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[Mass screening for breast cancer in Japan].

To establish effective mass screening projects for breast cancer, our study group (Tominaga group) was co-sponsored by the Ministry of Welfare. From 1968 to 1986, 643,513 women at the initial screening and 719,189 women at the subsequent screening were examined by physical examination. Abnormalities were found in 24,864 (3.9%) and 23,880 (3.3%) of these women, respectively. Cancer was detected in 833 women (detection rate 0.13%) and 428 women (0.06%), respectively. To establish the criteria for assessing the life-prolonging effect of mass screening for breast cancer, clinical stage and prognosis of breast cancer detected by mass screening were compared with those for matched patients in outpatients clinics. Early stages were significantly more common in the patients detected by mass screening. The 5-year survival rate was significantly higher in the patients detected by mass screening (91.7% vs. 85.6%; P less than 0.01), but the difference with the other group was not significant (80.5% vs. 78.1%). Women who had conducted breast self-examination (BSE) showed a higher survival rate than those who had not. We were not able to confirm the general belief that interval cancer is more aggressive in nature and shows a poorer prognosis than the cancer detected through periodic screening.

Breast Neoplasms↗

Screening helical CT for mass screening of lung cancer: application of low-dose and single-breath-hold scanning.

PURPOSE: To investigate the usefulness of helical CT with low-dose and single-breath-hold scanning for lung cancer screening. MATERIALS AND METHODS: Twenty-four helical CT scans of the lung were performed using various parameters in 10 healthy volunteers. The effects of tube current and pitch were evaluated by assessment of image quality and detection of simulated nodules. Screening helical CT was performed at 120 kVp, 50 mA, 1 sec/rotation, 10 mm collimation, and a pitch of 2.0 in 110 patients. The ability of this method to detect nodules and masses, focal parenchymal opacities, and diffuse fibrotic changes was evaluated using conventional CT as the gold standard. RESULTS: A reduction in tube current to 50 mA did not significantly change the assessment of image quality or detection of simulated nodules. Although these factors were degraded by increasing the pitch, there was no significant difference between 1.5 and 2.0. Screening helical CT permitted the entire lung to be scanned with ease during a single-breath-hold in all patients. This method detected 177 of 196 nodules and masses (87 of 91 lesions greater than 5 mm in diameter), 54 of 57 focal parenchymal opacities, and 15 of 15 cases with fibrotic changes. CONCLUSION: Screening helical CT with low-dose and single-breath-hold scanning shows promise for lung cancer screening.

Adult↗

[Early detection in the mass screening for breast cancer].

Mass screening for breast cancer has been conducted in Japan mainly by physical examination, defined as a standard method in Law of the Health Services for the Aged. Detection rate of early breast cancer by physical examination ranged between 40 and 50%. To improve the detection rate of breast cancer at the early stage, some screening trials using a film mammography were carried out in recent years. Detection rates of early breast cancer in these trials were reported to be improved largely, suggesting the effectiveness of breast cancer screening would be improved by the screening with film mammography.

Aged↗

Improved detection rate of early breast cancer in mass screening combined with mammography.

A cohort study to compare mass screening with and without mammography was conducted in Miyagi Prefecture, Japan in order to establish whether the effectiveness of breast cancer screening would be improved when mammography was combined with physical examination. A trial of mass screening combined with mammography was carried out in 9634 women aged over 50. Lateral imaging of the breast using single-view film mammography was performed at the first stage of mass screening in addition to physical examination of the breast. Results in the trial were compared with those obtained in 35511 age-matched subjects without mammography. Thirty breast cancers were found in the trial with a detection rate of 0.31%, which was much higher than that (0.08%) obtained by physical examination without mammography. In 15 of the 30 patients the breast tumor was not palpated at the first screening, but abnormal findings were detected in the mammography. A higher rate (73%) of early breast cancer was obtained in the screening trial with mammography than that (39%) obtained in the screening with physical examination alone. Mass screening combined with mammography is superior to that without mammography for breast cancer screening, especially for the detection of non-palpable, early breast cancer.

