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PubMed2006

Factors influencing behavioral intention regarding prostate cancer screening among older African-American men.

PURPOSE: To assess factors associated with perceptions of prostate cancer screening among African-American men aged > or = 55 years based upon items developed using the Preventive Health model (PHM). RESEARCH APPROACH: Focus group research and thematic coding using content analysis. SETTING: A large midwestern, private, nonprofit health system. PARTICIPANTS: African-American men aged > or = 55 years. Focus group 1 included 10 men who ranged in age from 55-87 years, with a mean age of 73.4 years. The 11 participants in focus group 2 ranged in age from 55-81 years, with a mean age of 68.7 years. METHODOLOGICAL APPROACH: Focus group questions were developed based on the conceptual framework of the PHM. African-American men aged > or = 55 years were randomly selected from the patient population of the healthcare system to participate in one of two focus groups. Content analysis was used to code the focus group transcripts. MAIN RESEARCH VARIABLES: Self-reported perceptions of prostate cancer screening. FINDINGS: Major themes emerging from the focus groups related to prostate cancer screening include: lack of knowledge regarding cancer, fear of cancer, confusion between prostate cancer screening and prostate cancer diagnostic tests, encouragement by others as motivation for cancer screening, intergenerational transfer of health information, lack of health insurance coverage as a barrier to prostate cancer screening and treatment, and limited availability of screening clinic hours during nonworking hours. INTERPRETATION: The information gained from this study could be used to develop interventions promoting informed and shared decision-making by patients and their providers regarding prostate cancer screening.

Black or African American↗

PubMed2005

Present strategy of lung cancer screening and surgical management.

Previous lung cancer screening trials in the United States (US) employing chest X ray and sputum cytology did not demonstrate reductions in lung cancer mortality. However, recent case control studies in Japan demonstrated a decrease in lung cancer mortality in the computed tomography (CT) screened group. Lung cancer screening using chest CT detected more cancers at an earlier stage than chest X ray. Before CT screening is widely performed, lung cancer mortality reduction should be proved in a scientific manner. The problem of a much higher false positive rate of this method should be solved. The subtypes of adenocarcinoma; bronchioloalveolar carcinoma (BAC) tends to show specific CT findings called ground glass opacity (GGO) and a favorable prognosis can be expected. BAC is usually invisible by chest X ray and detected only by CT. Recent studies have shown the proportion of GGO is strongly related to biological malignancy of small adenocarcinoma. Based on this fact, thoracic surgeons wish to identify the possibility of limited resection for minimally invasive cancers. Lung cancer researchers are interested in evaluating the nature of small adenocarcinoma as well as the carcinogenic process. A comprehensive understanding of screening-detected cancers including the CT images, pathology and genetic analysis is necessary for optimum management of such nodules.

Adenocarcinoma↗

PubMed1995

Controversies in breast cancer screening.

Because breast cancer is the most common cancer occurring in women in the United States, early detection of breast cancer through screening mammography, physician clinical examination, and breast self-examination has been recommended. However, despite admonitions to physicians and patients to be aggressive in their screening efforts, there has been continued controversy regarding appropriate guidelines for screening. In December 1993, the National Cancer Institute announced that it could no longer recommend routine mammographic screening for women age 40-49 years, which it had previously supported along with other medical organizations. This change in policy, along with data from the Canadian National Breast Screening Study showing an increased mortality rate for screened women, created confusion for physicians and patients alike. The controversy about screening guidelines has created many practical concerns for the physicians involved in the primary health care of women. In the current paper, the author discussed the development of screening guidelines and the current recommendations of various medical organizations and reviewed the data from studies supporting and challenging the current guidelines, with a focus on screening guidelines for women age 40-49 and the elderly. Recommendations are made for physicians on how to communicate with patients regarding screening controversies.

Adult↗

PubMed1999

Breast cancer screening in 21 countries: delivery of services, notification of results and outcomes ascertainment.

