European Screening Research Articles

Design of a general-purpose European compound screening library for EU-OPENSCREEN.

This work describes a collaborative effort to define and apply a protocol for the rational selection of a general-purpose screening library, to be used by the screening platforms affiliated with the EU-OPENSCREEN initiative. It is designed as a standard source of compounds for primary screening against novel biological targets, at the request of research partners. Given the general nature of the potential applications of this compound collection, the focus of the selection strategy lies on ensuring chemical stability, absence of reactive compounds, screening-compliant physicochemical properties, loose compliance to drug-likeness criteria (as drug design is a major, but not exclusive application), and maximal diversity/coverage of chemical space, aimed at providing hits for a wide spectrum of drugable targets. Finally, practical availability/cost issues cannot be avoided. The main goal of this publication is to inform potential future users of this library about its conception, sources, and characteristics. The outline of the selection procedure, notably of the filtering rules designed by a large committee of European medicinal chemists and chemoinformaticians, may be of general methodological interest for the screening/medicinal chemistry community. The selection task of 200K molecules out of a pre-filtered set of 1.4M candidates was shared by five independent European research groups, each picking a subset of 40K compounds according to their own in-house methodology and expertise. An in-depth analysis of chemical space coverage of the library serves not only to characterize the collection, but also to compare the various chemoinformatics-driven selection procedures of maximal diversity sets. Compound selections contributed by various participating groups were mapped onto general-purpose self-organizing maps (SOMs) built on the basis of marketed drugs and bioactive reference molecules. In this way, the occupancy of chemical space by the EU-OPENSCREEN library could be directly compared with distributions of known bioactives of various classes. This mapping highlights the relevance of the selection and shows how the consensus reached by merging the five different 40K selections contributes to achieve this relevance. The approach also allows one to readily identify subsets of target- or target-class-oriented compounds from the EU-OPENSCREEN library to suit the needs of the diverse range of potential users. The final EU-OPENSCREEN library, assembled by merging five independent selections of 40K compounds from various expert groups, represents an excellent example of a Europe-wide collaborative effort toward the common objective of building best-in-class European open screening platforms.

European breast cancer service screening outcomes: a first balance sheet of the benefits and harms.

A recent comprehensive review has been carried out to quantify the benefits and harms of the European population-based mammographic screening programs. Five literature reviews were conducted on the basis of the observational published studies evaluating breast cancer mortality reduction, breast cancer overdiagnosis, and false-positive results. On the basis of the studies reviewed, the authors present a first estimate of the benefit and harm balance sheet. For every 1,000 women screened biennially from ages 50 to 51 years until ages 68 to 69 years and followed up until age 79 years, an estimated seven to nine breast cancer deaths are avoided, four cases are overdiagnosed, 170 women have at least one recall followed by noninvasive assessment with a negative result, and 30 women have at least one recall followed by invasive procedures yielding a negative result. The chance of a breast cancer death being avoided by population-based mammography screening of appropriate quality is more than that of overdiagnosis by screening. These outcomes should be communicated to women offered service screening in Europe.

Nutritional risk assessment in patients with chronic liver disease

To use the European Nutritional Risk Screening (NRS)-2002 survey tool to investigate nutritional risk associated to different degrees of liver disease and to assess its ability to identify the nutritional risk of hospitalized patients with chronic liver disease. A total of 366 hospitalized patients were assessed with the NRS-2002 on the day of admission. Patients who meet the criteria for malnourishment (NRS-2002 score of more than 3 points (severely impaired nutritional status with body mass index (BMI) less than 18.5 kg/m2) were selected for further study to determine liver function. Patients were classified according to liver dysfunction-related features, including cirrhosis status, Child-Pugh classification, and underlying disease causes (e.g.alcohol, hepatitis virus infection). Chi square test was used in statistical analysis of inter-group difference. The incidence of patients surveyed who were at nutritional risk was 41.0%, and the incidence of malnutrition was 7.6%. The patients with liver failure showed the highest rate of nutritional risk (72.8%). Moreover, among the 97 patients with liver cirrhosis, significantly more had Child-Pugh grade B than grade A (88.6% vs.33.1%; x2=24.019, P=0.000). The cause of liver failure with the highest incidence of nutritional risk was alcohol-related liver disease (66.7%). The overall malnutrition rate among the total 156 patients classified by the NRS-2002 as being at nutritional risk was 76.2%. The NRS-2002 is a suitable screening tool for use in Chinese patients with mild early liver disease, but it must be interpreted carefully as its findings alone may promote a false positive rate. The NRS-2002 is less accurate in patients with end-stage liver disease.

