Mass screening for prostate cancer--how to eliminate clinically insignificant cancer

The ultimate aim of the mass screening program for prostate cancer is to decrease prostate cancer mortality, which can be demonstrated only in a well-designed and well-controlled trial comparing screened and unscreened populations. However, no trials have been performed to demonstrate the effect of this program. Some reports claimed that such a program includes the high possibility of detecting clinically insignificant cancer, for example, latent cancer. In this paper, early cancer detection and treatment in mass screening program are discussed.     

Effectiveness of screening for prostate cancer

In this, our second article, we assess the value of screening for prostate cancer. There is insufficient evidence to recommend for or against routine digital rectal examination as an effective screening test for prostate cancer in asymptomatic men. It is recommended that tumour markers, such as prostate specific antigen, and transrectal ultrasound are not used for routine screening purposes.     

Update on prostate cancer screening

Prostate cancer is the second most common cause of death in men; it is diagnosed in about 1 in 10 men. Significant risk factors include, but are not limited to, race and age; the peak age at diagnosis is the seventh decade. A through screening program, sensitive to the risk factors and targeted to patients with curable prostate cancer, can decrease the rates of mortality and morbidity associated with this disease, without overtreating patients who have latent cancer. Screening methods include annual digital rectal examinations and prostate-specific antigen tests. Staging is important when treatment options are considered and treatment morbidity rate is weighed against disease mortality rate. Research concerning genetics changes and chemoprevention trials of vitamins and hormonal agents are targeted toward primary prevention. Implications for practice should include primary prevention, screening and detection, public education, and monitoring of the disease.     

Characteristics of men reporting for prostate cancer screening

A survey to determine demographics, prostate cancer screening practices, and prostate cancer-related knowledge and beliefs was administered to over 1,700 participants at five sites during Prostate Cancer Awareness Week (1991) screening events. Findings are presented by site since significant differences in demographics existed. Results suggest that screenings conducted at the major medical centers attract primarily white males, a number of whom already practice adequate secondary prevention. Thus, if optimal benefit is sought through mass prostate cancer screening, innovative strategies to reach populations that are currently underserved and at risk are necessary.     

Cues to action in prostate cancer screening

PURPOSES/OBJECTIVES: To describe factors that cue men of all ages to participate in prostate cancer screening programs and to explore the relationship of age to the rating of the cues. DESIGN: Exploratory survey. SETTING: A large community prostate cancer screening program in the Midwest. SAMPLE: 127 men (mean = 66.3 years of age) who participated in community prostate screening. METHODS: Subjects completed and returned by mail the 13-item Prostate Screening Follow-Up Questionnaire developed, piloted, and refined by the investigator for measuring the rating of the cues to action. MAIN OUTCOME MEASURES: Results of the rating of each cue to action, selected demographic variables, and comparison of the cue ratings by age group. FINDINGS: Appointment scheduling, reminder cards, a friend/family member with cancer, and newspaper promotion were perceived by the sample as most influential in their decision to have prostate cancer screening. No practical significant differences in cue ratings were found between the two age groups: 70 years of age and older and less than 70 years of age. CONCLUSION: Reminder cards, specific appointments, and newspaper promotion should be used when structuring community prostate cancer screening programs. Men who have a friend or family member with cancer may be more likely to participate in screening activities. IMPLICATIONS FOR NURSING PRACTICE: By incorporating influential cues to action into their everyday practice, nurses can be instrumental in reaching the population of men who are at risk for prostate cancer. Strategies for promoting prostate cancer screening should include: educating patients and family members about prostate cancer screening guidelines, using specific influential promotional practices when setting up prostate screening programs, and networking with seniors programs in the community.     

Decisions about prostate cancer screening in managed care

The primary object of this research project was to establish the amount of incisor retraction to be expected during full fixed mechanotherapy and to generate regression models that could provide more accurate prediction of each of the three most popular combinations of symmetrical premolar extractions, where extraoral anchorage would not be used. Pretreatment and posttreatment records of 73 cases that had their four first premolars extracted (group 44), 74 cases with four second premolar extractions (group 55), and 59 cases with upper first and lower second premolar extractions (group 45) were selected. All these cases were treated by one orthodontist, who used the same edgewise technique throughout. The results indicate that, on average, maxillary retraction in relation to the facial plane (N Po) differed only slightly between group 55 (mean 4.2 +/- 2.4 mm) and group 44 (mean 4.7 +/- 2.3 mm), with relatively more retraction for group 45 (mean 6.6 +/- 2.5 mm; p < 0.05). In contrast, the mandibular incisors were retracted slightly more in group 44 than in the other two groups (p < 0.05). The regression models that were developed could be useful as an additional tool to assist the practitioner in the selection of which teeth to extract for a particular case.     

