Showing papers on "Mass screening published in 1982"

Ten- to Fourteen-Year Effect of Screening on Breast Cancer Mortality

Abstract: Results from the randomized trial conducted by the Health Insurance Plan (HIP) to determine the efficacy of breast cancer screening with mammography and palpation are reported for longer periods than previously available. By the end of 10 years after entry, the study group's mortality due to breast cancer was about 30% below the control group's. Arithmetic gains due to screening were maintained through year 14; relative gains declined. With increases in the period of follow-up, cumulative survival rates among cases detected by mammography alone (palpation negative during screening), decreased more rapidly than rates among other subgroups, but survival rates for mammography cases remained relatively high. Study women aged 40-49 years at entry began to show lower breast cancer mortality than those in the control group as duration of follow-up increased. Reservations are advanced about the acceptance of this finding as evidence of the efficacy of screening under age 50 under the conditions of the HIP study. The reservations are based on the observation that the decrease of mortality among the study group aged 45-49 at entry is concentrated entirely among cases diagnosed after they reached 50 years of age.

IgE screening in 1701 newborn infants and the development of atopic disease during infancy.

Abstract: IgE screening was done using the Phadebas IgE PRIST technique on the cord blood of 1701 newborn infants. Of these 8.3% developed obvious or probable atopic disease, predominantly atopic dermatitis and bronchial asthma, during the first 18 months of life. Of infants with a family history of atopic disease 10.5% developed such illness; the corresponding figure for infants with an initially high IgE concentration was 70%. Atopic disease developed in 73% of infants with a high IgE concentration in cord blood and a family history, but in only 3% of infants with a low IgE and no family history. A high IgE concentration in cord blood was associated with a high IgE and a positive radioallergosorbent test at between ages 18 and 24 months more often than was a low initial IgE level, indicating that in man as in animals there are high and low IgE responders already genetically coded at birth. IgE screening in cord blood is recommended if there is obvious atopy in both parents or if severe atopic disease if present in a sibling or in one parent.

Pseudoexfoliation, Intraocular Pressure, and Senile Lens Changes in a Population-Based Survey

Abstract: • The prevalence rate of pseudoexfoliation among persons in the Framingham Eye Study, a population-based survey, increased from 0.6% for ages 52 to 64 years to 2.6% for ages 65 to 74 years to 5.0% for ages 75 to 85 years. Age-adjusted rates showed a statistically significant 2.3 to 1.0 female to male ratio. Pseudoexfoliation was associated with higher intraocular pressure levels and more frequent senile lens changes, but the latter relationship was not statistically significant. The age-specific prevalence rates for the Framingham population are similar to those reported from a mass screening of subjects in Norway, where the condition is thought to be especially common. Some of the previously reported geographic variations in prevalence rates may be due to differences in disease definitions, subject selection, and examination conditions.

A prospective prevalence study of scoliosis in Southern Sweden.

Abstract: In Malmo, Sweden, 17,181 school children born in the years 1961-1965 were screened for scoliosis once a year between the ages of 7 and 16 years, during 1971-1980. Children with clinical signs of scoliosis including a positive forward bending test were admitted to the Department of Orthopedic Surgery for reinvestigation and AP roentgenograms. There were 474 children with a scoliosis measuring 5 degrees of more (prevalence 2.8 per cent). Among the girls this prevalence was 4.3 per cent (n = 367) and among the boys 1.2 per cent (n = 107). This combined screening test revealed in girls a higher percentage of scoliosis measuring 10-14 degrees than 5-9 degrees, 1.3 and 1.1, respectively. In boys, however, the number of curves measuring 5-9 degrees was almost equal to the number exceeding 9 degrees. Thus, the rotational component of the scoliosis seems to be less pronounced in girls and curves less than 10 degrees can easily be missed in them. Therefore, 10 degrees is recommended as the lower limit when using this screening technique. With 10 degrees as the lower limit, the scoliosis prevalence was 3.2 per cent in girls and 0.5 per cent in boys. Ninety-six of the girls (1.1 per cent) had a scoliosis exceeding 19 degrees. 46 showed a progression of the scoliosis, which indicated brace treatment in 42 cases and surgical treatment in 4 cases. Among the boys 12 had curves measuring more than 19 degrees (0.14 per cent). Four boys with curves exceeding 24 degrees were treated with a brace. Thus, the risk of progression was higher in girls as compared with boys; 0.5 per cent of the girls and 0.05 per cent of the boys were treated. Another 0.2 per cent of the girls should also have been treated but, for various reasons, treatment was not carried out.

