Design, implementation, and analysis of 42,387 participants Taiwan community-based integrated screening group
Article first published online: 3 MAR 2004
Copyright © 2004 American Cancer Society
Volume 100, Issue 8, pages 1734–1743, 15 April 2004
How to Cite
Chen, T. H.-H., Chiu, Y.-H., Luh, D.-L., Yen, M.-F., Wu, H.-M., Chen, L.-S., Tung, T.-H., Huang, C.-C., Chan, C.-C., Shiu, M.-N., Yeh, Y.-P., Liou, H.-H., Liao, C.-S., Lai, H.-C., Chiang, C.-P., Peng, H.-L., Tseng, C.-D., Yen, M.-S., Hsu, W.-C. and Chen, C.-H. (2004), Community-based multiple screening model. Cancer, 100: 1734–1743. doi: 10.1002/cncr.20171
See related editorial on pages 000–000, this issue.
Steering committee for design and analysis: Institute of Preventive Medicine (Tony Hsiu-Hsi Chen, D.D.S., Ph.D., Ming-Fang Yen, M.Sc., Chao-Sheng Liao, M.D., Ph.D., and Yen-Po Yeh, M.D.), Graduate Institute of Epidemiology (Hui-Min Wu, M.Sc.), and Institute of Occupational Medicine and Industrial Hygiene (Chang-Chuan Chan, Sc.D.), College of Public Health, National Taiwan University; School of Medical Technology (Hsin-Chih Lai, Ph.D.), School of Dentistry (Chun-Pin Chiang, D.D.S., D.M.Sc.), and Department of Pharmacology (Horng-Huei Liou, M.D., Ph.D.), College of Medicine, National Taiwan University; Department of Social Work (Chih-Chung Huang, B.Sc.), College of Social Science, National Taiwan University; Department of Public Health (Dih-Ling Luh, Ph.D.), College of Health Care and Management, Chung Shan Medical University; Institute of Public Health (Tao-Hsing Tung, M.Sc.) and Institute of Health Informatics and Decision Making (Li-Sheng Chen, M.Sc. and Yueh-Hsia Chiu, M.Sc.), National Yang-Ming University; and Health Bureau of Keelung City (Yueh-Hsia Chiu, M.Sc.).
Clinical committee for case referral and care: Department of Internal Medicine (Chuen-Den Tseng, M.D., Ph.D. and M. H. Wang), College of Medicine, National Taiwan University; Department of Gastroenterology (Chao-Sheng Liao, M.D., M.Sc.), Department of Neurology (Wei-Chih Hsu, M.D., M.Sc.), and Department of Diagnostic Radiology (Hui-Ling Peng, M.D.), Shin Kong Memorial Hospital; Department of Obstetrics and Gynecology (Ming-Shyen Yen, M.D.), Taipei Veterans General Hospital; Health Bureau of Keelung City (Yueh-Hsia Chiu, M.Sc. and Ming-Neng Shiu, M.D., Ph.D.); and Department of Internal Medicine, Chang-Gung Memorial Hospital of Keelung (Chih-Hung Chen, M.D.)
Implementation committee: Health Bureau of Keelung City (Yao-Der Chen, Po-En Wang, Chih-Fang Tsou, Ting-Ting Wang, Hsiang-Lan Kuo, Shu-Yuan Hu, Yu-Lan Shih, Hui-Chen Lee, Chun-Liang Wu, Yi-Feng Huang, Hui-Chen Chen, Mo-Sin Chung, and Lin-Lon Tseng) and Shin-Kong Memorial Hospital (Kuan-En Chu and Wei-Hsu Ko).
- Issue published online: 30 MAR 2004
- Article first published online: 3 MAR 2004
- Manuscript Accepted: 1 DEC 2003
- Manuscript Revised: 18 NOV 2003
- Manuscript Received: 15 SEP 2003
- Colorectal cancer and liver cancer screening: National Science Council. Grant Number: NSC 91-2320-B002-167
- Colorectal cancer and liver cancer screening: National Health Research Institute. Grant Number: NHRI-EX90-8828PC
- cervical cancer screening: Department of Health, Taiwan. Grant Number: DOH 89-TD-1172
- Oral cancer screening: Department of Health, Taiwan. Grant Number: DOH 89-TD-1173
- breast cancer screening: Department of Health, Taiwan. Grant Number: DOH 91-TD-1039
- Obesity and diabetes mellitus research: National Science Council. Grant Number: NSC 91-2320-B002-171
- Hyperlipidemia and hypertension research: National Science Council. Grant Number: NSC 91-2320-B002-172
- Health Care Policy of Community Preventive Medicine in Keelung City: Department of Health, Taiwan
- multiple disease screening;
- community-based integrated screening;
- cancer screening;
- chronic disease screening;
- metabolic syndrome
Multiple disease screening may have several advantages over single disease screening because of the economics of scale, with the high yield of detecting asymptomatic diseases, the identification of multiple diseases or risk factors simultaneously, the enhancement of the attendance rate, and the efficiency of follow-up.
An integrated model of community-based multiple screening was designed and conducted between 1999 and 2001 in Keelung, Taiwan. The authors used a Papanicolaou (Pap) smear screening program as a base to integrate other screening regimens encompassing four other neoplastic diseases and three nonneoplastic chronic diseases. Screening methods, the interscreening interval, and the follow-up for each screening regimen were designed based on evidence-based literature and current national screening policy.
A total of 42,387 subjects participated in the screening activities. A 25% increase in the attendance rate for Pap smear screening was demonstrated after the introduction of multiple disease screening programs. At the first screen, this program yielded a total of 677 asymptomatic neoplasms (16.0 per 1000), including a large proportion of precancerous lesions and small presymptomatic tumors without lymph node involvement. The association between the occurrence of neoplasm and the presence of comorbid nonneoplastic chronic disease was found to be statistically significant (odds ratio, 1.64; 95% confidence interval, 1.38–1.94 [P < 0.05]). The authors also identified 5314 subjects with metabolic syndrome who were at a greater risk for colorectal and oral neoplasias.
The results of the current study demonstrate that an outreach and community-based multiple screening program not only enhances attendance rates but also has a high yield of early cases of various diseases simultaneously, and provides a natural opportunity to elucidate the correlation between neoplastic disease and nonneoplastic chronic disease. Cancer 2004. © 2004 American Cancer Society.