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PubMed1983

Comparative values of school physical examinations and mass screening tests.

In this study mass screenings identified more problems than did physical examinations, but more problems per 100 contacts were identified by physical examinations (51.6) than by screenings (4.7). When time necessary to accomplish the evaluation is considered, screenings are a more efficient way of identifying problems in the general diagnostic categories for which screenings can be provided, but most (85.8%) of the problems identified by physical examination were in categories for which screenings are not provided. Overall, 99.1% of the problems were identified without overlap between physical examinations and screenings. Eighty-three percent of the problems identified by physical examinations were previously unknown. By the end of the school year, 86.3% of the problems identified by physical examinations and 94.5% of those identified by screenings had been or were in the process of being resolved. The integration of physical examinations and screenings in a school setting, staffed by nurse practitioners supported by physicians, can maximize the identification and resolution of health problems.

Child↗
PubMed1998

Is there a future for neuroblastoma mass screening?

It is apparent that mass screening at the age of six months in Japan detects significant numbers of otherwise spontaneously regressing tumors. Nishi et al. estimated that at least 50% of tumors detected by screening with the HPLC method would otherwise regress spontaneously [31]. Considering that not all patients found by screening who were treated and survived required therapy to obtain that result, the proportion of spontaneously regressing NBLs would be even larger. Nobody can deny that screening at the age of six months detects some tumors that would otherwise be found clinically later on. Indeed, our data show that screening led to some decrease in incidence at the age of 3 years [10]. However, this study also showed that the tumors detected by screening would, if not picked up on screening, have grown very slowly over 3 years. That is, they were not rapidly progressing tumors. There is evidence showing that evolution from tumors with favorable biologic features to tumors with unfavorable ones is unlikely [32], while no convincing example of such evolution has been reported.

Adolescent↗
PubMed2000

Mass screening in low-income populations: the challenges of securing diagnostic and treatment services in a national cancer screening program.

Funding for many mass screening programs for low-income and uninsured populations provides resources for screening tests, yet only rarely does it provide coverage for necessary follow-up diagnostic and treatment services. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP), a federally funded initiative that provides cancer screening to low-income uninsured and underinsured women, covers some diagnostic follow-up tests and no treatment services. We conducted in-depth case studies of seven state programs participating in the NBCCEDP to investigate the strategies and approaches being used to secure diagnostic and treatment services. The results suggest that the program relies on a patchwork of resources--at state and local levels--to provide diagnostic and treatment services. This includes a number of components of local safety nets, all of which are unstable and have uncertain futures. Public health disease-screening initiatives need to reconsider the feasibility of continued reliance on case-by-case appeals to the local safety net for diagnostic follow-up and treatment services.

Breast Neoplasms↗
PubMed2003

Is the mass screening for neuroblastoma ineffective?

Though a recent study (Schilling et al. 2002) concluded that the mass screening for neuroblastoma targeting children age 12 months was ineffective, we pointed out several serious problems and reestimated its effectiveness using their data. They employed the subjects in the "control area" as controls, not the "non-participants" whose biases are fewer because their area is the same as that of the participants. The incidence of neuroblastoma among the subjects in the "control area" was about 25% smaller than that of the "non-participants". This leads to underestimation of the effectiveness of the mass screening. They combined false negatives with true positives to calculate the incidence of the "screened group". But since many spontaneous regression cases are included in the true positives, this method inflates the incidence of the "screened group", leading to underestimation of the effectiveness of the mass screening. When the false negatives are compared with the non-participants, the incidence of the cases in stage 4 among the latter is about 40% of that of the former, and the mortality is less than two-thirds. The percentage of spontaneous regression cases among the true positives is estimated to be about 40%. These results are better than those of the Japanese screening programs (targeting infants age 6 months), supporting the effectiveness of mass screening for neuroblastoma.

False Negative Reactions↗
PubMed1995

Haemoccult test properties according to type and number of positive slides in mass screening for colorectal cancer.

Despite encouraging results from recent studies, there is still no consensus to undertake mass screening using the Haemoccult test in the general population. The success of mass screening for colorectal cancer depends among other things on Haemoccult test properties. In on-going screening programmes, the Haemoccult test consists of six slides and a test is considered positive if at least one slide is coloured. The aim of this work was to study the influence of the type and number of positive slides on the Haemoccult test's positive predictive value and characteristics of screened lesions. This work focuses on 63,958 first tests in a mass screening programme in Calvados (France) among people aged 45-74 years. There was a linear relation between the positive predictive value for cancer or an adenoma larger than 1 cm and the number of positive slides (P < 10(-4)). The positive predictive value for cancer or large adenoma was significantly higher when 4-6 slides were positive (44.3%) than when only 1-3 were positive (19.1%) (P < 10(-4)). In this latter group, the subjects in whom tumours were detected were younger and had significantly less extensive cancers. Borderline tests (no slides positive and at least one slide with a blue coloration confined to the edges) had a positive predictive value for cancer or an adenoma larger than 1 cm no different to that of tests with 1-3 positive slides. Subjects with borderline results were markedly younger than the others and had less extensive cancers and rectal localisation more often than the others. Our results suggest that (1) increasing the number of positive slides required to declare a test positive leads to an increase in the positive predictive value but is not to be recommended because of the sensitivity of the test and (2) considering borderline Haemoccult tests as positive in on-going and future mass screening campaigns would allow an increase in the sensitivity of the test, especially for rectal cancer and low extensive tumours without any decrease in its positive predictive value.

