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PubMed1993

Social support and cancer screening among older black Americans.

BACKGROUND: Age-adjusted cancer mortality is 27% higher for Black Americans than for the general U.S. population, which may result from inappropriate use of cancer detection tests. Social support has been shown to affect adjustment to breast cancer and survival, but it has not been studied as a predictor of use of preventive health care services in the older population. Our hypothesis is that larger social networks are associated with greater utilization of cancer-screening tests in the older population. PURPOSE: The objective of this study was to examine the relationship between social support and use of cancer-screening tests among older Black Americans. METHODS: Data for this study were obtained from a 1986 baseline survey evaluation of a community intervention program to increase cancer awareness and a 1991 end-point survey of use of cancer detection tests. Our study sample consisted of 617 Black Americans aged 55 years or older who lived in San Francisco (Calif.), the control community, and in Oakland (Calif.), the target community for intervention. The survey included measures of 1) social network characteristics, as determined by a modified version of Berkman and Syme's Social Network Index; 2) demographic characteristics; and 3) use of six cancer-screening tests--mammography, occult blood stool examination, cervical smear, clinical breast examination, digital rectal examination, and sigmoidoscopy. RESULTS: Multiple logistic regression analysis of the Social Network Index results indicated statistically significant positive associations of social support with the use of mammography and occult blood stool examination but not with the other cancer-screening tests. There were statistically significant associations between having HMO (Health Maintenance Organization) insurance and increased use of mammography and occult blood stool examination, compared with having Medi-Cal or other insurance. The interval between the surveys had a statistically significant positive association with use of mammography. These significant associations were not explained by differences in the other variables, which included health status, age, gender, education, type of health insurance, interval between the surveys, and a regular source of care. CONCLUSIONS: Social support seems to be associated with increased use of mammography and occult blood stool examinations among older Black Americans. IMPLICATIONS: Interventions designed to increase utilization of social networks may be an effective way to increase use of cancer screening, which may ultimately lead to reduced mortality from cancer.

Black or African American↗

PubMed1998

Cervical cancer screening.

OBJECTIVE: To review the role of family physicians in screening for cancer of the cervix, to review the evidence for screening, in particular, frequency and technique for screening, and to review the reasons cervical cancer has not been prevented and the role of family physicians in addressing these failures. QUALITY OF EVIDENCE: The value of screening has been established with level II evidence. Many of the unresolved issues are not supported either way by good evidence; level II and III evidence predominates. MAIN FINDINGS: In Canada, 1350 women were predicted to be diagnosed with cancer of the cervix in 1996. Most of these women had not been screened. Minority, rural, low-income, and older women face important barriers to screening. Family physicians have a role in reaching out to these women to provide effective health care, including cancer screening. When cancer screening is performed, it should conform to recommended techniques with appropriate follow up of abnormal test results. CONCLUSIONS: Family physicians have an important role in preventing cancer of the cervix. Efforts should be concentrated on encouraging a greater proportion of eligible women to be screened. Criteria are suggested for effective screening.

Diagnostic Errors↗

PubMed2004

Colorectal cancer screening disparities related to obesity and gender.