Attendance at a breast screening clinic: a problem of administration or attitudes

Abstract: In a study of why a sample of women, aged 45-64 and registered with a group practice in Edinburgh, attended or did not attend the Edinburgh Breast Screening Clinic demographic, aetiological, social, and perceptual characteristics of attenders and non-attenders were compared. Similar proportions of attenders and non-attenders knew the chance of a breast lump being cancer and were aware of the benefits of early diagnosis and treatment. The study, however, suggests that non-attenders saw the screening clinic as a place of risk while the attenders saw screening in a positive light: 79% of non-attenders as compared with 36% of attenders said that they were afraid of cancer being found, and most women attended either to reassure themselves that they had not got breast cancer or to receive early treatment if they had. Furthermore, 72% of non-attenders as compared with 13% of attenders were anxious that their lives would be disrupted if cancer were found at the screening clinic. There may well be an important irreducible element to non-attendance due to attitudinal factors; the ethical implications of attempting to eliminate this require careful consideration.

Case definition in case-control studies of the efficacy of screening.

Abstract: Evaluation of the efficacy of screening programs involves the comparison of morbidity or mortality rates between screened and unscreened populations. Such comparisons are made most convincingly by means of experiments (1, 2), exemplified by the study of screening for breast cancer carried out by the Health Insurance Plan of Greater New York (HIP) (3). However, there are serious practical difficulties with experimental studies of screening: they are expensive, may require many years to complete, and usually can be done only when new screening procedures are introduced. Once a procedure is established as a part of medical practice, as the Papanicolaou (Pap) smear is, it may be necessary to rely on nonexperimental methods to evaluate it. Nonexperimental studies are more susceptible than are experimental ones to "confounding." For example, social class (as reflected in education or income) is directly related to frequency of screening with the Pap smear, but is inversely related to cervical cancer rates; relatively low rates of cervical cancer among frequently screened women could be secondary to their relatively high social class. Despite this drawback of the nonexperimental approach, there may be times when it will be able to provide information that cannot be obtained otherwise. (A discussion of the roles of experi-

Screening for cystic fibrosis by dried blood spot trypsin assay.

Abstract: Immunoreactive trypsin was measured in dried blood specimens from 14,000 infants. A second test was performed in 0 . 2% of the population in whom blood trypsin levels were greater than 80 ng/ml. Five infants with cystic fibrosis were then detected, with only one case of persistent hypertrypsinaemia in whom this diagnosis could not be established. No false-negative test results have yet been identified. Seventeen infants with cystic fibrosis were tested inthe first 2 weeks of life, only one of whom had a blood trypsin concentration less than 80 ng/ml.

Mass screening of neuroblastoma in infancy.

Abstract: A vanillylmandelic acid spot test for screening infants for neuroblastoma was developed in cooperation with 11 health centers in Kyoto, Japan. In this system, the parent sends a filter paper spotted with the infant's urine at 6 or 7 months of age. From 78,331 infants screened during the six years from July 1973 to September 1979, four asymptomatic infants with neuroblastoma were discovered. Three of them have already completed their treatments and have recovered. The cost of screening 13,000 infants per year was $7,500. One false-negative test was encountered, as were a number of false-positive tests.

Moiré Topography in School Screening for Structural Scoliosis

Abstract: Schoolgirls, aged 10-17 years, were screened for structural scoliosis at school using both conventional clinical screening with a forward bending test and moire topography. Those suspected of having scoliosis were examined in an orthopaedic clinic for the presence of clinically significant scoliosis, defined as lateral deviation of 10 degrees or more measured according to Cobb. The screening revealed 41 cases of scoliosis, corresponding to a prevalence of 4.1 per cent. In 39 girls the scoliosis had not been recognized previously. In this study moire topography revealed twice as many cases of scoliosis as did conventional clinical screening. The diagnostic sensitivity of moire topography proved to be high (0.997). The method is, however, loaded by many false positive results. No correlation between the degree of lateral deviation, judged by X-ray examination, and the difference in contour lines, judged by moire topography, was found.

Alcohol consumption and blood pressure: survey of the relationship at a health-screening clinic.