Following clinical trial evidence of mammography screening's efficacy and effectiveness, data are needed from organized population-based programmes to determine whether screening in these programmes results in breast cancer mortality reductions comparable to those demonstrated in controlled settings. The International Breast Cancer Screening Network (IBSN) conducted two international programme assessments: in 1990 among nine countries and in 1995 among 22 countries, obtaining information on the organization and process for screening within breast cancer screening programmes. This manuscript describes procedures for recruitment, service delivery, interpretation and communication of results, case ascertainment, and quality assurance. Practices in more established programmes are compared with pilot programmes. Each IBSN country defined a unique programme of population-based breast cancer screening. Some programmes were sub-national rather than national in scope, while others were in pilot stages of development. Screening took place in dedicated centres in established programmes and in both dedicated and general radiology centres in pilot programmes. Although most countries used personal invitation systems to recruit women to screening, other recruitment mechanisms were used. Most countries used two-view mammography in their screening programmes. About half had implemented independent double reading of mammograms, considering it a key component of high-quality mammography screening. In conclusion, diversity exists in the organization and delivery of screening mammography internationally. Quality assurance activities are a priority and are being evaluated in the IBSN.

Australia↗

PubMed1996

Breast cancer screening in older women.

BACKGROUND: There is currently an epidemic of breast cancer in women 65 years of age and older. The purposes of this paper are to explore the breast cancer screening behaviors of older women and to identify some of the determinants of screening in these women. METHODS: Data were analyzed from the 1987 National Health Interview Survey, a continuous nationwide household interview survey of the U.S. civilian, noninstitutionalized population. RESULTS: As in other studies, the utilization of breast cancer screening by older women was less in older women than in younger women. This was true for both mammography and clinical breast examination. A number of determinants of screening in older women were identified here. Women with a usual source of care and/or no activity limitation, as well as high school graduates, were the ones most likely to have received a screening mammogram and/or a screening clinical breast exam during the past year. DISCUSSION: The failure of older women to receive adequate breast cancer screening is an important concern which should be reevaluated, given the breast cancer epidemic in this population. This study identified a number of determinants of breast cancer screening in older women. For the most part, these determinants point to the primary care physician as the key to breast cancer screening in these women. Therefore, the primary care physician must be informed of, and encouraged to follow, the recommendations for periodic breast cancer screening in older women.

Aged↗

PubMed2000

Breast cancer screening in regional Hispanic populations.

Although Hispanics' use of breast cancer screening services has been investigated, to date there have been no published studies of distinct Hispanic populations in different areas of the country. Using the diverse populations and sites involved in the National Hispanic Leadership Initiative on Cancer 'En Acción', this study examines ethno-regional differences in breast cancer screening rates among these groups and explores the correlates of screening participation. Data collected through telephone surveys were analyzed for women 40 years of age and older (n = 2082). After controlling for demographic variables traditionally related to breast cancer screening rates, it was found that ethno-regional differences in breast cancer screening practices clearly persisted. In addition to traditional demographic factors, other variables evidently underlie differences in Hispanics' utilization of breast cancer screening services. These variables may be cultural and should be investigated in future research. Meanwhile, researchers should not refer to the 'Hispanic' population at large without identifying, addressing and clarifying the ethno-regional characteristics of their samples.

Adult↗

PubMedDate not supplied

Clinic-based interventions to promote breast and cervical cancer screening.

BACKGROUND: Breast and cervical cancer continue to claim the lives of women. Early detection modalities for these cancers are available; however, utilization rates are far from optimal. Studies have documented the motivating effect that physician recommendations have on compliance with preventive health behaviors. The goal of this study was to develop and implement strategies to improve the use of cervical and breast cancer screening among African-American women age 40 and older who resided in low-income housing communities. METHODS: Baseline surveys among clinic providers and a random sample of women in the target population indicated areas to be included in intervention material. Community health center-based strategies included educational interventions for providers and patients, follow-up interventions for abnormal screening tests, and the implementation of a computer tracking system. Pap smear and mammogram utilization rates at the health center were tracked throughout the project period to assess the effect of the clinic-based interventions. RESULTS: Both Pap smear and mammography rates increased over time. Fifteen cases of breast cancer and 1 case of invasive cervical cancer have been detected. Compliance rates for follow-up for cervical dysplasia have increased from 50 to 90%. CONCLUSIONS: These results suggest that clinic-based interventions can improve the use of breast and cervical cancer screening and follow-up among low-income women.

Adult↗

PubMed2003

Breast cancer screening beliefs by practice location.

