Jump to Volume 4, Issue 1, March 1997
Jump to Volume 4, Issue 3, September 1997
Jump to Volume 4, Issue 4, December 1997

Editorials
Case-control studies of the efficacy of screening for cancer: can we earn them some respect.
NS Weiss. J Med Screen 1997 4: 57-59.

Screening for Huntington disease and certain other dominantly inherited disorders: a case for preimplantation genetic testing.
JD Schulman and SH Black. J Med Screen 1997 4: 58-59.

Journal Articles
Screening for fragile X syndrome: information needs for health planners.
J Murray, H Cuckle, G Taylor, and J Hewison. J Med Screen 1997 4: 60-94.

Reliability of statistics on Down's syndrome notifications.
T Huang, HC Watt, NJ Wald, JK Morris, D Mutton, and E Alberman. J Med Screen 1997 4: 95-97.
OBJECTIVES: To evaluate the completeness of notifications of Down's syndrome live births and terminations to the Office for National Statistics (ONS) using data from the National Down Syndrome Cytogenetic Register (NDSCR). To examine the agreement of observed birth prevalence of Down's syndrome with the expected birth prevalence derived from published maternal age specific rates.
METHODS: The number of live births (adjusted to allow for the estimated underascertainment) and the number of terminations due to fetal Down's syndrome from NDSCR were compared with those figures reported to the ONS. Subsequently, using the NDSCR figures, the live birth prevalence of Down's syndrome that would have occurred in the absence of antenatal diagnosis and selective termination was calculated in England and Wales in the years 1990-1993. These figures were compared with those derived by applying published age specific prevalences to the maternal age distribution in England and Wales.
RESULTS: It is estimated that only 48% and 46% respectively of Down's syndrome live births and terminations of pregnancy were notified to ONS between 1990 and 1993. The annual expected birth prevalences of Down's syndrome obtained by applying maternal age specific prevalences to the maternal age distribution were in close agreement with observed rates from NDSCR.
CONCLUSIONS: There is considerable underreporting of Down's syndrome births and terminations to ONS. The NDSCR data are more complete and therefore the effects of screening should be monitored using data from this source, or using estimates derived from the age specific rates of Down's syndrome.

Use of two view mammography compared with one view in the detection of small invasive cancers: further results from the National Health Service breast screening programme.
RG Blanks, SM Moss, and MG Wallis. J Med Screen 1997 4: 98-101.
OBJECTIVE: To examine further the effect of using two view mammography in comparison with one view mammography in the detection of small (<15 mm) invasive cancers for programmes in the National Health Service breast screening programme (NHSBSP). The study is in two parts: first the effect on the small invasive cancer detection rate for programmes that changed from using one view to two views for first (prevalent) screens, and secondly the effect on the small invasive cancer detection rate for programmes that used two views for subsequent (incident) screens compared with programmes that used one view.
SETTING: Screening programme data from the NHSBSP.
METHODS: Data were collated from all screening programmes in the United Kingdom on standard "Korner" returns (KC62 forms) for the screening years 1 April 1994 to 31 March 1995 and 1 April 1995 to 31 March 1996. The comparison between one and two view mammography was made using indirectly age standardised invasive cancer detection rates.
RESULTS: For prevalent (first) screens, programmes changing from one view mammography in 1994/95 to two views in 1995/96 reported a 45% (95% confidence interval (CI) 25% to 68%) increase in the detection of invasive cancers of <15 mm. In comparison, programmes that were already using two views in 1994/95 showed no change in 1995/96. For incident (subsequent) screens the small number of programmes that have opted to use two views reported 25% (95% CI 1% to 55%) more invasive cancers of <15mm than programmes using one view in 1995/96, and 42% (95% CI 11% to 81%) more in 1994/95.
CONCLUSIONS: These results confirm the benefit of using two view mammography in the detection of small invasive cancers, and provide evidence that this effect is seen in subsequent screens as well as the first screen.