Age Factors↗

Simplified models of screening for chronic disease: estimation procedures from mass screening programmes.

The performance of a screening programme depends on a number of parameters, which may need different types of information for their estimation. In this paper, two characteristics of interest, the sojourn-time distribution and the sensitivity, are considered, and estimation procedures, based on data which should be available from a mass screening programme, are proposed. The methods are applied to published data from the HIP breast cancer screening project, to which a negative exponential distribution for the sojourn-time distribution fitted better than the other families of distribution considered.

Breast Neoplasms↗

[The relationship between health gain and effort in mass screening for breast cancer].

Mass screening for breast cancer reduces the mortality of this disease. In the Netherlands, with a very high incidence of breast cancer, a well organized health care system and a stable economic prosperity, the decision taken to implement nationwide breast cancer screening for the female population aged 50-70 years appears well-founded. The first data indeed suggest a reduction of breast cancer in the coming years. The effects of screening as such will be difficult to evaluate since the programme leads also to optimalization of breast cancer treatment in general. Other factors, such as adjuvant therapy, may have a beneficial effect on breast cancer mortality, reducing the yield of the screening proper. This and the non-negligible negative aspects should not be hidden from the public. Continuous evaluation and quality control, not only in mammography techniques and reading, but also in the treatment of the detected cases, are essential for a successful screening programme.

Aged↗

Neuroblastoma. Mass screening for early detection and its prognosis.

Since July 1973, the authors began developing a mass screening system using a VMA (vanilmandelic acid) spot test on 6-to-7 month-old infants for early detection of neuroblastoma in Kyoto city, Japan. Using this method, six infants with this tumor were discovered; five of the six infants were cured, and one is under treatment. These patients showed a favorable prognosis on early diagnosis. In this article, 57 neuroblastoma patients from the Department of Pediatrics, Kyoto Prefectural University of Medicine, treated during the last 20 years, from July 1962 to June 1982, are evaluated. Since the mass screening program has run smoothly since July 1974, clinical findings are compared between 35 neuroblastoma cases before mass screening from the 12-year period from July 1962 to June 1974 and 22 cases after mass screening, during the 8-year period from July 1974 to June 1982. Before mass screening, only 20% (7/35) of the patients were discovered with neuroblastoma younger than 12 months of age and 68.6% were older than 2 years of age. After mass screening, 54.6% (12/22) of the patients were younger than 12 months of age and only 31.8% (7/22) were older than 2 years of age. Before mass screening, 17.1% (6/35) survived with five of the six surviving patients being younger than 12 months of age at the time of diagnosis; 72.7% (16/22) of the patients detected after mass screening are living now. Eleven of the 16 patients have already been cured, and the remaining 5 patients are presently undergoing treatment. A marked improvement of their prognoses is dependent on the early detection of this tumor by mass screening. To date, using the VMA spot test for early detection in infancy is convenient and effective for improvement of its prognosis.

Abdominal Neoplasms↗

Hemoglobinopathies and glucose-6-phosphate dehydrogenase deficiency in one of the regions of Azerbaijan: mass screening and laboratory investigations.

Mass screening in the Geok-chai region of Azerbaijan covered 264 persons. 2 families with abnormal hemoglbin were detected. Electrophoresis in PAG and on cellulose acetate films as well as sickling test showed that in 3 out of 9 members of one of the families HbS was detected. 6 out of 8 members of the others family appeared to be HbD-carriers. In 4 members of this family abnormal hemoglobin was found out in combination with G-6-PDH deficiency. No clinical manifestations were found. A number of beta-thalassemia cases were detected in screened children as well as in adults. Hemoglobin oxygen equilibrium curves were studied in patients with heterozygous beta-thalassemia. In case of G-6-PDH deficiency when it is not possible to obtain active enzyme zones on the columns with PAG these zones can be detected when CoCl2 (2 mM) is added into the incubation medium.

Adolescent↗

Personality and electroencephalography: significance of epileptiform activity on mass screening electroencephalography.