BACKGROUND: This study examines variations in breast cancer screening among primary care clinicians by geographic location of clinical practice. METHODS: A cross-sectional survey design was used to examine approaches to breast cancer screening among physicians, nurse practitioners, and physician assistants involved in primary care practice. A summary index of beliefs about breast cancer screening was created by summing the total number of responses in agreement with each of four survey items; values for this summary variable ranged between zero and four. Respondents were classified into urban, rural and suburban categories based upon practise location. RESULTS: Among the 428 respondents, agreement with "correct" responses ranged from 50% to 71% for the individual survey items; overall, half agreed with three or more of the four breast cancer screening items. While no significant differences were noted by practice location, variation in responses were evident. Reported use of written breast cancer guidelines was less in both suburban (OR = 0.51) and urban areas (OR = 0.56) when compared to clinicians in rural areas. CONCLUSION: Development of an evidence-based consensus statement regarding breast cancer screening would support a single set of unambiguous guidelines for implementation in all primary care settings, thus decreasing variations in how breast cancer screening is approached across varied clinical settings.

Attitude of Health Personnel↗

PubMed2003

Cancer screening estimates for U.S. metropolitan areas.

OBJECTIVES: To provide estimates of breast, cervical, and colorectal cancer screening for metropolitan areas in the United States. METHODS: Behavioral Risk Factor Surveillance System (BRFSS) data from 1997 to 1999 were reweighted and analyzed for 69 U.S. metropolitan areas for the receipt of a Papanicolaou (Pap) test (ages > or =18 years); mammography (ages > or =40 years); fecal occult blood testing and sigmoidoscopy (ages > or =50 years). Stratified analyses by demographics were performed for 25 metropolitan areas with populations of > or =1.5 million. RESULTS: Metropolitan estimates ranged from 64.6% to 82.0% for mammography and from 77.2% to 91.7% for Pap tests. There was much greater variability in estimates for colorectal cancer screening, with a 3.6-fold difference in the range of estimates for fecal occult blood testing (9.9% to 35.2%) and a 2.5-fold difference for sigmoidoscopy (17.3% to 43.3%). In the 25 largest areas, prevalence of cancer screening was generally lower for persons with a high school education or less and for those without health insurance. Compared with women aged 50 to 64 years, mammography estimates were lower for women aged 40 to 49 years in 13 of the 25 metropolitan areas. Pap testing was less common among women aged > or =65 years, and colorectal cancer screening was less common for persons aged 50 to 64 years. CONCLUSIONS: Estimates of cancer screening varied substantially across metropolitan areas. Increased efforts to improve cancer screening are needed in many urban areas, especially for colorectal cancer screening. The BRFSS is a useful, inexpensive, and timely resource for providing metropolitan-area cancer screening estimates and may be used in the future to guide local or county-level screening efforts.

Adult↗

PubMed2004

[Prevention practices and cancer screening among general practitioners in Picardy (France)].

In France, cancers are the leading causes of death in men and in women aged to 35 to 65, and the cancer incidence in Picardy area is among the highest in France. General practitioners can play a key role in prevention and early detection of cancer. The aim of this study was to assess their current clinical practices concerning risk factors like tobacco, alcohol, diet, sun exposure and cancer screening. A questionnaire on primary prevention and cancer screening practices of general practitioners (GP) in the Picardy area was administered to 480 GP (31%). Questions concerned primary prevention (tobacco, alcohol, diet, sun exposure) and cancer screening (breast, uterine cervix, colon-rectum, prostate, other cancers). In addition, the GP were also interviewed on difficulties encountered in their practice and about their perception of the prevention actions. Smoking prevention is the best structured primary prevention action, unlike alcohol prevention and advice on diet seem to be more difficult strategies. We noted a great diversity for screening, even for cancers with a consensus, like breast, uterine cervix and colon-rectum cancers. Lot of physicians reported ordering prostatic specific antigen test (91%) but are only 5% to have fecal occult blood tests. 83% of the GP screened their patients on skin cancer at least once a year. These findings suggest that general practitioners can play a key role in prevention and early detection of cancer, but have difficulties like lack of time, lack of expertise or non compliance of their patients.

Alcohol Drinking↗

PubMed2001

Cervical cancer screening in Porto Alegre, Brazil: alternative methods for detecting cancer precursors in a developing country.

OBJECTIVE: This study was conducted to test the performance characteristics of cervical cancer screening by visual inspection of the cervix with acetic acid and iodine solution. METHODS: A total of 100 women were screened for cervical cancer by Pap smear and naked eye inspection of the cervix after application of acetic acid and iodine solution. RESULTS: Comparing visual inspection to the Pap test, a sensitivity of 85.7%, specificity of 78.5%, and concordance of 79% (p < .0011) was established. Comparing the Pap test with colposcopy, the corresponding figures were 42.9%, 92.3%, and 66.6% (p < .077), respectively. Visual inspection compared to colposcopy showed corresponding figures of 100%, 7.7%, and 55.5% (p = .48), respectively. Colposcopy and biopsy had an agreement of 100%. CONCLUSIONS: Visual inspection with acetic acid and iodine solution proved to be a reasonable method of screening for cervical cancer precursors.