Budget impact analysis of switching to digital mammography in a population-based breast cancer screening program: a discrete event simulation model.

ObjectiveTo assess the budgetary impact of switching from screen-film mammography to full-field digital mammography in a population-based breast cancer screening program.MethodsA discrete-event simulation model was built to reproduce the breast cancer screening process (biennial mammographic screening of women aged 50 to 69 years) combined with the natural history of breast cancer. The simulation started with 100,000 women and, during a 20-year simulation horizon, new women were dynamically entered according to the aging of the Spanish population. Data on screening were obtained from Spanish breast cancer screening programs. Data on the natural history of breast cancer were based on US data adapted to our population. A budget impact analysis comparing digital with screen-film screening mammography was performed in a sample of 2,000 simulation runs. A sensitivity analysis was performed for crucial screening-related parameters. Distinct scenarios for recall and detection rates were compared.ResultsStatistically significant savings were found for overall costs, treatment costs and the costs of additional tests in the long term. The overall cost saving was 1,115,857€ (95%CI from 932,147 to 1,299,567) in the 10th year and 2,866,124€ (95%CI from 2,492,610 to 3,239,638) in the 20th year, representing 4.5% and 8.1% of the overall cost associated with screen-film mammography. The sensitivity analysis showed net savings in the long term.ConclusionsSwitching to digital mammography in a population-based breast cancer screening program saves long-term budget expense, in addition to providing technical advantages. Our results were consistent across distinct scenarios representing the different results obtained in European breast cancer screening programs.

Patch test results of the dental personnel with contact dermatitis

Objectives: Dental personnel have high risk of occupational contact dermatitis. The aim of this study is to detect the materials which cause contact sensitization and the frequency of contact dermatitis by using patch tests with European standard series and dental screening series in dental personnel. Methods: Between August 2008 and July 2009, 461 dental personnel working in Ankara (Turkey) were examined and age, gender, previous history of dermatitis, area of the skin affected and clinical diagnosis were noted. About 198 (43%) of the dental personnel were diagnosed contact dermatitis. Sixty-five of the dental personnel accepted to be patch tested. Results: Dental technicians, dentists and dental nurses constitute 69.2%, 24.6% and 6.2% of patch tested 65 patients, respectively. Positive reactions to at least one allergen were detected with European standard series at 20% and with dental series at 10.8% among the dental personnel. The most common allergens were nickel sulfate (12.3%), acrylates (6.1%) and para-tertiary-butylphenol-formaldehyde resin (4.6%). The most common acrylate was ethyleneglycol dimethacrylate (3.1%). Conclusions: We believe our study will be helpful to dermatologists about frequency of contact dermatitis among dental personnel and allergens that cause contact sensitivity for developing new methods to protect the personnel in dentistry against sensitization.

Screening for lung cancer

The purpose of this review is to provide an update on the current data about low-dose computed tomography (LD-CT) lung cancer screening. The National Lung Screening Trial (NLST) was the first study that provided statistical evidence that LD-CT screening for lung cancer significantly reduces lung cancer mortality by 20%. Three statistically underpowered European trials could not confirm the positive effect of LD-CT screening on lung cancer mortality. Major obstacles in lung cancer screening are overdiagnosis and the large number of false-positive results. In the NLST, more than 24% of the screens were positive, most of which (96.4%) proved to be benign in nature. Optimized protocols for the workup of detected nodules may help to reduce the number of false-positive screens. Currently, the NLST is the only sufficiently powered trial to report a lower mortality rate with LD-CT screening. Long-term follow-up data are still anticipated on the European screening trials. Furthermore, data on the extent of the potential dangers of LD-CT screening, such as overdiagnosis, false-positive results, and the effect of cumulative radiation dose, have yet to be investigated thoroughly.