BACKGROUND: Obesity is associated with a higher incidence of colorectal cancer and increased colorectal cancer mortality. Obese women are less likely to undergo breast and cervical cancer screening than nonobese women. It is not known whether obesity is associated with a lower likelihood of colorectal cancer screening. OBJECTIVE: To evaluate whether there is an association between body mass index (BMI) and rates of colorectal cancer screening. To examine whether BMI-related disparities in colorectal cancer screening differ between men and women. DESIGN AND SETTING: The Behavioral Risk Factor Surveillance System, a cross-sectional random-digit telephone survey of noninstitutionalized adults conducted by the Centers for Disease Control and Prevention and state health departments in the 50 states and Washington, DC in 1999. PATIENTS: Survey respondents (N= 52886) between 51 and 80 years of age representing 64563332 U.S. adults eligible for colorectal cancer screening. INTERVENTIONS AND MEASUREMENTS: Adjusted rates of self-reported colorectal cancer screening with fecal occult blood testing within the past year or endoscopic screening (sigmoidoscopy or colonoscopy) within the past 5 years. RESULTS: The colorectal cancer screening rate was 43.8% overall. The rate of screening by FOBT within the last year or endoscopic screening within the past 5 years was 39.5% for the morbidly obese group, 45.0% for the obese group, 44.3% for the overweight group, and 43.5% for the normal weight group. The difference in screening rates was entirely attributable to differences in BMI among women. After statistical adjustment for potential confounders, morbidly obese women were less likely than normal weight women to be screened (adjusted rate difference, -5.6%; 95% confidence interval, -8.5 to -2.6). Screening rates among normal weight, overweight, and obese women, and among men in different weight groups did not differ significantly. CONCLUSIONS: Colorectal cancer screening rates among age-eligible persons in the U.S. are disturbingly low. Morbidly obese women, who are at higher risk than others to develop and to die from colorectal cancer, are less likely to be screened. Efforts to increase colorectal cancer screening are needed for all age-eligible groups, but should also include targeted screening of morbidly obese women since they could reap substantial clinical benefits from screening.

Aged↗

PubMed2003

Assessing the evidence for organised cancer screening programmes.

The aim of this study was to review the evidence in the literature for organised cancer screening programmes. A Medline search for publications related to organised cancer screening programmes and their components was done. While there is a broad descriptive literature on various cancer screening programmes, there are few published studies that evaluate the impact of organised cancer screening. Most of the evidence to date is from Scandinavian cervical and breast cancer screening programmes. There is a moderate amount of literature that evaluates specific components of cancer screening programmes (such as quality control and recruitment). There is a substantial body of literature on organised cancer screening programmes. However, the studies tend to describe organised screening programmes rather than evaluate their effectiveness relative to opportunistic screening. Furthermore, most studies focus on individual components of organised screening programmes, rather than on the programmes as a whole. More research is needed that directly compares organised with opportunistic cancer screening.

Breast Neoplasms↗

PubMed1991

Breast cancer screening among relatives of women with breast cancer.

BACKGROUND: National surveys indicate that only 15% to 30% of all women in the general population 50 years of age or older have an annual mammogram. METHODS: We studied first-degree female relatives of women with breast cancer, who are at elevated risk of disease, to describe the breast cancer screening practices of these relatives and to improve their practices through a program of intensive education. We report here the screening behaviors of 2471 relatives of women with breast cancer. RESULTS: Self-reported behaviors were as follows: 49% performed monthly breast self-examination and 70% had annual breast examinations by a medical professional. Of 983 women 50 years of age or older, 49% had had a mammogram, but only 14% have a mammogram annually. Of women 50 years of age or older who had never had a mammogram, 92% reported never having had one recommended by a medical professional. CONCLUSIONS: Our findings indicate that screening behaviors in relatives of breast cancer patients are not substantially different from those of women in the general population. Enhanced efforts both to educate medical professionals and to encourage women to demand screening mammography are necessary to reduce breast cancer mortality.

Adult↗

PubMed1996

Blood donor centres can effectively publicise cancer screening.

The ability of the blood transfusion service to promote cancer screening using the uptake of colorectal cancer screening offered to blood donors as a model was measured. Blood donors were sent an explanation of colorectal cancer screening with their appointment time to give blood. Free faecal occult blood tests (Haemoccult) were offered by a doctor to donors who attended the Leicester Blood Donor Centre. 556 registered blood donors (309 men, 247 women) aged 51 to 65 years were invited to donate blood over a three month period. Of the subjects who arrived to donate and accepted screening. 63% completed a faecal occult blood test with similar compliance in men and women (66% vs. 59%, chi 2 = 1.0, ns). Compliance was higher in older donors aged 61 to 65 years than those aged 51 to 60 years in both men (90% vs. 60%, chi 2 = 7.0, P < 0.01) and women (87% vs. 51%, chi 2 = 6.2, P < 0.02). The proportion of the total target population screened, which included those donors invited to give blood but who did not attend was 21%. This approach successfully targeted donors who attended to give blood, although only a small proportion of the total target population was screened. Blood donor centres could display cancer screening and health promotion literature and encourage doctors supervising sessions to provide further information and advice to donors.

