Screening for breast cancer, time to think--and stop? National Evaluation Team for Breast Cancer Screening (NETB)
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Results for “Cancer screening”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Screening for breast cancer. Screen women over 65.
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[European recommendations for quality assurance in the setting of mammographic screening for breast cancer. Report of pathologists of the working group "Breast Cancer Screening" of the European Union].
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Effect of a short structured session on medical student breast cancer screening knowledge.
Formalized instruction in breast cancer screening during medical school may help improve early breast cancer detection and survival. Physicians-in-training must be proficient in skills relating to breast cancer screening. This study investigates the baseline breast cancer screening knowledge of medical students, the benefit of a structured lecture session, and its effect on improving medical students' knowledge of cancer screening. A self-administrated questionnaire relating to breast cancer screening was given to third-year medical students. A 60-minute structured lecture session was given to the medical students regarding breast cancer screening. A postintervention survey was administered immediately following the session. A total of 27 medical students were evaluated. There was a statistically significant improvement following the formalized teaching session (84% to 93%; p < 0.0016). While few students (15%) reported having previous instruction in cancer screening, most students (96%) felt that a formal session should be offered during medical school. While medical student knowledge of breast cancer screening may be adequate, formalized instruction in breast cancer health practices can improve medical student knowledge. Most students had limited previous instruction in breast cancer prevention and welcomed the opportunity for structured training in breast cancer prevention, education, and detection. Until a formal course becomes a fundamental aspect of medical education, a short structured session should be instituted.
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The cancer screening practices of adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.
BACKGROUND: The current study characterized the self-reported cancer screening practices of adult survivors of childhood cancer. METHODS: A cohort of 9434 long-term survivors of childhood cancer and a comparison group of 2667 siblings completed a 289-item survey that included items regarding cancer-screening practices. RESULTS: Overall, 27.3% of female respondents reported performing breast self-examination (BSE) regularly, 78.2% reported undergoing a Papanicolaou smear within the previous 3 years, 62.4% underwent a clinical breast examination (CBE) within the last year, and 20.9% had gotten a mammogram at least once in their lifetime. Approximately 17.4% of male respondents reported performing regular testicular self-examination (TSE). Women age > or =30 years who had been exposed to chest or mantle radiation therapy were more likely to report undergoing CBE (odds ratio [OR], 1.59; 95% confidence interval [95% CI], 1.32-1.92) and mammography (OR, 1.92; 95% CI, 1.47-2.56). Compared with the sibling comparison group, survivors demonstrated an increased likelihood of performing TSE (OR, 1.52; 95% CI, 1.22-1.85) or BSE (OR, 1.30; 95% CI, 1.10-1.52), of having undergone a CBE within the last year (OR, 1.18; 95% CI, 1.02-1.35), and of ever having undergone a mammogram (OR, 1.82; 95% CI, 1.52-2.17). CONCLUSIONS: The results of the current study demonstrate that the cancer screening practices among survivors of childhood cancer are below optimal levels. Primary care physicians who include childhood cancer survivors among their patients could benefit these individuals by informing them about future cancer risks and recommending appropriate evidence-based screening.
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Telomerase-A molecular marker for cervical cancer screening.
Cervical cancer is one of the most common cancers in women and can be routinely screened for by the Papanicolaou smear. Screening for HPV high-risk types 16 and 18 has augmented the sensitivity of this test, but still some cases remain undetected. We have investigated the utility of assaying telomerase activity as a possible screening marker for cervical cancer. Telomerase activity was studied in relation to HPV 16/18 infection, Papanicolaou smear cytopathology, and biopsy histopathology in a total of 88 subjects, consisting of 29 cervical cancer cases, 19 control hysterectomy samples, 16 precancerous cervical scrapes, 6 cervical samples from other gynecological malignancies, and 18 normal healthy cervical scrapings. Telomerase activity was detected in 96.5% of cervical tumor samples and in 68.7% of premalignant cervical scrapings but was not detected in control hysterectomy samples and in cervical scrapings of normal healthy controls. Telomerase assay had a diagnostic accuracy of 95.8 in tissue samples, 79.1 in scrapings and 91.2 in all. Whereas HPV-16/18 subtyping had a diagnostic accuracy of 89.5% in tissue samples, 70.5% in scrapings, and 82.1% in all. There was also 71% agreement between telomerase activity and HPV-16/18 infection. The absence of telomerase activity in cervical scrapes from healthy women indicated the potential of telomerase to serve as a good screening marker for the early diagnosis of cervical cancer. For the first time we have also shown the ability of telomerase to detect micro and probably occult metastasis in gynecological malignancies.
