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PubMed1990

[A simple mathematical model for a quantitative evaluation of mass screening for detection of cancer].

In Japan, where the mass screening of various cancer are actively pursued under the auspices of the Adult Health Promotion Act of the Japanese Government, the incidence rate of various cancers has been undergoing a drastic change since 1960. Cancers of stomach and uterine cervix, which had predominated, are decreasing steadily, whereas lung, colon and breast cancers are rapidly increasing. To provide therapeutic care on the basis of accurate data, the mass screening system must be re-evaluated so as to maintain its effectiveness and efficiency. For this purpose, a simple, deterministic model is proposed to measure the cost-effectiveness of the mass screening quantitatively. The effect of the screening is estimated by the net number of lives that have been saved by the screening, with the final result being shown as the cost require to save one life of a certain age and sex. The model, although only an approximation, fits all kinds of cancers by changing the parameters employed in the mathematical equation, and has been found useful for forecasting the results of future mass screenings for the detection of cancers in Japan.

Humans↗
PubMed1989

[Studies on prostatism of males fifty years of age and older--analysis on results of a second mass screening for prostatic diseases in Tanno town].

We conducted a second mass screening for prostatism on males 50 years of age and older in the Tanno town area, to determine the incidence of benign prostatic hypertrophy (BPH) and prostatic carcinoma. We also studied how often elderly males had symptoms related to prostatism according to their age. The incidence of BPH was 10.0% in these males who were received the first and/or second mass screening as well as those treated previously, when BPH was defined as the prostate with a moderately or greater enlarged size upon digital palpation. The incidence of BPH was 8.9% in males fifty years of age and older who lived in Tanno town. The figures tended to elevate with the advance of age. Two new patients with prostatic carcinoma were discovered during this second mass screening, which resulted in a total of 8 patients discovered in this area. Of these 8 patients, 6 had been found in the first screening. The incidence of prostatic carcinoma was 1.4% in those males who received the first or second mass screening as well as those treated previously, and that in all the males who lived in the town was 1.0%. Further efforts will be necessary to establish a more convenient system that can provide less costly screening procedures and more effective diagnostic procedures to detect localized prostatic carcinoma. With advance in age the male tended to have a higher incidence of prostate with a moderately or markedly enlarged size, and symptoms related to prostatism. In addition, the urinary flow rate tended to decrease, irrespective of the prostate size. The results supported the significance of mass screening for prostatism.

Age Factors↗
PubMed1987

Appropriate frequency of mass-screening for uterine cervical cancer.

Between 1973 and 1983, 250,264 Japanese women in Shimane Prefecture were mass-screened for uterine cervical cancer. A malignancy was detected in 218. Carcinoma in situ (CIS)-(stage 0) was present in 92 (42.2%) and 126 (57.8%) had an invasive cancer (stage Ia or above). Of the 218, only 90 (41.3%) had undergone previous mass-screening. The history of these 90 (stage 0: 45, stage Ia or above: 45) was examined retrospectively to determine appropriate frequency of mass-screening for uterine cervical cancer in CIS. 1) Three (6.7%) out of 45 patients with invasive cancer were found within 12 months after the last mass-screening, the number being definitely small compared with the 20 (44.4%) found within 24 months (p less than 0.01). 2) Three (21.4%) out of 14 patients with malignancy found within 12 months after the last mass-screening taken were diagnosed as cases of invasive cancer, the number being definitely small compared with the 17 (56.7%) patients with invasive cancer out of 30 patients with malignancy found within 12 approximately 24 months (p less than 0.05). 3) 3/45 (6.7%) had an invasive cancer, despite yearly mass-screening for 3 years. The previous cytological assessment was class I or II and the previous colposcopical examination revealed no abnormal findings. 4) Of the 45 with CIS, 11 (24.4%) underwent yearly mass-screening for over 3 consecutive years. I conclude that mass-screening for uterine cervical cancer should be done once a year.

Adult↗
PubMed1991

The effect of mass screening for breast cancer: results of a multivariate analysis.