Aged↗

PubMed1997

Outcomes study of a course in breast-cancer screening.

BACKGROUND: The Breast Cancer Screening Module is a professional training course within the Professional Education for Prevention and Early Detection (PEPED) program at the University of Texas M. D. Anderson Cancer Center. An outcomes study was done to determine the module's ability to improve screening practices crucial to breast-cancer control. METHODS: The five-day course combines 17 hours of class work with 20 hours of hands-on clinical training. Subjects were followed for one year post-training. Six outcome areas were evaluated: 1) knowledge about breast-cancer prevention; 2) clinical skills; 3) changes in routine practice; 4) numbers of patients screened, referred, and diagnosed; 5) trainee satisfaction with the course; and 6) barriers to implementing screening in routine practice. The study population was 63 subjects (all nurse professionals). RESULTS: Outcomes were positive in all six evaluation areas-significant gains in general and clinical knowledge tests (p < or = 0.05); a significant increase from 54.2% pre-training to 70.5% post-training in risk counseling (p < or = 0.05); a sustained increase in screening practices (4.3 times and 2.8 times greater at 6 and 12 months post-training, respectively); 72% rate of high course satisfaction; and barriers to improved screening practices, such as time limitations among 60.4% of subjects and 57.6% of their employers, were identified. CONCLUSIONS: This unique training enhances breast-cancer prevention and screening practices and early detection.

Breast Neoplasms↗

PubMed2006

Low rates of colorectal, cervical, and breast cancer screening in Asian Americans compared with non-Hispanic whites: Cultural influences or access to care?

BACKGROUND: Asian Americans have lower cancer screening rates compared with non-Hispanic whites (NHWs). Little is known about mechanisms that underlie disparities in cancer screening. The objectives of the current study were 1) to determine the relation between nativity, years in the United States, language, and cancer screening in NHWs and Asian Americans, independent of access to care and 2) to determine whether Asians reported different reasons than NHWs for not obtaining cancer screening. METHODS: This population-based study included 36,660 NHWs, 1298 Chinese, 944 Filipinos, 803 Koreans, 857 Vietnamese, and 1036 Other Asians from the 2001 California Health Interview Survey. The main study outcomes were 1) self-reported colorectal, cervical, and breast cancer screening and 2) reasons for not obtaining cancer screening. RESULTS: After adjusting for access to care, several Asian subgroups still had significantly lower rates of all types of cancer screening compared with NHWs. Adjusting for nativity, years in the United States, and English language attenuated the relation between Asian ethnicity and lower rates of colorectal and breast cancer screening. When they were asked what the most important reason was for not having each screening test, foreign-born Asians were significantly more likely than United States-born NHWs to report that they "didn't have problems/symptoms" (P < .01). CONCLUSIONS: Nativity, years in the United States, and English language may be markers of cultural differences that are mediating cancer screening disparities. Foreign-born Asians may believe that cancer screening is in response to symptoms rather than tests that are used prior to the development of symptoms. Health education messages must consider how to communicate effectively that "cancer screening is valuable, because it finds cancer before it is advanced enough to cause symptoms."

Adult↗

PubMed2004

A survey of individual preference for colorectal cancer screening technique.

BACKGROUND: Due to the low participation in colorectal cancer screening, public preference for colorectal cancer screening modality was determined. METHODS: A cross-sectional survey was performed of healthy ambulatory adults in a pediatrics primary care office and neighboring church. Overall preference was ranked for each of four colorectal cancer screening modalities: Faecal Occult Blood, Fiberoptic Sigmoidoscopy, Barium Enema and Colonoscopy. Four additional domains of preference also were ranked: suspected discomfort, embarrassment, inconvenience and danger of each exam. RESULTS: 80 surveys were analyzed, 57 of which were received from participants who had experienced none of the screening tests. Fecal Occult Blood Testing is significantly preferred over each other screening modality in overall preference and every domain of preference, among all subjects and those who had experienced none of the tests. CONCLUSIONS: Efforts to increase public participation in colorectal cancer screening may be more effective if undertaken in the context of public perceptions of screening choices.

