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PubMed1995

Principles of Cancer Screening.

Early detection of cancer, prior to its clinical manifestations, appears to be a worthwhile and desirable goal. Yet, the concept and acceptance of cancer screening remain controversial and often confusing. While the benefits of screening are obvious to those whose screening tests have resulted in successful interventions, attention also needs to be given to the risks, economic costs, and psychological effects of screening procedures. Specific governing principles that define the cancers to be screened, the appropriate screening test, and the measurement of outcomes should be established in order for a screening program to be deemed worthwhile. A beneficial screening strategy detects cancer prior to its systemic spread, alters the natural history of the disease, and defers the time of death.

Journal Article↗

PubMed2000

[Estimating cost functions of cancer screening programs provided by municipalities].

OBJECTIVE: To estimate cost functions of cancer screening programs for stomach, lung, colorectal, cervical, and breast cancers provided by municipalities and to describe the relationship between the costs and the scale of cancer screening programs. METHODS: Subjects were all the municipalities in Japan. Questionnaires were sent to 3,182 subjects and 1,860 responses were received. Data obtained from questionnaires were the number of persons screened and the total cost of each program in the 1998 fiscal year. A cost function of each program was specified as a linear model, a power model, and a cubic model, and the fitness of each model was estimated. RESULTS: Long-run cost functions of all the cancer screening programs allowed better explanation of the relationship between the number of persons screened and the total cost than short-run cost functions. The average costs of stomach, colorectal, and cervical cancer screening programs increased and the average cost of the lung cancer screening program decreased, as the number of persons screened increased. The cost function of the breast cancer screening program could not be identified. CONCLUSIONS: It is necessary to estimate not only cost functions but also production functions of cancer screening programs using the data related to products, costs, and factors of production to evaluate the efficiency of cancer screening programs.

Cities↗

PubMed2004

Barriers to cancer screening by rural Appalachian primary care providers.

CONTEXT: Rural Appalachia has significantly higher overall cancer mortality compared with national rates, and lack of cancer screening is believed to be one of the contributing factors. Reducing the cancer disparity in this region must include strategies to address suboptimal cancer screening practices by rural Appalachian primary care providers (PCPs). PURPOSE: To identify and investigate barriers to recommending and/or performing cancer screening among rural Appalachian PCPs. METHODS: A semistructured focus group research design was used to elicit perceived barriers to recommending and/or performing cancer screening from 36 rural Appalachian PCPs (in 5 groups), including physicians, nurse practitioners, and a physician assistant. FINDINGS: Findings indicate that rural Appalachian PCPs may not be performing recommended cancer screenings for a number of reasons. Time constraints, conflicting guidelines, and perceptions that patients do not value prevention were reported barriers to cancer screening. The PCPs in this study expressed frustration in attempting to encourage cancer screening and cited patient factors such as socioeconomic status, Appalachian culture, and cancer fatalism as barriers to cancer screening. CONCLUSIONS: Rural Appalachian PCPs encounter various barriers, such as lack of time and multiple cancer screening guidelines, to incorporating cancer screening into their practice routine. The findings underscore the negative impact of some cultural factors on preventive care delivered by PCPs. Increased provider education is needed on how best to encourage cancer screening within a cultural context and should include clarification and understanding of current cancer screening guidelines.

Anecdotes as Topic↗

PubMed1997

Oral cancer screening in the elderly: the home healthcare nurse's role.

Screening for oral cancer is an often overlooked element of annual medical examinations and physical assessments in the elderly. As the elderly population increases, more emphasis will be placed on caring for clients in the home, and oral cancer screening will be provided by nurses. This article outlines the most common types of oral cancer and provides step-by-step instructions of performing an oral cancer screening examination.

Aged↗

PubMedDate not supplied

A randomized controlled trial to increase cancer screening among attendees of community health centers.

BACKGROUND: We assessed the efficacy of the Cancer Screening Office Systems (Cancer SOS), an intervention designed to increase cancer screening in primary care settings serving disadvantaged populations. METHODS: Eight primary care clinics participating in a county-funded health insurance plan in Hillsborough County, Fla, agreed to take part in a cluster-randomized experimental trial. The Cancer SOS had 2 components: a cancer-screening checklist with chart stickers that indicated whether specific cancer-screening tests were due, ordered, or completed; and a division of office responsibilities to achieve high screening rates. Established patients were eligible if they were between the ages of 50 and 75 years and had no contraindication for screening. Data abstracted from charts of independent samples collected at baseline (n = 1,196) and at a 12-month follow-up (n = 1,237) was used to assess whether the patient was up-to-date on one or more of the following cancer-screening tests: mammogram, Papanicolaou (Pap) smear, or fecal occult blood testing (FOBT). RESULTS: In multivariate analysis that controlled for baseline screening rates, secular trends, and other patient and clinic characteristics, the intervention increased the odds of mammograms (odds ratio [OR] = 1.62, 95% confidence interval [CI], 1.07-9.78, P = .023) and fecal occult blood tests (OR = 2.5, 95% CI, 1.65-4.0, P <.0001) with a trend toward greater use of Pap smears (OR = 1.57, 95% CI, 0.92-2.64, P = .096). CONCLUSIONS: The Cancer SOS intervention significantly increased rates of cancer screening among primary care clinics serving disadvantaged populations. The Cancer SOS intervention is one option for providers or policy makers who wish to address cancer related health disparities.

