Community-based multiple screening model: design, implementation, and analysis of 42,387 participants.
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.
Chen
Tony Hsiu-Hsi
TH
Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. stony@episerv.cph.ntu.edu.tw
Chiu
Yueh-Hsia
YH
Luh
Dih-Ling
DL
Yen
Ming-Fang
MF
Wu
Hui-Min
HM
Chen
Li-Sheng
LS
Tung
Tao-Hsin
TH
Huang
Chih-Chung
CC
Chan
Chang-Chuan
CC
Shiu
Ming-Neng
MN
Yeh
Yen-Po
YP
Liou
Horng-Huei
HH
Liao
Chao-Sheng
CS
Lai
Hsin-Chih
HC
Chiang
Chun-Pin
CP
Peng
Hui-Ling
HL
Tseng
Chuen-Den
CD
Yen
Ming-Shyen
MS
Hsu
Wei-Chih
WC
Chen
Chih-Hung
CH
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*