Neuroblastoma Mass Screening in Late Infancy: Insights Into the Biology of Neuroblastic Tumors

2003 ◽  
Vol 21 (22) ◽  
pp. 4228-4234 ◽  
Author(s):  
Reinhold Kerbl ◽  
Christian E. Urban ◽  
Inge M. Ambros ◽  
Hans J. Dornbusch ◽  
Wolfgang Schwinger ◽  
...  
Keyword(s):  
Mass Screening ◽  
Tumor Heterogeneity ◽  
Detection Rate ◽  
Screening Program ◽  
Mycn Amplification ◽  
Screening Programs ◽  
Incidence And Mortality ◽  
Stage 4 ◽  
Genetic Features ◽  
Neuroblastic Tumors

Purpose: Neuroblastoma screening in early infancy has detected predominantly “favorable” tumors. We postponed screening to an age between 7 and 12 months to test whether this shift of screening age might influence the detection rate of genetically/clinically unfavorable tumors. Patients and Methods: In a 10-year period, 313,860 infants were screened by analysis of urine catecholamines. When a neuroblastoma was diagnosed, at least two different areas from every tumor were analyzed for genetic features (MYCN amplification, 1p status, ploidy). Furthermore, neuroblastoma incidence and mortality of the screened group and the cohort of 572,483 children not participating in the screening program were compared. Results: Forty-six neuroblastomas were detected by mass screening. In 17 tumors (37%) at least one of the biologic features was “unfavorable.” In 10 of 17 patients, one or more of these alterations were only focally present (tumor heterogeneity). In the screened cohort, neuroblastoma incidence was significantly higher when compared with unscreened children (18.2 v 11.2/100,000 births), while there was a trend towards lower incidence of stage 4 over 1 year (2.2 v 3.8). Mortality was not significantly different (0.96 v 1.57). Conclusion: In contrast to other neuroblastoma screening programs, more than one-third of patients were found with unfavorable genetic markers in our study. The high proportion of focal alterations suggests that biologically young neuroblastomas may consist of genetically favorable and unfavorable parts/areas/clones. We conclude that at least one-third of neuroblastomas detected by screening in late infancy are anticipated cases. This, however, does not result in significantly reduced mortality.

Which Cases Are Found and Missed by Neuroblastoma Screening at 1 Year? Results From the 1992 to 1995 Study in Three Federal States of Germany

1999 ◽  
Vol 17 (4) ◽  
pp. 1200-1200 ◽  
Author(s):  
F. Berthold ◽  
A. Baillot ◽  
B. Hero ◽  
P. Schurr ◽  
A. Nerenz ◽  
...  
Keyword(s):  
Detection Rate ◽  
Compliance Rate ◽  
False Negative ◽  
Gas Chromatography Mass Spectrometry ◽  
Federal States ◽  
Prognostic Features ◽  
Screening Programs ◽  
German Federal States ◽  
Stage 4 ◽  
Stage 1

