bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of Abnormal Screens on Delays and Prognostic Indicators of Screen-Detected Breast Carcinoma
Authors: Ganry O , Peng J , Dubreuil A 
Published: January 2017

Background: Delay to diagnosis following an abnormal screening result is associated with morbidity such as anxiety, but its effect on prognosis is unknown. Methods: Using data from the Somme area breast cancer screening programme (France), we identified 29,511 women aged 50–69 years who underwent screening between 1996 and 2000. We prospectively followed women with an abnormal screening result until completion of the assessment process and evaluated the effect of delay to notification, diagnosis and treatment on prognostic indicators. Results: Women with high-suspicion screens (n=976) compared with those with intermediate-suspicion screens (n=1008) were investigated more promptly, presented larger tumours (62% vs 42%, p=0.03), and were more likely to be lymph node positive (36% vs 17%, p=0.02). Compared with a delay to diagnosis ≤1 month, the odds ratio for tumour size greater than 10 mm was 1.4 (95% confidence interval[CI], 0.90–1.90) for a delay of 1 to ≤6 months, and 1.8 (95% CI, 1.02–2.85) for a delay >6 months. Similarly, a 1.4-fold and 2-fold increased risk of lymph node involvement was observed for delays of >3 to ≤6 months and >6 months, respectively, compared with the reference interval. Conclusion: The authors' findings suggest that women with high-suspicion mammograms were investigated more promptly, and that delays to diagnosis of asymptomatic breast carcinoma >6 months were associated with progression of the cancer measured by tumour size >10 mm and lymph node metastasis.
Psychological Consequences of Screening Mammography
Authors: Cockburn Jill , Staples Margaret , Hurley Susan F , De Luise Trudy 
Published: January 2017

To examine the psychological consequences at a number of stages in the screening process for women attending a screening mammography programme. Setting- A pilot mammographic screening programme in Melbourne, Australia. Method — The psychological consequences questionnaire (PCQ; a reliable and valid measure of the psychological consequences of screening mammography) was used to measure the emotional, social, and physical functioning of women in a mammographic screening programme and a control community sample. A screening group (in whom no abnormality was detected at initial screen; n=142) had four measurements: at screening clinic; before results were received; one week after all-clear results were received; and eight months after initial visit. The recall group (who were recalled for further investigation which showed the detected abnormality to be benign; n = 58) had measurements at the same points as the screening group and an additional measurement while waiting at the recall assessment clinic. A randomly selected community control group (n = 52) had measurements one week, two weeks, three weeks; and eight months after consenting to participate. Emotional, social, and physical functioning of women in the screening group did not change over time and at no point differed significantly from that of community controls. The profiles of emotional and physical dysfunction of women in the recall group differed significantly from those of the screening and control groups. The level of emotional and physical dysfunction in the recall group was highest while waiting at recall assessment clinic, and scores were still significantly higher than scores obtained at comparable times from screening and control groups one week after obtaining notification that there was no sign of cancer (emotional P< 0·001; physical P < 0·05). This difference had disappeared eight months after the screening visit, when the level of emotional and physical functioning was similar to that of the screening and control groups. Social dysfunction scores did not change significantly over time and were similar for all three groups. Given that up to 10% of women are recalled for further investigations on first round screening, significant numbers of women may have psychological consequences. This speaks for the necessity for accurate reading of mammograms to minimise the false positive recall rate, and for counselling services to be available at recall assessment centres.
Preventing Manifestations of Hereditary Haemochromatosis through Population Based Screening
Authors: Haddow James E , Ledue Thomas B 
Published: January 2017

To evaluate the efficacy of identifying presymptomatic hereditary haemochromatosis through population based screening. Review the hereditary pattern, prevalence, and clinical manifestations of haemochromatosis. Estimate the detection and false positive rates associated with available screening and diagnostic tests. Develop examples of screening protocols and other components that would be necessary for proper implementation. Identify potential barriers and objections. Hereditary haemochromatosis, an autosomal recessive disorder with a prevalence of three to five per thousand in the general population, is associated with a wide variety of clinical manifestations, usually beginning in mid to late adult years. Identifying and treating this disorder after symptoms appear can arrest its progress but usually cannot reverse existing damage to joints, liver, pancreas, pituitary gland, and other organs. Measuring transferrin saturation in serum is now known to be a reliable screening test for haemochromatosis when applied to a general population of healthy adults, detecting about 80% of cases, with a 0·3% false positive rate. Liver biopsy with iron staining and total iron concentration is the recommended diagnostic test for subjects with positive screening tests. Treatment with phlebotomy can then prevent manifestations. Effective systematic identification and management of presymptomatic haemochromatosis in the general population is best accomplished within the framework of an organised screening programme. Potential barriers include accessibility of young adult populations and attitudes in the health community that severe clinical manifestations are relatively uncommon. It is recommended that pilot programmes be undertaken to determine the feasibility of introducing screening for haemochromatosis as part of routine health care.
Screening for Melanoma and Options For-Its Evaluation
Authors: Elwood J M 
Published: January 2017