Journal Article↗

PubMedDate not supplied

Low national breast and cervical cancer-screening rates in American Indian and Alaska Native women with diabetes.

BACKGROUND: The cervical cancer mortality rate for American Indian and Alaska Native women is twice that of all races in the United States. To date the only published national breast and cervical cancer-screening rates for American Indian and Alaska Native women are based on self-reported data. When the Indian Health Service (IHS) conducts an annual audit on patients with diabetes, it includes cancer screening. This observational study presents national breast and cervical cancer-screening rates for American Indian and Alaska Native women with diabetes. METHODS: Cancer-screening rates were extracted from the 1995 diabetic audit for the 12 IHS areas. These rates were compared with rates for women without diabetes of the same age, 50 to 69 years, by chart review, at four IHS hospitals in the Aberdeen IHS area. RESULTS: Screening rates for women with diabetes in the 12 areas varied: mammogram (ever) 35% to 78%; clinical breast examination (last year) 28% to 70%, and Papanicolaou smear (last year) 26% to 69%. The Aberdeen IHS area women with diabetes had 51% more clinic visits per year than women without diabetes, but the groups had similar screening rates. CONCLUSION: Cancer-screening rates for American Indian and Alaska Native women vary by region. In the Aberdeen IHS area, women with diabetes had more visits (missed opportunities) but similar screening rates as women without diabetes. The diabetic audit could be used to monitor national IHS cancer-screening trends for women with diabetes and in the Aberdeen IHS area for all women aged 50 to 69 years.

Aged↗

PubMedDate not supplied

Cancer screening practices among women in a community health center population.

BACKGROUND: Cancer takes a disproportionate toll on disadvantaged Americans. Poverty and low education are risk factors for underuse of cancer screening. METHODS: In this report, we discuss predictors of adherence to cancer screening (mammography, clinical breast exam [CBE], and Pap tests) among 926 women who receive care at a community health center that serves a predominantly low-income and minority population. We examine predictors for each of the tests and for a composite measure of overall cancer screening test compliance. In studying multiple screening behaviors we not only investigate factors associated with each individual behavior, but we also identify consistently effective factors across several behaviors. RESULTS: The analysis indicates consistent effects of age, education, and insurance status on cancer screening. In addition, decisional balance, a measure of a person's beliefs about the pros and cons of complying with the screening test, is associated strongly with adherence. We have extended earlier findings about the positive relationship between decisional balance and mammography to include decisional balance and Pap tests, as well. This finding suggests that behavioral interventions that target decisional balance can effectively promote adherence to cancer screening tests.

Adolescent↗

PubMed1992

Practical considerations of melanoma/skin cancer screening clinics.

In 1989 a voluntary melanoma/skin cancer screening clinic was held in Oss, the Netherlands. The campaign was carried out according to the free clinics conducted since 1985 in the USA. Our experiences with the first clinic urged us to improve on the organization of the screen. This produced a better yield of the second screen, conducted in 1990 in Arnhem. In this paper we present the practical and organizational implications of melanoma/skin cancer screening based on both screening exercises. It is emphasized that only dermatologists should screen. Concomitant public education will enhance self-selection of people at risk for melanoma/skin cancer. There should be ample provider time, sufficient auxiliary personnel and abundant examination rooms. Total-body skin examination is optional. Follow-up of positive screenees is mandatory. It is concluded that melanoma/skin cancer screening is feasible, particularly in countries with a high dermatologist-to-patient ratio.

Advertising↗

PubMed2006

[Cervical cancer screening of HIV-positive women: is a prolongation of the screening interval meaningful?].