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The breast cancer screening controversy and the National Institutes of Health Consensus Development Conference on Breast Cancer Screening for Women Ages 40-49.
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Does the 'inverse screening law' apply to oral cancer screening and regular dental check-ups?
OBJECTIVE: Early detection through regular screening is a measure used in certain cancer prevention strategies. This approach has been advocated for the prevention of oral cancers in the UK. The objective of this study was to assess whether people at higher risk of oral cancer in the UK visit dentists on a regular basis, and thereby afford opportunities for oral cancer screening. METHODS: Data from two large national surveys were used. Firstly, data from the Health Survey for England, 2001, were used to assess the relationship between dental attendance (the outcome measure) and recognized oral cancer risk factors; there were 13,784 participants with complete data. We used known risk factors for oral cancer (age >40 years, male sex, alcohol intake >28 units per week, cigarettes >20 per day, and fruit and vegetables <5 times a day) to generate a risk score for oral cancer. Logistic regression was used to compute the odds ratios for regular dental attendance according to risk score. All analyses used education and social class as covariates. We also used data from the British Household Panel Survey to assess whether dental attendance behaviour is sustained over a set period of time (5,547 participants with complete data). RESULTS: In persons in the higher risk category (as defined above) of the five risk factors, age, sex, alcohol, smoking, and fruit/vegetables, 68%, 56%, 52%, 43% and 60%, respectively reported regular dental check-ups. In persons with 0, 1, 2, 3, 4 and 5 of these risk factors, the odds ratio for regular dental check-ups was 1.00, 0.93, 0.81, 0.64, 0.50 and 0.28, respectively. The probability of regular dental attendance was low in all groups with a higher risk of oral cancer. In the longitudinal sample, the low probability of visiting a dentist regularly was stable over time. CONCLUSION: Opportunistic screening for oral cancer in general dental practice in the UK is unlikely to be an effective preventive strategy.
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The effect of Medicare reimbursement for screening mammography on utilization and payment. National Cancer Institute Breast Cancer Screening Consortium.
OBJECTIVE: In January 1991, Medicare extended its mammography benefit to reimburse for breast cancer screening mammograms. In 1991 and again in 1993, the National Cancer Institute Breast Cancer Screening Consortium (BCSC) conducted a survey to test the hypothesis that this benefit would increase mammography use among women over the age of 65. METHODS: The authors analyzed data on non-Hispanic white women ages 65 to 74 living in 11 geographic areas targeted by the BCSC for an earlier study--six that had received cancer screening educational interventions and five control subsites--to measure the impact of the newly adopted Medicare benefit on the use of mammography and use of Medicare to reimburse mammography costs. RESULTS: The data show little overall increase between 1991 and 1993 in reported mammography use among respondents to the survey. However, in six intervention and five control subsites there was an increase in the percentage of women who reported using public payment sources to at least partially reimburse the cost of mammograms. In three intervention subsites, the increase from 1991 to 1993 in the percentage of women using public sources of payment was greater than in the corresponding control subsites. CONCLUSIONS: These findings suggest that public health interventions are more likely to succeed when educational promotion accompanies a financial benefit.
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The value of ovarian cancer screening.
Ovarian cancer is the commonest cause of death from a gynaecological malignancy. Diagnosis of the disease at an early stage is associated with significantly improved survival rate. This suggests that screening may impact on disease mortality. This review addresses the current methods of screening, the ongoing trials and future of screening for ovarian cancer.
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Age-specific effectiveness of the Nijmegen population-based breast cancer-screening program: assessment of early indicators of screening effectiveness.
BACKGROUND: The benefits of mammographic screening for breast cancer are not clear for women less than 50 years old. PURPOSE: Our aim was to evaluate the effectiveness of breast cancer screening in different age groups. METHODS: A mammographic breast cancer-screening program with a 2-year screening interval has been under way in Nijmegen, The Netherlands, since 1975. After eight rounds, more than 40,000 women have been invited to participate. All breast cancer cases diagnosed in the invited population, whether detected by screening or clinically, have been considered in this study. The age groups are younger than 50 years, 50-69 years, and 70 years or older at last invitation before diagnosis. Our assessment of the effectiveness of screening is based on the proportion of screen-detected cancers among all cancers and on the disease stage at diagnosis. RESULTS: For women younger than 50, compliance was 75%, and 37% (85/230) of the cancers were detected by screening. The age group 50-69 years had a compliance of 65% with 48% (288/595) of cancers detected by screening, and the group 70 years or older had a 25% compliance with 35% (108/305) of cancers detected by screening. The sizes of the cancers detected by screening were smaller than those detected clinically for all age groups. The age group under 50 showed no substantial difference in the proportion of positive axillary lymph node status between screening-detected and clinically diagnosed cancers, while among older women, the proportion of lymph node involvement was substantially higher for clinically detected cases. A significantly lower frequency of advanced stages was observed in screen-detected compared with clinically diagnosed cancers for women 50 years of age or older (P < .001) but not in women under 50 (P = .35). CONCLUSIONS: No positive effect of the biennial screening program is apparent for women under age 50. For women aged 50 and above, the screen-detected cancers have a more favorable stage distribution than clinically diagnosed cancers, a prerequisite for a reduction in breast cancer mortality.
