European randomized study of prostate cancer screening: first-year results of the Finnish trial.
(25/10392)
Approximately 20000 men 55-67 years of age from two areas in Finland were identified from the Population Registry and randomized either to the screening arm (1/3) or the control arm (2/3) of a prostate cancer screening trial. In the first round, the participation rate in the screening arm was 69%. Of the 5053 screened participants, 428 (8.5%) had a serum prostate-specific antigen (PSA) concentration of 4.0 ng/ml or higher, and diagnostic examinations were performed on 399 of them. A total of 106 cancers were detected among them corresponding to a positive predictive value of 27%, which is comparable with mammography screening for breast cancer. The prostate cancer detection rate based on a serum PSA concentration of 4.0 ng ml(-1) or higher was 2.1%. Approximately nine out of ten screen-detected prostate cancers were localized (85% clinical stage T1-T2) and well or moderately differentiated (42% World Health Organization (WHO) grade I and 50% grade II), which suggests a higher proportion of curable cancers compared with cases detected by other means. (+info)
Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics.
(26/10392)
OBJECTIVE: To assess the impact of screening on the incidence of and mortality from cervical cancer. DESIGN: Comparison of age specific incidence and mortality before and after the introduction of the national call and recall system in 1988. SETTING: England. SUBJECTS: Women aged over 19 years. RESULTS: From the mid-1960s, the number of smears taken rose continuously to 4.5 million at the end of the 1980s. Between 1988 and 1994, coverage of the target group doubled to around 85%. Registrations of in situ disease increased broadly in parallel with the numbers of smears taken. The overall incidence of invasive disease remained stable up to the end of the 1980s, although there were strong cohort effects; from 1990 incidence fell continuously and in 1995 was 35% lower than in the 1980s. The fall in overall mortality since 1950 accelerated at the end of the 1980s; there were strong cohort effects. Mortality in women under 55 was much lower in the 1990s than would have been expected. CONCLUSIONS: The national call and recall system and incentive payments to general practitioners increased coverage to around 85%. This resulted in falls in incidence of invasive disease in all regions of England and in all age groups from 30 to 74. The falls in mortality in older women were largely unrelated to screening, but without screening there might have been 800 more deaths from cervical cancer in women under 55 in 1997. (+info)
Use of laboratory testing for genital chlamydial infection in Norway.
(27/10392)
OBJECTIVE: To assess the use of laboratory tests for genital chlamydial infection in Norway. DESIGN: Questionnaire survey of general practitioners' practice in chlamydial testing, retrospective survey of laboratory records, 1986-91, and prospective study of testing in one laboratory during four weeks. SETTING: All 18 microbiological laboratories in Norway (4.2 million population), including one serving all doctors in Vestfold county (0.2 million population). SUBJECTS: 302 general practitioners. MAIN MEASURES: GPs' routine practice, methods used for testing, 1986-91, and sex specific and age group specific testing in 1991. RESULTS: 201(69%) GPs replied to the questionnaire: 101(51%) would test all women younger than 25 years at routine pelvic examination, 107(54%) all girls at first pelvic examination, 131(66%) all pregnant women, and 106(54%) all men whose female partner had urogenital complaints. Nationwide in 1986, 122,000 tests were performed (2.9 per 100 population); 10% were positive and 51% were cell culture tests. In 1991, 341,000 tests were performed (8.0 per 100 population); 4.5% were positive and 15% were cell culture tests. 13,184 tests were performed in Vestfold in 1991 (6.6 per 100 population). The age group specific rates (per 100 population) among women were: age 15-19 years, 22.0(95% confidence interval 18.2 to 25.8); 20-24 years, 47.2(42.1 to 52.3); 25-29 years, 42.3(37.1 to 47.5); 30-34 years, 29.8(25.4 to 34.2); and 35-39 years, 12.5(9.5 to 15.5). CONCLUSIONS: GPs use liberal indications for testing. The dramatic increase in testing, especially by enzyme immunoassays, in populations with a low prevalence of infection results in low cost effectiveness and low predictive value of positive tests, which in women over 29 years is estimated as 17-36%. IMPLICATIONS: Doctors should be educated about the limitations of enzyme immunoassays in screening low prevalence populations, and laboratories should apply a confirmatory test to specimens testing positive with such assays. (+info)
Controlling schistosomiasis: the cost-effectiveness of alternative delivery strategies.
(28/10392)
Sustainable schistosomiasis control cannot be based on large-scale vertical treatment strategies in most endemic countries, yet little is known about the costs and effectiveness of more affordable options. This paper presents calculations of the cost-effectiveness of two forms of chemotherapy targeted at school-children and compares them with chemotherapy integrated into the routine activities of the primary health care system. The focus is on Schistosoma haematobium. Economic and epidemiological data are taken from the Kilombero District of Tanzania. The paper also develops a framework for possible use by programme managers to evaluate similar options in different epidemiological settings. The results suggest that all three options are more affordable and sustainable than the vertical strategies for which cost data are available in the literature. Passive testing and treatment through primary health facilities proved the most effective and cost-effective option given the screening and compliance rates observed in the Kilombero District. (+info)
Choice of screening tests.
(29/10392)
In this paper, we consider one of the decisions that have to be made about a screening programme: which type of test to use. Our study shows that knowledge of the sensitivities, specificities, and costs of alternative tests is an inadequate basis for the choice of test. The monetary values of the different possible results of the test must also be estimated, or judgements made about the likely magnitude of these values. If judgements have to be made, they should be explicit, because different individuals are likely to judge differently, and their opinions will critically affect the choice of test. (+info)
Screening for mild hypertension: costs and benefits.
(30/10392)
It is important to understand the full implications of introducing a new screening and treatment programme into the National Health Service. In this paper, we calculate, for mild hypertension, the cost of community-based screening and the cost of case-finding in general practice. We show that case-finding in general practice is both less expensive and more efficient. We calculate the cost of running a programme in general practice for five years and divide that cost by an estimate of the number of deaths that might be prevented as a result of introducing such a programme. This calculation give a minimum cost for extending a life by the programme. (+info)
Epidemiology and screening for prostate cancer.
(31/10392)
This activity is designed for primary care physicians, internists, and general audiences. GOAL: To provide the reader with a basic understanding of the controversy surrounding population-based prostate cancer screening and of the tools needed to conduct early detection programs for prostate cancer among enrollees. OBJECTIVES: 1. Become familiar with the national debate regarding population-based prostate cancer screening. 2. Learn the essential elements of prostate specific antigen testing for patients. 3. Understand the cost-effectiveness and medico-legal/informed consent issues surrounding prostate cancer detection and screening. (+info)
The rationale for skin cancer screening and prevention.
(32/10392)
Skin cancer, the most common malignancy in the United States, accounts for considerable morbidity and mortality. Efforts at lessening the burden of this disease are possible through both primary and secondary prevention, although some barriers may detract from the ability of primary care physicians to perform skin cancer screening. Public education combined with increased vigilance by physicians and other health professionals may significantly alter the morbidity and mortality associated with this disease entity. (+info)