The impact of human papillomavirus genotype on colposcopic appearance: a cross‐sectional analysis

To study colposcopic performance in diagnosing high-grade cervical intraepithelial neoplasia or cervical cancer (CIN2+ and CIN3+) using colposcopic characteristics and high-risk human papillomavirus (hrHPV) genotyping. Cross-sectional multicentre study. Two colposcopy clinics in The Netherlands and Spain. Six hundred and ten women aged 17years and older referred for colposcopy because of abnormal cytology. A cervical smear was obtained. Colposcopists identified the worst lesion, graded their impression and scored the colposcopic characteristics of the lesions. Up to four biopsies were collected, including one biopsy from visually normal tissue. CIN2+ and CIN3+, positive for HPV16 or other high-risk HPV types (non-16 hrHPV-positive). The mean age in HPV16-positive CIN2+ women was 35.1years compared with 39.1years in women with other hrHPV types (P=0.002). Sensitivity for colposcopy to detect CIN2+ was 87.9% (95%CI 83.2-91.5), using colposcopic cut-off of 'any abnormality'. The remaining CIN2+ were found by a biopsy from visually normal tissue or endocervical curettage (ECC). Detection of CIN2+ by lesion-targeted biopsies was not different between HPV16-positive women [119/135; 88.1% (95%CI 81.2-92.9)] and non-16 hrHPV-positive women [100/115; 87.0% (95%CI 79.1-92.3); P=0.776]. In multivariate analysis, 'acetowhitening' [odds ratio (OR) 1.91, 95%CI 1.56-3.17], 'time of appearance' (OR 1.95, 95%CI 1.21-3.15) and 'lesion >25% of visible cervix' (OR 2.25, 95%CI 1.44-3.51) were associated with CIN2+. In this population following European screening practice, HPV16-related CIN2+ lesions were detected at younger age and showed similar colposcopic impression as non-16 hrHPV high-grade lesions. There was no relationship between any of the colposcopic characteristics and HPV16 status.

The Future Role for Colposcopy in Europe

Improvements in the performance of cervical screening may be limited by the diagnostic performance of colposcopy. Nonetheless, colposcopy remains the best available tool to assess women considered at high risk for having or developing cervical cancer. The provision and role of colposcopy across Europe is variable. Introduction of vaccination against human papillomavirus (HPV) types 16 and 18 as well as the possible switch to HPV-based screening is likely to change the profiles of women presenting to colposcopy services and provide management difficulties for the colposcopist.The standard of colposcopy in Europe can be maintained or improved despite a variable availability of screening. The prevalence of cervical intraepithelial neoplasia grade 3 may decrease for women having had HPV vaccination. The incidence of cervical intraepithelial neoplasia grade 3 and cervical cancer in second and subsequent rounds of HPV-based screening are likely to decrease compared to cytology-based screening. In HPV-based screening, the numbers of women with no detectable or minor abnormalities at colposcopy and with screen-detected glandular disease are likely to increase. We have considered how these issues will affect states that have varying implementation of organized cervical screening programs and varying degrees of implementation of HPV testing or vaccination.The development of quality assurance across Europe accompanying these program changes is discussed.

Risk-behaviour screening for identifying adolescents with mental health problems in Europe