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Cancer screening and risk-reducing behaviors of women seeking genetic cancer risk assessment for breast and ovarian cancers.
PURPOSE/OBJECTIVES: To examine breast and ovarian cancer screening and risk-reducing behaviors of women seeking genetic cancer risk assessment (GCRA). DESIGN: Descriptive, cross-sectional. SETTING: An insurance-based clinic that serves high-risk patients in a southern California cancer center. SAMPLE: 134 women with breast or ovarian cancer (affected group) and 80 women with a family history of breast or ovarian cancer (unaffected group). The mean age of the sample was 48 years (range = 21-86), 79% were Caucasian, 66% were married, 60% were college educated, and 78% had children. Most affected women had early-stage disease. Unaffected women had a family history of breast (86%) or ovarian (14%) cancer. METHODS: Mailed surveys assessed pre-GCRA health behaviors and health and family histories. MAIN RESEARCH VARIABLES: Breast cancer screening (mammograms, clinical breast examination [CBE], breast self-examination), ovarian cancer screening (CA-125, pelvic ultrasound), and breast and ovarian cancer risk-reducing strategies (tamoxifen, bilateral mastectomy, oral contraceptive pills, bilateral salpingo-oophorectomy). FINDINGS: Twenty-one percent of the women who should have been having a mammogram had not had an annual examination as recommended, and 30% of affected women had not had annual CBEs. Few women took tamoxifen or oral contraceptive pills or had a bilateral salpingo-oophorectomy or bilateral mastectomy for cancer risk reduction. Twelve percent likely had unnecessary ovarian cancer screening. About 35% used other means, including herbs and homeopathy, for cancer prevention. CONCLUSIONS: Nearly a third of the affected women had not had appropriate breast cancer screening. About 12% used unsubstantiated, potentially harmful cancer "prevention" measures (e.g., herbs). IMPLICATIONS FOR NURSING: Nurses should assess clients' personal and family breast and ovarian cancer histories and promote cancer screening and risk-reducing behaviors that are appropriate for age and risk level.
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Colorectal cancer-screening tests and associated health behaviors.
BACKGROUND: Studies have shown that screening reduces colorectal cancer mortality. We analyzed national survey data to determine rates of use of fecal occult blood testing (FOBT) and sigmoidoscopy, and to determine if these rates differ by demographic factors and other health behaviors. METHODS: A total of 52,754 respondents aged >or=50 years were questioned in the 1997 Behavioral Risk Factor Surveillance System (BRFSS) survey (a random-digit-dialing telephone survey of the non-institutionalized U.S. population) about their use of FOBT and sigmoidoscopy. RESULTS: The age-adjusted proportion of respondents who reported having had a colorectal cancer screening test during the recommended time interval (past year for FOBT and past 5 years for sigmoidoscopy) was 19.8% for FOBT, 30.5% for sigmoidoscopy, and 41.1% for either FOBT or sigmoidoscopy. Rates of use of colorectal cancer screening tests were higher for those who had other screening tests (mammography, Papanicolaou smear, and cholesterol check). There were also differences in rates of use of colorectal cancer screening tests according to other health behaviors (smoking, seat belt use, fruit and vegetable intake, and physical activity) and several demographic factors. However, none of the subgroups that we examined reported a rate of FOBT use above 29% within the past year or a rate of sigmoidoscopy use above 41% within the past 5 years. CONCLUSIONS: While rates of use of FOBT and sigmoidoscopy were higher among people who practiced other healthy behaviors, rates of use were still quite low in all subgroups. There is a need for increased awareness of the importance of colorectal cancer screening.
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The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial of the National Cancer Institute: history, organization, and status.