Abstract: We studied the association between stated alcohol consumption and blood pressure, making allowance for age, adiposity and smoking in 13535 men and 7385 women who were not receiving antihypertensive treatment. They represented a wide cross-section of the inner Sydney working population with 95% aged between 18 and 70. We found a high degree of linear correlation between stated alcohol consumption and blood pressure, diastolic and systolic. This relationship was independent of age, adiposity and smoking. For each 100 g/week increase in stated alcohol consumption, diastolic blood pressure increased by 0.12 kPa (0.92 mmHg) in men and by 0.20 kPa (1.5 mmHg) in women; no threshold for this effect was evident. A plateau appeared at about 500 g/week. Blood pressure increased significantly with age and adiposity (Quetelet's index). Smoking was associated with a lower diastolic blood pressure. The difference in mean diastolic blood pressure between smokers and non-smokers was 0.20 kPa (1.5 mmHg) for men and 0.27 kPa (2.1 mmHg) for women.

Pre-School Children with Impaired Hearing in Göteborg 1964 -1980

Abstract: Two audiological test methods - Respiration Audiometry and Visual Reinforcement Audiometry (VRA) - have been developed at the Department of Audiology, Sahl-grenska Hospital, Goteborg. The most suitable age for Respiration Audiometry is neonatal period up to 5 months and for VRA 10 months up to 2 years. A programme for early identification of hearing impairment in children was started in Goteborg in 1970. The programme included identification of high-risk infants at maternity hospitals, information to parents about hearing and language development and screening of hearing at the child welfare clinics at the age of 8 months and again at the age of 4 years. Children who failed the screening test underwent hearing assessment at the Department of Audiology. During a ten-year period (children born 1970-1979) 179 children with impaired hearing had their hearing impairment diagnosed. Seventeen per cent of them were high-risk children from maternity hospitals, 28% came from child welfare clinics, 24% from other me...

Growth, development, and reassessment of hypothyroid infants diagnosed by screening.

Abstract: Thirty]six neonates in whom hypothyroidism was diagnosed after thyroid stimulating hormone screening were reassessed at 1 year. All had grown satisfactorily and the mental development scores were normal in all except two. Treatment was withdrawn in 32 and persistent hypothyroidism was confirmed in 31 cases. Thyroid stimulating hormone concentrations were raised in one-third of cases before the withdrawal of treatment and this was associated with generally lower concentrations of serum thyroxine (T4) and smaller doses of L-thyroxine than in those cases with normal concentrations of thyroid stimulating hormone. In treating congenital hypothyroidism, serum T4 concentrations should be monitored regularly and the dose of thyroxine adjusted to maintain serum T4 in the upper part of the reference range.

Prospects for eliminating racial differences in breast cancer survival rates.

Abstract: Results from the randomized trial underway in the Health Insurance Plan of Greater New York to determine the efficacy of periodic screening with mammography and palpation of the breast have been examined to determine the effect of screening on racial differences in breast cancer survival rates. Consistent with experience in general populations, the control group showed a lower five-year survival rate among non-White women with breast cancer than among White women. In the study group, 65 per cent of whom participated in the screening program, there was no differential in the survival rates of the two racial groups. The elimination of the unfavorable status among non-Whites through screening does not appear to be explained by various artifacts explored. Secondary prevention measures may offer the possibility of reducing or closing the gap in breast cancer survival rates between White and non-White women.

Screening for cancer of the uterine cervix in Iceland 1965--1978.

Abstract: The trends in the mortality and morbidity from cervical cancer in Iceland for the period 1965–1978 are examined in relation to the screening programme that began in 1964. By 1970 over 80% of the female population under the age of 65 had been screened at least once, and by 1977 over 65% of women under the age of 75 had been screened at least twice. Mortality fell by 60% between 1959–1970 and 1975–1978, with a corresponding fall in the incidence of advanced tumors. The mortality rates among the unscreened population are more than ten-fold greater than among the screened. The greater part of the fall in mortality is attributed to the mass screening programme.

Optimising the age, number of tests, and test interval for cervical screening in Canada.