Indicated prevention of mental illness is an important public health concern among youth. The aim of this study was to establish a European school-based professional screening among adolescents, which included variables on both a broad range of risk-behaviours and psychopathology; and to investigate the indicative value of adolescent risk-behaviour and self-reported psychopathology on help-seeking and psychological problems that required subsequent mental healthcare. A two-stage professional screening approach was developed and performed within the multi-centre study "Saving and Empowering Young Lives in Europe" (SEYLE). The first stage of screening comprised a self-report questionnaire on a representative sample of 3,070 adolescents from 11 European countries. In the second stage, students deemed at-risk for mental health problems were evaluated using a semi-structured clinical interview performed by healthcare professionals. 61 % of participants (n = 1,865) were identified as being at-risk in stage one. In stage two, 384 participants (12.5 % of the original sample) were found to require subsequent mental healthcare during semi-structured, clinical assessment. Among those, 18.5 % of pupils were identified due to screening for psychopathology alone; 29.4 % due to screening for risk-behaviours alone; and 52.1 % by a combination of both. Young age and peer victimization increased help-seeking, while very low body mass index, depression, suicidal behaviour and substance abuse were the best predictors of referral to mental healthcare. Screening of risk-behaviours significantly increased the number of detected students requiring subsequent mental healthcare. Screening of risk-behaviours added significant value in identifying the significant amount of European pupils with mental health problems. Therefore, attention to adolescent risk-behaviours in addition to psychopathology is critical in facilitating prevention and early intervention. Identifying factors that increase compliance to clinical interviews are crucial in improving screening procedures.

Mammography Screening - as of 2013.

Introduction: Since 2008 the German Mammography Screening Programme has been available throughout Germany to all women aged between 50 and 69. The programme strictly follows the European Guidelines. There are controversial discussions in the media as well as in the specialised press. Materials and Methods: Overview of the available data with regard to an evaluation of randomised studies and with regard to quality-assured screening programmes in accordance with EU Guidelines (including data from 18 screening countries). Results: Positive effects of screening: reduction in mortality, less invasive treatment. Negative effects: False-positive diagnoses and biopsy recommendations, so-called overdiagnoses, radiation dose. Limits of screening: Interval carcinomas, incomplete reduction in mortality. A mathematical synopsis of the latest publications from the European screening programmes with the diagnosis rates in Germany determined from > 4.6 million screening examinations produces the following: a total of 10 000 mammograms are created for 1000 women (P) taking part in the Mammography Screening Programme (each of whom undergoes 10 mammograms in 20 years). Overall, the risk of triggering breast cancer through a mammogram is very clearly below the annual natural risk of suffering from breast cancer. In the German screening, of these 1000 women, an average of 288 women are called back once in 20 years as a result of changes that are ultimately benign (< 3 % per cycle). Of these, 74 of the 288 women undergo a biopsy due to a benign change (false-positive biopsy recommendations, usually punch or vacuum biopsies). According to EUROSCREEN, 71 carcinomas develop among participants (56 are discovered in the screening, 15 in the interval), and 67 carcinomas among non-participants (N-P) (in some cases, several years later) during this period. The 4 additional diagnoses among the Ps are referred to as overdiagnoses, as they do not contribute to a reduction in mortality (these participants die beforehand from other causes of death). With regard to the carcinomas that concern the screening periods, 11 women out of 1000 die among the Ps; there are 19 deaths among the N-Ps (within the observation period plus follow-up period). Discussion: The false-positive rate is unavoidable, but is far lower with mammography screening than with other methods. Overdiagnoses are to be expected with any early detection. All calculations require assumptions and are therefore highly discrepant. They have very low evidence levels. The radiation dose should not be an argument against screening when applied correctly due to the very low risk and significant benefits. Interval carcinomas indicate the limits of a mammography screening programme. False-negatives only represent a subset of the interval carcinomas and are not to be equated with them. There is a very high evidence level for a significant reduction in mortality through mammography screening. For the first time, an independent expert commission has confirmed the results of the randomised studies and the statement of the WHO from 2002 and their further validity. Participants can expect a reduction in mortality of 30 %. Data from the current European screening programmes confirm a mortality reduction of 43 %, corresponding to 8/19 saved lives among 71 women with breast cancer or 1000 asymptomatic Ps. Many additional Ps benefit from less invasive treatment due to the early detection. Conclusions: As a result of the risk/benefit ratio, mammography screening should absolutely be recommended to asymptomatic women aged between 50-69. High importance is given to the provision of education for women by the treating gynaecologists as regards the opportunities for quality-assured early detection available to them in the healthcare system.

Lungenkrebsscreening aktuell - Wo stehen wir 2013?

