Challenges in evaluation of screening for gastric cancer among men based on nonrandomized design

Background: Objective was to quantify biases in screening for gastric cancer when comparing attenders to nonattenders using serum pepsinogen I (SPGI) level as primary test.Methods: In mid 1990s, all men aged 51-65 years from two Finnish cities were invited to SPGI screening. Mortality and premature mortality in attenders were compared to nonattenders. Efficacy of screening was studied by 15 years' follow-up of standardized mortality ratio (SMR) and potential years of life lost (PYLL) due to gastric cancer. Bias due to selective attendance was quantified using corrective coefficients based on total cancer incidence and mortality, and gastric cancer-specific incidence and mortality for total population and nonattenders.Results: In 1994-1996, men aged 51-65 years (16,872) were invited to SPGI assay and 12,175 men (72%) attended. SPGI was 25 microg/l or less in 610 (5%) men, indicating severe atrophic gastritis (AG). Post-screening gastroscopy was performed to 435 men with low SPGI. Of these, 168 men were referred for treatment due to abnormal focal lesions. Attributable proportions in reductions of SMR and PYLL from gastric cancer due to screening were 59% and 67%. After correcting for selective participation, attributable proportions were reduced to 23% and 39%.Conclusions: Biomarker screening by low SPGI among middle-aged men followed by upper gastrointestinal endoscopy decreased long-term and premature mortality due to gastric cancer. However, in spite of methodological corrections done, the results do not justify any firm conclusions or recommend general screening programs. Randomized trials are warranted for this purpose.Peer reviewe

Whole, turret and step methods of rapid rescreening : is there any difference in performance?

We compared the performance of the Whole, Turret and Step techniques of 100% rapid rescreening (RR) in detection of falsenegatives in cervical cytology. We tested RR performance with cytologists trained and among those without training. We revised 1,000 consecutive slides from women participating in an ongoing international screening trial. Two teams of experienced cytologists performed the RR techniques: one trained in RR procedures and the other not trained. The sensitivities in the trained group were Whole 46.6%, Turret 47.4% and Step 50.9%; and in the non-trained group were 38.6, 31.6 and 47.4%, respectively. The j coefficient showed a weak agreement between the two groups of cytologists and between the three RR techniques. The RR techniques are more valuable if used by trained cytologists. In the trained group, we did not observe significant differences between the RR techniques used, whereas in the non-trained group, the Step technique had the best sensitivity

Determinants of Acceptance of Cervical Cancer Screening in Dar es Salaam, Tanzania.

To describe how demographic characteristics and knowledge of cervical cancer influence screening acceptance among women living in Dar es Salaam, Tanzania. Multistage cluster sampling was carried out in 45 randomly selected streets in Dar es Salaam. Women between the ages of 25-59 who lived in the sampled streets were invited to a cervical cancer screening; 804 women accepted and 313 rejected the invitation. Information on demographic characteristics and knowledge of cervical cancer were obtained through structured questionnaire interviews. Women aged 35-44 and women aged 45-59 had increased ORs of 3.52 and 7.09, respectively, for accepting screening. Increased accepting rates were also found among single women (OR 2.43) and among women who had attended primary or secondary school (ORs of 1.81 and 1.94). Women who had 0-2 children were also more prone to accept screening in comparison with women who had five or more children (OR 3.21). Finally, knowledge of cervical cancer and awareness of the existing screening program were also associated with increased acceptance rates (ORs of 5.90 and 4.20). There are identifiable subgroups where cervical cancer screening can be increased in Dar es Salaam. Special attention should be paid to women of low education and women of high parity. In addition, knowledge and awareness raising campaigns that goes hand in hand with culturally acceptable screening services will likely lead to an increased uptake of cervical cancer screening

Kokonaistutkimus vai otos

Kokonaistutkimuksen ja otoksen etuja ja haittoja ei voi erottaa tutkimuksen yleisestä tavoitteesta. Tieteellisissä ongelmissa havaintoaineisto on sekä teknisessä että käsitteellisessä mielessä otos. Kokonaistutkimus on varsinkin Pohjoismaissa monien hallinnollisten ja suunnitteluongelmien lähestymistapa. Näin syntyneillä rekistereillä on usein arvaamattomia käyttöalueita varsinaisen välittömän tavoitteen lisäksi. Tällainen tarpeellinen käyttö tulisi turvata tulevassa tietosuojalainsäädännössä

Epidemiologisten indikaattoreitten tulkinnasta

Epidemiologiassa taudin ilmaantumiseen perustuvat vaarasuhteet viittaavat altistuksen etiologiseen merkittävyyteen. Epidemiologiset tunnusluvut ovat mielekkäitä ja edellyttävät taudin monisyajattelun ja probabilistisen kausaliteettikäsitteen hyväksymistä. Tällöin taudilla voi olla enemmän kuin 100 prosenttia syitä, ja kääntäen taudin laajakaan ehkäisy ei ole välttämättä riittävää kaikkien syytekijöiden poistamiseksi. Kuolleisuus ja siihen perustuvat vakioidut kuolleisuussuhteet eivät suoraan viittaa pitkäikäisyyteen. Keski-iän huomattavasta suurenemisesta huolimatta maksimaalinen elinaika on mm. Suomessa ollut lähes vakio, mikä viittaa siihen, että saavutetaan se raja, jonka jälkeen preventiolla kuolemien estämisen rooli on vain rajallinen ja ehkäisyn painopiste tulee siirtymään toimintakyvyn ja muiden elämänlaatua säätelevien tekijöiden parantamiseen