The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial is enrolling 148,000 men and women ages 55-74 at ten screening centers nationwide with balanced randomization to intervention and control arms. For prostate cancer, men receive a digital rectal examination and a blood test for prostate-specific antigen. For lung cancer, men and women receive a posteroanterior view chest X-ray. For colorectal cancer, men and women undergo a 60-cm flexible sigmoidoscopy. For ovarian cancer, women receive a blood test for the CA125 tumor marker and transvaginal ultrasound. Members of the control arm continue with their usual care. Follow-up in both groups will continue for at least 13 years from randomization to assess health status and cause of death. The primary endpoint is mortality from the four PLCO cancers, which accounts for about 53% of all cancer deaths in men and 41% of cancer deaths in women in the United States each year. Blood specimens are collected from screened participants, buccal cell DNA from controls, and histology slides from cases; these are maintained in a biorepository. Participants complete a baseline questionnaire (covering health status and risk factors) and a dietary questionnaire. More than 12,000 participants were enrolled in the pilot phase (concluded in September 1994). Changes in the eligibility criteria followed. As of April 2000, enrollment exceeded 144,500. Data are scanned into designated on-site computers for uploading by participant identification number to the coordinating center for quality checks, archival storage, and preparation of analysis datasets for use by the National Cancer Institute (NCI). Scientific direction is provided by NCI scientists, trial investigators, external consultants, and an independent data safety and monitoring board. Performance and data quality are monitored via data edits, site visits, random record audits, and teleconferences. The PLCO trial is formally endorsed by the American Cancer Society and has been ranked by the American Urological Association as one of the most important prostate cancer studies being conducted. Special efforts to enroll black participants are cosponsored by the U.S. Centers for Disease Control and Prevention.
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Review on cervical cancer screening.
This article reviews literature of cervical cancer screening including the following topics: (1) basic conditions concerning screening; (2) consensus on cervical cancer screening; (3) some limitations and problems of cancer screening; (4) intervals of cervical cancer screening; (5) evaluation of cervical cancer screening; (6) methods for cervical cancer screening; (7) target population for screening (participants of both screening and rescreening); (8) selective screening (teenagers, pregnant women, prostitutes, hospital patients, clinic patients, immunosuppressive patients, and referral); (9) reports on screening programs in various countries; and (10) cost and benefit of screening.
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BRCA1 mutation testing for Japanese patients with ovarian cancer in breast cancer screening.
From February 1996 to April 1998, 2967 women received screening for breast cancer in the gynecologic ambulatory practice of the Hokkaido University Hospital. In 116 Japanese women with epithelial ovarian cancer, mutation analysis of BRCA1 exon 11 in genomic DNA was performed by the stop codon (SC) assay and DNA sequence analysis. Clinicopathological factors were also investigated in these patients. The aim of this study was to examine the advantages of performing BRCA1 mutation testing for ovarian cancer patients during breast cancer screening. We achieved a high detection rate (6.0%) of patients with germline mutations in BRCA1. The high frequencies of breast ovarian cancer syndrome, serous adenocarcinoma, high histological grades, advanced FIGO stages, and breast cancer as double cancer were found to be characteristic of ovarian cancer with germline mutations in BRCA1. These characteristics may assist physicians in selecting BRCA1 mutation testing for ovarian cancer patients. The mean age at diagnosis of ovarian cancer was 51.0 and 51.2 years in the groups with and without mutation, respectively, and no difference was found in age at diagnosis. All of the nine living female mutation carriers were offered the options of increased surveillance or prophylactic surgery, and all chose the former. We have performed breast cancer screening and/or ovarian cancer screening every 6 months for these carriers. This may allow another advantage in establishing a relationship of mutual trust with a patient from a series of responsible follow-ups.
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Colorectal cancer screening.
Colorectal cancer is a major public health burden worldwide. There is clear-cut evidence that screening will reduce colorectal cancer mortality and the only contentious issue is which screening tool to use. Most evidence points towards screening with fecal occult blood testing. The immunochemical fecal occult blood tests have a higher sensitivity than the guaiac-based tests. In addition, their automation and haemoglobin quantification allows a threshold for colonoscopy to be selected that can be accommodated within individual health care systems.
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Endometrial cancer screening.
Endometrial cancer is the most common malignancy of the female genital tract. The prognosis of the endometrial carcinoma is strongly correlated with the myometrial infiltration depth. Therefore, it is of utmost clinical interest to detect the malignancies at the earliest stage or even as a precancer. All approaches, like cytologies and uterine smears, have failed to fulfil prerequisites for screening of endometrial cancer. Measurement of the endometrial thickness by transvaginosonography (TVS) can define a risk group for endometrial cancer in postmenopausal women. Further investigations have to clarify whether the combination of TVS and color Doppler can reduce the number of false-positive findings.
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