Lung cancer is one of the leading causes of death in Europe and the USA. A relatively good prognosis is limited to those patients in whom the tumor is detected at an early stage. As clinical symptoms of lung cancer are a late finding in the natural course of the disease, most of the patients are diagnosed at an advanced tumor stage when palliative care remains the only therapeutic option. For this reason, early diagnosis of lung cancer might save lives. The National Lung Screening Trial (NLST), in the U. S. A., provided evidence that screening with low-dose CT (LD-CT) is able to reduce lung cancer mortality by 20.0 %. The encouraging results of the NLST, however, could not be confirmed by the preliminary results of ongoing European trials. Even if the European trials are able to confirm a reduction in lung cancer mortality by LD-CT, a number of important questions must be answered before the implementation of nationwide screening programs. First of all, the population that might benefit from CT lung cancer screening has to be defined precisely. Furthermore, guidelines have to be established about how to manage screening participants with detected lung nodules, as the vast majority of these pulmonary nodules will prove to be benign. This review article summarizes the results of the NLST and the initial data from the European screening trials, and will discuss some of the major open questions in lung cancer screening with CT.

Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

A prospective study of the accuracy and concordance between in-situ and postfixation measurements of colorectal polyp size and their potential impact upon surveillance

To determine the differences between in-situ, prefixation and postfixation colorectal polyp measurements, their clinical impact upon determining adenoma surveillance intervals, and to compare postfixation measurements using three different devices. A prospective study of 107 colorectal polyps resected from 65 consecutive patients (45 men, 20 women) undergoing colonoscopy as part of the Bowel Cancer Screening Programme was undertaken. The polyps were measured in situ, prefixation (study gold standard) and using three measurement devices (ruler, callipers and magnifying lens) postfixation in formalin. Prefixation ruler measurements were significantly higher than in-situ (P=0.02) and postfixation ruler measurements (P=0.04). No significant difference was observed between in-situ and postfixation ruler measurements (P=0.36), although in-situ measurements were more variable. In-situ measurements also generated more variation in surveillance intervals than postfixation measurements (9.3 vs. 5.6%). No significant difference was seen between measurements obtained by the three different devices postfixation (P=0.89). This study provides evidence supporting the use of postfixation polyp size measurements as advised by recent European pathology colorectal cancer screening recommendations. In the absence of a clinically significant difference between measurement devices, we advise the ruler to be used as a standard for postfixation measurements because of its widespread availability.

Characteristics of Lung Cancers Detected by Computer Tomography Screening in the Randomized NELSON Trial

The NELSON (Nederlands Leuvens Longkanker Screenings Onderzoek) trial is, with 15,822 participants, the largest European lung cancer computer tomography screening trial. A volumetry-based screening strategy, stringent criteria for a positive screening, and an increasing length of screening interval are particular features of the NELSON trial. To determine the effect of stringent referral criteria and increasing screening interval on the characteristics of screen-detected lung cancers, and to compare this across screening rounds, between sexes, and with other screening trials. All NELSON participants with screen-detected lung cancer in the first three rounds were included. Lung cancer stage at diagnosis, histological subtype, and tumor localization were compared between the screening rounds, the sexes, and with other screening trials. In the first three screening rounds, 200 participants were diagnosed with 209 lung cancers. Of these lung cancers, 70.8% were diagnosed at stage I and 8.1% at stage IIIB-IV, and 51.2% were adenocarcinomas. There was no significant difference in cancer stage, histology, or tumor localization across the screening rounds. Women were diagnosed at a significantly more favorable cancer stage than men. Compared with other trials, the screen-detected lung cancers of the NELSON trial were relatively more often diagnosed at stage I and less often at stage IIIB-IV. Despite stringent criteria for a positive screening, an increasing length of screening interval, and few female participants, the screening strategy of the NELSON trial resulted in a favorable cancer stage distribution at diagnosis, which is essential for the effectiveness of our screening strategy. Clinical trial registered with www.trialregister.nl (ISRCTN63545820).

