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PubMed1994

[Family influence on cancer screening participation in seven communities in Taiwan].

Cancer is the leading cause of death in Taiwan. Since there is no definitive method for cancer prevention, early detection play a major role in fighting cancer. Factors that affect people's willingness to participate cancer screening have been discussed widely except for those relating to the family. The family's role in motivation & influencing its members to participate in an invited cancer-screening program was studied in seven Taiwanese communities. 5% of participants in each area for both genders were chosen by stratified random sampling, and matched with teice-informed nonparticipants who were chosen by sex, age, and neighborhood. By means of a home visit and structured questionnaire, 729 of the 987 eligible cases were interviewed (73.9%). The main findings were that the response was higher among people with higher education, nonsmokers, and those who felt the scheduled time and place of attendance was suitable and convenient. Moreover, in the 6 variables related to family (family structure, family life cycle, cancer history in family and friends, family APGAR, family support about health problems, and family's opinion about cancer screening), the last 4 variables were found to be significantly related by chi-square analysis to the attendance. Finally, a logistic regression analysis adjusted by age, sex, education, smoking habits, time available and traffic factors was used to analyze how family factors affect attendance. The result was cancer history in family and friends (odd ratio = 2.42) and family's encouragement (odd ratio = 1.85) had a positive association.

Adult↗

PubMedDate not supplied

The experience and satisfaction of women attending breast cancer screening.

PURPOSE/OBJECTIVES: To determine women's satisfaction and experience with breast cancer screening and associated factors. DESIGN: Exploratory, descriptive design. SETTING: One center of the Ontario Breast Screening Program, a province-wide breast cancer screening program. SAMPLE: Nonprobability sample of 315 asymptomatic women, age 50 years or older, with no previous history of breast malignancy. METHODS: Data were collected from the entire sample of 315 women immediately postscreening using a self-report questionnaire and from a subgroup of 256 women by telephone interview at three weeks post-screening. MAIN RESEARCH VARIABLES: Satisfaction with and intentions and anxiety regarding breast cancer screening. FINDINGS: Overall, women reported a high level of satisfaction with their screening experience, including respect for privacy, encouragement to ask questions, and provision of information. Two areas of concern that participants identified were mammogram discomfort and fear about radiation risks. At the postscreening interview, women reported that breast screening had relatively little impact on social or physical aspects of their lives, but it did have a positive effect on certain emotional issues, such as their feelings of reassurance, well-being, and relaxation. CONCLUSION: Since the degree of satisfaction that participants in health services report has been shown to influence attendance patterns, assessing breast screening programs from the perspective of attendees is necessary. Such assessment can identify areas of satisfaction and concern and, thus, provide information for developing interventions aimed at promoting recruitment and retention. IMPLICATIONS FOR NURSING PRACTICE: As health educators, nurses play an important role in providing breast cancer screening information to women. As well as being knowledgeable about screening guidelines and the benefits of screening, nurses also must recognize women's concerns about radiation risks and pain or discomfort with the procedure and be prepared to provide teaching and support for these women.

Aged↗

PubMed2003

Evaluation of The Netherlands breast cancer screening programme.

The Netherlands breast cancer screening programme for women aged 50-75 years was gradually implemented during 1989-1997. Short-term indicators for this mammography screening are 80% attendance (800 000 examinations yearly), and for the subsequent screening examinations 7.4 referrals for clinical assessment per 1000 women screened, 4.7 biopsies and 3.6 breast cancers detected. Breast cancer mortality in The Netherlands has been decreasing since 1997 after having been stable for decades. The challenge now is to disentangle the relative contributions of mammographic screening, earlier clinical diagnosis, less aggressive tumours, treatment advances and risk factors towards this decline.

Age Distribution↗

PubMed2000

Life expectancy benefits of cancer screening in the end-stage renal disease population.

