title: Community-based multiple screening model: design, implementation, and analysis of 42,387 participants.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. stony@episerv.cph.ntu.edu.tw
authors.forename: Tony Hsiu-Hsi
authors.initials: TH
authors.lastname: Chen
authors.forename: Yueh-Hsia
authors.initials: YH
authors.lastname: Chiu
authors.forename: Dih-Ling
authors.initials: DL
authors.lastname: Luh
authors.forename: Ming-Fang
authors.initials: MF
authors.lastname: Yen
authors.forename: Hui-Min
authors.initials: HM
authors.lastname: Wu
authors.forename: Li-Sheng
authors.initials: LS
authors.lastname: Chen
authors.forename: Tao-Hsin
authors.initials: TH
authors.lastname: Tung
authors.forename: Chih-Chung
authors.initials: CC
authors.lastname: Huang
authors.forename: Chang-Chuan
authors.initials: CC
authors.lastname: Chan
authors.forename: Ming-Neng
authors.initials: MN
authors.lastname: Shiu
authors.forename: Yen-Po
authors.initials: YP
authors.lastname: Yeh
authors.forename: Horng-Huei
authors.initials: HH
authors.lastname: Liou
authors.forename: Chao-Sheng
authors.initials: CS
authors.lastname: Liao
authors.forename: Hsin-Chih
authors.initials: HC
authors.lastname: Lai
authors.forename: Chun-Pin
authors.initials: CP
authors.lastname: Chiang
authors.forename: Hui-Ling
authors.initials: HL
authors.lastname: Peng
authors.forename: Chuen-Den
authors.initials: CD
authors.lastname: Tseng
authors.forename: Ming-Shyen
authors.initials: MS
authors.lastname: Yen
authors.forename: Wei-Chih
authors.initials: WC
authors.lastname: Hsu
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D002908:Chronic Disease; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003153:Community Health Services; D003159:Community-Institutional Relations; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis*; D065006:Papanicolaou Test; D012107:Research Design; D013624:Taiwan; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000706:statistics & numerical data*