Cervical screening of Arabic-speaking women in Australian general practice.
M Lesjak, J Ward, and C Rissel. J Med Screen 1997 4: 107-111.
OBJECTIVE: To determine recency and predictors of cervical screening among Arabic-speaking women in Sydney, Australia.
METHOD: A consecutive sample of Arabic-speaking women, attending 20 Arabic-speaking general practitioners, was asked to complete a self administered health risk questionnaire available in Arabic or English which included three questions about cervical screening knowledge and behaviour.
RESULTS: Of 756 eligible women, 526 (70%) returned completed questionnaires. Of these, 69 (13%) did not know what a cervical smear was. Sixteen per cent of overseas-born compared with 2% of Australian-born women at risk had not heard of a cervical smear. Women were defined as being at risk of cervical cancer if they had both been married and not had a hysterectomy. Of 318 women at risk for cervical cancer who knew what a cervical smear was, 66% had had a smear in the last two years, a further 7% were attending for one that day while 11% had not had a smear for at least two years, 9% had never had one and 7% did not answer/could not remember. Religion, age, and residence in Australia for more than 10 years were significant and independent predictors of screening after adjustment for other variables in simultaneous logistic regression model (P = 0.002, P = 0.002, and P = 0.040 respectively). Muslim women and older women were more likely to be underscreened, and women with more than 10 years' residence in Australia were more likely to have been screened in the last two years. Acculturation, smoking status, health status, duration of relationship with participating doctor, and chronic disease were not significant predictors of a recent smear.
CONCLUSION: As only 73% of women at risk had been screened in the last two years, including women attending on the day and 9% had never been screened, Arabic-speaking women should be a priority for public campaigns, particularly Muslim and older women. Studies to evaluate the effectiveness and acceptability of reminders by ethnic general practitioners are recommended.

Clinical Trial
Randomised trial of prostate cancer screening in The Netherlands: assessment of acceptance and motives for attendance.
HG Nijs, DM Tordoir, JH Schuurman, WJ Kirkels, and FH Schroder. J Med Screen 1997 4: 102-106.
OBJECTIVES: To assess motives for attending a randomised population based prostate cancer screening trial, and to assess acceptance of screening and invitation procedures.
METHODS: First pilot of the European Randomised Study of Screening for Prostate Cancer (ERSPC; 1992/1993). Men aged 55-75 years, randomly selected from the population register of four city districts of Rotterdam, were invited by a single invitation for screening. Screening consisted of prostate specific antigen prescreening followed by either (1) digital rectal examination, transrectal ultrasound, and, on indication, biopsy, or (2) no additional screening. After screening, or in the case of non-attendance, a questionnaire was sent to a random sample of 600 attenders and 400 non-attenders, with a reminder after three weeks.
OUTCOME MEASURES: In both attenders and non-attenders: knowledge of prostate cancer, attitudes towards screening, motives for attending, procedural aspects and sociodemographic characteristics. In attenders, acceptance of screening procedures.
RESULTS: The response rate for the questionnaire was 76%: 94% in attenders and 42% in non-attenders. The main reasons for attending were expected personal benefit (76%) and scientific value (39%), and those for not attending were absence of urological complaints (41%) and anticipated pain or discomfort (24%). Uptake of screening was 32%, which increased to a sustained 42% in following years. Attenders, compared with non-attenders, were significantly younger, more often married, better educated, and had higher perceived health status, more knowledge about prostate cancer, and a more positive attitude towards screening. Information materials and invitation procedures were well accepted (high report marks and satisfaction, and 95% would attend for rescreening). A single prostate specific antigen determination was liked less than a combination of all three screening modalities.
CONCLUSIONS: (1) The main reasons for attending are personal benefit and science, and those for not attending were absence of urological complaints and anticipated pain or discomfort; (2) knowledge, attitudes, and motives for attending are comparable with other screening programmes; hence, for population based prostate cancer screening, known health promotional aspects should be carefully considered; (3) prostate specific antigen, digital rectal examination and transrectal ultrasound are acceptable to attenders.

Jump to top