Colorectal cancer(CRC)is the second most frequent malignant disease in Europe.Every year,412 000people are diagnosed with this condition,and 207 000patients die of it.In 2003,recommendations forscreening programs were...Colorectal cancer(CRC)is the second most frequent malignant disease in Europe.Every year,412 000people are diagnosed with this condition,and 207 000patients die of it.In 2003,recommendations forscreening programs were issued by the Council of the European Union(EU),and these currently serve as thebasis for the preparation of European guidelines forCRC screening.The manner in which CRC screening iscarried out varies significantly from country to countrywithin the EU,both in terms of organization and thescreening test chosen.A screening program of onesort or another has been implemented in 19 of 27 EUcountries.The most frequently applied method is testing stool for occult bleeding(fecal occult blood test,FOBT).In recent years,a screening colonoscopy hasbeen introduced,either as the only method(Poland)orthe method of choice(Germany,Czech Republic).展开更多
AIM： To compare high resolution colonoscopy （Olympus Lucera） with a megapixel high resolution system （Pentax HiLine） as an in-service evaluation. METHODS： Polyp detection rates and measures of performance were c...AIM： To compare high resolution colonoscopy （Olympus Lucera） with a megapixel high resolution system （Pentax HiLine） as an in-service evaluation. METHODS： Polyp detection rates and measures of performance were collected for 269 colonoscopy procedures. Five colonoscopists conducted the study over a three month period, as part of the United Kingdom bowel cancer screening program. RESULTS：There were no differences in procedure duration （x^2 p = 0.98）, caecal intubation rates （x^2 P = 0.67）, or depth of sedation （x^2 P = 0.64）. Mild discomfort was more common in the Pentax group （x^2 p = 0.036）. Adenoma detection rate was significantly higher in the Pentax group （x^2 test for trend P = 0.01）. Most of the extra polyps detected were flat or sessile adenomas. CONCLUSION： Megapixel definition colonoscopes improve adenoma detection without compromising other measures of endoscope performance. Increased polyp detection rates may improve future outcomes in bowel cancer screening programs.展开更多
（Screening programs for cervical cancer： a ＂SWOT＂ investigation in the Calabria Region）---The low adherence to screening programs for cervical cancer in Calabria, was analyzed by performing a SWOT analysis with c...（Screening programs for cervical cancer： a ＂SWOT＂ investigation in the Calabria Region）---The low adherence to screening programs for cervical cancer in Calabria, was analyzed by performing a SWOT analysis with concerned health professionals. The survey shows that screening organized in Calabria is active and well regulated, the human and financial resources are scarce and the healthcare management has paid little attention to the prevention of women＇s cancers. In the perspective of a necessary improvement of the regional system of screening, it would be appropriate to enable promotion strategies and more effective communication, overcoming possible cultural factors hindering.展开更多
AIM:To assess:(1)frequency and clinical relevanceof gluten sensitive enteropathy(GSE)detected by serology in a mass screening program;(2)sensitivity of antitransglutaminase(tTGA)and antiendomysium antibodies(EmA);and(...AIM:To assess:(1)frequency and clinical relevanceof gluten sensitive enteropathy(GSE)detected by serology in a mass screening program;(2)sensitivity of antitransglutaminase(tTGA)and antiendomysium antibodies(EmA);and(3)adherence to gluten-free diet(GFD)and follow-up. METHODS:One thousand,eight hundred and sixtyeight subjects recruited from an occupational health department underwent analysis for tTGA and EmA and, if positive,duodenal biopsy,DQ2/DQ8 genotyping, clinical feature recording,blood tests,and densitometry were performed.Since>98%of individuals had tTGA <2 U/mL,this value was established as the cut-off limit of normality and was considered positive when confirmed twice in the same sample.Adherence to a GFD and follow up were registered. RESULTS:Twenty-six(1.39%)subjects had positive tTGA and/or EmA,and 21 underwent biopsy:six Marsh Ⅲ(oneⅢa,fourⅢb,oneⅢc),nine MarshⅠand six Marsh 0(frequency of GSE 1:125).The sensitivity of EmA for GSE was 46.6%(11.1%for MarshⅠ,100% for MarshⅢ),while for tTGA,it was 93.3%(88.8% for MarshⅠ,100%for MarshⅢ).All 15 patients with abnormal histology had clinical features related to GSE.MarshⅠandⅢsubjects had more abdominal pain than Marsh 0(P=0.029),and a similar trend was observed for distension and diarrhea.No differences in the percentage of osteopenia were found between MarshⅠandⅢ(P=0.608).Adherence to follow-up was 69.2%.Of 15 GSE patients,66.7%followed a GFD with 80%responding to it. CONCLUSION:GSE in the general population is frequent and clinically relevant,irrespective of histological severity.tTGA is the marker of choice.Mass screening programs are useful in identifying patients who can benefit from GFD and follow-up.展开更多
This article demonstrates that decision trees have several applications in screening for incidences of various cancers in the publicly funded health care system of Canada. This article reviews previous research on the...This article demonstrates that decision trees have several applications in screening for incidences of various cancers in the publicly funded health care system of Canada. This article reviews previous research on the design of various types of decision trees to identify the relevant decision-making parameters that should be incorporated into enhanced usage of decision trees. This article proposes a methodology for screening breast and prostate cancers. While an accounting is made for various financial costs and benefits, comments are made on the limitations of the modeling exercise through identification of problems in assigning probabilities, the use of samples in ascertaining population parameters, ethical concerns, and measuring a cost per life year. This article concludes with prospects for future research including private sector versus public sector financing and the incorporation of opportunity costs into the decision-making process.展开更多
基金Supported by International Agency for Research on Cancer(Lawrence von Karsa,MD)International Digestive Cancer Alliance(Professor Meinhard Classen,MD,Professor Sidney JWinawer,MD)
文摘Colorectal cancer(CRC)is the second most frequent malignant disease in Europe.Every year,412 000people are diagnosed with this condition,and 207 000patients die of it.In 2003,recommendations forscreening programs were issued by the Council of the European Union(EU),and these currently serve as thebasis for the preparation of European guidelines forCRC screening.The manner in which CRC screening iscarried out varies significantly from country to countrywithin the EU,both in terms of organization and thescreening test chosen.A screening program of onesort or another has been implemented in 19 of 27 EUcountries.The most frequently applied method is testing stool for occult bleeding(fecal occult blood test,FOBT).In recent years,a screening colonoscopy hasbeen introduced,either as the only method(Poland)orthe method of choice(Germany,Czech Republic).