Aged↗
PubMed1997

Colorectal cancer mass-screening: estimation of faecal occult blood test sensitivity, taking into account cancer mean sojourn time.

Mass screening using the faecal occult blood test (FOBT) can reduce mortality from colorectal cancer. Reliable estimation of FOBT sensitivity is crucial in assessing the potential effectiveness of a mass-screening procedure. Available estimates could be inaccurate because they neglect the temporal aspect of screening. The aim of our study was to estimate the sensitivity of the FOBT in mass screening for colorectal cancer, taking into account the duration of the pre-clinical phase of the disease assessed by the mean sojourn time (MST), and to assess whether MST and FOBT sensitivity differ according to cancer subsite. We analysed data taken from the first round of the mass-screening programme of the department of Calvados (France), involving 164,364 subjects of whom 43.4% participated in FOB screening. MST and sensitivity were estimated using a simple empirical approach, a traditional maximum likelihood method and log-linear modelling using the Bayesian technique of Gibbs sampling. MST was estimated as between 4.5 and 5 years for all subsites combined. According to the Gibbs sampling method, MSTs were 3.5, 6.4 and 2.6 years for proximal colon, distal colon and rectal cancer, respectively. Our estimation methods give a low sensitivity for the FOBT (50%), results for different subsites being closer to each other, slightly higher for proximal cancer. Our results strongly suggest that tumour growth rates are very different according to subsite, slowest for distal cancer and speediest for rectal cancer. Consideration of FOBT sensitivity without MST appears unreliable. Our results by subsite suggest that combining FOBT and sigmoidoscopy could be a good strategy for colorectal cancer screening.

Aged↗
PubMed1992

Mass screening of neuroblastoma in Sapporo City, Japan.

In Sapporo City a mass screening program for neuroblastoma aiming at 6-month-old infants has been performed since April 1981. By March 1990, 136,001 infants were screened; 26 true-positive cases of neuroblastoma and six false-negative cases were detected. The sensitivity of the mass screening method was about 80% throughout the 9 years. During the 9-year period, a total of nine children with neuroblastoma who were not screened were also identified. Clinical stage, age at diagnosis, and survival rate for the 32 patients who were screened (26 true positives and six false negatives) were much more favorable than those for the nine patients who were not screened. A remarkable decrease in the incidence of cases of neuroblastoma with advanced clinical stages over 1 year of age, especially among children 1-4 years of age, was noted after the start of the mass screening. The mortality from this tumor in children up to 4 years of age significantly decreased after the start of the urinary screening program. Rescreening at 14 months of age was begun in April, 1991 in Sapporo City. Performing two screening examinations decreases the probability of overlooking a patient. Thus, it is expected that tumors missed on the first screening would be detected by the second screening.

Biomarkers, Tumor↗
PubMed2002

Outcome in patients with lung cancer found retrospectively to have had evidence of disease on past lung cancer mass screening roentgenograms.

This study enrolled 143 asymptomatic patients with lung cancer detected by mass screening during an 8-year period (January 1, 1993 to December 31, 2000) and who had received a lung cancer mass screening roentgenogram one year before the disease was found. There was no difference between the 5-year survival rates in patients with one-year delayed detection of lung cancer (n=62) and in patients without (n=81) (46 vs. 58%, log rank: P=0.1330, Wilcoxon: P=0.1008). However, according to the tumor size on the overlooked chest roentgenogram, the outcome in stage I+II patients with missed tumors >20 mm in dimension (n=20) was worse than those with missed tumors <10 mm (n=24) or those with missed tumors 10-20 mm (n=18) (40 vs. 82 or 81%, log rank: P=0.0047, Wilcoxon: P=0.0010). All missed tumors in the lung field that did not overlap thoracic components were <10 mm in dimension and appeared as patchy ground-glass opacities, and they could not have been recognized if there was no other information that the tumor developed in that location. This might also be related to the lack of mortality effectiveness of previous lung cancer mass screening problem. Although it may be difficult to find the tumors <10 mm on a chest roentgenogram on mass screening, one-year delayed detection of lung cancer < or = 20 mm will not affect the prognosis.