Aged↗

PubMed1995

Modelling issues in cancer screening.

The two main goals of modelling cancer screening are data analysis and evaluation. In data analysis, analytical-numerical statistical models are used to test hypotheses about preclinical disease, the screening test, and the association between early detection and risk of dying from the cancer. Evaluation in cancer screening is supported by model-based prediction of screening effects and cost-effectiveness. Simulation models are suitable for these tasks, and can also be used to identify efficient age-ranges and intervals between screening tests. Striking differences exist between screening models for cervical cancer and breast cancer, which are the two cancer types for which screening is common practice. The two main problems in cervical cancer screening are the proportion of progressive and regressive among screen-detected lesions, and the impact of screening on incidence and mortality. In breast cancer, regression is not (yet) a big issue, and the relationship between screening and mortality reduction has been demonstrated in randomized controlled trials (at least for women older than 50 years). The weakest link in current breast cancer models is the association between earliness of detection and improvement in prognosis. The modelling outcomes and their usefulness are decisively influenced by the data sets that were used in quantifying the model, and the subclassifications of the data that were considered. New or pending modelling issues include HPV-based screening in cervical cancer, screening models for colorectal cancer, the use of surrogate outcome measures and model-based meta-analysis of screening trials.

Breast Neoplasms↗

PubMedDate not supplied

Community prostate cancer screening.

Health promotion and cancer prevention, including screening, are two important aspects of cancer care. However barriers exist to patients receiving recommended cancer screening procedures. One way to overcome these barriers is through the use of community cancer screening programs. This article presents a prototype of a community prostate cancer screening program. The program planning, staffing, promotion, cost and finance, and follow-up activities are explained. Furthermore, examples of communication tools and follow-up protocol, and results of 4 years of community screening programs are described. Recommendations for future community screening give insight for program improvement.

Community Health Services↗

PubMed1997

Socioeconomic status and cancer screening.

The only widely applied cancer screening programmes are those for cancers of the cervix and female breast. Participation in breast cancer screening has been shown to depend on income and education, health insurance and type of health service. Women in low social classes tend to have lower screening participation rates than those in higher classes. Socioeconomic differences in screening practices tend to decrease when participation is promoted, cultural and economic barriers are removed, and social support is offered. In both developed and developing countries, women of low socioeconomic status have a higher than average risk of cervical cancer, and a lower than average participation in Pap smear screening.

Adult↗

PubMed1994

Feasibility study of a randomised trial of ovarian cancer screening among the general population.

OBJECTIVE: To determine the feasibility of a randomised trial of ovarian cancer screening among women attending a breast cancer screening centre. DESIGN: Randomised controlled trial of ovarian cancer screening using transvaginal ultrasonography as a primary screening test and colour Doppler imaging as a secondary screening test in the screened group and no intervention in the control group. SETTING: Reading breast cancer screening centre (United Kingdom). SUBJECTS: 8678 women, without a bilateral oophorectomy or hysterectomy, aged between 50 and 64 attending for NHS breast cancer screening between September 1989 and February 1993. MAIN OUTCOME MEASURES: Uptake of ovarian cancer screening among eligible women and the screening false positive rate (considered as the referral rate to a gynaecologist for surgical intervention). RESULTS: 82% (7124/8678) of eligible women agreed to join the trial and were randomly allocated in equal numbers to each arm of the trial. 3280 women had an initial scan. The false positive rate after ultrasonography alone was 2.9% (86/2952), but this dropped to 0.5% after colour Doppler as a secondary screening test. One stage I primary ovarian cancer was detected at screening in a 58 year old women. CONCLUSIONS: A randomised trial of ovarian cancer screening using ultrasonography and colour Doppler imaging is feasible and acceptable among women attending a breast cancer screening centre. The results indicate that the expected odds of being affected given a positive result in the general population would be about 1:12. A full randomised trial of ovarian cancer screening with mortality as the end point is needed to assess whether screening reduces mortality from this disease. A multicentre European trial is currently in progress.

Costs and Cost Analysis↗

PubMedDate not supplied

Cancer screening, reproductive history, socioeconomic status, and anticipated cancer-related behavior among Hmong adults.