To evaluate the life-prolonging effect of mass screening for breast cancer, we compared the risk of death for the patients detected by mass screening with that for the patients diagnosed in out-patient clinics, after adjusting for other relevant factors simultaneously by using the Cox regression model. A multivariate analysis using the Cox regression model in which clinical staging of disease was taken as one of the independent variables, showed that the risk of death for patients detected by mass screening was smaller by 0.765 times than that for patients found in out-patient clinics although the reduction was not statistically significant. This small reduction might be partly due to the effect of mass screening through early detection even within the same stage, and partly due to length bias, lead time bias and self-selection bias. When clinical staging of disease was removed from the independent variables, the risk of death for patients detected by mass screening was reduced from 0.765 times to 0.677 times that for patients diagnosed in out-patient clinics, which was statistically significant (P greater than 0.01). For asymptomatic patients detected by mass screening, such as reduction of the risk of death was from 0.789 times to 0.555 times that for patients found in out-patient clinics (P less than 0.05). These results suggest that mass screening for breast cancer may contribute to the reduction of the risk of death, although the effect of biases inherent in periodic screening was not removed completely in the present analysis.

Breast Neoplasms↗
PubMed1990

[Present status of neuroblastoma mass screening in Japan. Neuroblastoma-Committee of the Japanese Childhood Cancer Society].

In 1973, mass screening program for 6-month old infants for early detection of neuroblastoma using a VMA spot test of a urine sample was initiated in Kyoto. In 1985, nation wide mass screening was initiated throughout the entire country and the Government has given the financial support to each district. In 1988, the Government recommended the institution of mass screening by quantitative measurements of VMA, HVA and creatinine using HPLC (high performance liquid chromatography), instead of the qualitative test of VMA alone. From 1974, at the time of initiation of mass screening for neuroblastoma to the end of October, 1989, 383 cases with this tumor have been discovered throughout the screening program. Three hundreds eighty three cases (88%) of them had been registered to the Neuroblastoma Committee of the Japanese Society of Pediatric Oncology. In this paper, the mass screening program was introduced and the 337 cases with this tumor detected by 6-month old screening were analyzed their clinical symptoms, findings, urinary VMA and HVA levels, primary sites, weights of primary tumor, histology, stages at diagnosis, metastatic sites, and the results of the treatment. Three hundreds twenty eight cases (97%) of them are expected to be cured. And we discussed clinical problems related to mass screening program for neuroblastoma, such as an increase of the incidence of infantile neuroblastomas detected by this program and the spontaneous regression.

Adolescent↗
PubMed1990

Comparisons of interval breast cancers with other breast cancers detected through mass screening and in outpatient clinics in Japan.

In a nation-wide collaborative study on mass screening for breast cancer, we collected 152 cases of interval breast cancer diagnosed at 35 hospitals or clinics distributed throughout Japan. The definition of interval breast cancer used in the present study is "breast cancer cases which were diagnosed as having 'no malignant findings' in a previous screening for breast cancer but subsequently diagnosed as 'breast cancer' at a hospital or medical clinic within two years of the previous screening." The clinical stages and prognoses of these interval cancer were analyzed and compared with those of other breast cancers detected through mass screening and in outpatient clinics. In the clinical staging of interval breast cancer, Tis (non infiltrating cancer) accounted for only 2.1%, compared to 8.0% in cases detected through mass screening. At stage I 43.4% were interval breast cancers compared to 32.9% breast cancers detected through mass screening and 25.4% diagnosed in outpatient clinics. The stage differences between interval breast cancers and breast cancers detected through mass screening were not statistically significant. Five-year survival rates were 85.6% for interval breast cancers, 91.7% for breast cancers detected through mass screening and 84.7% for breast cancers diagnosed in outpatient clinics. Ten-year survival rates were 75.9, 80.5 and 78.1%, respectively, suggesting the interval breast cancer cases to show a similar prognosis to that of breast cancer cases diagnosed in outpatient clinics. The differences in five- and 10-year survival rates among the three groups were not statistically significant. From the present study we were not able to confirm the general belief of interval cancer being more aggressive in nature and showing a poorer prognosis than cancer detected through periodic screening. The reasons for this are discussed.

Adult↗
PubMed1984

Comparison of two screening tests for Streptococcus mutans and evaluation of their suitability for mass screenings and private practice.

Two simple microbiological tests for quantitating salivary Streptococcus mutans levels were compared with each other and evaluated for suitability for mass screenings and private practice. Both tests use mitis salivarius medium with bacitracin (MSB) and are selective for S. mutans. One test estimates colonies grown on agar (MSBA) and the other estimates colonies grown in broth that adhere to glass (MSBB). Both are scored from 1 (lowest) to 5 (highest). Children (293) in grades 5 and 6 in Tallahassee, Florida (nonfluoridated) were tested for S. mutans levels. Scores of children by both tests were significantly similar (chi 2, regression and Kappa statistical analysis). Correlation coefficients (regression) between scores and DMFS increments of the previous 4 yr were 0.35 (MSBA) and 0.26 (MSBB). Both tests were very good in identifying children with low caries increments, but positive scores did not correlate well with high caries increments. Sampling and interpreting took 2 min (MSBA) and 1 min (MSBB). Cost of MSBA/child was $1.15, and MSBB/child $1.25. These tests are economical and suitable for mass screenings to identify low risk populations who do not require preventive treatment.

