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PubMed2004

The Group-Based Medical Mistrust Scale: psychometric properties and association with breast cancer screening.

BACKGROUND: There is little research on medical mistrust as a barrier to breast cancer screening. This study investigated the psychometric properties of a new scale, the Group-Based Medical Mistrust Scale (GBMMS), and its association with cancer screening attitudes and breast cancer screening practices among African American and Latina women. METHODS: Participants were 168 African American and Latina urban women who completed the GBMMS and measures of sociodemographics, cancer screening pros and cons, acculturation, breast cancer screening practices and physician recommendation of such screening. RESULTS: A principal components analysis of GBMMS items revealed three factors that were analyzed as subscales: (1) suspicion, (2) group disparities in health care, and (3) lack of support from health care providers. Convergent validity of the GBMMS was supported by its negative association with perceived benefits of cancer screening and acculturation and positive association with perceived disadvantages of cancer screening. Results further showed that women who reported no previous mammogram or a long-term lapse in mammography participation (>5 years) had significantly higher total GBMMS scores (P < 0.04) compared to women who were either adherent to mammography guidelines or nonadherent but reported a mammogram within the past 5 years. This analysis controlled for physician recommendation. CONCLUSIONS: Results support the validity of the GBMMS and its association with breast cancer screening adherence. The GBMMS may be used to further investigate medical mistrust as a barrier to screening for cancers for which ethnic group disparities have been observed.

Adult↗

PubMed2006

Prostate cancer screening in high-risk men: African American Hereditary Prostate Cancer Study Network.

BACKGROUND: There are scant data available on prostate cancer screening among high-risk African American men with positive family histories. It is important to determine whether or not their screening rates differ from those in the general population. METHODS: This study computed rates of previous digital rectal examination (DRE) and prostate-specific antigen (PSA) screening for prostate cancer in cancer-free (unaffected) relatives age 40-69 years from African American families that had four or more men with prostate cancer. The rates for these 134 high-risk African American men from the African American Hereditary Prostate Cancer Study (AAHPC) were compared with nationwide estimates obtained from participants in the 1998 and 2000 National Health Interview Survey (NHIS), for which the numbers of demographically comparable subjects were 5583 (4900 Caucasians, plus 683 African Americans) and 3359 (2948 Caucasians, 411 African Americans), respectively. RESULTS: Men in the AAHPC cohort (with a strong positive family history) had significantly less screening than both African Americans and Caucasians in the NHIS cohorts. Only about one-third (35%) of the men in the AAHPC unaffected cohort had ever had a DRE, and only about 45% of them had ever received a PSA test. These rates were much lower than those obtained for African American men in the NHIS: 45% for DRE and 65% for PSA. These discrepancies increased with age. CONCLUSIONS: Older African American men with positive family histories report surprisingly low rates of DRE and PSA screening compared with their counterparts in the NHIS surveys. At-risk men need to be informed of the benefits and limitations of prostate cancer screening and actively involved in decision-making for or against prostate cancer screening.

Adult↗

PubMed1982

A review of oral cancer screening and detection in the metropolitan Detroit cancer control program.

In summarizing the experience of the twenty-seven months of the oral cancer screening and detection program the data indicate: 1.) Cancers were detected at earlier stages than is reported nationally. Further investigation is needed to determine whether there is a correlation between early detection and increased survival. (Kaufman 1980). 2.) The detection of fifteen precancerous lesions is significant in that intervention may have precluded malignant transformation. 3.) Of those found with oral cancers, eight were symptomatic and two were asymptomatic, while in the premalignant group five were symptomatic and seven were asymptomatic. On the basis of these data, it appears that the symptomatic group chose the screening program as a pathway of entry into the medical system. The motivation for this choice requires investigation. Possible hypotheses are: screening by a registered dental hygienist and in a familiar setting was less threatening than by a physician or dentist in a formal medical setting. The reputation of the MCF, as a center of excellence in cancer control, may have contributed to the willingness to be screened. 4.) The incidental detection of five skin and three laryngeal cancers was an aid to cancer control. 5.) The program successfully trained and utilized registered dental hygienists in oral cancer screening thereby demonstrating an economical use of professional health resources. Follow-up is needed to ascertain whether their training is successfully applied in private practice. 6.) Efforts to reach the high risk population were less productive than expected because, while target screening sites serviced heavy drinkers and smokers, their populations were sometimes less than 40 years-of-age. This finding suggests a need for more refined strategies for accessing high risk populations.

