveillance. Ongoing iterative efforts and consultation are needed to ensure future progress.

Centers for Disease Control and Prevention, U.S.↗
PubMed2003

Role of plasma and urinary calcium and phosphorus measurements in early detection of phosphorus deficiency in very low birthweight infants.

AIM: To analyse the role of serum and urinary calcium and phosphorus levels in early detection of mineral deficiency in very low birthweight (VLBW) infants born appropriate (AGA) and small for gestational age (SGA). METHODS: 64 VLBW infants were included in a cohort study and divided into two groups: AGA (n = 30) and SGA infants (n = 34). Then, they were divided according to the presence of radiological signs of metabolic bone disease (MBD): with MBD (n = 21) and without MBD (n = 34). Blood samples and 6 h urine collections were obtained for calcium, phosphorus, alkaline phosphatase activity and creatinine determinations between 3 and 5 wk of life. RESULTS: There were no biochemical differences between AGA and SGA. Higher values of urinary calcium (MBD = 31.9 +/- 20.2, without MBD = 19.8 +/- 15.4; p = 0.017), calciuria (MBD = 2.3 +/- 0.3, without MBD = 1.4 +/- 0.8; p = 0.037) and alkaline phosphatase activity (MBD = 369 +/- 114, without MBD = 310 +/- 93; p = 0.04) were found in infants who developed MBD. Both groups showed high tubular phosphorus reabsorption indicating mineral deficiency. CONCLUSION: Serum calcium and phosphorus levels are not good markers in early detection of mineral deficiency. However, the monitoring of calcium urinary levels may be helpful in early detection of mineral deficiency.

Alkaline Phosphatase↗
PubMedDate not supplied

[Early detection and intervention of hearing impairment in Cuba: outcome after 20 years].

INTRODUCTION: Infant hearing loss is a highly prevalent disorder which untreated can severely disrupt normal brain development. As a result there is a significant delay in language acquisition as well as many cognitive and emotional problems in the child. Over the last decades important advances have occurred in the available technology for early detection and assessment of hearing impairment. Therefore many countries worldwide have become aware of the need for hearing screening programs. The optimal protocols depending on the local conditions of health care as well as the availability of technological and human resources. AIM: To summarize the results obtained over the last 20 years by an ongoing hearing screening protocol. DEVELOPMENT: Data on the coverage program, sensitivity and specificity, age of identification of hearing losses, diagnostic and intervention stages will be summarized and discussed. Also the long terms effects of early detection on the child cognitive and language development are analyzed. Finally, the possible role of a new technique based on the recording of multiple auditory steady state potentials with Cuban equipment (AUDIX system) was evaluated within this context. CONCLUSIONS: The Cuban targeting multiple high risk hearing screening program is a useful alternative to early detection of hearing losses. The average detection age of hearing loss was 10 months during the period of optimal functioning. Cognitive, emotional and linguistic development are improved by early detection and intervention. The multiple auditory steady state responses can provide valuable audiometric information within a screening context.

Child↗
PubMed2005

[The meaning of the early detection of dementia].

The significance of early detection of dementia is that there is some benefit from almost all involved, especially, patients, their family, attending physicans and administration (local financial affairs), 1) Both patients and their family can recognize that dementia is not ageing but a disease. They can have the hope that early treatment of dementia can improve symptom. Moreover, their family and care givers can look after demented persons more easily by acquiring the knowledge of the official welfare system and how to cope with dementia-related problem behavior. These can reduce ill-treatment. 2) The improvement or supression of dementia symptoms, and the teaching of how to handle daily life can give attending physican an incentive to treat. 3) If the onset of dementia can be delayed for 2 years, administration can reduce expenses by 560 billion yen in all Japan, which would benefit the medical economy greatly.

Aged↗
PubMed2000

Common congenital heart defects. The value of early detection.