基金Supported by Proportion of UCLH/UCL funding from the Department of Health’s NIHR Biomedical Research Centres funding schemeA grant from the UCL experimental cancer medicine centreUnrestricted educational grant support from Pentax United Kingdom (Lovat LB)
文摘AIM： To compare high resolution colonoscopy （Olympus Lucera） with a megapixel high resolution system （Pentax HiLine） as an in-service evaluation. METHODS： Polyp detection rates and measures of performance were collected for 269 colonoscopy procedures. Five colonoscopists conducted the study over a three month period, as part of the United Kingdom bowel cancer screening program. RESULTS：There were no differences in procedure duration （x^2 p = 0.98）, caecal intubation rates （x^2 P = 0.67）, or depth of sedation （x^2 P = 0.64）. Mild discomfort was more common in the Pentax group （x^2 p = 0.036）. Adenoma detection rate was significantly higher in the Pentax group （x^2 test for trend P = 0.01）. Most of the extra polyps detected were flat or sessile adenomas. CONCLUSION： Megapixel definition colonoscopes improve adenoma detection without compromising other measures of endoscope performance. Increased polyp detection rates may improve future outcomes in bowel cancer screening programs.
文摘（Screening programs for cervical cancer： a ＂SWOT＂ investigation in the Calabria Region）---The low adherence to screening programs for cervical cancer in Calabria, was analyzed by performing a SWOT analysis with concerned health professionals. The survey shows that screening organized in Calabria is active and well regulated, the human and financial resources are scarce and the healthcare management has paid little attention to the prevention of women＇s cancers. In the perspective of a necessary improvement of the regional system of screening, it would be appropriate to enable promotion strategies and more effective communication, overcoming possible cultural factors hindering.
基金Supported by"FundacióBanc de Sabadell"(Barcelona,Spain)
文摘AIM:To assess:(1)frequency and clinical relevanceof gluten sensitive enteropathy(GSE)detected by serology in a mass screening program;(2)sensitivity of antitransglutaminase(tTGA)and antiendomysium antibodies(EmA);and(3)adherence to gluten-free diet(GFD)and follow-up. METHODS:One thousand,eight hundred and sixtyeight subjects recruited from an occupational health department underwent analysis for tTGA and EmA and, if positive,duodenal biopsy,DQ2/DQ8 genotyping, clinical feature recording,blood tests,and densitometry were performed.Since>98%of individuals had tTGA <2 U/mL,this value was established as the cut-off limit of normality and was considered positive when confirmed twice in the same sample.Adherence to a GFD and follow up were registered. RESULTS:Twenty-six(1.39%)subjects had positive tTGA and/or EmA,and 21 underwent biopsy:six Marsh Ⅲ(oneⅢa,fourⅢb,oneⅢc),nine MarshⅠand six Marsh 0(frequency of GSE 1:125).The sensitivity of EmA for GSE was 46.6%(11.1%for MarshⅠ,100% for MarshⅢ),while for tTGA,it was 93.3%(88.8% for MarshⅠ,100%for MarshⅢ).All 15 patients with abnormal histology had clinical features related to GSE.MarshⅠandⅢsubjects had more abdominal pain than Marsh 0(P=0.029),and a similar trend was observed for distension and diarrhea.No differences in the percentage of osteopenia were found between MarshⅠandⅢ(P=0.608).Adherence to follow-up was 69.2%.Of 15 GSE patients,66.7%followed a GFD with 80%responding to it. CONCLUSION:GSE in the general population is frequent and clinically relevant,irrespective of histological severity.tTGA is the marker of choice.Mass screening programs are useful in identifying patients who can benefit from GFD and follow-up.
文摘This article demonstrates that decision trees have several applications in screening for incidences of various cancers in the publicly funded health care system of Canada. This article reviews previous research on the design of various types of decision trees to identify the relevant decision-making parameters that should be incorporated into enhanced usage of decision trees. This article proposes a methodology for screening breast and prostate cancers. While an accounting is made for various financial costs and benefits, comments are made on the limitations of the modeling exercise through identification of problems in assigning probabilities, the use of samples in ascertaining population parameters, ethical concerns, and measuring a cost per life year. This article concludes with prospects for future research including private sector versus public sector financing and the incorporation of opportunity costs into the decision-making process.