Adult↗

PubMed2000

The importance of health insurance as a determinant of cancer screening: evidence from the Women's Health Initiative.

BACKGROUND: Amid current changes in health care access across the United States, the importance of health insurance status and insurance type relative to demographic, actual, and perceived health variables as determinants of screening for breast, colorectal, and cervical cancer is uncertain. This analysis evaluates the hypothesis that health insurance independently predicts cancer screening in the Women's Health Initia tive Observational Study cohort. METHODS: Questionnaire data from 55,278 women en rolled in the Women's Health Initiative Observational Study between September 1994 and February 1997 were analyzed by multiple logistic regression to identify predictors of self-reported mammography within 2 years, Pap smear within 3 years, and stool guaiac or flexible sigmoidoscopy within 5 years. RESULTS: Positive determinants of reporting cancer screening were age, ethnic origin, household income, educational level, family history of cancer, having a usual care provider, time since last provider visit, and insurance status and type. Smoking, diabetes, and, among older women, prior cardiovascular events were negative determinants of cancer screening. Among women younger than 65, lacking health insurance or having fee-for-service insurance was strongly associated with failure to report cancer screening, independently of having or using a usual care provider and of demographics, self-perceived health, and health characteristics. Among women 65 and older, those with Medicare alone were less likely, whereas those with Medicare + prepaid insurance were more likely, to report cancer screening. CONCLUSIONS: In the Women's Health Initiative Obser vational Study, a large, diverse group of older women, health insurance type and status were among the most important determinants of cancer screening indepen dent of demographics, chronic health conditions, and self-perceived health characteristics.

Age Factors↗

PubMed2005

Are older adults up-to-date with cancer screening and vaccinations?

INTRODUCTION: Public health organizations in the United States emphasize the importance of providing routine screening for breast cancer, cervical cancer, and colorectal cancer, as well as vaccinations against influenza and pneumococcal disease among older adults. We report a composite measure of adults aged 50 years and older who receive recommended cancer screening services and vaccinations. METHODS: We analyzed state data from the 2002 Behavioral Risk Factor Surveillance System, which included 105,860 respondents aged 50 and older. We created a composite measure that included colonoscopy or sigmoidoscopy within 10 years or a fecal occult blood test in the past year, an influenza vaccination in the past year, a Papanicolaou test within 3 years for women with an intact cervix, a mammogram, and for adults aged 65 and older, a pneumonia vaccination during their lifetime. We performed separate analyses for four age and sex groups: men aged 50 to 64, women aged 50 to 64, men aged 65 and older, and women aged 65 and older. RESULTS: The percentage of each age and sex group that was up-to-date according to our composite measure ranged from 21.1% of women aged 50 to 64 (four tests) to 39.6% of men aged 65 and older (three tests). For each group, results varied by income, education, race/ethnicity, insurance status, and whether the respondent had a personal physician. CONCLUSION: These results suggest the need to improve the delivery of cancer screenings and vaccinations among adults aged 50 and older. We propose continued efforts to measure use of clinical preventive services.

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PubMed2004

Institutional commitment to rectal cancer screening results in earlier-stage cancers on diagnosis.

BACKGROUND: The Veterans Administration hospitals underwent an institutional directive in 1998 to meet a colorectal cancer screening (CRCS) standard. This intervention should result in an increase in the hospital's screening rate and percentage of early-stage rectal cancers diagnosed. METHODS: A retrospective review, from 1991 to 2002, of our institution's pathology and cancer registry databases for rectal cancers. CRCS data were obtained from the Veterans Administration Prevention Disease Index. Cancer stage at diagnosis was compared before and after the directive and was compared with the National Cancer Data Base and the Surveillance, Epidemiology, and End Results data. RESULTS: The rate of CRCS was 55% in 1998 and increased to 75% in 2003. During the 11 years studied, a total of 147 rectal cancers were diagnosed. After the Veterans Administration directive, there was a significant increase in stage 0 cancers (P < .02) and an overall migration to earlier-stage cancers. Our Veterans Administration hospital had a significantly greater percentage of stage 0 cancers both before (P < .007) and after the directive (P < .00) and had fewer stage 3 cancers after the directive (P < .03) compared with National Cancer Data Base data. Compared with Surveillance, Epidemiology, and End Results data, the Palo Alto Veterans Affairs Health Care System had more local disease (P < .03) and less regional disease (P < .006). CONCLUSIONS: These data suggest that a monitored institutional directive may significantly increase early detection of rectal cancers. This should result in a greater survival rate and lower local recurrence rate, because survival is predicated on stage at presentation. This may serve as a model for other health-care systems.