In the United States, breast, cervical, colorectal and prostate cancer screening rates are low or non-existent in the Hmong population compared to non-Hispanic Whites. No Hmong adults report ever participating in prostate (male only) and colorectal cancer screening. US-born Hmong women, those living in the US 20 years, and those 39 years old are more likely to be screened for breast and cervical cancer than other women. The Hmong, in general, are a young population (median age = 34 years) with low socioeconomic status. As a function of these characteristics, 52% of Hmong women reported having their first child at 15-19 years old and continued to bear children until 40-54 years old. The combination of young age at first pregnancy and multiparity probably protects Hmong women from breast cancer but elevates cervical cancer risk.

Adolescent↗

PubMed2002

[Lung cancer screening--its efficacy and limitations].

Although the purpose of cancer screening is to decrease the number of cancer deaths, the efficacy of some cancer screening programs has not been proved. This article describes the authorized method for the lung cancer screening system in Japan, and introduces papers reporting the efficacy of lung cancer screening. The problems in the present lung cancer screening system in Japan are also discussed.

Cytodiagnosis↗

PubMed2004

Proteomics in cancer screening and management in gynecologic cancer.

Biomarkers are used routinely for population screening, disease diagnosis and prognosis, monitoring of therapy, and prediction of therapeutic response. Unfortunately, most biomarkers have low sensitivity and specificity and little predictive value. Novel techniques for better screening and early diagnosis of ovarian cancer are urgently needed. Proteomics, the study of the cellular proteins and their activation states, integrates some fundamental techniques, including high-throughput protein purification and profiling, genomic and proteomic databases, and mass spectrometry. In oncology, proteomics will contribute greatly to our understanding of gene functions in tumor development and provide information in clinical applications. This article reviews proteomic techniques and their potential applications in gynecologic cancer screening and management.

Biomarkers, Tumor↗

PubMed2003

Determinants of colorectal cancer screening in women undergoing mammography.

OBJECTIVES: Women who participate in screening for breast cancer are more likely to participate in screening for colorectal cancer. We studied such a motivated group of women to identify predictors of, and barriers to, participation in colorectal cancer screening by endoscopy. METHODS: We distributed surveys to 551 women > or = 50 yr of age while they were awaiting mammography at four sites in and around Boston, MA from June to September, 2000. The 40-question survey assessed knowledge, attitudes, and beliefs about, and behaviors toward, breast and colorectal cancer screening. Regression models were used to determine factors associated with having had sigmoidoscopy or colonoscopy. RESULTS: Seventy-nine percent of the women completed all or part of the survey. Half (221/438) reported ever having had sigmoidoscopy or colonoscopy. Of these, 93% did so at the recommendation of their primary care provider. Factors associated with participation in endoscopic screening included compliance with annual fecal occult blood testing, a family history of colorectal cancer, and indifference toward the gender of the doctor performing the endoscopy. CONCLUSIONS: Women undergoing mammography overwhelmingly cite the recommendation of their primary care provider as the reason for participating in colorectal cancer screening by endoscopy. Women who preferred a female endoscopist were less likely to have been screened. Whenever possible, primary care providers should offer women the choice of a female endoscopist for colorectal cancer screening.

Aged↗

PubMed1986

Sensitivity of fecal hemoccult testing and flexible sigmoidoscopy for colorectal cancer screening.

Fecal Hemoccult testing and flexible sigmoidoscopy have been proposed as means of screening for colorectal cancer in the general population, as well as in identified high-risk groups. A colorectal cancer screening program was conducted for the Pattern Makers' League of North America. A total of 1,473 white males were screened with fecal Hemoccult testing and flexible sigmoidoscopy during the period 1981 to 1983. The fecal Hemoccult test after diet restriction was positive in 38 workers (2.6%). Among 12 colorectal cancers, including in situ cases, only three were positive by this test. The sensitivity of this test for picking up cancer is only 25%. The positive predictive value was 7.9%. It is concluded that the Hemoccult test for the detection of colorectal cancer and polyps is not a valuable tool because of low sensitivity, whereas flexible sigmoidoscopy has a significant role in colorectal cancer screening of an asymptomatic population at risk.

Colonic Neoplasms↗

PubMed2005

Breast cancer screening in Canada: a review.

