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Different characteristics of neuroblastomas in cases found by mass screening and non-screening: evaluation of mass screening for neuroblastoma in Kitakyushu City.

Neuroblastoma accounts for 24 of 109 patients who have been managed by the pediatric tumor outpatient clinic of our university hospital. Among the malignant solid tumors, neuroblastomas are the most numerous. We investigated neuroblastomas found by mass screening oncologically and epidemiologically. Up until March 31, 1991, seven cases were detected from 64,885 infants who received mass screening by the Kitakyushu City System which we had introduced in 1985. This system is based on an individual health survey program for infants in the city. Six of seven cases found by the screening were treated in our department. None of them, including stage III and stage IV cases, showed any conventional risk factors such as high serum levels of neuron specific enolase, ferritin, amplification of N-myc gene, nor cytogenetic abnormalities. Histopathological studies revealed that ganglioneuroblastoma was observed in 9 of 13 cases over one year of age, whereas it was observed only in two screened cases out of 11 cases under one year of age. According to the classification of Shimada et al., there was one stroma-rich tumor, which is rare in infants and usually a matured type, in the screened cases. Interestingly, another one of the six screened cases regressed spontaneously without any treatment. These cases suggested that some neuroblastomas in the process of maturation or spontaneous regression could be detected by mass screening. On the other hand, 9 of 13 non-screened cases over one-year-old died. Although mass screening at six months of age decreased the mortality rate by neuroblastoma in infancy, the prognosis of neuroblastoma in patients over one-year-old remained still poor. Mass screening should be carried out in a health survey program at one year and six months of age in order to improve the outcome.

Child↗

[Reevaluation of benefit and risk of mass screening for stomach cancer--comparison between X-ray diagnosis and endoscopy as the screening test].

Mass screening for stomach cancer has been widely performed throughout Japan, since stomach cancer is the most important disease among various malignant diseases in Japan. As a screening test, the X-ray diagnosis with barium contrast medium is used and the risk of X-ray exposure must be considered in order to compare with the benefit of the mass screening. We have reported in the previous article in 1977 that the benefit and risk of stomach cancer mass screening become equal at age of 40 y.o. Since then, various conditions with the mass screening of stomach cancer have changed so that reevaluation of the benefit and risk relationship is necessary. Especially the risk coefficient of radiation-induced stomach cancer has been revised drastically in the report of United Nations Scientific Committee on the effects of radiation in 1988. So, in this report, the benefit of mass screening of stomach cancer is defined as the net elongation of average life expectancy due to the life saved, and the risk of the screening is defined as the net shortage of average life expectancy due to the radiation-induced stomach cancer and leukemia. Since the benefit increases rapidly with age and the risk decreases with age, a certain age at which the benefit and risk become identical should be found and under this age the mass screening is not justified to be performed. Assuming X-ray dose equivalent to stomach of 10 mSv and risk coefficient of stomach cancer of 12.6 X 10(-3) Sv-1 from the United Nations report, the critical age is found to be about 35 y.o. for men and women.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Involvement of general practitioners in mass screening. Experience of a colorectal cancer mass screening programme in the Calvados region (France).

Good compliance with screening programmes is essential and experience from ongoing studies points to the importance of involving general practitioners (GPs). The aim of this study was to evaluate factors influencing the participation of GPs in a screening programme, as well as acceptance of the test by the population. Fifty GPs were randomly chosen among the 117 practices of three districts in Calvados (France) where haemoccult test-based mass screening for colorectal cancer was underway. Each GP was asked to fill in a personal questionnaire as well as a detailed record for each patient between 45 and 74 years seen in the practice during a 1-week period. The GPs offered the test to 95% of the patients. The overall refusal rate was 7.8%, and was higher in women than in men (9.9% vs 5.9%; P < 0.05). Manual workers had a lower refusal rate than other occupational groups (2.5% vs 8.5%; P < 0.05). The GP's motivation was an important factor in patient compliance: the refusal rate was 5.4% in the case of highly motivated GPs, against 20.0% when the GP was poorly motivated (P < 0.01). GP motivation was higher in urban than in rural areas (P < 0.05) but did not depend on sex, age or the duration or type of practice. According to the GPs, motivating factors were the perceived need for screening, involvement in planning the campaign, and regular feedback. Conversely, a lack of time and the possibility of false-negative results were the most important impediments. This study demonstrates that patient compliance is closely linked to practitioner motivation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Indianapolis cholesterol screening 1987: does mass screening accomplish its goal?