Aged↗

PubMedDate not supplied

The stool DNA test: an emerging technology in colorectal cancer screening.

The stool DNA test is considered an emerging technology in screening for colorectal cancer. The stool DNA test detects DNA markers which are shed from cells of premalignant adenomas and cancers into the stool. Potentially, both preclinical and clinical colorectal cancer may be detected. Panels of multiple DNA markers are used to ensure a high sensitivity for colorectal cancer. In this article, several advantages of the stool DNA test (compared with current colorectal cancer screening methods) are discussed. The stool DNA test may be more patient-friendly and has a higher degree of sensitivity and specificity for colorectal cancer. No bowel or dietary preparation is required and the test is noninvasive. The stool DNA test screens the entire colon and may detect some other types of cancers proximal to the colon. In the future, there may be potential to use the stool DNA test to screen for aerodigestive cancers (lung, esophageal, gastric, and pancreatic), in addition to colorectal cancer. An improved noninvasive screening test would help allocate colonoscopy resources to those patients who would benefit the most. Colorectal cancer screening cost-effectiveness may also be improved. Some limitations of the stool DNA test include the need for clinical studies in average-risk populations and marker refinement. An automated testing system may help reduce costs and turnaround times. Despite recognized limitations, the stool DNA test is a promising new diagnostic tool with the potential to improve effectiveness of colorectal cancer screening.

Colorectal Neoplasms↗

PubMed1990

Breast cancer screening in Tel Aviv.

Optimal breast cancer screening includes both physical examination and mammography. In anticipation of the addition of routine mammographic screening to Israel's 25-year-old early breast cancer detection program, we examined the demographic characteristics of almost one thousand women attending a breast cancer screening examination in Tel Aviv for the first time. The specific objective of the survey was to see whether women attending screening were those who stood a good chance of benefiting from it. Only half the women were aged 40 or older, and there was a preponderance of women of Western origin. Almost half had a breast-related complaint at the time of the visit. Targeted public education and appropriate administrative measures are necessary to ensure that women who can benefit from screening attend screening clinics and that clinics are not filled to capacity by women needing diagnostic evaluation and followup rather than routine screening. Tel Aviv general practitioners appeared to be aware of the advantages of breast cancer screening.

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PubMed2000

[Evaluation of population-based lung cancer screening in Niigata and analysis of interval cases based on comparison lung cancer registry with screening records].

Survival analysis has been used as one way to examine the efficacy of cancer screening. However, this type of study is susceptible to many sources of bias, especially to a length bias. In the city of Sukumo in Japan, a survival analysis considering screening history for the purpose of eliminating the length bias was conducted. The efficacy of lung cancer screening was assessed by comparing those who participated in the screening in the year preceding diagnosis, with those who did not. The 5-year survival rate was 44% in the former and 16% in the latter. We tried to evaluate population-based lung-cancer screening in Niigata using the method as that of Sukumo by comparing lung-cancer registry data with screening records, those who died of lung cancer from 1991 to 1994 in the study area and had the opportunity to be screened were categorized according to the screening history for the year preceding diagnosis. The 5-year survival rate was 41% in those who were screened and 19% in those not screened. In addition, the median survival time of the former was 37 months, significantly longer than the 12 months of the latter. Replication of study results in different populations may suggest the efficacy of lung-cancer screening on an annual basis. We also analyzed the clinical background of 47 interval cases in the search for a future direction for the improvement of the screening method.

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PubMed1989

Stage-shift cancer screening model.