Organized screening for breast cancer in Canada began in 1988 and has been implemented in all provinces and 2 of the 3 territories. Quality initiatives are promoted through national guidelines which detail best practices in various areas, including achieving quality through a client-service approach, recruitment and capacity, retention, quality of mammography, reporting, communication of results, follow-up and diagnostic workup, and program evaluation; it also offers detailed guidelines for the pathological examination and reporting of breast specimens. The Canadian Breast Cancer Data Base is a national breast cancer screening surveillance system whose objective is to collect information from provincial-screening programs. These data are used to monitor and evaluate the performance of programs and allow comparison with national and international results. A series of standardized performance indicators and targets for the evaluation of performance and quality of organized breast cancer screening programs have been developed from the data base. Although health care is a provincial responsibility in Canada, the collective reporting and comparison of results both nationally and internationally is beneficial in evaluating and refining both screening programs and individual radiologist performance. The results of Canadian performance indicators compare favourably with those of other well-established international screening programs. There are variations in performance indicators across the provinces and territories, but these differences are not extreme.

Adult↗

PubMed2007

Changes in cancer worry associated with participation in ovarian cancer screening.

While ovarian cancer is rare and screening is not recommended for most women, it is being studied as a way to reduce ovarian cancer mortality. As effective strategies for screening emerge it will be important to understand the quality of life (QOL) effects of participation in ovarian cancer screening. In this study, we examined the effects of participation in an ovarian cancer screening program on worry about cancer risk and QOL. A randomized controlled clinical trial (n = 592) was conducted. Women without a family history suggestive of a BRCA1/2 mutation were randomly assigned to screening and risk counseling, separately and in combination. Results were compared to women randomized to usual care alone. Levels of cancer worry fell for all study groups and QOL was unaffected; no statistically significant differences were found between groups. Increased levels of worry about ovarian cancer at 2-year follow-up were found among participants in screening receiving abnormal test results. For those who receive abnormal results, screening may have long-term effects and increase worry about cancer risk. Further research will be required to examine the possibility that screening reduces worry when women receive only normal, presumably reassuring, results.

Adult↗

PubMed1990

Statistical considerations in cancer screening programs.

The goal of cancer screening is the early detection and treatment of disease, with a consequent reduction in the mortality rate. Evaluation of whether a particular screening program can achieve this goal is a difficult task. Two components of the screening process must be assessed. The first is the ability of the screening test to detect cancer early while minimizing the number of false-positive results. In this regard, the specificity of the test ordinarily must be very high, approaching 99%. No screening test for prostate cancer has yet been reported to have a specificity this high, indicating that any prostate cancer screening program using currently available tests will have to deal with the problem of a large number of false-positive findings. To evaluate the overall impact of a screening program, the best procedure is the randomized controlled trial with cancer-specific mortality as the endpoint. This endpoint is used because it avoids the lead time and length biases inherent in other outcome variables such as stage shift and case survival. The screening randomized controlled trial must be carefully planned and implemented, because it is lengthier and more costly than the usual therapy trial because of differences in study populations, trial design relative to the planned population intervention, and the extent of knowledge of disease natural history. A further important component of screening evaluation is cost. The decision to implement or continue a screening program can be aided by using cost-effectiveness analysis, which bases a decision on the ranking of cost-to-benefit ratios for the various programs contending for limited funds. Screening cost includes the cost of the test, the cost of side effects of the test, and the costs of biopsy and treatment, while screening benefit can be measured in terms of lives saved, life years saved, or quality-adjusted life years.

Cost-Benefit Analysis↗

PubMed2001

[Breast complaints during the Dutch nationwide breast cancer screening program: increased risk of referral and of breast cancer].

OBJECTIVE: To determine the prevalence of breast complaints reported on a questionnaire among participants in the first round of the national breast cancer screening programme in the Netherlands, and to assess the relationship between these complaints and referral and diagnosis of breast cancer. DESIGN: Retrospective controlled study. METHOD: Women in the South screening region of the Dutch nation-wide breast cancer screening programme (Stichting Bevolkingsonderzoek Borstkander Zuid (BoBZ)) received a medical questionnaire together with the invitation for participation in the screening programme. This questionnaire was only reviewed by the radiologist if there were doubts concerning referral. The study assessed whether participants with these complaints had higher risks of referral and screen-detected breast cancer than those without these complaints. In this study two random and independent samples were drawn from the screening files: 1116 women who attended the first screening round and 1113 women who were referred for medical checkup in the same screening round. RESULTS: The prevalence of breast complaints reported in the first screening round was 5.1% (95% CI = 3.9-6.6). More than half of the complaints included pain not related to menses; nipple secretion; changes in skin (retraction or discolouration) or tumours. The referral risk for women with these complaints was more than twice that for women without complaints (adjusted odds ratio (OR) = 2.3; 95% CI = 1.4-3.8) and their risk of screen-detected breast cancer was more than three times as high (adjusted OR = 3.3; 95% CI = 1.4-3.8). Up to 5.8% of the screen-detected breast cancers could be attributed to the breast complaints. CONCLUSION: Breast complaints at the time of breast cancer screening increased the risk of breast cancer being detected, but it is not clear as yet whether the screening will benefit from the explicit incorporation of questions regarding complaints.

Adult↗