To evaluate the impact of large scale population screening for elevated total cholesterol, a city-wide event was scheduled in Indianapolis during nine days in February 1987. Altogether, 29,954 individuals were screened, and more than 32% were found to be at moderate or high risk using the classification recommended by the National Institutes of Health at the time of the screening for heart disease on the basis of their total plasma cholesterol concentrations. Although larger numbers of females and whites volunteered to be screened, the screened population represented a broad range of age and education levels. Results of a followup questionnaire returned by 18% of those at moderate of high risk revealed that after receipt of an elevated cholesterol result, 67% of the respondents scheduled a physician visit. The majority of those not doing so (53%) contacted their physician for other reasons or by telephone. Results of the followup indicate that screened subjects responded appropriately to the results received. The results of this project indicate that mass screening is only one tool to successfully identify individuals at risk. Given the biases present in the screened population, other strategies should be used to identify at-risk members of population groups unlikely to participate in similar screening events.

Adult↗

Mass screening of urea cycle diseases: a new mass screening method of hyperornithinemia by using two coupling enzymes.

We devised a new microfluorometric mass screening method for determining ornithine in only one blood disc of 3 mm in diameter (blood of 2-3 microliters) by use of two coupling enzymes, ornithine aminotransferase and delta'-pyrroline-5-carboxylate reductase. We could apply this method to some cases of gyrate atrophy of the choroid and retina. Our method can be applied in range of 0 to 12-16 nmoles or about 54.8 mg% or about 4 mM ornithine in blood. Ornithine values by our method were well correlated with those by an amino acid analyser.

Amino Acid Metabolism, Inborn Errors↗

Mass screening for neuroblastoma in infants in Japan. Interim report of a mass screening study group.

A mass screening system for the early detection by means of a vanillylmandelic acid test of neuroblastoma in 6-month-old infants in Japan has been developed in eight districts. 16 of the 281 939 infants screened by this test had neuroblastoma, equivalent to a very high incidence of 1 in 17 621. 15 of the 16 children with neuroblastoma are alive; the other child died 1 month after surgery. This mass screening system for neuroblastoma used in infancy can help to improve prognosis in infants with this malignant disorder.

Adrenal Gland Neoplasms↗

[Detection of asymptomatic prolactinoma by a mass screening program].

Mass screening for prolactinoma was performed among the general population of 10,550 normal adults (8,450 men and 2,100 women) using a paired assay method for serum PRL. Forty subjects with hyperprolactinemia were studied. There were five patients with pituitary prolactinoma, and 10 with 'big' prolactinemia. The patients with prolactinoma had few if any complaints. The occurrence of asymptomatic big prolactinemia showed marked female predominance. The implication of such a screening program for laboratory medicine in future is two-fold: 1) prospect of laboratory 'physician' taking active role in the promotion of mass screening program to cover wide range of disorders affecting adult population and 2) feasibility of analyzing or discovering subclinical disorders of academic interest, being allowed to explore every single individual in the population.

Adult↗

Mass screening for breast cancer: comparison of the clinical stages and prognosis of breast cancer detected by mass screening and in out-patient clinics.

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 in 11 regions of Japan were compared with those for matched patients in out-patient clinics. A total of 728 patients detected by mass screening and 1,450 found in the out-patient clinics were reviewed. The stage of the disease was Tis or I in 40.9% of the patients detected by mass screening, and 28.7% of those found in the out-patient clinics. In contrast, stage III was found in 9.3% and 14.6%, respectively, indicating that early stages were significantly more common in the patients detected by mass screening. The overall survival curve for the patients detected by mass screening was compared with that for those found in the out-patient clinics. 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), while the 10-year survival rate was slightly higher in the same group of patients, but the difference from 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 conducted BSE.

Breast Neoplasms↗

[An epidemiological evaluation of the efficacy of mass screening for uterine cancer in Japan. The relationship between coverage rate of mass screening and reduction in death rate from uterine cancer].