A stage-shift cancer screening model is developed in the context of a randomized controlled trial (RCT) of cancer screening. In the model, detection by screening causes the time of diagnosis of the cancer to be advanced so that either the stage at diagnosis is shifted from one stage to the next lower one or the stage of diagnosis is unchanged but the cancer is diagnosed earlier in the stage. These are called external and internal stage shifts, respectively. At each stage the extent of the external and internal shifts and any associated mortality benefits are estimated. Further, the model allows the interrelationships of these benefits within and between stages to be delineated. This then allows us to better understand the results of the RCT. Data from a completed breast cancer screening RCT are used to illustrate the application of the model and its value in improving our understanding of the trial's results.

Adult↗

PubMed2005

Primary care physicians' awareness and adherence to cervical cancer screening guidelines in Texas.

BACKGROUND: Cervical cancer screening guidelines were created to help healthcare professionals in appropriate screening utilizing the PAP test. However, significant variation in cervical cancer screening among primary care physicians has been noted. Knowledge of the awareness of and adherence to cervical cancer screening guidelines by primary care physicians will help determine how best to disseminate and educate these physicians regarding the guidelines in hopes of reducing unnecessary screening and improving screening for under screened populations. METHODS: A cross-sectional, mailed survey involving Family Medicine (FP), Community Internal Medicine (CIM), and Obstetrics/Gynecology (OB) physicians practicing in a large University-affiliated, multi-specialty group practice associated with an 186,000-member HMO in Central Texas (n = 177) was conducted in 2001-2002. RESULTS: Most physicians performed PAP testing (50.4%). PAP screening was noted to vary significantly by specialty (P < 0.0001). All OBs were aware of at least one published guideline, compared to 96% of FPs and 91% of CIMs (P < 0.05). A wide variation was reported regarding adherence to published guidelines. In addition, there was significant intraspecialty variation regarding adherence to the physicians' own specialty's guidelines. CONCLUSIONS: While most physicians in the primary care setting perform PAP tests and are aware of published guidelines for PAP screening, adherence to the published guidelines varies considerably even in the same clinical setting.

Adult↗

PubMed2006

[Women's willingness to pay for cancer screening].

OBJECTIVES: The goal of this study is to measure women's willingness to pay for cancer screening and to identify those factors associated with this willingness to pay METHODS: A population-based telephone survey was performed on 1,562 women (aged 30 years or over) for 2 weeks (9-23th, July, 2004). Data about sociodemographic characteristics, health behaviors, the intention of the cancer screenings and willingness to pay for cancer screening were collected. 1,400 respondents were included in the analysis. The women's willingness to pay for cancer screening and the factors associated with this willingness to pay were evaluated. RESULTS: The results show that 76% of all respondents have a willingness to pay for cancer screening. Among those who are willing to pay, the average and median amount of money for which the respondents are willing to pay are 126,636 (s.d.: 58,414) and 120,000 won, respectively. As the status of education & the income are higher, the average amount that women are willing to pay becomes much more. The amount of money women are willing to pay is the highest during the 'contemplation' stage. Being willing to pay or not is associated with a change of behavior (transtheoretical model), the income, the concern about the cancer risk, the family cancer history, the marital status, the general health exam, age and the place of residence. Income is associated with a greater willingness to pay. Old age was associated with a lower willingness to pay. CONCLUSIONS: According to the two-part model, income and TTM are the most important variables associated with the willingness to pay for cancer screening. The cancer screening participation rate is low compared with the willingness to pay for cancer screening. It is thought that we have to consider the participants' behavior that's associated with cancer screening and their willingness to pay in order to organize and manage cancer screening program.

Adult↗

PubMed2005

Uncovering homeless African-American women's knowledge of breast cancer and their use of breast cancer screening services.

This study explored the knowledge of breast cancer and the use of breast cancer screening services by homeless African-American women in an attempt to understand their use of cancer screening services and whether they understood the information about breast cancer and breast cancer screening. A qualitative study using a focus group format was employed to obtain a deeper understanding of the participants' experiences as they related to knowledge of breast cancer and their use of breast cancer screening services. The sample consisted of 25 (N = 25) African-American women who were currently living in a transient shelter for homeless women and children. Three, one-hour focus group sessions were conducted over a three-week period. Sessions were audio taped and transcribed for analysis. Content analysis was used to analyze the data. Findings from the study revealed categories that were associated with the women's personal experiences with cancer, their knowledge of breast cancer and experiences with the use of screening services, and their motivations as they related to breast cancer screenings. These categories can be useful in providing access to care and in addressing cancer education, screening behaviors, and program planning in homeless African-American women.

