This document summarizes the findings of a study on the effectiveness of early detection of cancers and chronic diseases through a community-based integrated screening (CIS) program in Keelung, Taiwan over 13 years. The key findings are: 1) Mortality rates were 50-55% lower for CIS program attendees compared to non-attendees, and the overall mortality rate in Keelung was 23% lower than the national average. 2) The CIS program was associated with significant mortality reductions for several causes, including 43-65% lower rates for hypertension, 41-57% lower for cerebrovascular disease, and 14-46% lower for various cancers. 3) Over 13 years, the CIS

1. Early Detection of Cancers and Chronic
Diseases
Sam Li-Sheng Chen
School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taiwan
1
On behalf of Taiwan Cancer Screening Evaluation Group

2. 2
Cancer 2004;100:1734–43.

3. 3

4. 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.

5. Chronic diseases & Cancers
Mets 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)
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Cancer 2004;100:1734–43

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KCIS No.6
KCIS No.10
KCIS No.28

7. 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 screening
Annual 278.30 167.87 102.82 0.67 0.52-0.86
Biennial 253.48 192.69 113.94 0.74 0.58-0.94
Three-yearly 241.88 204.29 119.02 0.77 0.61-0.98
Four-yearly 234.96 211.21 121.91 0.79 0.62-1.00
Five-yearly 231.17 215.00 124.25 0.81 0.64-1.02
Single screening
Annual 329.54 195.22 118.22 0.77 0.60-0.97
Biennial 300.17 224.58 131.24 0.85 0.67-1.07
Three-yearly 286.43 238.33 137.18 0.89 0.71-1.12
Four-yearly 278.20 246.55 140.57 0.91 0.73-1.15
Five-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

8. No screening (NS)
Multiple screening (MS)
Single screening (CS)
Cost-effectiveness analysis for
different screening regimes
Wang et al., JMS, 2006

9. The Effectiveness of Early Detection on
Cancers and Chronic Diseses
9

10. Materials & Methods
 Study design
Before-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 epoch
Age standardized observed mortality in post-screening
phase was used to compare with the age standardized
expected mortality for compared groups in pre-
screening phase
Considering the selection-bias adjustment

11. 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
CoverageRate
Male Female
80%
54%

12. 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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13. RR in comparison between nationwide and
Keelung city
Age
Keelung 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)

14. Specific Causes
Mortality 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)
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* 50-69 yrs

15. 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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16. 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!