Showing papers on "Mass screening published in 1968"

The search for risk factors in breast cancer.

Abstract: A prospective study of breast cancer risk factors was undertaken in conjunction with an evaluation of periodic breast cancer screening with mammography (soft-tissue X ray) and clinical examination in women 40-64 years old. The screening study was initiated in December 1963 by the Health Insurance Plan of Greater New York in cooperation with 23 of its affiliated medical groups and then began to be accompanied by the risk-factor study. Among 20211 women initially screened a detection rate of 2.72/1000 women occurred as compared with a rate of 1.62/1000 in the control group (no special screening). The risk-factor data concern cancers detected at the initial examination or the first annual reexamination and the cases detected between these examinations (total of 101 cancers). About 81% of initially-screened women had a first annual reexamination. Women participating in the initial screening examinations tended to be younger more educated and generally more concerned about cancer. Ratios of relative risks for variables in which a definite or suggestive relationship with breast cancer existed included never-married vs. married (2.3) 1-2 vs. more pregnancies (2.0) menarche under 12 vs. at 15 or older (1.7) 30 or more years of menstrual activity vs. less than 30 years (1.4) 1 or more breast conditions vs. none (3.1) and history of 1 or more sisters with breast cancer vs. none (1.9). No clear-cut relationship emerged involving age at first and age at last pregnancy age at menopause or interval since last menopause. The somewhat greater risk apparent at first glance for women with some college dissipated when adjustments were made for marriage and parity. No relationship involving duration of breast feeding was noted although only a small proportion of the women had long periods of lactation.

Screening for Bacteriuria With a Test Paper for Glucose

Abstract: A glucose-specific test paper which is sufficiently sensitive to react with the small amounts of glucose present in urine from normal persons in the fasting state can be used to discriminate between urine samples containing more than and those containing less than 1 to 1.5 mg of glucose per 100 ml of urine. This provides a screening method for significant bacteriuria in an apparently healthy population since urine samples, obtained under standardized conditions from subjects in the fasting state with such bacteriuria, contain either very little or no glucose.

Mortality from cancer of the cervix uteri in British Columbia and other parts of Canada.

Abstract: The belief that carcinoma-in-situ of the cervix uteri commonly develops into invasive cancer is based on a variety of evidence including: (i) The similar appearance of the cells in the two lesions; (ii) The observation that some patients in whom carcinoma-in-situ had been diagnosed by biopsy subsequently developed invasive cancer; (iii) The fact that carcinoma-in-situ is more prevalent than invasive cancer and appears at a younger

Set of simple side-room urine tests for detection of inborn errors of metabolism.

Abstract: search for further rapid and economical methods of detecting metabolic diseases. The success of the ferric chloride and more recently Guthrie's bacterial inhibition tests for the detection of phenylketonuria is well established, and wide-scale surveys based on these tests have yielded much information regarding the incidence of phenylketonuria in newborn infants and also in the apparently normal population. More recently the use of one-dimensional paper chromatography for amino-acids2 3 or other simple chemical tests4 in large-scale screening pro grammes has revealed the existence of many other previously unsuspected inborn errors of metabolism.5 6 It is not yet pos sible to treat all of these disorders. However, increased recog nition of rare metabolic disease through such programmes has led to the development of successful treatment in several dis orders provided that the disease is recognized in early life before the onset of mental retardation or other systemic manifesta tions.' The diseases which are known to be caused by inborn errors of metabolism are clinically so diverse8 that it may appear confusing to consider them collectively. However, the common factor that justifies grouping them together is that the correct diagnosis can always be established by appropriate biochemical tests even when no clinical evidence exists of the underlying metabolic disorder. The main difficulty in diagnosing these diseases lies in deciding which patients merit the detailed and often costly laboratory investigations necessary to identify the biochemical defect. It is therefore advantageous to develop a programme of screening tests which can be economically applied to large numbers of samples to detect abnormal metabolites, and in this way select the patients who should be further investi gated.