Adaptation, Psychological↗

PubMed1984

Breast cancer screening: significance of minimal breast cancers.

Analysis of cancers occurring during an aggressive screening program indicates: (1) In our study, during 3 years of active incidence screening of women under the age of 50 years, 24 cancers occurred, 14 of which were minimal. In the 3 years that there has been very limited screening, 23 cancers occurred, only five of which were minimal (p = 0.02393). (2) We projected that 110 breast cancers should have occurred in the incidence years of observation of this self-selected population of 10,531 women. In our screened population, 124 cancers occurred. This is not significantly different from the expected number. (3) In a similar period of observation of a similar sized screened population 112 cancers occurred in Louisville and 113 cases of cancer occurred in Seattle. There is no significant difference from the 124 cases reported in Cincinnati nor from the 110 cases expected. However, of all forms of cancer (prevalent, incident, interval) in Cincinnati, 67 cases were minimal, as against 35 in Louisville and 23 in Seattle (p = less than 0.0001). All in all, these data supported the concept that screening for breast cancer does not in any significant way increase the number of cancer cases detected, it only advances the stage of detection. The data also suggest that, for an aggressive screen, length-biased sampling does not seem to be an insurmountable obstacle.

Adult↗

PubMed2005

Patients' anxiety and expectations: how they influence family physicians' decisions to order cancer screening tests.

OBJECTIVE: To compare the influence of physicians' recommendations and patients' anxiety or expectations on the decision to order four cancer screening tests in clinical situations where guidelines were equivocal: screening for prostate cancer with prostate-specific antigen for men older than 50; breast cancer screening with mammography for women 40 to 49; colorectal cancer screening with fecal occult blood testing; and colorectal cancer screening with colonoscopy for patients older than 40. DESIGN: Cross-sectional mailed survey with clinical vignettes. SETTING: British Columbia, Alberta, Ontario, Quebec, and Prince Edward Island. PARTICIPANTS: Of 600 randomly selected family physicians in active practice approached, 351 responded, but 35 respondents were ineligible (response rate 62%). MAIN OUTCOME MEASURES: Decisions to order cancer screening tests, physicians' perceptions of recommendations, patients' anxiety about cancer, and patients' expectation to be tested. RESULTS: For all screening situations, physicians most likely to order the tests believed that routine screening with the test was recommended; physicians least likely to order tests believed routine screening was not. Patients' expectations or anxiety, however, markedly increased screening by physicians who did not believe that routine screening was recommended. In regression models, the interaction between physicians' recommendations and patients' anxiety or expectation was significant for all four screening tests. When patients had no anxiety or expectations, physicians' beliefs about screening strongly predicted test ordering. Physicians who believed routine screening was recommended ordered the test in most cases regardless of patient characteristics. But patients' anxiety or expectations markedly increased the probability that the test would be ordered. The probability of test ordering went from 0.28 to 0.54 for prostate-specific antigen (odds ratio [OR] = 1.9), from 0.15 to 0.44 for mammography (OR = 2.8), from 0.33 to 0.79 for fecal occult blood testing (OR = 2.4), and from 0.29 to 0.65 for colonoscopy (OR = 2.2). CONCLUSION: Differences in clinical judgment about recommended practice lead to practice variation, but physicians are also influenced by nonmedical factors, such as patients' anxiety and expectations of receiving tests. In terms of magnitude of influence, clinical judgment is more powerful than nonmedical patient factors, but patient factors are also powerful drivers of family physicians' decisions about cancer screening when practice guidelines are equivocal.

Adult↗

PubMed2004

Correlates of cervical cancer screening among underserved Hispanic and African-American women.