Adolescent↗

PubMed1999

Colorectal cancer screening: an overview of available methods and current recommendations.

BACKGROUND: Screening asymptomatic persons for colorectal cancer may decrease the incidence and mortality of this disease. METHODS: The MEDLINE database was used to identify articles addressing the rationale for colorectal cancer screening, methods used and their effectiveness, and current recommendations. RESULTS: Methods of screening for colorectal cancer include flexible sigmoidoscopy, fecal occult blood tests, barium enema, and colonoscopy. The method used and the frequency of screening are determined by assessing an individual's risk of having colorectal cancer. CONCLUSIONS: Colorectal cancer is a common malignancy in the United States, is curable when detected at an early stage, and is potentially preventable. The acceptance of colorectal cancer screening by patients and physicians has been suboptimal. while there remains little debate about the potential for screening to reduce mortality from colorectal cancer, debate continues about the cost-effectiveness of colorectal cancer screening when applied to the general population.

Adenomatous Polyps↗

PubMed1996

A program to increase breast and cervical cancer screening for Cambodian women in a midwestern community.

OBJECTIVE: To determine local screening rates for breast and cervical cancer screening among Cambodian women older than 50 years of age who had used the health-care system, to compare these rates with those for non-Cambodian women, to identify barriers to screening among Cambodians, and to implement community screening. MATERIAL AND METHODS: From review of medical records, cancer screening rates for 1 year among Cambodians (N = 57) were compared with rates for a matched non-Cambodian sample (N = 57). Southeast Asian focus groups identified barriers to screening as a basis for intervention. The intervention included community informational programs in the Cambodian language, group screening appointments, provision of transportation, use of female physicians and interpreters, and an informal clinic setting. Cancer screening rates were compared before and after the intervention. RESULTS: Initial screening rates for Cambodians were significantly lower than for the non-Cambodians. Expressed barriers included lack of knowledge about cancer, shyness at physical examination, lack of transportation, fear of a large, technical medical center, and individual appointments. After the intervention, community screening rates were almost 5 times higher than at baseline. CONCLUSION: The intervention was successful in overcoming organizational, economic, and cultural barriers to cancer screening among older Cambodian women in this setting.

Aged↗

PubMed1999

Interval cancers in the Dutch breast cancer screening programme.

The nationwide breast cancer screening programme in The Netherlands for women aged 50-69 started in 1989. In our study we assessed the occurrence and stage distribution of interval cancers in women screened during 1990-1993. Records of 0.84 million screened women were linked to the regional cancer registries yielding a follow-up of at least 2.5 years. Age-adjusted incidence rates and relative (proportionate) incidences per tumour size including ductal carcinoma in-situ were calculated for screen-detected and interval cancers, and cancers in not (yet) screened women, comparing them with published data from the UK regions North West and East Anglia. In total 1527 interval cancers were identified: 0.95 and 0.99 per 1000 woman-years of follow-up in the 2-year interval after initial and subsequent screens respectively. In the first year after initial screening interval cancers amounted to 27% (26% after subsequent screens) of underlying incidence, and in the second year to 52% (55%). Generally, interval cancers had a more favourable tumour size distribution than breast cancer in not (yet) screened women. The Dutch programme detected relatively less (favourable) invasive cancers in initial screens than the UK programme, whereas the number of interval cancers confirms UK findings. Measures should be considered to improve the detection of small invasive cancers and to reduce false-negative rates, even if this will lead to increasing referral rates.

Aged↗

PubMed2005

Celebrity endorsements of cancer screening.

