[Result of mass screening for uterine cancer at our department. 3. Occurrence of uterine cancer in a rural village after repeated mass screenings].
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Adult↗
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[Early detection of breast cancer by mass screening using mammography].
A mass screening trial for breast cancer using mammography was carried out in Tokushima Prefecture, either itinerant screening in the communities or center screening at the workplace. Craniocaudal and lateral oblique imagings of the breast using two-view film mammography were performed at the first stage of screening. In addition, physical examination of the breast was also performed on subjects independently. A total of 8 cases with breast cancer were found in these trials by mammography alone, and no cases with breast cancer were detected by physical examination. The detection rates were 0.19% in itinerant screening, and 0.92% in center screening, respectively. This was much higher than the level (0.10%) obtained by mass screening using physical examination alone in Japan. Moreover, in elderly patients (age over 50 years), the detection rates were higher (0.54%, 1.21%). The number of clinical stage for cases with breast cancer detected by these screening were 5 cases in TIS and 3 in stage I. Thus, all cases were patients with early-stage breast cancer. From these results, mass screening using mammography should be mandatory for elderly women (over 50 years) with asymptomatic breasts.
Adult↗
Evaluation of mass screening for thyroid cancer.
Mass screening for detecting both thyroid and breast cancer in adult women was carried out in Gunma Prefecture, Japan, between 1980 and 1986. The total number of subjects during the seven years was 152,651. The first screening was by inspection and palpation using experienced surgeons. Thyroid abnormalities were found in 5,902 subjects (3.9%) and 3,804 (2.5%) were required to attend a second examination. Thyroid carcinoma was detected in a total of 216 subjects, a detection rate of 0.14%. The detection rate for thyroid cancer was twice as high at the initial screening (0.19%) than that at subsequent periodic screenings (0.09%). Histological classifications of the detected thyroid cancers were: papillary carcinoma, 189 cases (87.5%); follicular carcinoma, 26 (12%); medullary carcinoma, 1 (0.5%). Eighty-seven percent of the thyroid cancers were asymptomatic at the time of screening. The tumor size were 2 cm or less in 126 patients (58.3%). Thyroid cancer detected by mass screening was revealed at an earlier stage and showed a significantly better survival rate compared to that of our usual outpatients. As differentiated carcinoma has been found at a higher incidence by mass screening, the program is useful for the early detection and treatment of thyroid cancer.
Adult↗
Estimate of lung cancer mortality from low-dose spiral computed tomography screening trials: implications for current mass screening recommendations.
PURPOSE: Low-dose computed tomography (CT) has been suggested for lung cancer screening. Several observational trials have published their preliminary results, and some investigators suggest that this technique will save lives. There are no mortality statistics, however, and the current study used published data from these trials to estimate the disease-specific mortality in this high-risk population. PATIENTS AND METHODS: Two nonrandomized CT screening trials were selected from the literature for analysis. The number of trial participants, the number of lung cancers diagnosed per year, and stage distribution of the cancers was recorded. Previously published 5-year survival data were used to calculate the number of predicted lung cancer deaths and estimate the overall lung cancer mortality per 1,000 person-years among participants screened. These statistics were then compared to the previous Mayo Lung Project, which used chest radiographs and sputum cytology for screening high-risk individuals. RESULTS: This study estimates the lung cancer mortality is 4.1 deaths per 1,000 person-years in the Mayo Clinic CT screening trial, and is 5.5 deaths per 1,000 person-years in the Early Lung Cancer Action Program trial. These data are similar to the lung cancer mortality of 4.4 deaths per 1,000 person-years in the interventional arm, and 3.9 deaths per 1,000 person-years in the usual-care arm of the previous Mayo Lung Project. CONCLUSION: These data suggest that CT screening could produce similar outcomes to prior chest radiographic trials in this high-risk group. Results from randomized trials are required, however, before the true utility of mass screening with CT for lung cancer can be determined.
Aged↗
Estimation of screening test (Hemoccult) sensitivity in colorectal cancer mass screening.
3 controlled cohorts of mass-screening for colorectal cancer using a biennial faecal occult blood (HemoccultII test on well-defined European populations have demonstrated a 14% to 18% reduction in specific mortality. We aimed to estimate the sensitivity (S) of this HemoccultII test and and also mean sojourn time (MST) from French colorectal mass-screening programme data. 6 biennial screening rounds were performed from 1988 to 1998 in 45 603 individuals aged 45-74 years in Saône-et-Loire (Burgundy, France). The prevalent/incidence ratio was calculated in order to obtain a direct estimate of the product S.MST. The analysis of the proportional incidence and its modelling was used to derive an indirect estimate of S and MST. The product S.MST was higher for males than females and higher for left colon than either the right colon or rectum. The analysis of the proportional incidence confirmed the result for subsites but no other significant differences were found. The sensitivity was estimated at 0.57 and the MST at 2.56 years. This study confirms that the sensitivity of the Hemoccult test is relatively low and that the relatively short sojourn time is in favour of annual screening.
