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Biomedical subjects

H Fielder

Publications and source records attributed to H Fielder.

15 recordsLinked to original sources
PubMed2006

Two-view mammography at the incident round has improved the rate of screen-detected breast cancer in Wales.

AIM: To investigate whether pre-invasive and invasive cancer detection rates were improved in Wales after the introduction of two views at incident screens. METHODS: The records of women attending follow-up screening for 2 years before and 2 years after the introduction of two-view incident screening were analysed. Cancer detection rates were compared before and after introduction of two view screening. RESULTS: At the incident round 98,752 women had one and 95,464 had two views. Five hundred and fifty-five cancers were detected with one view and 744 with two, an increased detection rate from 5.6 to 7.8 cancers per 1000 women screened (p=0.01). Two hundred and thirty-nine small cancers were detected with one view and 323 with two, increasing the detection rate from 2.4 to 3.4 per 1000 women screened (p=0.05). CONCLUSIONS: Two-view mammography at incident rounds detects more cancers and more favourable prognosis small cancers than single-view mammograms.

Breast Neoplasms↗
PubMed2006

A comparison of variability in Papanicolaou and liquid-based cytology inadequacy rates using Shewhart control charts.

OBJECTIVE: To use Shewhart control charts to compare variability in inadequacy rates from Papanicolaou (Pap) and liquid-based cytology (LBC). DESIGN: Retrospective analysis of quality assurance data. SETTING: Eleven Welsh cytology laboratories. METHODS: Shewhart 'p' charts were plotted for proportions of slides reported as inadequate. Charts were compared for statistical control. MAIN OUTCOME MEASURES: Evidence of statistical control in the processes. RESULTS: Control charts allowed easy interpretation of patterns in the data. Variability in inadequacy rates was much lower for LBC than for Pap cytology. CONCLUSION: Monitoring inadequate rates with Shewhart charts provides more information than tabular monitoring reports, assisting in quality improvement. With respect to inadequacy rates, LBC is less variable than Pap cytology.

Female↗
PubMed2006

Cervical screening in 20-24-year olds.

BACKGROUND: In 2003 the NHS Cervical Screening Programme in England changed the age at which women are first invited for cervical screening from 20 to 25 years. The aim of this review was to assess the evidence for benefit and harm of undertaking cervical screening in Wales for women aged 20-24 years. METHOD: A literature review looking for evidence of the effectiveness and potential harmful effects of cervical screening was undertaken. Welsh data for the number of cases of high-grade cervical intraepithelial neoplasia (CIN3) were examined and rates of invasive cervical cancer (1981-2003) for young women calculated. The medical notes of women less than 25 years old diagnosed with cervical cancer were reviewed and a cost analysis was performed. RESULTS: The literature review failed to identify any randomized controlled studies of the effectiveness of cervical screening in young women, but demonstrated that organized screening programmes result in a decrease in the incidence of cervical carcinoma. Following the introduction of the Welsh organized call/recall cervical screening programme in 1988, cervical cancer has been reduced by 58% in women aged 20-24 years and 45% in women aged 25-29 years (mean age-specific rate per 100,000 women aged 20-24 years: 4.2 in 1981-88 compared with 2.2 in 1989-2003). If these changes can be attributed to the screening of women aged 20-24, then the costs of at least pound sterling 82,500 are estimated to prevent one cervical cancer in this age group. CONCLUSIONS: The incidence of cervical cancer in young women has halved since the introduction of the Welsh-organized call-recall cervical screening programme. In Wales we recommend that women continue to be invited for cervical screening from 20 years of age. This will provide the information required to compare the incidence and stage at diagnosis of cervical cancer in young women invited for first time cervical screening at different ages across the UK.

Adult↗
PubMed2005

Patient demographics and treatment for early breast cancer: an observational study.

This study aims to examine relationships between demographic factors and treatment choice for early breast cancer (T2/N<1). Two hundred and two patients were offered modified radical mastectomy (MRM), breast conserving therapy (BCT) or MRM and reconstruction and interviewed at a University Hospital and oncology centre in South Wales. Median age at treatment was 57 (32-90) years. Seventy-one patients (35%) choose MRM, 10 (5%) MRM and reconstruction and 121 (60%) BCT. Median age of women choosing MRM was 61 and 55 for BC (P<0.0001). Single women (P=0.009) and those with no family history of breast cancer (P=0.02) were more likely to choose MRM. There was no difference between treatment choice and method of cancer detection and the age at which the patient left education (P=0.065). Mean histological tumour diameter was smaller for women choosing BC (15 mm) than for women choosing mastectomy (17 mm; P=0.014). There was no association between tumour grade and treatment choice.

Adult↗
PubMed2004

The inadequate smear: does it matter?