A review of the published evidence presented here argues that screening for melanoma is recommended and practised at present, but with wide diversity of opinions about its value; there is evidence that screening has considerable potential for benefit, but the evidence of actual benefit is limited; and there are substantial costs and potential hazards from screening. On this basis the evaluation of screening procedures for melanoma is important, and options for this are discussed. The ideal study design to assess the efficacy of melanoma screening in reducing mortality is a large scale randomised trial. This may need a well coordinated proposal involving several centres in one or more countries, and the cost would be substantial. Without such a trial, however, it is most likely that increasing resources will be put into poorly designed screening programmes of unknown value. The simplest and strongest designs use individual randomisation, but group randomisation designs may have practical advantages, though they require a greater sample size. Designs based on general population screening, and on screening only high risk groups, are both considered. They answer different questions. In countries with high incidence the value of general population screening is probably the more critical. Not enough is known to specify the type and frequency of screening precisely; both screening by doctors and self screening require evaluation, and annual screening should probably be tested. The age range at risk will depend on the local incidence, but is likely to be quite wide — for example, 45–69, and both sexes need inclusion. Thus a suggested design for a moderate to high incidence area would be a trial, randomised by individual or group, assessing at least two annual rounds of both screening by doctor and self screening (ideally by a factorial design), for adults aged 45–69, with mortality over several years' follow up as the critical outcome. In an area with good data systems such a study could compare screening offered to some 260.000 subjects with 10 times that number of controls passively followed up, with 90% power to detect a one third reduction in mortality. A general assessment of costs over five years gave estimates of $8.3 million for the screening programme and $2.4 million for the evaluation. The much weaker designs, area based cohort studies using individual data or a simpler ecological comparison, and case-control studies, are also considered. If well designed with attention to their methodological limitations they may be valuable but are unlikely to be as definitive as a randomised trial.
Tumour Markers and Screening for Gastrointestinal Cancer: A Follow up Study in Finland
Authors: Hakama Matti , Stenman Ulf-Hakan , Knekt Paul , Järvisalo Jorma , Leino Aila , Hakulinen Timo , Maatela Jouni , Aromaa Arpo 
Published: January 2017

Screening for gastrointestinal cancer is based mainly on a barium contrast x ray method and on identification of occult blood in stools. The methods are relatively expensive, not always acceptable to the participants, and there is only limited evidence of their effectiveness in reducing the mortality from gastrointestinal cancer. Objective - To investigate the validity of several tumour markers as a screening test for stomach cancer and for colorectal cancer. A registry of 36 265 serum samples drawn during 1968–72 was linked to the cancer registry. Follow up was during 1968–80 when 94 stomach cancers and 95 colorectal cancers were identified. One to two matched case-control design was applied, and the concentrations of CEA, CA 19–9, CA 50, and TATI were assessed. The mean values of the markers between the cases and the controls were almost the same for the total material. Case-control differences were found between the 11 sets with an interval of less than one year between drawing the sample and diagnosis of the cancer. The highest validity was found in CEA for colorectal cancer (specificity 91%; sensitivity 64%) and in CA 19–9 for stomach cancer (specificity 74%; sensitivity 73%). Conclusion — CEA, CA 19–9, CA 50, or TATI are not valid screening tests. Case-control differences were found with a potential one year screening interval, but they were not large enough for sufficient validity.
Encouraging Attendance at a Screening Mammography Programme: Determinants of Response to Different Recruitment Strategies
Authors: Schofield P E , Cockburn J , Hill D J , Reading D 
Published: January 2017