PURPOSE: Neuroblastoma screening during the first half-year of life is associated with a two- to three-fold overdiagnosis. Because regression processes seem to be confined to infancy, we investigated whether screening at 1 year would be associated with fewer overdiagnoses, and we investigated the characteristics of thus-detected and not-detected patients. PATIENTS AND METHODS: Thin-layer chromatography was used for semiquantitative assessment of urine samples dried on filter paper and obtained when patients were 10 to 14 months old (sample 1) and 17 to 19 months old (sample 2). Abnormal results were reanalyzed quantitatively from the same specimen by high-performance liquid chromatography and/or gas chromatography–mass spectrometry. RESULTS: A total of 200,054 children of the German federal states Lower Saxony, Northern Rhine-Westphalia, and Bremen were screened from May 1992 to April 1995. Of 229,078 investigated samples (100%), 228,245 (99.6%) were first, 657 (0.3%) were second, and 176 (0.08%) were third urine specimens. The compliance rate was 27.8%, but it continued to increase throughout the study period and in the last year it was 43.3%. The second screening offered at 18 months was accepted by only 12.1% (24,259) of the children. Thirty children underwent clinical examination, and nine asymptomatic neuroblastoma cases were detected (stage 1, n = 4; stage 2, n = 2; stage 3, n = 2; stage 4, n = 1; detection rate, 1:22,228). The results of 21 tests were false-positive. Ten children with false-negative test results presented 8 to 35 months later with neuroblastoma (stage 1 tumor, n = 1; stage 2, n = 1; stage 3, n = 1; stage 4, n = 7; five of nine tumors were N-myc–amplified tumors). Three children were nonsecretors at the time of diagnosis. Fifty-two patients were “missed” (not screened), and 37 children developed neuroblastoma before the age of screening (early cases). During the same period, a total of 23.6 cases per million children within the screening area and 24.0 cases per million children outside the screening area were diagnosed as neuroblastoma cases (not significant [NS]). In prescreening times in the area of the later screening states, 20.7 cases per million children were found (NS). CONCLUSION: Screening at 1 year of age demonstrated a lower detection rate than earlier screening programs and did not produce a “halo effect.” The good prognostic features of early-detected cases and the poor characteristics of not-detected-but-late-presenting cases corresponded to those of the related age groups.

scholarly journals A VIEW ON THE PROBLEM OF INADEQUATE SCREENING OF COLORECTAL CANCER IN UKRAINE

2019 ◽  
pp. 3-5
Author(s):  
Nelya Melnitchouk ◽  
Galyna Shabat
Keyword(s):  
Colorectal Cancer ◽  
Clinical Symptoms ◽  
Screening Program ◽  
Early Stage ◽  
Cancer Death ◽  
Common Cause ◽  
Screening Programs ◽  
Incidence And Mortality ◽  
National Organizations

The incidence of colorectal cancer (CRC) is increasing worldwide and it is the second most common cause of cancer death. There is a lot of investigations and improvement to rise quality of early diagnosis, successful treatment and effective preventions of colorectal cancer. Nowadays available few guidelines of international and national organizations what support effectiveness of screening programs. Colorectal cancer screening is effective way to decrease incidence and mortality with strong evidence confirmed by a lot of investigations of different scientific groups. Currently, Ukraine doesn’t have an established colorectal cancer program, what need to be changed as soon as possible. A lot of patients in Ukraine wait at home till the beginning of clinical symptoms, what often is the representation of later stage of diseases; and of course treatment of patients with later stage of diseases need more costs for treatment and show worst results of morbidity and mortality rate compare with patients treated at the early stage of diseases. We created a simulation Markov model and demonstrated that the implementation of the national screening program for colorectal cancer in Ukraine will be cost saving and will decrease the mortality from colorectal cancer significantly.

scholarly journals Overtreatment in nonmalignant lesions detected in a colorectal cancer screening program: a retrospective cohort study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joaquín Cubiella ◽  
Antía González ◽  
Raquel Almazán ◽  
Elena Rodríguez-Camacho ◽  
Raquel Zubizarreta ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Multivariable Analysis ◽  
Low Risk ◽  
Benign Lesions ◽  
Screening Programs ◽  
Crc Screening ◽  
European Guidelines ◽  
Adenoma Detection ◽  
Incidence And Mortality