Aged↗
[Mass screening for glaucoma].
Mass-screening of the population over 40 years by tonometry is not recommended for developed countries. However, tonometry of each patient attending the ophthalmologist, is absolutely necessary. Omitting tonometry is only justified, if special reasons prevent it, for example inflammations. If reading-glasses are always prescribed by the ophthalmologist and tonometry is done on each such patient, then this is the adequate and sufficient protection of the population against glaucoma blindness. Preventive examinations of the group in the highest danger to become blind from glaucoma, i.e. persons of 55-65 years of age, might perhaps be useful, if the tonometric limit is set high (30 mmHg) and if a check of the visual field by the Friedman-Analyzer is combined with tonometry. The aim of such examinations would not be the detection of suspicious or very early forms (tonometric glaucoma), but to screen for definite glaucoma cases with field-defects, which undetected would become blind. It seems, however, questionable, if the motivation of this age group will be sufficient. This should be found out by pilot-tests. In developing countries the question of mass-screening is entirely different. There glaucoma patients must be filtered out, in whom surgery is less risky than waiting without treatment. This can only be done by mass-screening including tonometry by the borderline-tonometer glaucotest, perimetry by the Friedman-Analyzer and estimation of the cup/disc-ratio.
Aged↗
[Benefit-risk analysis of mass screening for lung cancer].
The mass screening of lung cancer has been started with financial support of the Japanese Government from 1987. It should be emphasized, however, that mass screening programs of any kind have to be evaluated by means of benefit-risk analysis and cost-effectiveness analysis. This is the first report on the benefit-risk analysis for mass screening program of lung cancer in Japan. The benefit of the lung cancer mass screening is defined as a net elongation of average life expectancy due to early detection of the cancer. It is calculated as a function of age and sex. While, the risk of the screening program is defined as a net shortage of average life expectancy due to radiation carcinogenesis of leukemia and lung cancer. In the case of radiation carcinogenesis, latent time and plateau period are considered in the calculation of the risk. Since the benefit increases with age and the risk decreases with age for both sexes, one can obtain a certain age at which the benefit and the risk cross. Assuming dose equivalent of lung of 1 mSv and risk coefficient of 15.1 X 10(-3) Sv-1, the crossing ages of men and women are about 42 y.o. and 47 y.o. respectively. We consider that these ages are rather high when chest radiograph is to be used as a screening test. It is recommended that the dose equivalent of lung should be lowered to 0.1 mSv if the mass screening of lung cancer is to be performed.
Adolescent↗
[Study on frequency of prostate carcinoma and benign prostatic hypertrophy by mass screening in Hokkaido].
We conducted mass screenings for prostate diseases on male subjects over fifty years of age in three separate areas in Hokkaido. Prostate carcinoma and benign prostatic hypertrophy were searched in the 1,764 participants. Histopathologically proven prostate carcinoma was found in twenty-two (1.25%) of the 1,764 participants. This frequency of carcinoma was higher than any other carcinoma found in the mass screenings for gastric, uterine, breast and lung carcinoma in Hokkaido. Of the 22 prostate carcinomas found, 68% were in the early stage (stage B). This stage distribution was clearly distinct from that of prostate carcinoma found on the hospital visit, most of which had already progressed to an advanced stage. These results indicate that mass screening for prostate carcinoma on greater than or equal to 50 year old-male subjects is efficient in finding carcinoma of all stages but, in particular, carcinoma of early stage, when compared with mass screening for other carcinomas. BPH, defined as a moderately or markedly enlarged prostate on rectal palpation, was found in 10% of the participants. Questionnaire on subjective symptoms of voiding disturbance in the participants has confirmed that these symptoms, mainly elicited by BPH, become manifested in fifties and more frequent with age. Of thirteen patients with prostate carcinoma who received both rectal examination and prostate-related markers measurement in serum at the time of mass screening, three without induration of the prostate were diagnosed as having carcinoma from an abnormal value of the serum markers. This result suggests that the marker(s) is one of the useful screening tests for detecting carcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)
Acid Phosphatase↗
Analysis of renal biopsies performed in children with abnormal findings in urinary mass screening.