From the mass screening EEG, 31 primary school children and 17 junior high school (Jr-HS) students with paroxysmal discharge were chosen. An equal number of children with disorganized patterns, including a few borderline ones, and with normal patterns were selected from the same classes. School performance and behavior assessments were evaluated based on the school records. Both in primary and Jr-HSs, the order of school performance in these three groups was as follows (shown hereafter--an average score of seven subjects for primary school children; that of 9 for Jr-HS). Firstly, normal EEG group (21.5 +/- 5.53; 30.1 +/- 6.08); secondly, epileptiform EEG group (21.1 +/- 5.09; 27.4 +/- 6.09); lastly, disorganized EEG group (20.8 +/- 5.11; 26.2 +/- 7.32). In behavior assessments, teachers highly evaluated the children with normal EEG both in primary and Jr-HSs. On the contrary, those with disorganized EEGs were not as highly evaluated, especially in primary school.

Adolescent↗

Newborn mass screening for galactosemia.

Methods for mass screening of newborns for galactosemia have been available since 1964. Although galactosemia is rare, many countries have included screening for galactosemia in their national screening programs, yet other countries deny the necessity for screening. Despite the early appearance of clinical symptoms, newborns may be reliably diagnosed in time only through mass screening.

Galactosemias↗

Prognostic discrimination among neuroblastomas according to Ha-ras/trk A gene expression: a comparison of the profiles of neuroblastomas detected clinically and those detected through mass screening.

BACKGROUND: Neuroblastomas (NBs) exhibit a wide variety of clinical behavior. It is important to determine the biology of NB before treatment is instituted. METHODS: One hundred six NBs detected clinically (clinical NBs) were classified according to immunohistochemical expression of the Ha-ras and trk A genes. Association of the two-gene expression with patient outcome was examined retrospectively, and the possibility of prognostic prediction was evaluated. The profile of the expression of the two genes in 85 NBs detected through mass screening (mass NBs) was compared with that in clinical NBs. RESULTS: Ha-rasltrk A expression in clinical NBs was associated with disease free survival, even when the NBs had no amplification of the N-myc gene. Multivariate analysis demonstrated that the expression of Ha-rasl/trk A was a significant prognostic factor that was independent of stage, age at diagnosis, and N-myc amplification. Favorable outcomes of patients with advanced NB were distinguished by high Ha-ras and high trk A expression, and unfavorable outcomes were distinguished by low Ha-ras and low trk A expression. A profile of the two genes in mass NBs was different from that in clinical NBs. Greater than 50% of the mass NBs were detected as localized tumors with high Ha-ras and high trk A expression. The mass screening detected NBs with favorable and unfavorable biology. CONCLUSIONS: The expression of Ha-ras and trk A is an excellent predictor of both favorable and unfavorable biology in NBs. The information it provides can be important in determining the appropriate therapeutic intervention for each patient.

Age Factors↗

The quality of mass screening for breast cancer by physical examination.

Mass screening for breast cancer using physical examination alone has been carried out since 1983 in Zentsuji, Kagawa Prefecture, Japan. Over a 7-year period, breast cancer was detected in 11 of a total 8,271 examinees, the detection rate being high at 0.13%. The detected cases included a few early-staged breast cancers, suggesting that mass screenings are of slight efficacy. Seven cases of interval cancer were found by breast self-examination after the mass screenings, supporting the value of breast self-examination. A relatively large number of interval breast cancers was detected in 1985 and 1986, when the rates of required further examination remained under 1%. The sensitivity and specificity of this screening were 61.1% and 94.5%, respectively, indicating a low sensitivity. These results suggest that the qualitative diagnoses made from the first screening by physical examination alone were often revealed to be false negatives. Therefore, the existing diagnosis should be employed in the first screenings. It is recommended that mammography be introduced to detect breast tumors which are nonpalpable or undetectable by physical examination alone.

Adult↗

Laparoscopic surgery for neuroblastoma identified by mass screening.