To predict attendance at a mammographic screening programme after a community health promotion campaign and attendance after a personal invitation in addition to that campaign. Setting – A pilot mammographic screening programme in Melbourne, Australia. Methods — Attendance was encouraged by a community health promotion campaign and one year later, a personal invitation was sent to all women who had not yet attended. Drawn from two regions of a defined area (close to and distant from the screening centre), 618 women were interviewed before the programme started, and subsequent attendance at the programme was recorded. Over half of the women (58%) in the sample residing close to the screening centre and 44% of women in the more distant sample attended. The personal invitation boosted attendance, particularly in the distal sample where attendance was more than doubled. Overall, attendance was predicted by ease of access to the programme; positive intention to attend; moderate experience of, perceived susceptibility to, concern about, and knowledge of breast cancer; adoption of other preventive health behaviours; having a job; and older age. Proximity to the programme, positive initial intentions, having heard of a mammogram, no concern about radiation from a mammogram, high personal control over health, and belonging to a club were associated with attendance after exposure to only the health promotion campaign. A personal invitation encouraged attendance among women without these characteristics. A personal invitation in addition to a community promotion campaign seems to overcome many barriers to attendance. Attendance may be further increased by informing women of the benefits of early detection and improving access to the screening centre.
Use of Anonymous Newborn Serosurveys to Evaluate Antenatal HIV Screening Programmes
Authors: Holland F J , Ades A E , Davison C F , Parker S , Berry T , Hjelm M , Wilcox A H , Cubitt D , Hudson C N , Peckham C S 
Published: January 2017

To evaluate the extent to which antenatal HIV screening programmes identify HIV infected women who go to term. Comparison of results of two surveillance systems. An anonymous neonatal HIV serosurvey was used to estimate the numbers of HIV infected women giving birth; reporting by obstetricians was used to assess the proportion who had been identified. Three Thames regions. 729 105 neonatal blood samples were tested, of which 484 were HIV seropositive. Newborn HIV seroprevalence is increasing, at different rates, in inner London, suburban London, and in non-metropolitan districts. During the past four years the proportion of infected women who have been identified before delivery is 16.9%, but less than half of these were diagnosed during pregnancy. In 1993 only five of the 128 (4%) previously undiagnosed infected women delivering babies were identified by antenatal screening. Despite increased emphasis on antenatal testing for HIV in areas of higher prevalence the number of undiagnosed women delivering babies continues to increase. Consideration should be given to alternative strategies for offering antenatal HIV testing. Antenatal screening programmes should be monitored continuously by comparing anonymous neonatal seroprevalence with clinical reports from obstetricians.
Improving Breast Screening Uptake: Persuading Initial Non-Attenders to Attend
Authors: Turner Katrina M , Wilson Brenda J , Gilbert Fiona J 
Published: January 2017

Firstly, to determine whether the acceptance rate of the second invitation for breast screening (sent to women who have failed to attend after the first invitation) might be increased by an accompanying letter from a general practitioner (GP letter). Secondly, to identify the additional costs of sending such a letter. 465 women registered with four practices in a single health centre were recruited into a randomised controlled trial in which the intervention was the inclusion of a standard, photocopied letter signed by the non-attender's doctor with the second invitation to attend for breast screening. The control group received only the standard invitation from the breast screening centre. The costs associated with the intervention were assessed from data supplied by the breast screening centre, supplemented by direct observation of the preparation of second invitations and semistructured interviews with the staff taking part. The attendance rate of the test group one month after the second invitation for screening was significantly higher than that of the control group (21% v 10%, P<0.01). The average cost of a GP letter included with the invitation was 1.1 pence and the marginal cost for each extra attender was 9.6 pence. No non-monetary costs were identified. The inclusion of a GP letter appeared to be effective and feasible in increasing the attendance rate to the second invitation. This intervention should be tested in other screening groups to confirm the effectiveness of a GP letter and its cost effectiveness.
Is Screening Once at Age 65 an Effective Method for Detection of Abdominal Aortic Aneurysms?
Authors: Khoo D E , Ashton H , Scott R A P 
Published: January 2017

To evaluate whether a single screening at 65 or screening at 65 and 70 are the methods of choice to detect the majority of abdominal aortic aneurysms (AAA) suitable for treatment. District general hospital, district general practice and community. Data were collated from four studies (a pilot, a control trial, and two cohorts) of abdominal ultrasound screening of an invited group of 11 666 men and women aged 65–80 to derive age related prevalence, invitation acceptance rates, and operative mortality. Deaths from AAA rupture were obtained from district registrars' returns. The prevalence of AAA increased with age being greater overall in men (6·8%) than in women (1·2%). From ages 65 to 80 the prevalence in men increased from 5·4% to 10·4%, and in women from 0·6% to 2·1%. In men and women 4% of patients dying from AAA rupture were aged 65 or under and 85% of deaths occurred over the age of 70. Acceptance rates for screening decreased between 65 and 80 from 80·5% to 66·2% in men and from 72·7% to 58·3% in women. In elective or symptomatic patients operative mortality was zero up to the age of 70, increasing to 7·1% in older patients. Men should be screened at age 65 to obtain a high acceptance rate and to identify those with AAA most likely to benefit from treatment. The prevalence is relatively low at this age so an additional screen at age 70 is recommended, which would pick up a further 3·7% of patients with AAA, at which age intervention is likely to be of benefit.
Tailored Written Invitations for Second round Breast Cancer Screening: A Randomised Controlled Trial
Authors: Meldrum Patricia , Turnbull Deborah , Dobson Hilary M , Colquhoun Carol , Gilmour W Harper , McIlwaine Gillian M 
Published: January 2017