Phenylketonuria. Mass screening of newborns in Ireland.

Abstract: Phenylketonuria was, until recently, regarded as a very rare disease with an estimated incidence of between 1 in 18,000 and 1 in 40,000 (Centerwall, Berry, and Woolf, 1963). The results of massscreening surveys of newborns in the United States showed that the incidence was approximately 1 in 10,000 (MacCready and Hussey, 1964), while a similar experience in Israel showed an incidence of 1 in 9000 (Cohen et al., 1966). The early detection of phenylketonuria, followed by dietary restriction of phenylalanine, provides the best hope of avoiding mental retardation in this condition. The introduction of a simple microbiological inhibition method for the estimation of blood phenylalanine has made it possible to carry out large-scale screening programmes on newborn infants (Guthrie and Susi, 1963). The suitability of the Guthrie method was assessed in a pilot project in Dublin (Cahalane, 1964), and, subsequently, it was decided to make the method generally available, so that all newborn infants in the Republic of Ireland could be tested (Lancet, 1966). A description of the organization of this nation-wide testing programme, and of the results achieved in the first 16 months of its operation, is given in this report. The State Department of Health decided on the establishment of the scheme and undertook the financial commitment. A central laboratory was established in the Pathology Department of the Children's Hospital, Temple Street, Dublin. Preliminary publicity was based on lectures and talks to medical societies and on announcements in appropriate medical journals. The press, radio, and television services co-operated in informing the general public. Testing began on February 1, 1966, and those concerned with the newborn, i.e. paediatricians, obstetricians, public health authorities, hospital

Identification of the Tuberculous-Infected by Skin Tests

Abstract: An ideal skin test for identifying persons with tuberculous infection would elicit a reaction in all of those infected, and only those infected with M . tuberculosis. The present tuberculin test fulfills the first requirement very satisfactorily. In appropriate dosage, it gives a reaction in almost every individual who has had a tuberculous infection. Moreover, there is no indication that i t gives reactions in persons who are not infected at all. It fails to fulfill the second requirement, however, in that it may give cross reactions in persons infected with other (nontuberculous) mycobacteria. The first reactions recognized as cross reactions were those elicited only by large doses (100 or 250 Tuberculin Units ( T U ) ) of tuberculin, and the discontinuance of such doses eliminated a large proportion of the cross reactions. It soon became apparent, however, that not all reactions, even to the 5 TU dose, were specific, that is, caused by tuberculous infection. Some reactions, particularly the small ones, could be interpreted in no other way than as cross reactions. In an attempt to reduce the number of persons with cross reactions in the group regarded as having a tuberculous infection, the dividing point used to separate “reactors” from “nonreactor~” was raised; from 5 mm, to 6 mm, then to 8 mm, and recently to 10 mm. It was recognized, however, that this procedure did not effect a perfect separation of the tuberculous-infected from the nontuberculous. As the dividing point was pushed up, an increasing percentage of the persons having only cross reactions to tuberculin was eliminated from the “reactor” group, but so also was an increasing percentage of the tuberculous-infected. Some laboratory results illustrate the difficulty of using just the tuberculin test to distinguish individuals with tuberculoiis infection from those infected with other mycobacteria. FIGURE 1 shows frequency distributions of reaction sizes to Purified Protein Derivative (PPD-St ) tuberculin in three groups of experimentally infected guinea pigs. In the upper section are reactions in animals infected with virulent tubercle bacilli. Virtually all react to tuberculin, with rather large reactions distributed in a form approximating a normal frequency curve. In the middle section are reactions in animals infected with a Battey type of “atypical” mycobacteria. The cross reactions in these animals are less frequent and smaller than the specific reactions in the tuberculous animals. However, some of the reactions in each group fall within the same size range. There is no single point on the size scale above which all reactions are specific, and below which all are cross reactions. In the bottom section is a mixed group of animals, half of them infected with tubeicle bacilli, and half with Battey bacilli. The shape of the distribution in this group, showing an excess of smaller reactions compared with the tuberculous animals, would of itself indicate that not all the animals are tuberculous-infected. But with the tuberculin test alone, it is not possible to efficiently separate the tuberculous from the Battey infected animals.