OBJECTIVE: Cervical cancer screening guidelines stated recently that the screening interval of healthy women can be extended up to 3 years. Can those recommendations be applied for high risk populations? MATERIAL AND METHODS: In a prospective setting 305 HIV-positive women have been enrolled in this analysis between September 2000 and December 2003. Patients have been characterized according to HPV (human papilloma virus) prevalence, CIN (cervical intraepithelial neoplasia) incidence and CD4 cell count. RESULTS: 41 % of all HIV-positive women were HPV positive (oncogene subtypes). In patients with diminished CD4 cells the HPV prevalence increased to 60 % (54/90). CIN was found in 27 % (83/305) women. CIN was more frequent by HPV-positive women with a CD4 cell count < 200 mm (3) (52 %, 38/72). The CIN incidence was also high in HIV-positive women with negative HPV infection and diminished CD4 cell count (39 %, 7/18 vs.7 %, 11/161). CONCLUSIONS: The current cervical cancer screening guidelines are not helpful in HIV-positive women. The CIN incidence is significantly higher as in the HIV-positive population. For this reason this high risk population as e. g. HIV-infected women need an intensive care of diagnostic tools and short screening intervals to detect CIN.

Adolescent↗

PubMed1999

A novel form of ascertainment bias in case-control studies of cancer screening.

In case-control studies of cancer screening, some have generally admonished investigators against case definitions based on diagnosis dates because of lead-time bias. However, perhaps partly due to vagueness, the admonitions have been frequently ignored. A recurrence-time model simulates case ascertainment when diagnosis must occur within a specific calendar period. The model depends on screening test sensitivity and rate, age-specific preclinical incidence rates, and preclinical duration time and survival time distributions. For one study of sigmoidoscopic screening for colorectal cancer, when the true odds ratio is 1, its estimate is 0.50 to 0.75 under plausible assumptions. This bias can affect any observational study wherein case definition depends on diagnosis times (e.g., health-plan enrollment data). To avoid bias in observational investigations of cancer screening wherein the case definition depends on the diagnosis date, one must ensure that both screening and preclinical incidence do not occur before the case definition period.

Adult↗

PubMed2002

All-cause mortality in randomized trials of cancer screening.

BACKGROUND: The most widely accepted end point in randomized cancer screening trials is disease-specific mortality. The validity of this end point, however, rests on the assumption that cause of death can be determined accurately. An alternative end point is all-cause mortality, which depends only on the accurate ascertainment of deaths and when they occur. We compared disease-specific and all-cause mortality in published randomized cancer-screening trials to indirectly assess the validity of the disease-specific mortality end point. METHODS: We examined all 12 published randomized trials of cancer screening for which both end points were available (seven of mammography, three of fecal occult blood detection, and two of chest x-ray screening for lung cancer). For each randomized trial, we subtracted disease-specific mortality observed in the screened group from that observed in the control group and all-cause mortality in the screened group from that in the control group. We then compared the differences in these two mortality measures. RESULTS: In five of the 12 trials, differences in the two mortality rates went in opposite directions, suggesting opposite effects of screening. In four of these five trials, disease-specific mortality was lower in the screened group than in the control group, whereas all-cause mortality was the same or higher. In two of the remaining seven trials, the mortality rate differences were in the same direction but their magnitudes were inconsistent; i.e., the difference in all-cause mortality exceeded the disease-specific mortality in the control group. Thus, results of seven of the 12 trials were inconsistent in their direction or magnitude. CONCLUSION: Major inconsistencies were identified in disease-specific and all-cause mortality end points in randomized cancer screening trials. Because all-cause mortality is not affected by bias in classifying the cause of death, it should be examined when interpreting the results of randomized cancer-screening trials.

Bias↗

PubMed2001

Knowledge, attitudes, and practices related to breast cancer screening: a survey of Arabic women.

BACKGROUND: Incorporating breast cancer screening into day-to-day clinical care leads to early diagnosis and decreases mortality. Patients' participation in screening depends on their knowledge and attitudes, other barriers, and physician behavior. METHODS: A cross-sectional questionnaire survey was conducted to evaluate knowledge, attitudes, barriers, and practices related to breast cancer screening among Arabic women. A convenience sample was selected from 1,750 women aged 40-65 years who, for any reason, attended primary health care (PHC) clinics in Al-Ain, United Arab Emirates (UAE). RESULTS: Of the 1,750 invited women, 1,445 agreed to participate; 78 were excluded from analysis because of histories of breast cancer. Breast self-examination (BSE) was practiced by 12.7% of the study population, clinical breast examination (CBE) by 13.8%, and mammography by 10.3%. Knowledge about breast cancer screening was low in the study population. Women were infrequently instructed about or offered screening for breast cancer by health professionals. Being employed was an independent predictor for participation in the three screening examinations. CONCLUSIONS: Health workers infrequently offered screening examinations and women lacked adequate knowledge about breast cancer screening. Acquired information about barriers to screening may help in the design of effective screening programs for Arabic women.

Adult↗