Bacteriological Techniques↗
PubMed1985

[Mass screening for uterine cancer].

Begun in the latter half of the sixties, mass screening for uterine cancer received a fresh impetus with the implementation in February of 1983 of the Health of the Aged Act. Under the latter law, a certain number of problems were also encountered, since autonomous municipalities were newly involved. This report is a description of the Pap test under the new screening system and methods of the uterine cancer mass screening approach or the screening system advanced by Japan Society of obstetrics & gynecology, committee on uterine cancer screening. It covers the primary screening, the secondary screening and detailed screening, their roles and manner in which they are implemented in terms of the local situation. Also, the points deserving the greatest care up through the detailed screening are presented. The importance in particular of the results of the Pap test at the stage of the primary screening, the histological findings, and the reliable transaction of the specimens therefrom, are emphasized. For the mass screening for uterine cancer to result in lower cancer mortality, it is necessary that there be at least 30% of the women aged 30 and over who reside in a given district submitting to the mass screening judging from the results garnered both at home and abroad. The measures needed to reach this goal are introduced. The steps conventionally employed to attain this objective of a higher proportion of women being examined, as well as the mass media propaganda, have their limits. The role of the committees for supervising administration of the screening must be amplified as a concrete means to implement the Health of the Aged Act; the role of the municipalities, which support this realization, must be stressed, the importance of administration policy in the form of periodical examinations, examinations focused on the women of certain ages and the plans for testing with due balance in responsibility between mobile and stationary facility examinations, must be upgraded. Communications with the local medical association and related organizations is also crucial.

Colposcopy↗
PubMed1966

Use of water-drinking tonography in mass screening for glaucoma.

The results of mass screening for glaucoma of workers in a factory in Chiba Prefecture, Japan, are reported. At the first-stage examination, tonometry was performed with standardized Schiøtz tonometers on 1,527 subjects (3,054 eyes) with no ocular symptoms. When the tension was 5.0/5.5 gm or higher, the patient was regarded as a preliminary suspect and a detailed ophthalmologic examination was recommended. The second-stage examination, in the University Clinic included campimetry, vision tests, water-drinking tonography, tonometry with applanation and Schiøtz tonometers, funduscopy and gonioscopy. Of the 239 (381 eyes) preliminary suspects, 79 came to the Clinic for the second-stage examination. Water-drinking tonography, done on 104 eyes with tension of greater than 5.0/5.5 gm, revealed that 48 had a Po/C ratio greater than 100, which strongly suggests the presence of glaucoma. In water-drinking tonography, a Po/C ratio greater than 100 was noted in about 34% of 58 eyes with a tension of 4.25/5.5-5.0/5.5 gm, suggesting that the index for separating glaucoma suspects from normals could be brought down to the level of 5.0/5.5 gm. The over-all percentage of glaucoma cases found was 1.3%. The efficacy of water-drinking tonography in mass screening for glaucoma has been discussed.

Adolescent↗
PubMed1996

[Mass screening for prostate cancer in Japan].

Since 1975 mass screening for prostate cancer has been performed in Japan. The Prostate Research Foundation has analysed the data every year that collected from all institutes performing a mass screening. Up to 1993, 67, 225 subjects were examined. The detection rate of prostate cancer was 0.69%. Approximately half of the cancer were stage B, and the subjects who have metastatic stage were only 20% and the pattern of stage seemed to be different from that of patients who visited hospitals. In Chiba prefecture the subjects lived in a district of south Boso peninsula received a mass screening for prostate cancer with total of 1,964 men from 1985, and 17 cancers were diagnosed (0.87%). The distribution of prostate-specific antigen (PSA) assayed with Tandem-R kit was examined using the stocked sera (n = 976) of the screening for prostate cancer in Chiba prefecture. The percentage of 0.05-4.0 ng/ml, 4.1-9.9 ng/ml, over than 10.0 ng/ml of the PSA, were 89.6%, 7.0%, 3.4%, respectively. This distribution is approximately as same as the previous reports by the United States and Canada.