Adult↗
PubMed1984

[Current issues and future prospects of mass screening for breast cancer].

As the breast carcinoma has a tendency to increase lately, the mass screening for it is being undertaken on a national wide scale. Kanagawa prefecture obtaining cooperation from universities and many hospitals there, 144,000 women for five years have undertaken the mass screening since 1978. As a primary examination, many doctors are sent to each parts of Kanagawa prefecture. This mass screening enables to examine the women in the wide area economically and easily. Moreover, it can be a great opportunity for them to get knowledge for the detection of the early breast carcinoma. However, this kind of way needs so many doctors and limits the numbers of examinees. We got the conclusion comparing to the way of the mass screening adapted by Kawasaki city, that is the examinees should go to the public health centers.

Adult↗
PubMed1993

A comparison of breast cancers detected by mass screening and those found in out-patient clinics.

We evaluated the results of a mass screening study on breast cancer detection by physical examination alone conducted in Ishikawa Prefecture from 1978 to 1990. The number of cases of breast cancer detected by mass screening was then compared with that found in out-patient clinics during the same period. Breast cancer was detected in 88 of 152,969 women by mass screening, the detection rate being 0.06% for the total study: 0.08% at the initial screening and 0.04% at periodic screenings. Early stage breast cancer was more frequently detected during periodic screenings than at the initial screening or in out-patient clinics. Moreover, although the initial screenings may have identified patients with breast cancer at more advanced stages, the survival was not significantly different. The results of this series led us to conclude that mass screening by physical examination alone may have no impact on the mortality rate of breast cancer.

Adult↗
PubMed1987

Breast cancer detected by mass screening using physical examination alone.

In Tokushima prefecture, mass screening for breast cancer has been conducted using physical examination alone since 1970. Breast cancer was detected in 116 of 111,571 screened women up until 1984. The detection rate was 0.08 per cent in total examinees, 0.13 per cent in initial examinees, and 0.04 per cent in subsequent examinees. The patients with breast cancer were divided into three groups, i.e., 62 cases detected at initial screening, 28 cases detected at subsequent screenings, and 26 interval cancer cases. 510 patients with breast cancer in the outpatient clinic were serving as controls. The stage classification and nodal involvement were significantly different between the mass screening group and the control group, but not significantly different among the three groups. The interval cases were detected at an early stage. The survival rates were not significantly different between the three groups and the control group. Efforts should be doubled to educate women about the proper method of breast self-examination in order to promote the early detection of breast cancer.

Adult↗
PubMed1986

Determination of urinary vanillylmandelic acid and homovanillic acid by high performance liquid chromatography for mass screening of neuroblastoma.

In order to develop a mass screening method for the early detection of neuroblastoma, we measured urinary vanillylmandelic acid (VMA) and homovanillic acid (HVA) by a high performance liquid chromatography (HPLC) equipped with an electrochemical detector. Urinary samples were collected on a piece of filter paper and then pre-treated by a simple method. Measurement of VMA and HVA was performed within a short period of time, and by about 80 samples per a day could be analyzed by automatic system. The method described herein proved to be reliable, and we thus recommend it as a useful method for measurement of both VMA and HVA, leading to more accurate detection of neuroblastoma in mass screening test.

Chromatography, High Pressure Liquid↗
PubMed1994

High detection rate of breast cancer by mass screening using mammography in Japan.

A trial of mass screening for breast cancer using both mammography and physical examination (independently) was carried out in women over 50 years of age in Tokushima Prefecture. Breast cancer was detected in eight of a total of 950 examinees by mammography alone, and no cases of breast cancer were detected by physical examination. The detection rate of breast cancer was 0.84%, which is very much higher than that obtained by conventional mass screening using physical examination alone. The detection rate increased especially in the sixth and seventh decades of life. All eight detected breast cancers were in the early stage. Based on these results, it is recommended to employ mammography in breast cancer screening for asymptomatic women aged over 50 years.

Adult↗
PubMedDate not supplied

Mass screening for cancer of the endometrium in Miyagi Prefecture, Japan.

OBJECTIVE: To survey the results of mass screening for cancer of the endometrium performed over a six-year period in Miyagi Prefecture, Japan. STUDY DESIGN: Materials were cytodiagnostic samples of the endometrium examined by the Miyagi Cancer Society. The samples were classified into two groups: The mass screening group, from whom samples were collected according to the Health and Medical Service Law for the Aged, and the outpatient group, consisting of samples from other patients. The rates of subjects judged to require close examination and the detection rate of cancer of the endometrium in the two groups were compared. RESULTS: In the mass screening group, the rate of subjects judged to require close examination and the detection rate of cancer of the endometrium were 2.3% and 0.11%, respectively, while they were 5.9% and 0.39%, respectively, in the outpatient group; the differences between the two groups were significant. CONCLUSION: To improve the detection rate in mass screening for endometrial cancer according to the Health and Medical Service Law for the Aged, it is necessary to establish a new criterion for selecting subjects.