Celebrities often promote cancer screening by relating personal anecdotes about their own diagnosis or that of a loved one. We used data obtained from a random-digit dialing survey conducted in the United States from December 2001 through July 2002 to examine the extent to which adults of screening age without a history of cancer had seen or heard or been influenced by celebrity endorsements of screening mammography, prostate-specific antigen (PSA) testing, or sigmoidoscopy or colonoscopy. The survey response rate was 72% among those known to be eligible and 51% among potentially eligible people accounting for those who could not be contacted. A total of 360 women aged 40 years or older and 140 men aged 50 years or older participated in the survey. Most respondents reported they "had seen or heard a celebrity talk about" mammography (73% of women aged 40 years or older), PSA testing (63% of men aged 50 years or older), or sigmoidoscopy or colonoscopy (52% of adults aged 50 years or older). At least one-fourth of respondents who had seen or heard a celebrity endorsement said that the endorsement made them more likely to undergo mammography (25%), PSA testing (31%), or sigmoidoscopy or colonoscopy (37%).

Adult↗

PubMed1988

Cervical cancer screening practices among older women: results from the Maryland Cervical Cancer Case-Control Study.

Considerable evidence shows a large proportion of older women have either never had a Pap test or have significant gaps in their history of cervical cancer screening. Differences in health care utilization patterns by age, cohort differences in use of medical subspecialities, and provider reluctance to perform cancer screening within the general medical care encounter have been suggested as reasons for underscreening. Our study conducted in 1985 documents prior health care utilization patterns of 153 cases of Maryland women with invasive cervical cancer compared with a matched control group. Analysis within three age groups showed that cases were significantly less likely to have ever had a Pap test or to receive regular Pap testing, primarily due to differences in medical care utilization patterns. Never having an obstetrician-gynecology visit, a recent (less than 3 years) internist visit, or not having any out-patient visit were significant risk factors. Other risks included older age at first Pap test, reporting not being told to have routine Pap tests, and not using contraceptives. In a multiple logistic regression analysis, recent out-patient visits and lifetime use of an obstetrician-gynecologist remained significant after adjusting for age interactions with recent Pap test history, underscoring the importance of medical care utilization patterns for screening of cancer of the uterine cervix among the elderly.

Adult↗

PubMed2003

[Health economics analysis of breast cancer screening].

INTRODUCTION: The organized breast cancer screening programme has started in Hungary at the end of 2001. AIM: To assess the screening rate, the cost of screening and treatment and to calculate the expected epidemiological and economic gain and cost-effectiveness of mass-screening programme. METHODS: The data derive from the financial database of the National Health Insurance Fund of Hungary from 2001. To assess the screening rate the authors used the code "No. 42400 mammography screening" of outpatient care. The cost of treatment includes the cost of outpatient care, the acute and chronic inpatient care, the subsidies of the prices of medicines and the expenditure on disability to work (including sickness-pay). The expected benefits of the screening programme were modeled with changing mortality decrease for a 10 years interval. RESULTS: The screening rates of women aged 45-65 for 2001 and 2002 were 7% and 21.7%, respectively. The cost of treatment of breast cancer was around 8.6 billion Hungarian forints (29,939,868 USD, 33,426,321 EUR) in 2001. In the age-group 45-65 with 10% mortality decline 509 lives (net present value, NPV: 365), with 20% mortality decline 1.074 (NPV: 772) lives and with 30% mortality decline 1.582 (NPV: 1.139) lives can be saved during a 10 years screening programme. The cost of one life saved varies between 5.7 million forints (19,876 USD, 22,190 EUR)/life saved and 17.8 million forints (62,047 USD, 69,273 EUR)/life saved according to the mortality decline. The cost of one life year saved varies between 271,000 forints (946 USD, 1057 EUR)/life year saved and 847,000 forints (2955 USD, 3299 EUR)/life years saved. CONCLUSION: The implementation of organized breast cancer screening can lead to cost savings in Hungary. The cost-effectiveness of breast cancer screening seems to be acceptable for purchaser.

Breast Neoplasms↗

PubMed2005

[The unreasonableness of prostate-cancer screening and the ethical problems pertaining to its investigation].