Most neuroblastoma identified by mass screening are clearly different from the clinically diagnosed tumors with respect to biology, epidemiology, and outcome. Because the neuroblastomas detected by mass screening have favorable biological features (97% survival rate at 5 years), aggressive surgery may not be appropriate for such tumors. Laparoscopic adrenalectomy was performed on a 9-month-old boy and two 8-month-old girls who had suitable lesions. The tumors were small (< 20 mm in diameter). With the patients under general anesthesia, five trocars were placed in the abdomen. The abdominal wall traction method was used in addition to pneumoperitoneum. Intraabdominal pressure was maintained at below 4 mm Hg. The adrenal tumors were well encapsulated and completely excised, placed into a plastic bag, and removed through one of the 10-mm trocar sites. No lymphadenopathy was observed. The postoperative course was uneventful. The tumors were of favorable Shimada histology and had no N-myc gene amplification. The patients have survived, with no evidence of recurrence or metastasis, through the follow-up period of 17 to 22 months.

Adrenal Gland Neoplasms↗

[Evaluation of the usefulness for neonatal mass screening in light of 35 years personal experience].

The results and the significance of neonatal mass-screening programmes for inborn errors of metabolism, conducted by the National Research Institute of Mother and Child (NRIMC), are discussed. As the first in Poland, in 1964, mass-screening for phenylketonuria (PKU) was introduced. The BIA-Guthrie test was used. Other Guthrie tests (GBIA) were applied in homocystinuria, tyrosinemia, histidinemia and leucinosis (Maple Syrup Urine Disease-MSUD). In the middle of the 60. the Beutler and Baluda test was introduced for galactosaemia, as well as the Efron urine test in infant screening for different inborn errors of metabolism. In the middle of the 70., neonatal mass-screening for cystic fibrosis (CF, mucoviscidosis) was started. Meconium tests and the sweat test with ion selective chloride electrode were used. Apart from inborn errors of metabolism, we also introduced a screening programme for neuroblastoma in which vaniline mandelic acid (VMA) in urine was estimated and for congenital hypothyroidism were TSH level was assessed. The results of screening are shown in the tables and in the figures. In our opinion the best clinical results are obtained with screening for congenital hypothyroidism and for PKU, since very early detection and treatment in these diseases prevents severe mental retardation. We therefore consider that both these screening programmes should be treated as obligatory examinations in all neonates. Taking into consideration the fact that there are different types of hyperhenylalaninemias, the principles of differential diagnosis are discussed. Molecular genetic investigations, carried out in the NRIMC Department of Genetics proved to be a very important procedure in the verification of diagnosis of different mutations. The authors also discuss the problem of dietary treatment duration in PKU. In our opinion the hypophenyloalanine diet regimen in girls, should not be discontinued during adolescence, since there is the problem of maternal PKU and the possibility of foetal damage. The results of our own investigations of maternal PKU are discussed. The significance of mass-screening for galactosemia is still under discussion. In our opinion, mass-screening for galactosemia is not useful and we have discontinued it. Selective screening has been started combined with molecular genetic studies in high risk families. In the future, we plan to prepare guidelines on the principles of diagnosis and treatment of galactosemia in children and women in the reproductive age. Mass-screening for cystic fibrosis is also still under discussion. The results of the early screening programmes were not satisfactory and the tests were discontinued. In 1998, after reorganisation of the whole system, CF screening, using tripsin-radioimmune assays, was started again. The new screening programme is combined with molecular genetic investigation of different mutations. It is still too early to assess the importance and success of this CF mass-screening programme. We decided to discontinue the screening for homocystinuria, histidinemia, tyrosinemia, leucinosis and for neuroblastoma, since these programmes did not comply with criteria of mass-screening. In 1997, major reorganisation of screening programmes for inborn errors of metabolism, at NRIMC, was undertaken. The Guthrie test for PKU was changed to a quantitative colorimetric method. The immuno-luminometric method is used for TSH estimation. The whole system is based on complete computer control of all the steps of screening, from blood sampling on filter paper until the final diagnosis. The advantages of this modern system of organisation of the screening programme are discussed.