To evaluate the efficacy of mass screening for uterine cancer, the relationship between the coverage rate of mass screening and the reduction in mortality rate from uterine cancer was analyzed. The percent change in the AADR (Age-adjusted death rate) from 1979-1983 to 1984-1988 were compared between the high coverage rate areas and the control areas with relatively lower coverage rates, and among the high coverage rate areas with varied coverage rates. The main results were: (a) the decreases of AADR from uterine cancer were greater in three groups of high coverage rate areas than in control areas with low coverage rates. (b) Among three groups of high coverage rate areas with variation in coverage rates (> or = 20%, > or = 30%, > or = 40%), the higher the coverage rate was, the greater was the percent reduction (-45.9%, -52.3%, -63.5%) of AADR. These results suggest that systematic mass screening may be effective in reducing mortality from uterine cancer.

Adult↗

[Mass screening for detection of infants with hearing impairment. I. Methods and process of the mass screening examination for hearing].

A mass screening program to detect infants with hearing impairment was conducted at the Sapporo Toyohira Health Center in Hokkaido. Between April 1988 and March 1990, 5,676 infants were screened by a questionnaire at the time of the 4-month health examination. Out of the 5,080 cases who could be followed, nine infants underwent thorough otolaryngological examinations, and among the nine infants three cases with hearing impairment were detected. The prevalence rate was, therefore, one case out of 1,693 infants. Although false positive cases amounted to about 5% of the initial infant population, true positive cases were confirmed out of the initially screened positive cases at 7 or 10 months of age through other questionnaires and through behavioral hearing tests using a bell. No false negative cases were found. Inclusion of this mass screening system in the routine child health program is recommended.

Female↗

Mass screening for neuroblastoma in Japan. Committee of the Neuroblastoma Mass Screening Study of the Japanese Society of Pediatric Oncology.

The present status of NB mass screening in Japan, which is the first national trial in the world, is presented. This program was conducted in cooperation with infants' mothers, local health centers, screening centers and hospitals. Three hundred and thirty-seven cases detected by the program, from the start in Kyoto in 1974 to the end of 1989, are analyzed. As many cases were detected at early stages, 97% of them were expected to be cured. Several clinical, technical and programmatic problems are also discussed.

Child↗

Disomy 1 with terminal 1p deletion is frequent in mass-screening-negative/late-presenting neuroblastomas in young children, but not in mass-screening-positive neuroblastomas in infants.

The mass screening (MS) of neuroblastoma has been undertaken in Japan by measuring urinary catecholamine metabolites in infants at the age of 6 months. To clarify the biological characteristics of MS-positive (MS+) tumors in infants and MS-negative (MS-)/late-presenting tumors in young children, metaphase cytogenetic and/or interphase 2-color FISH analyses using terminal 1p and pericentromeric 1q probes were performed on 246 (186 MS+ and 60 MS-) patients with neuroblastomas. The 246 tumors were classified into 4 groups on the basis of the constitution of chromosome 1; 22 tumors had disomy 1 with no 1p deletion (Dis1Norm1p); 41 tumors had disomy 1 or tetrasomy 1, all with the 1p deletion (Dis1Del1p); 164 tumors had trisomy 1, pentasomy 1, or a mixed population of cells with trisomy 1 and cells with tetrasomy 1, none with 1p deletion (Tris1Norm1p); 19 tumors with the same copy numbers of chromosome 1 as the Tris1Norm1p group, had 1p deletion (Tris1Del1p). mycn amplification was absent in the Dis1Norm1p and Tris1Del1p groups, frequent in the Dis1Del1p group (24/41), and rare in the Tris1Norm1p group (3/164) (p < 0.0001). Event-free survival at 5 years was lowest [19.5%; 95% confidence interval (CI), 5.1-33.9] in the Dis1Del1p group, highest in the Tris1Norm1p (96.3%; 95% CI, 93.5-99.2) and Tris1Del1p (94.7%; 95% CI, 84.7-104.8) groups, and intermediate but varied (54.5%; 95% CI, 33.7-75.4) in the Dis1Norm1p group (p < 0.0001). Of the MS+ tumors, 90% were Tris1Norm1p or Tris1Del1p, and 55% of the MS- tumors were Dis1Del1p. The finding that the Dis1Del1p tumors were frequent in MS- but not in MS+ tumors suggests the limited efficacy of the MS program into reducing mortality from neuroblastoma.

Aneuploidy↗