BACKGROUND: Congenital heart disease forms the largest group of congenital anomalies and therapy is available for all conditions. The main challenge is the early detection and referral of such cases. OBJECTIVE: The important features of the commonest congenital heart defects are reviewed with an emphasis on the diagnostic features. The pivotal role of the general practitioner in the early detection and referral of these patients is emphasised. DISCUSSION: A high index of suspicion, general understanding of transitional changes, haemodynamic aspects, good listening skills and examination techniques with the appropriate use of investigative tools, especially echocardiography will enable the practitioner to have a higher success with early detection and screening of patients. Rapport with institutions and parents is of great importance.

Child↗
PubMed1996

Evaluation of the American Academy of Dermatology's National Skin Cancer Early Detection and Screening Program.

BACKGROUND: Increasing incidence and mortality rates from cutaneous melanoma are a major public health concern. As part of a national effort to enhance early detection of melanoma/skin cancer, the American Academy of Dermatology (AAD) has sponsored an annual education and early detection program that couples provision of skin cancer information to the general public with almost 750,000 free skin cancer examinations (1985-1994). OBJECTIVE: To begin to evaluate the impact of this effort, we determined the final pathology diagnosis of persons attending the 1992-1994 programs who had a suspected melanoma at the time of examination. METHODS: We directly contacted all such persons by telephone or mail and received pathology reports from those who had a subsequent biopsy. RESULTS: We contacted 96% of the 4458 persons with such lesions among the 282,555 screenings in the 1992-1994 programs. We obtained a final diagnosis for 72%, and the positive predictive value for melanoma was 17%. Three hundred seventy-one melanomas were found in 364 persons. More than 98% had localized disease. More than 90% of the confirmed melanomas with known histology were in situ or "thin" lesions (< or = 1.50 mm thick). The median thickness of all melanomas was 0.30 mm. The 8.3% of AAD cases with advanced melanoma (metastatic disease, regional disease, or lesions > or = 1.51 mm) is a lower proportion than that reported by the 1990 Surveillance, Epidemiology and End Result Registry. The rate of thickest lesions (> or = 4 mm) and late-stage melanomas among all participants was 2.83 per 100,000 population. Of persons with a confirmed melanoma, 39% indicated (before their examination) that without the free program, they would not have considered having a physician examine their skin. CONCLUSION: The 1992-1994 free AAD programs disseminated broad skin cancer educational messages, enabled thousands to obtain a free expert skin cancer examination, and found mostly thin, localized stage 1 melanomas (usually associated with a high projected 5-year survival rate). Because biases impose possible limitations, future studies with long-term follow-up and formal control groups should determine the impact of early detection programs on melanoma mortality.

Adult↗
PubMed2005

Detecting early signs of psychosis. Vignettes presented to professionals in primary healthcare and psychiatry.

Among personnel in primary healthcare and psychiatric care, the ability to detect early signs of psychosis was examined and compared. Differences due to sex, age, profession or time in the profession were explored. Three different vignettes concerning patients with mental illness were presented to the respondents, and every respondent was to mark what they thought were early signs of psychosis in the vignettes. The findings were compared with a pre-set standard of symptoms and signs. Healthcare personnel from two different administrative districts, Umeå and Ornsköldsvik in northern Sweden, participated in the study. The response rate was 77%, but for district nurses in the administrative district of Umeå it was only 25%, so therefore complementary interviews with nine district nurses in that district, representing the drop-outs, were performed. There was no difference whatsoever in ability to detect early signs of psychosis between personnel in primary healthcare and psychiatric care; nor were there any significant differences due to sex, age, profession or time in their profession. Detecting early signs of psychosis requires training and the ability to communicate with patients, as well as a special sensitivity to psychiatric conditions. This can be achieved by enhancing accessibility and continuity of primary healthcare for these patients. Furthermore, a greater sensitivity to early signs of psychosis must be created among all healthcare personnel. The co-operation between primary healthcare and psychiatric care must increase. Primary care physicians need opportunities to see patients over time in order to correctly interpret early signs and symptoms of psychiatric illness.