Mass screening programs for breast cancer in France. Comparative evaluation

OBJECTIVE: The purpose of this work was to comparatively assess the results of mass screening programs for breast cancer implemented in six French departments in 1986, within the scope of the National Fund for Health Prevention, Education and Information of the National Health Insurance Office of Salaried Workers. MATERIAL AND METHODS: The data collected by the screening centres were analyzed by ten assessment teams that were independent from the program promotion staff, all using the same evaluation form. A complementary population study performed in eight French districts then, allowed assessing the frequency of self-referred screening (mammography performed out of program). RESULTS: The rate of participation in screening programs, in relation to the invited population, ranged from 21 to 48%, according to the district (36% in average). This low participation was probably related to the extent of self-referred screening. In fact, 19 to 40% of women, according to the district, had previously had a screening mammographic coverage: rate was around 68% in women aged 50 to 69 years. Positive findings with mammography ranged from 4.5 to 15.8% (10.1% in average), while intervention rates ranged from 0.7 to 1.6% and detection rates from 3.8 to 6.2%. The ratio between benign tumors and cancers ranged from 0.7 to 2.1 according to the district. In order to enlighten the judgement on French results, we propose a comparison with the international standards in force. CONCLUSION: The various experiences with breast cancer screening in France show that this screening is technically feasible on the basis of existing medical structures. However, some criteria are still below the expected values, especially if compared with international standards. This result is probably accounted for by the high rate self-referred screening before age 40 in France. In these conditions, the question is whether extending breast cancer screening programs in France is an appropriate course of action.     

Epidemiology and clinical features of prostate cancer in Japan

The incidence rate of clinically manifest prostate cancer in 1992 was estimated 15.7 per 100,000 men, although it is increasing exponentially. Accordingly, 5399 deaths from prostate cancer in 1995 will be increased to 13,494 deaths in 2015. Change in dietary habit (more Western-style diet) is considered to be a major cause of the increase. Escalating number of elderly people in the Japanese population is another major reason of elevated incidence. On the other, public awareness of prostate cancer and introduction of serum PSA measurement to health check-up undoubtedly have raised the detection rate of early stage disease. The way of androgen ablation do not seem to have influenced on survival of the advanced disease so far. It remains to be clarified whether the combined androgen blockade using pure anti-androgens with castration provide better patients' survival than castration alone.     

A guinea pig''s view on prostate cancer screening trials

Although the combination of paclitaxel with doxorubicin has yielded high response rates in metastatic breast cancer, severe cardiotoxic events have been reported in several patients. The rationale for our study was to evaluate the activity of paclitaxel/doxorubicin combination in patients with this disease but to avoid excessive cardiotoxicity. Therefore, we administered 4 cycles of doxorubicin/paclitaxel followed by 6 cycles of standard cyclophosphamide, methotrexate and 5-fluorouracil (CMF) regimen. Study medication consisted of doxorubicin 60 mg/m2 as a 15-min intravenous infusion followed by paclitaxel 175 mg/m2 as a 3-hour infusion. CMF regimen consisted of cyclophosphamide 600 mg/m2 as 1-hour intravenous infusion followed by methotrexate 40 mg/m2 and 5-fluorouracil 600 mg/m2 bolus injection. The main toxicity of doxorubicin/paclitaxel treatment phase was neutropenia (WHO grade 3/4, 58%), but we observed only one cardiac adverse event. Toxicities of the CMF treatment phase were not significant. Of 24 patients evaluable for response, 2 (8%) had complete responses and 11 (46%) achieved partial response. Ten additional patients (42%) had stable disease. The median time to progression was 12 months and the median overall survival was 18.5 months. The sequential administration of doxorubicin and paclitaxel followed by CMF appeared active and well tolerated in patients with metastatic breast cancer.     

Mass survey of gastric cancer and leukemia in Miyagi Prefecture, Japan

A little more than 20,000 examinees of x-ray mass survey of gastric cancer and the controls were followed up from 1960 to 1977. Cumulative doses of x-rays were calculated for each examinee, and a collective dose in person-year-rads was constructed. Incidence of leukemia was ascertained from Miyagi Prefectural Cancer Registry. Seven cases of leukemia were found out of 242,689 person-year-rads in the irradiated population, and 9 cases out of 273,344 person-years in the controls. Incidence rate in the two groups was identical. Therefore, the risk of this mass survey was disproved.     

Mass screening for neuroblastoma and mortality in birth cohorts

Mortality resulting from neuroblastoma in birth cohorts in both Sapporo City and the whole of Japan was investigated to evaluate the effects of a high-performance liquid chromatography (HPLC) mass screening program, targeting on 6 month-old infants. In Sapporo City, the non-HPLC screened cohort showed no reduction in mortality at 4 years of age compared with the pre-screening cohort. However, the HPLC screened cohort showed a reduction of 69% in mortality compared with the pre-screening cohort. On a nation-wide scale, there was a significant decline in mortality for the non-HPLC screened cohort compared with the pre-screening cohort; for the HPLC screened cohort for 1989-1991, there was also a reduction in mortality for children younger than 2 years of age. The incidence of neuroblastoma at 1-4 years of age in the HPLC cohort in Sapporo City was about half that in the pre-screening cohort, along with and probably because of an increasing incidence among infants in the same cohort. Our findings suggest that HPLC screening may detect some poor-prognosis neuroblastoma cases at early stages, thus providing for more favorable therapy.