Thermography in the Diagnosis of Breast Cancer

Abstract: Although it has been demonstrated that thermography is capable of revealing most large breast carcinomas, its ability to detect and localize “occult” or preclinical lesions is still unknown. The accuracy of the method as compared with mammography also remains in question. In June 1964, a Pyroscan4 was made available to the Department of Radiology, Jefferson Medical College Hospital. A comparative study was initiated, utilizing a serial group of patients referred primarily for mammography. Although a high proportion of specific breast abnormalities was anticipated, the material was expected to be sufficiently diverse to provide some indication of the utility of the procedure from the standpoint of detection and mass screening. Literature The literature on surface temperature determinations as a method of detecting breast carcinomas is limited. In 1956, Lawson (5) reported a series of skin temperature measurements made with a contact thermometer over known carcinomas of the breast. In 1957 he described the ...

Mass screening of the newborn for metabolic disease.

Abstract: Over large parts of the world all newborn infants are, in principle or in practice, examined by some biochemical technique for phenylketonuria. This revolutionary practice is barely 10 years old; it is worth considering how it started and why it has spread. Until the development of a dietary treatment, phenylketonuria was considered, like the other inborn errors of metabolism, a suitable subject for academic research but of no importance to the practising paediatrician. This changed when it was found that dietary treatment of affected children aged more than a few months often led to improvement in their neurological and other signs and symptoms. However, some irreversible damage to the brain occurred during those first months-for optimum effect, treatment had to start within a few weeks of birth, long before any symptoms appeared (Woolf et al., 1958). Diagnosis had therefore to depend on biochemical tests of blood or urine from apparently well babies; and logically, such tests would have to be applied to all newborn infants. Preventive medicine of this type marks a revolution in medical thought; like all revolutions, it is not entirely unopposed, nor is it bloodless. The principle of screening all newborn infants for phenylketonuria has been very widely, though not quite universally, accepted-the major problems have been in obtaining the necessary specimens and in the tests themselves. The first attempt at mass screening all newborn infants in a city used liquid urine specimens collected by the mothers; the difficulties in obtaining suitable specimens of urine caused only 25% of newborn infants to be tested (Gibbs and Woolf, 1959). Use of 'Phenistix' by the health visitor improved the test rate to over 9900, but difficulties arose in carrying out and interpreting the test and in the later discovery of 'occult' phenylketonurics who gave negative results with Phenistix (Woolf, 1967a). For these and other reasons a considerable proportion of infants with phenylketonuria (perhaps 40%) were not diagnosed when Phenistix was nominally being widely used (Pitt and Wilmot, 1964; Stephenson and McBean, 1967; Woolf, 1967b; Carson, Carre, and Neill, 1968). Much more reliable laboratory tests are now available, e.g. the Guthrie inhibition assay using blood (Guthrie and Susi, 1963), spectrofluorometric assay of phenylalanine in blood (Hill et al., 1965; Searle et al., 1967), paper chromatographic detection of o-hydroxyphenylacetic acid in urine (Berry Umbarger, and Sutherland, 1965; Woolf, 1967a) or of phenylalanine in blood (Berry, 1962; Efron et al., 1964; Scriver, Davies, and Cullen, 1964; Mellon and Stiven, 1966). The blood specimens are collected by heel-prick on absorbent paper or in heparinized capillary tubes, the urine specimens by the mother placing absorbent paper in the infant's napkin. In Cardiff, for example, 98 9% of the infants born during 1967 were screened for phenylketonuria and six other inborn errors of metabolism by chromatographic examination of urine collected on filter paper. The chromatographic test for urinary o-hydroxyphenylacetic acid usually becomes positive at the same time as the Guthrie test on blood, on day 2-5 or occasionally later, and comparative tests have shown that the two are equally reliable: urine collection on or after day 10 to 14 is recommended for administrative and other reasons (Woolf, 1967a; and unpublished). Tests for urinary phenylpyruvic acid, in contrast, may not become positive for weeks, if at all. Testing filter paper urine specimens with ferric chloride overcomes the difficulties and uncertainties of collecting liquid specimens or using Phenistix on a wet napkin; however, a phenylketonuric might not give a positive result till he was 6 weeks old and, if he were of the occult type, not even then. Furthermore, phenylpyruvic acid gradually decomposes on filter paper (Centerwall, Berry, and Woolf, 1963), and a proportion of false negative results is to be expected from this cause. In this issue Cahalane (1968) reports the use of the Guthrie method in Ireland. The great bulk of the specimens of blood were collected, before discharge, in the hospitals in which the babies were born. Administratively this is by far the simplest