Age Factors↗
PubMed1993

[Estimation of risk due to radiation exposure in the mass screening of cancer in Japan].

Five types of mass screening programs for cancer are performed under the auspices of the Adult Health Promoting Act of the Japanese Government. The cancers involved are those of stomach, uterus, lung, breast and colon. Radiological images are routinely used for the screening of stomach and lung cancers, and mammography will be employed in the near future. In this study, the risk due to radiation exposure in the above-mentioned screening programs was estimated for an individual who participates in the screening of each cancer annually. The dose absorbed at each screening was estimated and an additive risk model was used as the pattern of occurrence of radiation-induced cancers for simplicity. Safety was also estimated. Results showed that the risk of a shortened life-expectancy as a result of undergoing annual mass screening for breast, stomach and lung cancer was insignificant in comparison with the average life-expectancy of about 80 years for Japanese men and women, and much smaller than the benefit of mass screening expressed in terms of prolonged life-expectancy. However, it should be emphasized that a quality control program must be established to keep the dose absorbed at each X-ray screening examination as low as reasonably possible.

Female↗
PubMed2000

[Is the benefit of organized mass screening for cervix cancer and breast cancer in Norway scientifically justified?].

BACKGROUND: It has been argued that mass screening may reduce mortality from cervical cancer and breast cancer in Norway by 50% and 39%, respectively. However, some authors doubt that mass screening for breast cancer is justifiable. This article discusses whether mass screening for cervical cancer in Norway is more effective than opportunistic screening. MATERIAL AND METHODS: The scientific methods used to justify organised mass screening for cervical cancer are reviewed and discussed, as are the randomised trials used to justify screening by mammography. The author is especially critical of the use of descriptive statistics to justify screening, on the assumption that there is a basic constant incidence or mortality rate. RESULTS: The incidence rates of pre-malignant conditions and cervical cancer in Norway are presented. There is no essential increase in the number of pre-malignant conditions after three years of organised mass screening compared to the previous three-year of unorganized screening. However, the number of pre-malignant conditions did increase from 1987 to 1992 due to a national recommendation for testing every three years. By contrast, incidence rates for cervical cancer remained almost constant in the 1987-97 period. INTERPRETATION: There is no scientific proof of organised mass screening for cervical cancer being preferable to unorganized screening. The author warns against only comparing observed rates with historic rates and rates in other countries; alternatively, rates among those who participate in the screening might be compared in a simultaneous analysis to rates among those who do not respond to the invitation. The author also suggests estimating correlation coefficients between individual test results to identify high-risk individuals.

Breast Neoplasms↗
PubMed1977

Selective screening for cervical cancer. Experience of the Finnish mass screening system.

Names of women eligible to be screened for cervical cancer are taken from the national population registry and the women are invited by a personal letter. The data, from these mass screenings are analysed and stored at the screening registry. To reduced the costs of the system and to increase the yield of preinvasive lesions the idea of selective screening was considered. Tt was decided that if people were selected according to their risk factors, as recorded in the national population registry, the screening would be ineffective as many cases of invasive cancer were found in the low risk groups. High risk factors were determined from anamnestic data on systems and from previous cytological diagnoses. The proportion of women with symptoms of bleeding or the class II-V smears without positive histological results constituted fewer than 10% of the participants, but 20% and 40% respectively of invasive carcinomas were found in these groups during the subsequent follow-up period. Thus it is suggested that selective screening apart from that based on age has a limited application and should be restricted mainly to the interval between the organised screenings, which in Finland is five years.

Adult↗
PubMed1998

Mass screening for neuroblastoma at 6 months of age: difficult to justify.

BACKGROUND/PURPOSE: A statistical analysis of the mass screening for neuroblastoma in Japan based on a population study rarely has been reported. This study aims to evaluate retrospectively the effectiveness of mass screening at 6 months of age using the available population data. METHODS: The data on the neuroblastoma cases registered by the Committee for Pediatric Solid Malignant Tumors in the Kyushu area were analyzed based on both screened and unscreened populations in the Kyushu area. RESULTS: From 1988 to 1992, the cumulative incidence of neuroblastoma in children less than 5 years of age was 82 in 484,599 for screened children, and 11 in 92,966 for unscreened children, respectively. Fourteen of the 82 screened patients had negative findings at 6 months of age (MS-negative cases). No significant difference was observed in the cumulative mortality rates from neuroblastoma in children younger than 5 years of age between the screened children and the unscreened children. Six of seven patients who died among the screened children were MS-negative cases with stage III or IV disease. In addition, no significant difference was found in the cumulative mortality rates from the neuroblastoma cases in patients less than 5 years of age between the children screened from 1988 to 1992 (7 of 484,599) and all children from 1980 to 1984 (14 of 668,084). CONCLUSIONS: These findings suggests that the majority of the patients detected by mass screening had a favorable prognosis, and, mass screening in Japan for children less than 6 months of age was not observed to reduce the incidence and mortality from neuroblastoma. Therefore, mass screening at 6 months of age was not found to improve substantially the prognosis of patients with unfavorable neuroblastoma identified over 1 year of age, which is the primary purpose of such mass screening for neuroblastoma.