BACKGROUND: School urinary mass screening tests are performed to make early diagnosis and provide proper treatment for chronic renal diseases. However, very few systemic analyses or studies have been reported regarding final diagnosis made on children with abnormal urinary screening results. AIM: To study the cases of renal biopsy in children detected in urinary screening. METHODS: We retrospectively analysed 461 cases of renal biopsy performed on children referred to us with abnormal school urinary mass screening results who satisfied indications for renal biopsy. RESULTS: Pathologically abnormal findings were observed in 285 (61.8%) patients. Thin glomerular basement membrane disease was detected in 127 (27.5%) cases and IgA nephropathy in 121 (26.2%) cases. Among those 461 children, microscopic haematuria was observed in 289 (62.7%) patients, proteinuria in nine (2.0%), and both in 163 (35.4%). In addition, a statistically higher rate of pathological abnormalities on renal biopsy was noted in the group with microscopic haematuria combined with proteinuria and also in cases with more severe haematuria. CONCLUSION: School urinary mass screening has greatly contributed to diagnosing chronic renal diseases. Continuous medical observation is required when abnormal urinalysis is observed, and a more aggressive medical approach such as renal biopsy should also be performed if necessary.
Child↗
[Significance of sources of error and quality control in cytologic mass screening].
The cervical mass screening programme in the GDR (since 1973) indicates a high degree of participation exhibiting a sufficient specificity. The sensitivity however has to become better. The main cause of false negative diagnoses is the insufficient gaining materials from the endocerrix channel. This may be corrected by a new plastic spatula. Both the consequent education of the prescreeners and collective final diagnoses may give further help to reduce cytological false negative diagnoses. False positive diagnoses are less fatal. They may be corrected by repeated controls, by special consultations, and by histology.
Cervix Uteri↗
[Cardiovascular risk factors of visitors to a mass-screening booth].
The attitude towards mass screening of serum cholesterol is controversial. In order to characterize the volunteers of such screenings and to test the representativity of its findings, we compared the data of 1686 adult health-screening participants collected during a trade fair in the city of Basel, Switzerland, with the results of two population-based studies, the Basel City Risk Factor Survey and the MONICA Project in Western Switzerland. Among those screened, there was an over-representation of women and older persons. The age-specific medians of blood cholesterol and proportions of hypercholesterolemic persons were consistently higher in female screenees--and marginally so in males--than in the reference populations, whereas higher proportions of persons with ideal cholesterol level in those screened were also observed, especially in younger males. Higher systolic blood pressure, lower relative body weight and less regular smoking were found consistently among the screenees. This cross-sectional study shows that the participants of such mass screening actions are a selective group of older, more frequently female health-conscious persons with a specific risk-factor pattern. Mass screenings of self-selected volunteers can, therefore, not be used for a reliable prediction of risk-factor distributions in the general population. Moreover, suggested further steps for those screenees with both health-conscious behavior and elevated biological risk-factor levels, such as second measurement, medical consultation and counselling, cannot be assured in the setting of a trade fair. The objectives and intentions of such mass screening activities should be reconsidered and discussed.
Adult↗
Neuroblastoma of the urinary bladder, preclinically detected by mass screening.
BACKGROUND: Since the introduction of mass screening of infants for neuroblastoma, the incidence of neuroblastoma has increased in Japan. The reason for this increased incidence is the possible inclusion of many neuroblastomas that would have regressed spontaneously and would never have been detected clinically. An extremely rare tumor at the dome of the urinary bladder in a 7-month-old infant was detected by the mass screening. METHODS: A case of neuroblastoma of the urinary bladder is reported with a review of the literature. The data in the Japan Children's Cancer Registry are also reviewed to analyze the incidence and the site of origin of neuroblastoma for evaluation of mass screening. RESULTS: A 7-month-old female infant was referred because of a positive urine vanillylmandelic acid screening test. Ultrasonography showed a solid mass attached to the urinary bladder. At laparotomy a 35 x 30 x 25-mm egg-shaped tumor was found at the dome of the bladder, and a partial cystectomy was performed. During the operation no changes in blood pressure occurred when the tumor was manipulated. Histologic diagnosis was rosette-fibrillary neuroblastoma originating in the bladder wall, with a favorable Shimada histopathologic classification. N-myc was not amplified, which predicted a favorable prognosis, and no postoperative chemotherapy was given. The patient was free of symptoms and tumor after a follow-up period of 16 months. Literature review revealed that this was the second case of neuroblastoma of the urinary bladder ever reported in the world, although several cases of pheochromocytoma originating in the bladder wall had been reported. Both neuroblastoma and pheochromocytoma derive from the neural crest. The sympathogonia from the neural crest, a common stem cell, differentiates into a ganglion cell or into a secretory cell known as a chromaffin cell, able to manufacture catecholamines. The first case in the world that was reported as neuroblastoma of the urinary bladder was in a 4-month-old infant who was noted to have a 4-cm lower abdominal mass on routine physical examination. A ganglioneuroblastoma of the dome of the bladder was excised and the patient was doing well. On reviewing the Japan Children's Cancer Registry, the incidence of neuroblastomas in infants has increased as well as the number of stage 1, 2, and 4s (stage 4 special) neuroblastomas since the introduction of mass screening. However, there has been no significant change in the number of stage 3 or 4 diseases diagnosed in older children. According to the Japan Children's Cancer Registry, pelvic origin neuroblastoma, which has been noted to have spontaneous regression, was more frequent in the primary tumors detected by mass screening when compared with those presenting clinically. During preparation of this manuscript another case of bladder dome neuroblastoma was detected by urinary vanillylmandelic acid screening of 6-month-old infants for neuroblastoma in Japan. CONCLUSION: These extremely rare cases of neuroblastoma of the urinary bladder involved children younger than 1 year of age and were incidentally detected by routine physical examination or mass screening. This raises the question of whether these tumors might have regressed spontaneously had they gone undetected and untreated.