The objective of this study was to quantify the incidence of underlying cervical intraepithelial neoplasia (CIN) among women referred for colposcopy with three consecutive inadequate smears. The design was a retrospective cohort study analysing data from a regional colposcopy database at Cervical Screening Wales. Women who were referred to all the colposcopy clinics in Wales with three consecutive inadequate smears, the third inadequate smear being taken between 1 April 2001 and 31 March 2002 constituted the study population. The results of the fourth smear taken at the colposcopy clinic after three consecutive inadequate smears, the worst biopsy results from any of the subsequent colposcopies and the relationship between the result of the fourth smear taken at colposcopy clinic and any histology result were the main outcome measures. The accuracy of the colposcopic opinion was also examined. Of the 433 women identified as having been referred because of three consecutive inadequate smears, 302 were linked to either a subsequent smear and/or a biopsy result. An adequate smear result was available for 85% of these women when the smear was taken in the colposcopy clinic; 77% were reported as negative and 8% were abnormal. Of the 347 women seen in the colposcopy clinic, high-grade CIN was seen in 3% and low-grade lesion in 8%. The sensitivity and specificity of the fourth inadequate smear test in predicting underlying CIN were 15% and 84% respectively, with a positive predictive value of 8%. The sensitivity and specificity of colposcopy in predicting histological CIN among patients with three inadequate smears was 70% and 49%, respectively, and the positive predictive value was 44%. This study raises the question as to whether three consecutive inadequate smears should be considered as an indication for colposcopy, or merely for a further smear to be taken in circumstances where there is a greater likelihood getting an adequate result.

Adult↗
PubMed2001

Results from 10 years of breast screening in Wales.

OBJECTIVE: To present results from 10 years of breast screening in Wales, including rates of interval cancers. SETTING: All women aged 50-64 years in Wales; approximately 250,000 in each screening round. METHODS: Breast Test Wales (BTW) began mammographic screening in 1989 as part of the National Breast Screening Programme. Two view mammography was introduced at the inception of the Welsh programme for all prevalent screens. Single view mammography was subsequently performed for incident screens. Interval cancers were identified by matching details from the BTW administrative screening database with the BTW database of all incident breast cancers for residents in Wales. RESULTS: For the first and second round prevalent screens, the cancer detection rate was 8.6 per 1000 and 7.4 per 1000 screened, respectively. The interval cancer rates following round one were 4.9 per 10,000 in the first 12 months, 9.0 per 10,000 between 12 and 24 months, and 11.6 per 10,000 between 24 and 36 months after screening. For the second round incident screens the detection rate was 4.6 per 1000 and the standardised detection ratio was 0.89, but the interval cancer rates in the first year after incident screens were not statistically different from those following prevalent screens. There was no change in the proportion of invasive breast cancers which were < 15 mm in diameter, or in the grades of invasive cancer between the first and second rounds, prevalent or incident screens. CONCLUSIONS: Breast Test Wales has achieved the standards set by the National Health Service Breast Screening Programme. Taking two views at the prevalent screen gave high sensitivity and may have resulted in the low standardised detection ratio at subsequent incident screens.

Breast Neoplasms↗
PubMed2001

Development of a protocol for evaluation of mammographic surveillance services in women under 50 with a family history of breast cancer.

BACKGROUND: Preliminary retrospective data suggest it is possible to identify impalpable breast cancer in women presenting with a family history of breast cancer under the age of 50, by using regular mammography. In consequence, this service is offered in a number of centres in the UK. The effectiveness of such a service, however, has not been fully evaluated. METHODS: We propose to perform such an evaluation in a cohort of 20000 women under the age of 50 with a significant family history of breast cancer, given regular mammographic surveillance over 5 years. Comparison of surgical and pathological data with completed and ongoing population screening trials using analysis techniques of varying complexity will be performed to obtain an accurate prediction of future breast-cancer mortality reduction. The formal aims are: i) to estimate the difference in breast-cancer mortality in women under the age of 50 with a significant family history of breast cancer having regular mammography, compared with those not being screened; ii) to estimate the cost-effectiveness of regular mammography in this group of women, compared with no screening. The increase in health service resource use attributable to such a policy will be compared with no screening, and costed. Incremental cost-effectiveness ratios of implementing the standardised mammography strategy compared with no screening will be presented in terms of the additional cost per cancer detected, per life saved and per life-year saved.

Adult↗
PubMed1996

Measurement of health status in patients with vertigo.

In order to assess how much disability is caused by vertigo, health status scores of patients referred with dizziness or vertigo were compared with local population normative data and with the severity of illness, measured by a disease-specific questionnaire. The questionnaires were administered by post to patients awaiting an ENT out-patient appointment. There was a strong correlation (P = 0.001) between the eight dimensions of the SF-36 (Mos 36 item short-form health survey) and disease severity, measured by the Dizziness Handicap Inventory questionnaire. Compared with the general population, vertigo sufferers had significant role limitation due to physical problems and social functioning (men) and physical problems and vitality (women). General health status is significantly affected by both the presence and severity of vertigo and the SF-36 may prove useful in assessing outcomes.

Activities of Daily Living↗
PubMed1995

Measuring health status with the SF-36: the need for regional norms.

BACKGROUND: Normative data on SF-36 scores in populations from Oxford and Aberdeen have recently been published. It has been suggested that such data provide suitable normative values for the UK population. However, other indices of health vary considerably across regions, and tend to be worse in areas such as South Wales. The objective of this study was to determine whether population SF-36 scores in West Glamorgan differ from scores from other parts of the United Kingdom. METHOD: The SF-36 health status questionnaire was administered to two random samples of adults aged 20-89 years, drawn from the West Glamorgan Family Health Services Authority register. One sample (n = 919) received postal questionnaires and those in the other sample (n = 1201) were interviewed in their own homes. Normative data from this study were compared with published data from other areas of the United Kingdom. RESULTS: SF-36 population scores were significantly lower in the two West Glamorgan samples; this was not due to differences in age, sex, social class, or response rates. CONCLUSION: Health status in West Glamorgan, as measured by the SF-36, is lower than in Oxford or Aberdeen. A national study would be required to provide appropriate normative data for the UK population.

Activities of Daily Living↗