Abstract Background Although colorectal cancer (CRC) screening programs reduce CRC incidence and mortality, they are associated with risks in healthy subjects. However, the risk of overtreatment and overdiagnosis has not been determined yet. The aim of this study was to report the surgery rates in patients with nonmalignant lesions detected within the first round of a fecal immunochemical test (FIT) based CRC screening program and the factors associated with it. Methods We included in this analysis all patients with nonmalignant lesions detected between May 2013 and June 2019 in the Galician (Spain) CRC screening program. We calculated surgery rate according to demographic variables, the risk classification according to the colonoscopy findings (European guidelines for quality assurance), the endoscopist’s adenoma detection rate (ADR) classified into quartiles and the hospital’s complexity level. We determined which variables were independently associated with surgery rate and expressed the association as Odds Ratio and its 95% confidence interval (CI). Results We included 15,707 patients in the analysis with high (19.9%), intermediate (26.9%) low risk (23.3%) adenomas and normal colonoscopy (29.9%) detected in the analyzed period. Colorectal surgery was performed in 162 patients (1.03, 95% CI 0.87–1.19), due to colonoscopy complications (0.02, 95% CI 0.00–0.05) and resection of colorectal benign lesions (1.00, 95% CI 0.85–1.16). Median hospital stay was 6 days with 17.3% patients developing minor complications, 7.4% major complications and one death. After discharge, complications developed in 18.4% patients. In benign lesions, an endoscopic resection was performed in 25.4% and a residual premalignant lesion was detected in 89.9%. The variables independently associated with surgery in the multivariable analysis were age (≥60 years = 1.57, 95% CI 1.11–2.23), sex (female = 2.10, 95% CI 1.52–2.91), the European guidelines classification (high risk = 67.94, 95% CI 24.87–185.59; intermediate risk = 5.63, 95% CI 1.89–16.80; low risk = 1.43; 95% CI 0.36–5.75), the endoscopist’s ADR (Q4 = 0.44, 95% CI 0.28–0.68; Q3 = 0.44, 95% CI 0.27–0.71; Q2 = 0.71, 95% CI 0.44–1.14) and the hospital (tertiary = 0.54, 95% CI 0.38–0.79). Conclusions In a CRC screening program, the surgery rate and the associated complications in patients with nonmalignant lesions are low, and related to age, sex, endoscopic findings, endoscopist’s ADR and the hospital’s complexity.

scholarly journals Controlling COVID-19 Pandemic: A Mass Screening Experience in Saudi Arabia

2021 ◽  
Vol 8 ◽  
Author(s):  
Anas A. Khan ◽  
Hadil M. Alahdal ◽  
Reem M. Alotaibi ◽  
Hana S. Sonbol ◽  
Rana H. Almaghrabi ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Mass Screening ◽  
Screening Program ◽  
Demographic Data ◽  
Active Phase ◽  
World Health ◽  
High Risk Population ◽  
Cross Sectional ◽  
Screening Programs ◽  
The World

A highly accelerating number of people around the world have been infected with novel Coronavirus disease 2019 (COVID-19). Mass screening programs were suggested by the World Health Organization (WHO) as an effective precautionary measure to contain the spread of the virus. On 16 April 2020, a COVID-19 mass screening program was initiated in Saudi Arabia in multiple phases. This study aims to analyze the number of detected COVID-19 cases, their demographic data, and regions most affected in the initial two phases of these mass screening programs. A retrospective cross-sectional study was conducted among the high-risk population as part of the COVID-19 mass screening program across all regions in Saudi Arabia during April and May 2020. A Chi-square-test was used to determine the associations between positive cases and various demographic variables. Out of 71,854 screened individuals, 13.50% (n = 9701) were COVID-19 positive, of which 83.27% (n = 59,835) were males. Among positive cases, in the 30–39 years age group, 6.36% were in the active phase, and 2.19% were in the community phase. Based on our experience, launching mass screening programs is crucial for early case detection, isolation, and pattern recognition for immediate public interventions.

Usefulness of Screening for Hypertension

PEDIATRICS ◽  
1984 ◽  
Vol 73 (6) ◽  
pp. 883-884
Author(s):  
DAVID E. FIXLER
Keyword(s):  
Early Detection ◽  
Mass Screening ◽  
Screening Program ◽  
Morbidity And Mortality ◽  
Screening Procedure ◽  
High Yield ◽  
Health Consequences ◽  
Screening Programs ◽  
Appropriate Treatment ◽  
Number Of Patients

In Reply.— Grossman has expressed the opinion that among the criteria for any screening procedure is that the disease being screened for is either prevalent or has severe health consequences. Although these are notable criteria, they in no means represent indications for initiating mass screening programs. Justification for a screening program is based on its having a high yield, that is, that early detection in a significant number of patients will lead to appropriate treatment and a significant decrease in morbidity and mortality.