Decision Trees↗

[A case-control study on the efficacy and the optimum interval of mass screening for prostatic cancer].

PURPOSE: The efficacy and the optimum interval of mass screening for prostatic cancer were investigated by a case-control study. MATERIALS AND METHODS: A matched pairs analysis by 1:5 was conducted between 31 cases of advanced prostatic cancer in stage C and D detected by mass screening and 155 controls of normal subjects selected at random. In all cases and controls, the history of taking part of the mass screening for last 3 years, then the estimates of odds ratios (OR) and 95% confidence intervals (95% CI) were calculated on discordant pairs of the matched analysis. RESULTS: OR to suffer from advanced prostatic cancer was 0.22 (95% CI: 0.07-0.70) in the group to submit to mass screening 1 year ago in comparison with the group not to submit once for 3 years. According to the analysis on the interval of submission to mass screening, the effect of screening to prevent the progression to advanced stages might be valied for 1 year. CONCLUSION: Mass screening for prostatic cancer every year might be efficient to reduce the number of patients progressing to advanced stages.

Aged↗

Outcome of patients with lung cancer detected by mass screening versus presentation with symptoms.

Lung cancers in the early stages are frequently detected via mass screening in Japan. The aim of this study is to evaluate the outcome of patients with lung cancer detected via mass screening and to compare them to those in whom the malignancy was detected by symptoms. A total of 774 untreated patients with lung cancer who were admitted to Department of Respiratory Medicine, Tsukuba University Hospital over a 20 year period up to 1995, were analyzed with reference to their reasons for detection of the cancer. In the mass screened group(116 patients), 50.0% of lung cancer was detected at stage I of TNM classification, while only 8.2% of patients with symptoms(561 patients) had stage I lung cancer (p = 0.0001). As lung cancers detected via mass screening were more often at operable stage (stage I, II or IIIA) (p = 0.0001), surgical treatment was chosen more frequently in the mass screened group(p = 0.0001). The outcome of patients with lung cancer detected via mass screening was more favorable than that of the patients detected by their symptoms (p = 0.0002). The early detection of lung cancer via mass screening contributes to improvement of the outcome.

Adenocarcinoma↗

[A study on the complementary scheme of mass screening for colorectal cancer in an asymptomatic population].

Both SPA immunological fecal occult blood test (SPA FOBT test) and detection of T-antigen in rectal mucus (Shams' test) were used as screening tests in asymptomatic mass screening to evaluate the complementary effect of both tests for detection of colorectal cancers. SPA FOBT test showed a positive rate of 11.1% and shams' test 8.9% among 7,740 subjects. In 498 cases with positive screening test, 11 cases of carcinomas and 88 adenomas were found with colonoscopy. Only 9 cancers and 55 adenomas showed positive result in SPA FOBT test and 8 cancers and 51 adenomas in Shams' test. Both tests combined could enhance the detective rate of cancer in asymptomatic mass screening from 81.8% with SPA FOBT test or 72.7% with Shams' test to 90.9%. This complementary effect was more obvious in adenoma detection. It is suggested that there were some shortcomings in sequential FOBT test for cancer detection, the combined use of the two different screening tests for detection of colorectal cancer could decrease the rate of missed detection.

Adenoma↗

Clinical characteristics of prostatic cancer detected by mass screening.

Since 1981 we have been studying prostate cancer (Pca) by mass screening in three cities, eight towns and seven villages in Gunma prefecture, Japan. From 1981 to 1985, 5,770 subjects were examined. The clinical character of Pca detected by mass screening is compared with control (i.e., Pca detected in the outpatient clinic in Gunma University). Of the 54 Pca patients detected by mass screening (Stage B: 28, C: 8, D: 18), approximately 50% had early-stage Pca. The ratio of early-stage Pca is significantly higher than in the control. An extended survival rate in high-stage Pca detected by mass screening also was observed through comparison with control. We determined two types of Pca in advanced stage: (1) asymptomatic or less symptomatic and better prognostic Pca found in mass screening and (2) symptomatic and worse prognostic Pca found in control.

Acid Phosphatase↗