Endometrial Neoplasms↗
PubMed1983

Therapy for cervical cancer detected by mass screening.

Over a 19 year period since 1962, 972 cases of cervical cancer have been detected by mass screening in Miyagi Prefecture, a detection rate of 0.11%. Among these cases, 551 (56.7%) were cases of carcinoma in situ. In contrast, cervical cancers detected by means of private screening gave a detection rate of 0.39% (889 cases), among which there were 611 cases of invasive carcinoma (68.7%). Among the 421 cases of invasive carcinoma detected by mass screening, 352 were Stage I, 52 were Stage II, 14 were Stage III and 1 was Stage IV. Moreover, 178 of the 352 Stage I cases were Stage Ia. The 5 year survival rate for the cervical cancer patients detected by mass screening was 97.8% for Stage 0, 92.9% for Stage I, 75% for Stage II, 45.5% for Stage III and 0% for Stage IV. The 5-year survival rate for invasive carcinoma was 88.7%. Twenty-five deaths due to recurrence of the cancer were found, but all such cases were invasive carcinomas. There were no mortalities due to recurrence of carcinoma in situ among such cases detected by mass screening.

Carcinoma↗
PubMed1995

Prostate-specific antigen in mass screening for carcinoma of the prostate.

BACKGROUND: Prostate-specific antigen (PSA) has various advantages over prostatic acid phosphatase (PAP) as a marker for prostate cancer, but its role in prostate cancer mass screening remains controversial. We measured serum PSA in addition to serum PAP determination and digital rectal examination (DRE) in our mass screening program to assess the usefulness of PSA for prostate cancer mass screening. METHODS: Serum PSA and PAP measurements and DRE were performed in 1249 patients in mass screening for carcinoma of the prostate in 1989 and 1990. Thirteen cancers were diagnosed. We calculated the mean plus standard deviations (2SD) of the PSA and PAP values of men without cancer, and assessed the usefulness of PSA for prostate cancer screening by using these figures as the upper limit of normal. RESULTS: The number positive for PSA, PAP and DRE were 39, 36 and 48, respectively. If our screening had been performed without DRE, three cancers would have remained undetected, and the number would have been the same if performed without PSA. If the screening had been performed without PAP, on the other hand, no cancers would have remained undetected. The sensitivities of PSA and PAP were 54% and 23%, respectively. The screening detection rate with DRE and PSA was 0.88%, and with DRE and PAP was 0.64%. CONCLUSIONS: Measurement of serum PSA values with adjustment of the cut-off value was considered more useful than PAP in mass screening for prostate cancer.

Acid Phosphatase↗
PubMed1987

Number and cure rate of neuroblastoma cases detected by the mass screening program in Japan: future aspects.

The annual incidence of neuroblastoma in Japan, a common malignancy of young children which has a very poor prognosis in progressive cases, was previously estimated to be 8.2 cases/million children under 15 years of age. Based on the Japanese National Census of the Population for 1982, the annual number of cases of this tumor is predicted to be 220. (Sawada et al: Med Pediatr Oncol 12:101-103, 1984). Before the mass screening program was started, one-fourth of all neuroblastoma cases were detected before the age of one by clinical symptoms and other findings. Since 1974, a neuroblastoma mass screening program for 6-month-old infants by means of a qualitative Vanilmandelic Acid (VMA) test has been in effect in Kyoto, Japan, for the prognostic improvement of neuroblastoma patients (Sawada et al: Am J Dis Child 136:710-712, 1982). A Neuroblastoma Mass Screening Study Group (NBMSSG) was organized in 1981 (Sawada et al: Lancet ii:271-272, 1984), and the mass screening program has grown to encompass eight selected areas. This group discovered 15 cases of neuroblastoma among 247,500 6-month-old infants, 1 of every 16,500, until the end of 1983, and 23 cases among 434,970, 1 of every 18,900, until the end of 1984. All cases were asymptomatic. As the incidence of infantile neuroblastoma detected by this program is projected to be 52.9-60.6 cases/million 6-month-old infants, it could be predicted that 80-91 neuroblastoma cases will be discovered annually in Japan by mass screening. The cure rate of 25 cases discovered by the mass screening and followed up over 20 months was 92% (Sawada: Lancet i:377,1986). In Japan, it should be possible to detect 135-146 cases--[symptomatic 55 = 220 X 1/4] + [80-91 cases detected by mass screening]--(61.4-66.4% of the total neuroblastoma cases) in infants under 1 year of age annually, and the cure rate of all neuroblastoma cases in Japan is expected to reach 60% or more.

Adolescent↗