INTRODUCTION: MASS SCREENING, HEALTH TECHNOLOGY ASSESSMENT, AND HEALTH POLICY IN SOME EUROPEAN COUNTRIES

2001 ◽  
Vol 17 (3) ◽  
pp. 269-274 ◽  
Author(s):  
Wija Oortwijn ◽  
H. David Banta ◽  
Richard Cranovsky
Keyword(s):  
Health Technology Assessment ◽  
Mass Screening ◽  
Technology Assessment ◽  
Screening Program ◽  
Specific Antigen ◽  
Health Technology ◽  
European Countries ◽  
Preventive Strategy ◽  
The European Union ◽  
Screening Programs

Objective: The series of papers in this issue was developed to examine the use of health technology assessment in policies toward prevention—specifically toward mass screening—in European countries. The papers actually examined three screening strategies: mammography screening for breast cancer, prostate-specific antigen screening for prostate cancer, and routine ultrasound in normal pregnancy.Methods: Papers were sought from the member states of the European Union, plus Switzerland. Ultimately, nine acceptable papers were received, and were reviewed, revised, and edited.Results: Screening is an accepted strategy in many countries for reducing the burden of disease through early detection and intervention. In part, this is because of successful screening programs that have been evaluated and implemented in many countries. At the same time, unevaluated and even useless and harmful screening programs—unjustified medically or economically—are widespread. Health technology assessment could help assure that only effective and cost-effective screening programs are implemented.Conclusion: The main conclusion is that screening is an important preventive strategy. Any screening program, however, should be carefully assessed before implementation.

scholarly journals Comparison of Flexible Sigmoidoscopy Screening in Average Risk Patients Performed by Nurses Versus Gastroenterologists

2018 ◽  
Vol 1 (2) ◽  
pp. 82-86 ◽  
Author(s):  
Anas Makhzoum ◽  
Jacob Louw ◽  
William G Paterson
Keyword(s):  
Colorectal Cancer ◽  
Detection Rate ◽  
Flexible Sigmoidoscopy ◽  
Screening Program ◽  
Low Risk ◽  
Adenoma Detection Rate ◽  
Average Risk ◽  
Detection Rates ◽  
Screening Programs ◽  
Adenoma Detection

Abstract Background Screening sigmoidoscopy is effective in reducing mortality from colorectal cancer. In 2009, Cancer Care Ontario (CCO) launched a nurse-performed screening flexible sigmoidoscopy program at Hotel Dieu Hospital, Kingston, Ontario. Prior to this program, there was a pilot sigmoidoscopy screening program by gastroenterologists in a similar average risk cohort. Aim To compare neoplasia detection rates and associated costs of screening sigmoidoscopy performed by nurses and gastroenterologists. Method A retrospective chart review was conducted on flexible sigmoidoscopies performed as part of two average risk screening programs performed by gastroenterologists and nurse-endoscopists. Detected polyps were categorized as hyperplastic, low-risk adenomas or high-risk adenomas. Average cost per procedure was estimated based on physician fee for service charges, nurse wage and benefits, physician supervisory fees, pathology costs and administrative expenses. Results There were 538 procedures performed by nurses and 174 by physicians. Adenomas were detected in 18% of nurse-performed procedures versus 9% in physician-performed procedures (p=0.003), with the higher adenoma detection rate restricted to low risk adenomas. One cancer was found in the physician group. Seven physicians performed the 174 sigmoidoscopies, with one physician performing the majority. This physician’s adenoma detection rate was 4.5%, whereas detection rate for the remaining physicians combined was 16.5%. Nurses biopsied more polyps per case (0.96 versus 0.18). Average estimated cost per case was greater for nurses ($387.54 versus $309.37). Conclusion Well-trained nurse-endoscopists can provide an effective service for colorectal cancer screening, but as currently structured in Ontario, the associated cost is higher for nurse-performed procedures.