Evaluation Studies as Topic↗
PubMed1975

Comparison between participants and non-participants at a gynaecological mass screening.

Nearly 35% of the women invited to the gynaecological mass screening in Uppsala do not participate. It is therefore of importance to study the reasons for this, especially as previous research in this field is sparse. We used a mail questionnaire which included questions concerning sociological data, gynaecological background, attitude to gynaecological examinations and to mass screening, attitude to cancer and to sexual matters. 87.5% of the sample of 800 women replied. We compared the group of women who had at some time participated in the mass screening with those who had never participated. The sociological variables were found to be closely correlated, and their individual significance could consequently not be distinguished. Those who had not participated did not as a whole constitute a critical group as regards detection of cancer, since it was found that most of these women had attended a gynaecologist elsewhere and, although they had had smears taken, they appeared to be poorly informed as to the type of cancer that the smear is intended to detect. Our questioning failed to show the women's attitude to cancer or to sexual matters was of significance for participation, although there is some evidence that the latter may be of some importance. The most significant difference disclosed between the groups was that non-participants consider gynaecological examinations more unpleasant than do participants. Furthermore it was found that women's expectations of the mass screening differ from what they consider to be included in the examination. Finally, measures intended to increase participation are suggested.

Adult↗
PubMed2000

[Randomized controlled trial of sequence mass screening program for colorectal cancer].

OBJECTIVE: In order to assess the effectiveness of mass screening program for colorectal cancer, a sequence mass screening program based on RPHA-FOBT and individual quantitative risk assessment model (attributive degree value, AD) was used and evaluated on its effectiveness in a randomized controlled trial. METHODS: The residents of Jiashan county aged 30 years and over were randomized to either screening or control groups in 1989. Participants in screening group were asked to fill in a questionnaire and to submit one paper slide with stool. Participants who tested positive underwent diagnostic evaluations including flexible sigmoidoscopy and colonoscopy. RESULTS: According to the cancer registry of Jiashan, after initial mass screening in 1989, the 8-year cumulative incidence per 1,000 of colorectal cancer in screening and control groups appeared to be 3.95 (95% CI 3.81 - 4.10) and 4.01 (95% CI 3.86 - 4.16) respectively. There was no significant statistical difference between two groups (P > 0.05). Nevertheless, the 8-year cumulative mortality for colorectal cancer in screening group (2.08 per 1,000; 95% CI 1.96 - 2.18) was reduced 14.7% comparing with the control group (2.44 per 1,000; 95% CI 2.33 - 2.55). In particular, the cumulative mortality of rectal cancer was significantly (31.7%) lower than that in control group. Log-rank test showed that survival rate of rectal cancer in screening group was higher than that in controls (log-rank = 9.01, P = 0.0027). CONCLUSIONS: The sequential mass-screening program which based on RPHA-FOBT and ADV might reduce the mortality for colorectal cancer in the Chinese population.

Adult↗
PubMed1989

A clinician's view of the mass screening of the newborn for inherited diseases: current practice and future considerations.

The case for or against mass screening for inherited diseases is discussed. There is universal acceptance for mass screening for phenylketonuria and congenital hypothyroidism. The case for mass screening for galactosaemia and for maple syrup urine disease is not very strong; they could be considered under the heading of 'urgent screening of the sick newborn'. It is difficult to find good arguments for mass screening for congenital adrenal hyperplasia. For screening for glucose-6-phosphate dehydrogenase deficiency and sickle cell disease, the established criteria for mass screening do not apply. A simple tool for early detection is now available and the population afflicted with a mutant gene which causes major health problems should receive special attention from its government. It is too early to offer any comment about cystic fibrosis screening; further developments must be awaited.

Cystic Fibrosis↗