Abstract: Different approaches to screening for cancer of the cervix by cervical cytology have been evaluated using a computer simulation model developed by Knox and data on the natural history of carcinoma-in-situ (or worse) from a cohort study of women screened in British Columbia, 1949-69. The natural history input parameters and the output parameters without screening were modified to reflect the earlier onset of carcinoma-in-situ in younger cohorts now being experienced in British Columbia, resulting in simulated mortality from carcinoma of the cervix approximately 50% greater than that experienced in Canada in 1955. The simulations showed that the sensitivity of the test and the proportion of women in the population who accept invitations to attend for screening materially influence the extent to which programmes reduce mortality. Missed screens also have an important impact. With a 75% test sensitivity, and an 80% population acceptance, a programme designed to reduce mortality by 90% would commence at age 25, involve triennial screens to age 52, or triennial screens to age 40 and quinquennial screens to age 60, a total of 10 tests in a lifetime. A repeat test at age 26 contributes nothing to the mortality benefit. Nevertheless, additional modifications of the natural history specifications to accommodate high-risk younger women would require a more frequent schedule of examinations under the age of 35, though at a substantial 'cost' in terms of the total number of examinations required in a population.

Chemiluminescence enzyme immunoassay of 17 alpha-hydroxyprogesterone using glucose oxidase and bis(2,4,6-trichlorophenyl) oxalate - fluorescent dye system.

Abstract: A highly sensitive enzyme immunoassay of 17α-hydroxyprogesterone has been developed. Glucose oxidase was used as a label enzyme and the double antibody solid phase method was adopted to separate the bound and free fractions after the immune reaction. In the assay of enzyme activity, hydrogen peroxide generated from glucose added as substrate was measured by the chemiluminescence reaction using bis (2, 4, 6-trichlorophenyl) oxalate and 8-anilinonaphthalene-1-sulfonic acid. The detection limit of this method is 0.5 pg/tube. The method is applicable to mass screening for congenital adrenal hyperplasia in neonates.

ASSESSMENT OF PLASMA TOTAL CHOLESTEROL AS A TEST TO DETECT ELEVATED LOW DENSITY (BETA) LIPOPROTEIN CHOLESTEROL LEVELS (TYPE IIa HYPERLIPOPROTEINEMIA) IN YOUNG SUBJECTS FROM A POPULATION-BASED SAMPLE

Abstract: The measurement of plasma total cholesterol as a screening test for an increased plasma level of low density lipoprotein cholesterol (greater than age- and sex-adjusted 95th percentile) with a normal plasma triglyceride level (type IIa hyperlipoproteinemia) was assessed in 1325 young subjects, aged 6 to 19 years, from seven North American populations during the years 1972-1976. When the age- and sex-specific 95th percentile for total cholesterol was used as the cutpoint for hypercholesterolemia, almost one third of young subjects with type IIa hyperlipoproteinemia were undetected (false negatives), and 40% of the test results were falsely positive. Ninety-eight per cent of all non-type IIa subjects were correctly identified. Lowering the percentile cutpoint decreased the false negative results but increased the false positive results; increasing the cutpoint had an opposite effect. Females had higher percentile cholesterol values than males; when extrinsic, arbitrary cholesterol cutpoints (175-210 mg/100 ml) for screening were used, there were fewer false negative but more false positive results in the females than in the males. When the prevalence of type IIa hyperlipoproteinemia was increased from 5 to 50%, the false positive tests decreased from 40 to 2%. A two-step screening for hypercholesterolemia did not improve efficiency. The use of plasma total cholesterol as a test for type IIa hyperlipoproteinemia in a general population results in a relatively large number of false positive and false negative tests.

Essential hypertension and psychological functioning: A study of factory workers

Abstract: This study was designed to examine the links between psychological characteristics and mild essential hypertension Hypertensives were identified through mass screening of industrial populations Sixteen men under the age of 56 whose blood pressure remained above 145/90 (145/95 for the 45-55 age group) on three separate occasions were compared with 13 age-matched normotensives from the same population Participants completed a series of personality questionnaires, and carried out concurrent mood ratings and blood pressure self-monitoring four times daily for 14 days Subjects remained unaware of their diagnostic status until the procedure was completed No differences between groups were found on measures of trait anxiety, total hostility or direction of hostility State anxiety and Type A (coronary-prone) scores were significantly higher in normotensives than in hypertensives Analysis of mood and self-monitored blood pressure revealed consistent correlations between negative mood and higher pressure in both groups Comparison of correlations between blood pressure, tension and anger with the correlations of pressure with a control mood scale permitted spurious associations based on expectancies or reporting biases to be distinguished from genuine effects Only the correlation between tension and systolic pressure in the hypertensive group exceeded the correlation with the control mood scale Self-monitored pressure also correlated with pressure levels recorded in the laboratory These results suggest that examination of blood pressure variations and psychological factors on a longitudinal basis may be valuable, particularly in the development of self-management procedures for essential hypertensives