Detection of Heart Disease in Children 1919-1967

Abstract: Since 1959, auscultation by physicians in screening 49,496 school children has yielded 4.5 cases of heart disease/1,000 students screened. Sensitivity by analysis of "inserted" cases averages 64%, but varies with capabilities of examining physicians. X-ray and ECG evaluations on smaller populations have yielded, respectively, 2.7 and 2.8 cases/1,000 children screened, and sensitivity results average 30 to 40%. The tape-recorded heart sounds technique has yielded 2.9 cases/1,000 in screening 188,925 children. Sensitivity by analysis of "inserted" cases averages 75% and, in the population of "naturally occurring" heart disease, 56%. In 23,148 school children, an analog-digital device (PhonoCardioScan) has yielded 4.8 cases/1,000 children screened. Of "inserted" cases, 69% have been detected. Sixtyfour to 80% of "naturally occurring" cases have been detected. With each technique, approximately 40% of the heart disease detected had been previously unknown. The specificity of these methods ranges from 95 to 99%. For primary screening the analog-digital device is the most effective currently available alternative to examination by cardiologists.

Serum Immunoglobulin Levels in Blood Donors Implicated in Transmission of Hepatitis

Abstract: The increased serum immunoglobulin level that occurs in viral hepatitis may persist for at least one to two years after the acute attack. Similar changes have been found in 21 of the expected maximum of 36 carriers of hepatitis virus among 63 blood donors implicated in the transmission of hepatitis. Immunoglobulin assay may provide a useful screening procedure for potential blood donors.

Thermography in mass screening for occult breast cancer.

Abstract: Thermography as a potential method for screening large segments of the population for breast cancer was studied in Minneapolis in a group of 2,523 volunteer women. There was an unacceptably large group wherein the thermogram was read as abnormal but no lesion could subsequently be proved. The reliability of the method was inadequate, since out of four patients diagnosed as having breast cancer, only one was found by thermogram. The examining physician diagnosed two of the lesions as suspicious and these were missed by the thermographic technique. The remaining lesion was missed by the examining physician and an initial reading of the thermogram as suspicious was changed to normal. The presence of technical difficulties and inability to examine women with large, pendulous breasts seemed to further invalidate this method as a logical screening procedure.

Impact of a cytologic screening program on a gynecologic malignancy service.

Abstract: A comprehensive cytologic screening program has been instrumental in the increased case finding and decreased mortality of patients with cervical cancer in a high risk population. In the 7 years of operation, 94,778 smears have been examined and 2327 atypical, 529 suspicious, and 133 positive cytologic examinations have resulted. During this period, there has been a reversal of the former predominance of invasive: in-situ lesions, and an associated redistribution in the stage of tumor exhibited. The multiple impact of an efficient cancer control program on a gynecologic malignancy service has necessitated modification in the therapy of cervical malignancy, in subsequent patient follow-up, and in the training program.