Adult↗
PubMed2005

Application of variable life adjusted display (VLAD) in early detection of deficiency in trauma care.

Early detection of deficient care is an increasingly important element of trauma audit. We aimed to assess the feasibility and demonstrate the use of a variable life adjusted display (VLAD) in trauma audit. Data from the Trauma Audit and Research Network database of Sheffield Teaching Hospitals NHS Trust were used to create a VLAD. A cumulative display of survival was plotted in which survivors were incorporated as a positive value equal to 1 minus the probability of survival, and deaths were incorporated as a negative value equal to the probability of survival. Downward deflections of the display thus indicated potentially deficient trauma care. Data from 191 consecutive patients over 1 year were plotted and displayed. The first 2 months of this period were characterised by a downward trend in the line, which may indicate suboptimum performance and provides an example of a trend that would prompt detailed review. The VLAD chart is a potentially useful "early warning" system for poor performance in trauma care. Further work should to be carried out to evaluate VLAD prospectively as an audit tool, perhaps involving comparison of VLAD charts from different institutions.

Adult↗
PubMed1996

Early detection of infected ureteral obstruction after SWL employing C-reactive protein.

Infection of the obstructed upper urinary tract is a severe complication of stone disease. Early detection and therapy is crucial to prevent septicemia. The authors investigated prospectively whether C-reactive protein (CRP) might act as a marker for the early detection of infected upper urinary tract obstruction. The serum concentration of CRP was compared with the classic markers of inflammation--white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and temperature--in the follow-up of 85 patients undergoing 173 extracorporeal shockwave lithotripsy (SWL) treatments. Post-SWL, 69% of the patients showed dilation of the upper tract on ultrasonography and 16.5% became symptomatic and required intervention. In this group, the mean CRP value was increased 18-fold, whereas the WBC count, ESR, and temperature were not markedly raised. In contrast, patients with no need for additional treatment showed no more than a 2-fold increase in CRP. C-Reactive protein seems to be a useful indicator for the early detection of infected upper urinary tract obstruction.

Adult↗
PubMed1993

Prostate-specific antigen: the new early detection test for prostate cancer.

Prostate cancer is the second leading cause of cancer deaths in men, affecting one in 11 men in the United States. Early detection in the preclinical stage offers the best chance of increased survival, decreased morbidity and possible cure. Prostate-specific-antigen assay is rapidly joining the digital rectal exam as the standard early detection test for prostate cancer because digital rectal exam alone is no longer considered adequate. The American Cancer Society now recommends an annual serum prostate-specific-antigen test for every man age 50 or older, and current evidence strongly suggests that combining the serum prostate-specific-antigen test with the digital rectal exam increases the early detection rate for prostate cancer. This article describes prostate-cancer screening guidelines, serum prostate-specific-antigen test interpretation and an algorithm for abnormal serum prostate-specific-antigen test follow-up.

Adult↗
PubMed2006

Early detection of lung cancer.

The overall 5-year survival of lung cancer is only 10% in Europe and 15% in the United States, and progress in curative treatments during the last 20 years has been modest. Late diagnosis of extensive disease is the main reason of failure. Early detection with low-dose spiral computed tomography (CT) is one of the most promising development of clinical research, and continuous improvements in technology can make this instrument more effective than mammography in breast cancer detection. In order to prove the benefit of early detection by reduction of lung cancer mortality, we need to enroll large numbers of high-risk individuals in multicentric prospective randomized trials combining primary prevention by smoking cessation with diagnostic intervention with low-dose spiral CT, optimal management of cancer and minimum damage for healthy individuals. Molecular biology research within early detection trials, combining genomic and proteomic analysis of blood and sputum, may improve the differential diagnosis, define the individual risk of cancer incidence and failure, and help target therapies on the basis of biologic profile.

Humans↗