Female↗
Screening for coeliac disease--has the time come for mass screening?
Several recent studies, in particular the Italian SIGEP study, have demonstrated that mass screening for coeliac disease using gliadin and endomysial antibody testing is now a realistic possibility. If mass screening is to receive serious consideration then it must be shown to be (i) effective, (ii) acceptable, and (iii) worthwhile (cost-effective). At present there is insufficient evidence as to the health benefits from treating screen-detected disease and as to the size of the risks associated with having undetected coeliac disease. It is also unclear whether truly asymptomatic screen-detected coeliacs will accept long-term dietary restriction. To answer these questions randomized trials of screening are needed. On current evidence, mass screening cannot be justified. Efficient case-finding may prove as effective and more acceptable.
Adolescent↗
[Problem of uterine and ovarian cancer mass screening].
We express the mass screening data of uterine cervical cancer, endometrial cancer, and ovarian cancer in Japan. The increase in cervical cancer mass screening rate, correlate well with decreasing mortality for uterine cancer, but mortality is re-increasing now. It is concern to increase of uterine cervical dysplasia and cervical cancer of young women. Then, we need to start the screening for more young women. The detect ratio of uterine corpus cancer is increasing now. Then, we need to change the object, and introduce new screening method for example, trans vaginal echogram. Ovarian cancer screening method is not establishment, but mortality rate in patients with ovarian cancer will be increase in future. Trans vaginal echogram is the better method for the screening. On the economical reason, we have a tendency the cancer screenings are neglected. It is important to watch the policy of health carefully.
Adult↗
[The organization of the database and data flow in mass screening for cervical cancer].
Mass screening, because of very many potential patients, requires storing and processing a great deal of medical and population information. That is why it should be supported not only by human resources but by computer techniques as well. The example of a computer science application in medicine is Populations Database System (PDB) which was designed and implemented in the Department of Institute of Mother and Child in Białystok. The aim of this work is to evaluate PDB System's effectiveness in mass screening for cervical cancer. Population database contains several standard database files (DBF) and indexes. All the data is organized as a relational database. Every data relationship is at least in 1NF (first normal form). Functional dependency holds for the structures of database. Because of great variety of stored data it was essential to design how to enter information and how to combine database files to avoid redundancy. It has particular importance for the special functions of system, for example printing and sending individual invitation for an examination. In addition the system can realize all standard database functions and some statistical analysis. Special attention was paid to the problem of data security which is particularly important for medical information. Thanks to PDB system we could realize mass and active screening for cervical cancer in Białystok. Without computer techniques it would be impossible to store, process and interpret so much data.
Databases as Topic↗
[A mass screening procedure for galactosemia utilizing E. coli Q396 and bacteriophage U3. (1) The method and results of the mass screening (author's transl)].
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Biological Assay↗
Making decisions about screening for ovarian cancer. Mass screening may not prove to be sound public health policy.
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Cost-Benefit Analysis↗
[The efficacy of mass screening for uterine cancer].
Mass screening for uterine cancer, mainly by cytological examination, has been conducted since 1962. The total number of examinees has been increasing and has remained at the same level for the last decade. The coverage rate of screening is only 16%, much lower than the target rate of screening, at present. According to the increase in the number of examinees, the mortality has fallen gradually, because the patients with cancer detected early on are increased and treated successfully with better QOL. However, there are some problems, as follows. 1) Although the coverage rate among the first-time examinee, women in their 30s and 70s are lower than the other groups, the rate of dysplasia and uterine cancer detected among them, are higher. 2) False, negative rate of cytology is relatively high. It is suggested the systemic mass screening is effective to reduce mortality from uterine cancer. It is necessary, however, to improve and certify the further efficacy of screening in reduction of mortality of uterine cancer, referring to procedures of cytology, especially for early detection of adenocarcinoma, and registration system from the point of cost-effectiveness.
Adenocarcinoma↗