BACKGROUND: Substantial subgroups of American women, specifically those of ethnic minorities, have not been screened for cervical cancer or are not screened at regular intervals. The rates for receipt of female-related cancer screening tests remain far below the goals set forth in Healthy People 2010. OBJECTIVE: This study applied a well-known, recently revised theoretical model of health care access and utilization, the Behavioral Model for Vulnerable Populations, to examine the correlates of the adherence to cervical cancer screening guidelines among publicly housed Hispanic and African-American women, two of the most vulnerable segments of our population. METHODS: This study conducted a cross-sectional survey of a community-based random sample of 230 African-American and Latino female heads of household, from a geographically defined area, the three urban public housing communities in Los Angeles County, CA. RESULTS: Only 62% of our sample had received a screening for cervical cancer within the past year. Yet, 29% of the sample claimed that no health care provider had ever told them that they needed a screening test for cervical cancer. Hispanic and older women are by far less likely to adhere to screening guidelines; in this study, 51% of Hispanics and 22% of African-Americans reported no screening within the last year. Multivariate analysis shows that affordability, continuity of care, and receiving advice from health care providers regarding a Papanicolaou (Pap) smear were significant predictors of up-to-date to cervical cancer screening. CONCLUSION: This study documents a significant disparity in screening for cervical cancer among underserved minorities, particularly Hispanic, uninsured, and older women. The continuity of obtaining medical services and receiving recommendations from physicians remain the core factors that are significantly associated with obtaining cervical cancer screening. These results underscore the need for continued efforts to ensure that medically underserved minority women have access to cancer screening services.

Adult↗

PubMed2004

Baseline findings of a randomized feasibility trial of lung cancer screening with spiral CT scan vs chest radiograph: the Lung Screening Study of the National Cancer Institute.

BACKGROUND: Low-radiation-dose spiral CT (LDCT) scanning is capable of detecting lung neoplasms in asymptomatic individuals. To determine whether such detection can reduce lung cancer mortality, a randomized controlled trial (RCT) of LDCT scanning is necessary. METHODS: The feasibility of conducting an RCT in asymptomatic individuals who are at high risk for lung cancer was explored in the Lung Screening Study (LSS), a 12-month special project of the ongoing Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial. During the fall of 2000, six PLCO screening centers recruited a total of 3,318 heavy or long-term smokers who were not participants in the PLCO trial and randomized them to receive either a screening LDCT scan (1,660 participants) or screening posteroanterior view chest radiograph (CXR) [1,658 participants]. RESULTS: The screens were completed on 96% of subjects in the LDCT scan arm and 93% of subjects in the CXR arm. A total of 20.5% of screened subjects in the LDCT scan arm and 9.8% of those in the CXR arm had findings that were suspicious for lung cancer. Thirty lung cancers in subjects in the LDCT arm and 7 lung cancers in patients in the CXR arm were diagnosed following a positive screening result. Additional data from the LSS indicated that, among persons who were at elevated risk for lung cancer, CT scan use was not pervasive, interest in participating in an RCT of LDCT scanning was strong, and few subjects randomized to CXR either refused their examination or sought a CT scan after their study CXR. INTERPRETATION: The results of the LSS demonstrated convincingly the feasibility of an RCT of LDCT scanning in the United States.

Aged↗

PubMed2000

Survey of internal medicine residents' use of the fecal occult blood test and their understanding of colorectal cancer screening and surveillance.

OBJECTIVE: Primary care physicians have imperfect understanding of current colorectal cancer screening guidelines and recommendations. Furthermore, compliance with colorectal cancer screening by internal medicine residents has been demonstrated to be poor. We sought to identify whether current trainees in internal medicine had adequate understanding of colorectal cancer screening and surveillance and test utilization. METHODS: We applied a structured questionnaire about colorectal cancer screening and the use of fecal occult blood tests to 168 internal medicine residents at four accredited programs in the U.S. They were also asked for recommendations about six hypothetical patients who may have been candidates for screening or surveillance. RESULTS: Seventy-one percent identified 50 yr as the currently recommended age to commence screening in an average-risk individual; 64.3% would begin screening with fecal occult blood testing and flexible sigmoidoscopy and 4.8% with colonoscopy. Most perform fecal occult blood testing on stool obtained at digital rectal exam and without prior dietary restrictions. Many use fecal occult blood testing for indications other than colorectal cancer screening. Only 29% recommended colonoscopy to evaluate a positive fecal occult blood test. Most residents plan to be screened for colorectal neoplasia at the appropriate age; significantly more opted for colonoscopy than recommended it for their patients. CONCLUSIONS: Internal medicine residents have many misperceptions regarding colorectal cancer screening and the utility of the fecal occult blood test. Educational efforts should be directed at internal medicine residents, many of whom plan careers in primary care, where most colorectal cancer screening is currently performed.

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