Excess all-cause mortality in the evaluation of a screening trial to account for selective participation

In addition to disease-specific mortality, a randomized controlled cancer screening trial may be evaluated in terms of excess mortality, in which case no patient-specific information on causes of death is needed. We studied the effect of not accounting for attendance on the calculated excess mortality in a prostate cancer screening trial. The numerator of the excess mortality rate related to prostate cancer diagnoses in each study arm equals the excess number of deaths observed in the cancer patients. The estimation of the expected number of deaths in the absence of the prostate cancer diagnoses has to account for the self-selection of those participating in the trial, particularly if the proportion of non-participants is substantial. The European prostate cancer screening trial (ERSPC). In the screening arm, non-attendees had roughly twice the mortality rate of attendees. Approximately twice as many cancers were detected in the screening arm compared with the control arm, primarily in attendees. Unless attendance is properly accounted for, the expected mortality of prostate cancer patients in the screening arm is overestimated by 0.9-3.6 deaths per 1000 person-years. Attendees have a lower all-cause mortality rate (are healthier) and a higher probability of a prostate cancer diagnosis than non-attendees and the men randomized to the control arm. If attendance is not accounted for, the excess mortality and the between-arm excess mortality rate ratio are underestimated and screening is considered more effective than it actually is. These effects may be sizeable, notably if non-attendance is common. Correcting for attendance status is important in the calculation of the excess mortality rate in prostate cancer patients that can be used in conjunction with a disease-specific mortality analysis in a randomized controlled cancer screening trial.

A comparison of the application of STOPP/START to patients’ drug lists with and without clinical information

A European screening tool (STOPP/START) has been formulated to identify the prescribing of potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs). Pharmacists working in community pharmacies could use STOPP/START as a guide to conducting medication use reviews; however, community pharmacists do not routinely have access to patients' clinical records. To compare the PIM and PPO detection rates from application of the STOPP/START criteria to patients' medication details alone with the detection rates from application of STOPP/START to information on patients' medications combined with clinical information. Community Pharmacy. Three pharmacists applied STOPP/START to 250 patient medication lists, containing information regarding dose, frequency and duration of treatment. The PIMs and PPOs identified by each pharmacist were compared with those identified by consensus agreement of two other pharmacists, who applied STOPP/START criteria using patients' full clinical records. The main outcome measures were: (1) PIM and PPO detection rates among pharmacists with access to patients' clinical information compared to PIM and PPO detection rates among pharmacists using patients' medication information only, and (2) the levels of agreement (calculated using Cohen's kappa statistic (k)) for the three most commonly identified PIMs and PPOs. Pharmacists with access to patients' clinical records identified significantly fewer PIMs than pharmacists without (p = 0.002). The three most commonly identified PIMs were benzodiazepines, proton pump inhibitors and duplicate drug classes, with kappa (k) statistic agreement ranges of 0.87-0.97, 0.60-0.68 and 0.39-0.85 respectively. PPOs were identified more often (p < 0.001) when clinical information was considered. The three most commonly identified PPOs were: bisphosphonates, β2-agonists and anti-platelets, with kappa (k) statistic agreement ranges of 0.89-1.0, 0.50-0.80 and 0.5-1.0 respectively. PIM detection is likely to be overestimated using STOPP and PPO detection underestimated using START when STOPP/START is used in isolation of clinical information. Agreement for a selected number of criteria for which clinical information is not required is good, suggesting that some criteria may be reliably deployed without clinical information during a medicines use review. However, for STOPP/START criteria to be deployed more effectively by pharmacists, access to the full clinical record is recommended.

