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Early Detection of Cancers and Chronic Diseases
Sam Li-Sheng ChenSchool of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taiwan
1On behalf of Taiwan Cancer Screening Evaluation Group
4
For KCIS no. 1
The public’s positive orientation toward Prevention and early detection, combined with dependable health education from their physician and other trusted sources, can lead to an informed consumer who will readily accept an effective, evidence-based model for periodic preventive health encounters.
KCIS study challenge us to move beyond opportunistic preventive care.
Chronic diseases & CancersMets associated with Colorectal Adenoma: OR=1.43(1.01-2.02)Mets associated with Oral Neoplasm: OR=1.68(1.03-2.75)
Hyperglycemia associated with HCC: OR=1.6(1.16-2.21)
Hypertension associated with Colorectal Neoplasm: OR=1.42(1.06-1.89)Hypertension associated with Oral Neoplasm: OR=1.67(1.07-2.59)
Obesity associated with Oral Neoplasm: OR=1.89(1.23-2.90)
5Cancer 2004;100:1734–43
Decision analysis for multiple screening and single screening
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Efficacy of Multiple & Single Screening
Screening regime CRC (A or B)CRC (C or D)or CRC death
CRC death RR 95% CI
Multiple screeningAnnual 278.30 167.87 102.82 0.67 0.52-0.86Biennial 253.48 192.69 113.94 0.74 0.58-0.94Three-yearly 241.88 204.29 119.02 0.77 0.61-0.98Four-yearly 234.96 211.21 121.91 0.79 0.62-1.00Five-yearly 231.17 215.00 124.25 0.81 0.64-1.02
Single screeningAnnual 329.54 195.22 118.22 0.77 0.60-0.97Biennial 300.17 224.58 131.24 0.85 0.67-1.07Three-yearly 286.43 238.33 137.18 0.89 0.71-1.12Four-yearly 278.20 246.55 140.57 0.91 0.73-1.15Five-yearly 273.70 251.05 143.35 0.93 0.74-1.17
Control 250.50 274.25 154.17 1
Yang et al., JMS, 2006
No screening (NS)Multiple screening (MS)Single screening (CS)
Cost-effectiveness analysis for different screening regimes
Wang et al., JMS, 2006
Materials & Methods Study designBefore-and-after quasi-experiment design by
comparing the mortality before (1987 to 1999 ) and after (2000 to 2012) community-based integrated screening (CIS) with identical 13 year epochAge standardized observed mortality in post-screening
phase was used to compare with the age standardized expected mortality for compared groups in pre-screening phaseConsidering the selection-bias adjustment
Coverage Rate in KCIS program
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0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
30-39 40-49 50-59 60-69 70-79
Cove
rage
Rat
e
Male Female
80%
54%
Relative Standardized Mortality Rate for attendant and non-attendant
Gender Attendant Non-Attendant Overall KCIS
RR(95%CI) RR(95%CI) RR (95%CI)
Male 0.51(0.48-0.55) 1.00(0.99-1.02) 0.83(0.81-0.85)Female 0.55(0.51-0.59) 0.88(0.85-0.90) 0.73(0.71-0.75)
Total 0.50(0.47-0.53) 0.95(0.93-0.96) 0.77(0.76-0.79)
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RR in comparison between nationwide and Keelung city
AgeKeelung Nationwide
RR(95% CI)
RR(95%CI)
RR(95% CI)
RR(95%CI)
30-39 0.94(0.88-0.99)
0.839(0.835-0.844)
40-49 0.93(0.89-0.96)
0.919(0.915-0.923)
50-59 0.78(0.75-0.81)
0.757(0.754-0.760)
60-69 0.71(0.68-0.73)
0.737(0.735-0.739)
70-79 0.76(0.74-0.78)
0.772(0.771-0.774)
Total 0.77(0.76-0.79)
0.77(0.76-0.79)
0.851(0.850-0.852)
0.851(0.850-0.852)
Specific CausesMortality Reduction
Male Female
Heart Disease 0.82(0.77-0.88) 0.57 (0.48-0.65)
Cerebrovascular Disease 0.57 (0.51-0.63) 0.41 (0.33-0.49)
Diabetes Mellitus 0.98 (0.91-1.06) 0.72(0.65-0.79)
Hypertension 0.43(0.27-0.59) 0.35 (0.16-0.54)
Chronic Liver Disease or Cirrhosis 0.69 (0.62-0.77) 0.77 (0.64-0.89)
Colorectal Cancer* 0.92(0.76-1.07) 1.11(0.95-1.26)
Liver Cancer 0.82(0.76-0.88) 0.90(0.80-1.00)
Cervical Cancer - 0.54(0.38-0.71)
Breast Cancer - 1.37 (1.24-1.51)14* 50-69 yrs
Conclusions• CIS has served over 120,000 Keelung people and saved
numerous lives over the past decade. • The 26% significant mortality reduction after 13-years of
follow-up in the CIS programme has been demonstrated.• CIS prevents deaths from hypertension by 57%-65%, followed
by 43%-59% in cerebrovascular disease, and 23%-31% in chronic liver diseases.
• CIS also prevents deaths from cancer by 14%, a remarkable 46% decrease death rate in cervical cancer
• This suggests a multiple screening programme considering multiple disease prevention is effective in prolonging the life.
15
Acknowledgements
• Health Promotion Administration, Ministry of Health and Welfare
• Public Health Staff in Community• Medical Professionals in Hospitals
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