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PubMed1978

Prospective evaluation of periodic breast examination programs: interval cases.

A mathematical model is developed and used to obtain estimates of the expected proportion of breast cancer cases which will be detected at scheduled examinations and between them in various periodic examination programs; the latter are called interval cases. Another model is used to get estimates of the proportion of women in such programs who get cancer and are expected to have axillary node metastases at the time of first treatment. Programs with or without patient self-examinations are also evaluated. The purpose of both models is to enable evaluations of different periodic schedules. Although interval cases have been reported to have poorer prognostic characteristics than those found at scheduled examinations, calculations indicate that large reductions in these cases do no imply an equivalent reduction in positive axillary node cases. Thus, interval case counts are a relatively weak measure of the success of a periodic program. However, they may still be valuable since programs which can be expected to have low porportions of interval cases are less dependent on efficient patient self-examinations. Cost-benefit calculations show how the relative costs of mammographic and physical examinations can be considered in the development of mass screening programs. For example, if a mammographic examinations cost three times as much as a physical, then a physical examination program may be preferred to one involving both modalities.

Axilla↗
PubMed2026

A hybrid effectiveness-implementation trial to integrate precision skin cancer risk feedback in federally qualified health centers.

BACKGROUND: Skin cancers are the most common type of cancer in the United States, occur in all segments of the population, and are preventable. Our previous research with primary care patients' demonstrated interest in and efficacy of a precision prevention intervention providing feedback on MC1R risk level (higher versus average) in combination with prevention education materials relative to a standard educational intervention. Our current study is a hybrid type 1 effectiveness-implementation trial deployed at six federally-qualified health centers. This paper presents the study protocol. METHODS: A community advisory panel will guide development of study materials and measures. Staff training at each clinic will be completed in-person. Patients will be approached and screened in-person. Those completing genetic testing and the baseline survey will be randomized to the precision versus standard intervention for each risk level with a target sample size of 286 for each combination. Primary outcomes of effectiveness, assessed at 6 and 12 months, include a tanning score (5 items assessing intentional and unintentional tanning), number of sunburns, conduct of a skin self-examination, and electronic health record documentation of clinician-patient communication about skin cancer prevention. Effectiveness comparisons will focus on the precision relative to the standard intervention among higher risk participants. Implementation data will be collected to identify barriers and facilitators. RESULTS: Effectiveness and implementation outcomes will be evaluated following study completion. CONCLUSIONS: Results will guide subsequent scale-up of the precision intervention, including modifications of the intervention as well as methods for implementation. CLINICAL TRIALS IDENTIFIER: NCT07222995.

Humans↗
PubMed1978

An analysis of the benefits of serial screening for breast cancer based upon a mathematical model of the disease.

A model of breast cancer is developed that consists of hypotheses about the age-specific incidence of the disease, the rate of disease progression, the tendency of the disease to be detected without benefit of regularly scheduled screening examinations, and prognosis related to the extent of disease at treatment. Parameters for the model are estimated from published data. The model is validated by comparing model predictions to data not used in parameterization. The model, under a variety of assumptions, is then used to analyze questions of interest about breast cancer screening strategies. These include the following: the benefits from screening with mammography and clinical examination as a function of the frequency and starting age of screening, the effect of different assumptions about radiation risks on the benefits of screening, the benefits from screening with mammography if yearly clinical examinations are performed, and the benefits from screening with mammography and clinical examination if self-examinations are performed.

Adult↗
PubMed1979

Increased incidence of breast carcinoma in patients with irradiation for post-partum mastitis: a screening situation.

In Rochester, New York, 606 women were treated with ionizing radiation for post-partum mastitis, mostly between 1940 and 1955. Two-thirds of all breasts were treated, the average dose per breast being 377 rads (at 2.5 cm breast depth). Mammographic examinations were performed on 265 of these women still residing in this vicinity. Two nonpalpable carcinomas (with no axillary node metastases) were found in the twelve breast lesions that have been biopsied. Some of the biopsies revealed premalignant changes. It is recommended that women in this high-risk category have close medical supervision, as well as periodic mammographic evaluation, and that the importance of periodic breast self-examinations should be emphasized.

Adult↗
PubMed1977

A survey of 4,793 oral lesions with emphasis on neoplasia and premalignancy.