Since the early 1990s, screening with prostate-specific antigen (PSA) testing has increased the incidence of prostate cancer. Any decrease in mortality will not be seen for at least a decade, due to the long natural history of prostate cancer. Death due to prostate cancer is rare, while the prevalence oflocalised tumours is high. The prognosis of these early-detected localised tumours is uncertain, because most patients will die from other causes. Complications of prostate-cancer therapy are common, with high rates of impotence, incontinence and gastrointestinal problems after prostatectomy or radiotherapy. Randomised trials of prostate-cancer screening, notably the 'European randomised screening for prostate cancer' (ERSPC) trial, began with the consent of ethical committees. There is a real uncertainty regarding the benefits of prostate-cancer screening. However, it is clear that these benefits are limited, because prostate-cancer death is rare before the age of 75 years. There is no real uncertainty about the harms of prostate-cancer screening. High prevalence and high rates of treatment complications deduct many disease- and disability-free years from the eligible population (men aged 55-74 years). Therefore, there has been no real uncertainty over the balance of harms and benefits in prostate-cancer screening trials. Days may be added to old age, at the cost of months of disease- and disability-free living. It is not in the best interest of eligible men to participate in these trials. Randomised trials evaluating prostate-cancer screening violate in principle and practice the Helsinki Declaration of the rights of human subjects in medical research.

Aged↗

PubMed2025

Circulating microRNA panels for multi-cancer detection and gastric cancer screening: leveraging a network biology approach.

BACKGROUND: Screening tests, particularly liquid biopsy with circulating miRNAs, hold significant potential for non-invasive cancer detection before symptoms manifest. METHODS: This study aimed to identify biomarkers with high sensitivity and specificity for multiple and specific cancer screening. 972 Serum miRNA profiles were compared across thirteen cancer types and healthy individuals using weighted miRNA co-expression network analysis. To prioritize miRNAs, module membership measure and miRNA trait significance were employed. Subsequently, for specific cancer screening, gastric cancer was focused on, using a similar strategy and a further step of preservation analysis. Machine learning techniques were then applied to evaluate two distinct miRNA panels: one for multi-cancer screening and another for gastric cancer classification. RESULTS: The first panel (hsa-miR-8073, hsa-miR-614, hsa-miR-548ah-5p, hsa-miR-1258) achieved 96.1% accuracy, 96% specificity, and 98.6% sensitivity in multi-cancer screening. The second panel (hsa-miR-1228-5p, hsa-miR-1343-3p, hsa-miR-6765-5p, hsa-miR-6787-5p) showed promise in detecting gastric cancer with 87% accuracy, 90% specificity, and 89% sensitivity. CONCLUSIONS: Both panels exhibit potential for patient classification in diagnostic and prognostic applications, highlighting the significance of liquid biopsy in advancing cancer screening methodologies.

Neoplasms↗

PubMed1989

Participation of high-risk subjects in colon cancer screening.

Siblings of colorectal cancer patients are estimated to be three times more likely to develop colorectal cancer. Although these high-risk siblings are appropriate candidates for colon cancer screening, the factors that affect their participation in screening programs are not known. A study was conducted to examine the factors that might influence participation in fecal occult blood test (FOBT) screening by high-risk siblings of recently diagnosed colon cancer patients and nonhigh-risk control siblings. Siblings were mailed a sample FOBT card, a letter informing them of their risk status, and an invitation to participate in the FOBT screening program. They were later interviewed by telephone about their intention to participate in FOBT screening. FOBT cards were returned by 52.2% of high-risk siblings compared with 37.7% of control siblings (P less than 0.005). Only 24.8% of the cancer siblings thought they were more likely to get colon cancer compared with others their own age, and 27.8% thought they were less likely. Perceived risk of cancer and demographic and health-related factors did not predict compliance beyond membership in the high-risk group. Siblings of colon cancer patients are more likely to participate in screening, and efforts to screen them could have a substantial impact on colorectal cancer. More work is needed to identify the factors responsible for compliance so that effective interventions can be developed.

Adult↗