Firstly, to determine if attendance for second round mammography screening in those sent a tailored letter (that is, making reference to their screening history) is increased compared with those sent a standard letter; secondly, to investigate the acceptability of tailored letters. North West Glasgow Breast Screening Centre. A randomised controlled trial. Overall attendance was unrelated to whether the women were sent a tailored or standard letter; 60% of those sent the standard letter attended (922/1531) compared with 62% of those sent the tailored letter (956/1552) (χ2 = 0·61, P = 0·4) (difference 2%; 95% confidence interval − 2% to 5%). There were no significant differences in percentage attendance within each of the study subgroups: women who attended previously and received an all clear result, women who attended previously and received a false positive result, women who were invited previously and failed to attend, and women who were previously too young to be invited for screening. However, there was a statistically significant difference in percentage attendance between these four groups, independent of letter type (χ2 = 510, P<0·00001). Although women found the letters acceptable and understandable, they did not seem to pay close attention to the content. Tailoring invitation letters does not have a significant effect on uptake rates for breast screening and does not justify the additional workload required.
UK Cervical Cancer Screening Programme: Setting a Research Agenda
Authors: Davies Christina , Brown Jackie 
Published: January 2017

The UK national cervical cancer screening programme aims at reducing the incidence of and mortality from carcinoma of the cervix. It is generally agreed that high grade cervical intraepithelial neoplasia should be treated aggressively, but the appropriate management strategies for women with lesser degrees of abnormality are uncertain because of the inability to distinguish lesions that are likely to progress to invasive disease from those that will regress spontaneously. The role of human papillomavirus (HPV) and the possible usefulness of HPV testing as a secondary screening tool in women with borderline or mild dyskaryosis is also unknown. This paper proposes an agenda for research into the uncertainties within the UK screening programme, suggesting that priority should be given to determining the most appropriate referral and management policies and the use of HPV DNA assay for women with borderline and mild dyskaryosis, so that those women at highest risk of developing invasive disease are treated. A randomised controlled trial is needed. The practical and methodological difficulties which would need to be considered and the need to convene a multidisciplinary research team to develop and implement the trial are highlighted.
Breast Screening: Adverse Psychological Consequences One Month after Placing Women on Early Recall Because of a Diagnostic Uncertainty. A Multicentre Study
Authors: Ong Giok , Austoker Joan , Brett Jo 
Published: January 2017

Background— It was the original intention of the UK National Health Service Breast Screening Programme (NHSBSP) to place women who were not diagnosed with cancer on three yearly routine recall (RR). In 1994–5 approximately 16 500 women, aged SO to 64, were placed on early recall (ER) at a shorter time interval, of which about 98% will have a normal result. This large number exceeds the expectations of the NHSBSP. Objective— To establish the adverse psychological consequences (PCs) for women one month after placement on ER because of a diagnostic uncertainty, and if detected, to suggest practical solutions to reduce them. Methods— Thirteen breast screening centres throughout the UK participated in the study. From March to October 199S all women who were placed on ER because of a diagnostic uncertainty were identified and compared with groups of women placed on RR (after mammography, assessment, fine needle aspiration, and a benign biopsy). These women were invited to complete a postal questionnaire one month after they were placed on ER or RR. One reminder was sent. Results— Overall 75% of women completed the questionnaire. The adverse PCs of placing women on ER because of a diagnostic uncertainty were higher (63%; n=81 of 130) than those of women placed on RR after mammography (29%; n=38 of 130) (P<0.00001) or assessment (50%; n=64 of 128)(Plt;0.05), but lower than the adverse PCs of women who underwent a benign biopsy (87%; n=26 of 30)(P<0.05). Factors that were significantly associated with subsequent adverse PCs were identified. Conclusions— The adverse PCs of being placed on ER because of a diagnostic uncertainty were significantly higher than those of women who turned out to have a false-positive mammographic result after assessment. Possible practical solutions are discussed.