Health Economic Analysis of the Neonatal Screening Program in Japan

1994 ◽  
Vol 10 (3) ◽  
pp. 382-391 ◽  
Author(s):  
Akinori Hisashige
Keyword(s):  
Mass Screening ◽  
Metabolic Diseases ◽  
Screening Program ◽  
Cost Benefit ◽  
Screening System ◽  
Health Economic Analysis ◽  
Screening Programs ◽  
Cost Benefit Ratio ◽  
The Cost ◽  
Mass Screening System

AbstractIn Japan, a nationwide mass screening system for neonatal metabolic diseases was established in 1977. This system consisted of screening programs for five main congenital metabolic diseases, including phenylketonuria (PKU). To evaluate the efficiency of the mass screening system, a costbenefit analysis of the screening program for PKU (as a typical case in Japan) was carried out. The costs of the detection and the treatment program were compared with the projected benefit (avoided costs) that results from prevention of the mental retardation associated with the disorders due to PKU. Costs and benefits were discounted at an annual rate of 7%. Assuming that the incidence of PKU was 1/80,500 and the total number of infants screened was 1.2 million, net benefits for the screening program were $283,000, and the cost-benefit ratio was 1:2.5. The sensitivity analysis for the incidence of PKU showed that the cost-benefit ratios exceeded one.

scholarly journals Overtreatment in Nonmalignant Lesions Detected in a Colorectal Cancer Screening Program: A Cross-Sectional Analysis.

2020 ◽  
Author(s):  
Joaquin Cubiella ◽  
Antía González ◽  
Raquel Almazán ◽  
Elena Rodríguez-Camacho ◽  
Raquel Zubizarreta ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Multivariable Analysis ◽  
Low Risk ◽  
Benign Lesions ◽  
Screening Programs ◽  
Crc Screening ◽  
European Guidelines ◽  
Adenoma Detection ◽  
Incidence And Mortality

Abstract Background: Although colorectal cancer (CRC) screening programs reduce CRC incidence and mortality, they are associated with risks in healthy subjects. However, the risk of overtreatment and overdiagnosis has not been determined yet. The aim of this study is to report the surgery rates in patients with nonmalignant lesions detected within the first round of a fecal immunochemical test (FIT) based CRC screening program and the factors associated with it. Methods: We included in this analysis all patients with nonmalignant lesions detected between May 2013 and June 2019. We calculated surgery rate according to demographic variables, the risk classification according to the colonoscopy findings (European guidelines for quality assurance), the endoscopist’s adenoma detection rate (ADR) classified into quartiles and the hospital’s complexity level. We determined which variables were independently associated with surgery rate and expressed the association as Odds Ratio and its 95% confidence interval (CI).Results: We included 15,707 patients in the analysis with high (19.3%), intermediate (25.1%) low risk (21.7%) adenomas and normal colonoscopy (27.8%) detected in the analyzed period. Colorectal surgery was performed in 162 (10.3‰, 95% CI 8.7-11.9), due to colonoscopy complications (0.2‰, 95% CI 0.005-0.5) and resection of colorectal benign lesions (10.0‰, 95% CI 8.5-11.6). Median hospital stay was 6 days with 17.3% patients developing minor complications, 7.4% major complications, one death. After discharge, complications developed in 18.4% patients. In benign lesions, an endoscopic resection was performed in 25.4% and a residual premalignant lesion was detected in 89.9%. The variables independently associated with surgery in the multivariable analysis were age (≥60 years= 1.57, 95% CI 1.11-2.23), sex (female= 2.10, 95% CI 1.52-2.91), the European guidelines classification (high risk= 67.94, 95% CI 24.87-185.59; intermediate risk= 5.63, 95% CI 1.89-16.80; low risk= 1.43; 95% CI 0.36-5.75), the endoscopist’s ADR (Q4= 0.44, 95% CI 0.28-0.68; Q3= 0.44, 95% CI 0.27-0.71; Q2= 0.71, 95% CI 0.44-1.14) and the hospital (third level= 0.54, 95% CI 0.38-0.79). Conclusions: In a CRC screening program, the surgery rate and the associated complications in patients with nonmalignant lesions are acceptable and related to age, sex, endoscopic findings, endoscopist’s ADR and the hospital’s complexity.

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