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

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Cancer 2004;100:1734–43.

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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

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KCIS No.6

KCIS No.10

KCIS No.28

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

The Effectiveness of Early Detection on Cancers and Chronic Diseses

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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.

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Acknowledgements

• Health Promotion Administration, Ministry of Health and Welfare

• Public Health Staff in Community• Medical Professionals in Hospitals

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Thank You for Your Attention!