Can the Gail model increase the predictive value of a positive mammogram in a European population screening setting? Results from a Spanish cohort

Aims of the studyThe Gail Model (GM) is the most well-known model to assess the individual risk of breast cancer (BC). Although its discriminatory accuracy is low in the clinical context, its usefulness in the screening setting is not well known. The aim of this study is to assess the utility of the GM in a European screening program. MethodsRetrospective cohort study of 2200 reassessed women with information on the GM available in a BC screening program in Barcelona, Spain. The 5 year-risk of BC applying the GM right after the screening mammogram was compared first with the actual woman's risk of BC in the same screening round and second with the BC risk during the next 5 years. ResultsThe curves of BC Gail risk overlapped for women with and without BC, both in the same screening episode as well as 5 years afterward. Overall sensitivity and specificity in the same screening episode were 22.3 and 86.5%, respectively, and 46.2 and 72.1% 5 years afterward. ROC curves were barely over the diagonal and the concordance statistics were 0.59 and 0.61, respectively. ConclusionThe GM has very low accuracy among women with a positive mammogram result, predicting BC both in the concomitant episode and 5 years later. Our results do not encourage the use of the GM in the screening context to aid the referral decision or the type of procedures after a positive mammogram or to identify women at high risk among those with a false-positive outcome.

Application of European nutritional risk screening on inpatients from department of neurology

Objective To evaluate the feasibility of European nutritional risk screening (NRS2002) on inpatients from our department of neurology,and investigate the incidence rate of nutritional risk,malnutrition,overweight and obesity of inpatients from department of neurology and neurosurgery.Methods 817 cases of patients were investigated,those who reached NRS2002 standard were graded on the next day of admission,and those who could not had exact BMI because they were not able to stand or had hydroncus had ALB test on the next day of admission.Patients' adjustment to NRS2002 was analyzed and nutritional risk,malnutrition,overweight and obesity were compared between department of neurology and neurosurgery.Results In department of neurology,the rate of complete adaption was 42.02％,incomplete adaption was 47.89％,and none adaption was 11.93％.while in the department of neurosurgary,the rate of complete adaption was 43.38％,incomplete adaption was 33.82％,and none adaption was 22.79％.The difference was statistically significant (x2 =20.331,P ＜ 0.01).The incidence rate of nutritional risk was 48.33％ in department of neurology and 30.48％ in the department of neurosurgery,and the difference was statistically significant (x2 =19.017,P ＜ 0.01).And the differences of incidence rate of malnutrition,overweight and obesity had no statistical significance between the department of neurology and neurosurgery (P ＞ 0.05).Conclusions NRS-2002 can be applied on patients from department of neurology,but data collection is affected because many patients cannot stand or have normal communication due to diseases,thus deviation may cause incomplete adaption or none adaption.Patients from department of neurology are more suitable to NRS2002 than those from department of neurosurgery and their incidence rate of nutritional risk is higher. Key words: Inpatients; Department of neurology; European nutritional risk screening; Malnutrition; Nutritional risk

Abstract FO01-01: Estimating how many prostate cancers are overdiagnosed: Overcoming challenges and avoiding mistakes

Abstract Despite the promise of the PSA test for early detection of prostate cancer, it is now clear that PSA screening can be costly, generating harms alongside benefits. Overdiagnosis, or the detection of cancers that would never have been detected clinically, is perhaps the harm of greatest concern in PSA screening. However, different studies provide widely varying assessments of the magnitude of the overdiagnosis problem. A report from the European prostate screening trial estimated that 48 men would have to be overdiagnosed to prevent one prostate cancer death, and a report based on US incidence trends estimated that more than one million men had been overdiagnosed and overtreated by 2005. These statistics are alarming but dramatically overstate the problem. In this presentation I will demonstrate how different definitions, methods and even populations can produce very different, and sometimes inaccurate, assessments of the frequency of overdiagnosis associated with PSA screening. I will present results from two studies of the US population that showed that about one in four men over 50 detected by PSA screening prior to 2000 was overdiagnosed. I will also present personalized estimates of the likelihood of overdiagnosis that vary from from 3 to 80% depending on age, grade and PSA. These estimates can be used in designing population screening programs that reduce costs and harms while preserving benefit. Citation Format: Ruth Etzioni. Estimating how many prostate cancers are overdiagnosed: Overcoming challenges and avoiding mistakes. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr FO01-01.

The 8th ISNS European Neonatal Screening Regional Meeting. 4–6 November, 2012, Budapest, Hungary

The 8th ISNS European Neonatal Screening Regional Meeting. 4–6 November, 2012, Budapest, Hungary