PENGARUH OUTDOOR EDUCATION TERHADAP KOHESIVITAS DAN KOMUNIKASI

Tujuan dalam penelitian ini adalah untuk mengetahui pengaruh outdoor education terhadap kohesivitas dan komunikasi siswa, juga melihat perbedaan pada kedua kelompok sampel. Program outdoor education yang digunakan adalah rivercamp. Penelitian ini menggunakan metode eksperimen dengan pendekatan kuantitatif. Sampel yang digunakan sebanyak 80 orang siswa SMP Putra Siliwangi Lembang yang dibagi ke dalam 2 kelompok, 40 siswa kelompok ekperimen dan 40 siswa kelompok kontrol. Instrumen yang digunakan dalam penelitian ini adalah skala kohesivitas kelompok dan skala komunikasi. Analisis data menggunakan uji t berpasangan atau Paired sample t test untuk melihat pengaruh perlakuan yang diberikan, dan independent sample t test untuk melihat perbedaan antara kedua kelompok sampel. Analisis dilakukan pada taraf signifikansi α = 0,05. Berdasarkan analisis dan pengolahan data, diperoleh hasil kohesivitas dengan t = 9,503 dan sig = 0,000 < 0,05, sedangkan untuk hasil komunikasi dengan t = 9,661 dan sig = 0,000 < 0,05. Untuk perbedaan antara kelompok sampel pada kohesivitas diperoleh nilai t = 6,751 dan sig = 0,000 < 0,05, sedangkan untuk komunikasi diperoleh nilai t = 5,407 dan sig = 0,000 < 0,05. Hasil penelitian ini menunjukan terdapat pengaruh yang signifikan outdoor education terhadap kohesivitas dan komunikasi siswa. Terdapat perbedaan yang signifikan antara kelompok eksperimen dan kontrol. Oleh karena itu dengan menggunakan outdoor education dapat meningkatkan nilai-nilai sosial (kohesivitas dan komunikasi) siswa.--------

Screening for colorectal cancer

Colorectal cancer (CRC) is the most common cancer in the Nordic countries after breast and prostate cancer. About 15 000 new cancers are diagnosed and more than 7 000 patients will die from CRC in 2005. CRC fulfils most of the criteria for applying screening; the natural history is well known compared with many other cancers. CRC may be cured by detection at an early stage and even prevented by removal of possible precursors like adenomas. Faecal occult blood test is the only CRC screening modality that has been subjected to adequately sized randomised controlled trials (RCT) with long-term followup results, using Hemoccult-II. Sensitivity for strictly asymptomatic CRC is less than 30% for a single screening round, but programme sensitivity has been estimated to be more. Biennial screening with un-rehydrated Hemoccult-II slides has shown a CRC mortality reduction of 15-/ 18% after approximately 10 years of follow-up in those targeted for screening. For those attending, the mortality reduction has been estimated at 23%. Denmark has decided to do feasibility studies to try to evaluate whether a population-based screening run by the community will have the same effect as has been demonstrated in the randomised trials. In Norway the government has accepted no formal population-based screening. In Finland, the Ministry of Social Affairs and Health made a recommendation in 2003 to the municipalities to run a randomised feasibility study with FOBT screening for colorectal cancer as a public health policy that is repeated every second year. In 2004 the first municipalities started. It has been claimed that today Sweden cannot afford CRC screening despite the potential mortality benefit. There is sufficient evidence for the efficacy of screening for colorectal cancer with fecal occult blood test every second year. There is, however, only little evidence on the effectiveness of screening when run as a public health service and there is insufficient knowledge of harmful effects and costs, even in RCTs

Lumpectomy with or without postoperative radiotherapy for breast cancer with favourable prognostic features: results of a randomized study

The aim of this trial was to study the value of adding post-operative radiotherapy to lumpectomy in a subgroup of breast cancer patients with favourable patient-, tumour-, and treatment-related prognostic features. 152 women aged over 40 with unifocal breast cancer seen in preoperative mammography were randomly assigned to lumpectomy alone (no-XRT group) or to lumpectomy followed by radiotherapy to the ipsilateral breast (50 Gy given within 5 weeks, XRT group). All cancers were required to be invasive node-negative, smaller than 2 cm in diameter and well or moderately differentiated, to contain no extensive intraductal component, to be progesterone receptor-positive, DNA diploid, have S-phase fraction ≤7 and be excised with at least 1 cm margin. During a mean follow-up time of 6.7 years, 13 (18.1%) cancers recurred locally in the no-XRT and 6 (7.5%) in the XRT group (P = 0.03). There was no difference between the groups in the ultimate breast preservation rate (95.0% vs. 94.4% in XRT and no-XRT, respectively, P = 0.88), distant metastasis-free survival (P = 0.36), or 5-year cancer-specific survival (97.1% in XRT and 98.6 in no-XRT). Radiation therapy given after lumpectomy reduces the frequency of ipsilateral breast recurrences even in women with small breast cancer with several favourable clinical and biological features. However, the breast preservation rate may not increase due to more frequent use of salvage mastectomies in patients treated with postoperative radiotherapy. © 2001 Cancer Research Campaign http://www.bjcancer.co