A survey was taken of a selected group of 4,793 oral lesions submitted to the oral pathology biopsy service between 1950 and 1970. About two thirds of all the specimens examined microscopically were classified as inflammatory, infectious, or reactive hyperplasia. Of the 12.6% of the sample classified as neoplasms, one of every five was malignant. Three of every four of the malignant neoplasms were microscopically diagnosed as squamous cell carcinomas. Benign neoplasms were most common in ages 40 to 60, whereas premalignancies and malignancies were most commonly discovered in the slightly older age group of 50 to 70. Although malignant neoplasms were found more often in men than women, there was a striking increase in the incidence of malignancies in women in the second ten-year period of the study. There were unexplainably few malignant neoplasms found in blacks. Patients should be taught to recognize the early signs of oral premalignancy and malignancy through the use of a simple method of self-examination at home. They should be discouraged from the frequent use of tobacco and alcohol, which have long been known to be predisposing factors in the production of oral squamous cell carcinomas.

Adult↗
PubMed1977

Screening for breast cancer: the role of mammography.

The early diagnosis of breast cancer by screening is a relatively new development in medical practice and its enthusiastic acceptance needs to be tempered by an appraisal of the costs, the risks and the potential benefits. No case can be made at present for screening well women under the age of 50 years, when such screening includes mammography. With the exception of women who have already had cancer in one breast, it is likely that those women under 50 with the associated "risk factors" are better managed by careful attention to breast self-examination and more frequent physical examinations. Provided that the radiation dose is less than one rad per examination, the benefits to women over 50 outweigh the risks of radiation-induced breast cancer. Against this must be placed the very large cost to the community of screening programmes and the relatively low additional benefits gained by incorporation of mammography into the screening process.

Adult↗
PubMed1977

Cancer detection in working women: a report on 7450 subjects.

A cancer detection programme for women was devised in 1964 by the writer, who attended an increasing number of work centres, mostly on an annual basis. During 12 years 7450 women were examined, some of them more than once. There were 237 abnormal Papanicolaou smears (in 112 of which the histological diagnosis was carcinoma or moderate to severe dysplasia), and 18 carcinomas of the breast. Education about cancer, teaching of breast self-examination and general counseling were also carried out. The high detection rate of cancer emphasizes the need for such services to be taken to the women at risk, and suggests that annual Papanicolaou smears are still the ideal.

Adolescent↗
PubMed1979

Reconstruction of the breast after mastectomy for cancer.

General surgeons are taking a more active role in the treatment of all the problems which face the patient who undergoes mastectomy. For many of these women, an important part of their adjustment is achieved by reconstruction of the breast. The number of women requesting reconstruction of the breast after mastectomy is increasing, and more women faced with mastectomy are asking their general surgeons for information about the procedure. It is hoped that as reconstruction of the breast becomes more widely appreciated, women will be encouraged to perform more frequent self-examinations and to seek earlier treatment of carcinoma of the breast. It is tempting to speculate that one ultimate benefit may be an improvement in the survival figures associated with this disease.

Breast↗
PubMed1979

[Prevention of breast cancer. An initiative launched by the Varese/3 southern outer health consortium (author's transl)].

The results of a breast tumour prevention campaign conducted in 1977-78 by the Varese/3 Southern Outer Health Consortium are described. All women aged 30-65 yr were asked to come for a clinical examination of the breast by suitably trained midwives. Periodic self-examination was explained on this occasion and a card was prepared with historical data for evaluation of the risk factors. 4708 of the 8226 women approached came for examination (57%). Of those subjected to further diagnostic tests, 170 are still under out-patient control, while 34 have been hospitalised with a neoplastic incidence of the order of 1.28%, coupled with a pathological picture with various probabilities of degeneration. On the whole, it is felt that the most useful feature of the venture was its contribution towards the health education of the female population, and its bringing out of risk factors. A favourable judgement is passed on the campaign and its continuation is suggested.

Adult↗
PubMed1978

Patient education and multiphasic screening: it can change behavior.

Two hundred ninety-two residents of Sonoma County, California, underwent multiphasic screeening and two sessions of group patient education aimed at reducing risk factors for cardiovascular disease, cancer, and automobile accidents. Approximately one year later all the participants were retested. A significant reduction was noted in systolic blood pressure in men and women, ages 50 to 70, cholesterol in men over age 40, and reported alcohol consumption in men. A significant increase was noted in the reported frequency of monthly breast self-examination in women, and in the amount of exercise and percentage of time seat belts were used in both sexes. No change was noted in reported amount of cigarette smoking, weight, fasting blood glucose, and triglycerides. The combined use of health hazard appraisal, multiphasic screening, and patient education can lead to a reduction in cardiac and other risk factors in well-motivated groups.

Adult↗