Health maintenance includes secondary prevention through cancer screening. There are no established guidelines for cancer screening patients with end-stage renal disease (ESRD). Using an established method of estimating life expectancy, published literature on cancer screening, and information from databases on mortality and malignancy (US Renal Data System 1997 Annual Data Report and the SEER Cancer and Statistical Review, 1973-1994), a "real-time life expectancy calculator" was developed to guide the primary help provider in making informed decisions on the benefits of cancer screening in individual patients. Potential days of life saved by each screening method can be calculated using the difference in life expectancy per the DEALE (declining exponential approximation of life expectancy) method with and without cancer screening. Using two sets of assumptions (one to enhance any bias toward support for screening and one to limit this bias), a range of potential days of life saved with screening for breast and colon cancer can be calculated in individual patients with ESRD. In breast cancer, for example, a 50-year-old black woman with ESRD and multiple risk factors would have 41 to 291 potential days of life saved with screening. A 60-year-old white woman with ESRD and diabetes mellitus (DM) would have only 1 to 16 days of life saved. This life expectancy calculator can guide the primary health care provider in making clinical decisions concerning screening in the ESRD population. In addition to assisting in patient education, the calculator can be updated as new information becomes available regarding relative risk, treatment, and mortality.

Breast Neoplasms↗

PubMed1999

Colorectal cancer screening: A guide to the guidelines.

The two most recent guidelines for colorectal cancer screening are those of the Agency for Healthcare Policy and Research, and the American Cancer Society. The guidelines are similar in many regards and reflect current literature, consensus opinion and compromise between members of multidisciplinary panels. The emphasis of both guidelines is to increase the options available for colorectal cancer screening. Increasing choice should expand the attractiveness of colorectal cancer screening to more patients and physicians, and the development of guidelines should help compel payers to provide reimbursement for colorectal cancer screening. These guidelines are summarized and evaluated as they pertain to colorectal cancer screening.

Canada↗

PubMed2007

A decade of breast cancer screening in The Netherlands: trends in the preoperative diagnosis of breast cancer.

PURPOSE: In a prospective, multi-institutional follow-up study we describe the trends in the preoperative pathologic confirmation of breast cancer of women who underwent breast cancer screening between 1995 and 2005. METHODS: We included all women aged 50-75 years who underwent biennial screening mammography in the southern breast cancer screening region of the Netherlands between February 13, 1995 and December 22, 2004. Clinical data, breast imaging reports, biopsy results and breast surgery reports were collected of all women with a positive screening result. Follow-up lasted through the next biennial screening examination and was approximately two years for all referred women. RESULTS: Of 258,900 mammographic screening examinations, 3,064 (1.2%) were positive screens. The majority of women (92%) were analyzed in four regional hospitals and workup yielded breast cancer in 1,332 women. From 1995 to 2005, the percentage of breast cancer cases that underwent percutaneous biopsy prior to surgery, increased from 42.4 to 100%. The proportion of cancers with a preoperative diagnosis of malignancy by percutaneous biopsy, increased from 27.1% in 1995 to 92.7% in 2004. Preoperative breast cancer confirmation by fine needle aspiration cytology (FNAC) gradually decreased from 91.3% to 14.5%, whereas preoperative confirmation by ultrasound guided core biopsy (USCB) or stereotactic core needle biopsy (SCNB) increased from 8.7% to 69.1% and from 0 to 17.4% respectively. CONCLUSIONS: A preoperative diagnosis of breast cancer is currently obtained in more than 90% of breast cancer patients. The increase in preoperative breast cancer diagnosis through 1995-2004 is correlated with the introduction of SNCB and increased use of USCB at the expense of FNAC.

Aged↗

PubMed2005

Impact of UK colorectal cancer screening pilot on primary care.

BACKGROUND: The UK Colorectal Cancer Screening Pilot has recently been completed to evaluate the feasibility of screening using the faecal occult blood test. Screening will be phased in over the next several years, and it is important to consider the impact on the NHS workforce. AIM: To determine the impact of the UK Colorectal Cancer Screening Pilot on primary care workload. DESIGN OF STUDY: A retrospective survey and prospective audit of general practice staff. SETTING: General practice. METHOD: Workload impact was assessed using a postal questionnaire and a prospective audit of activity in participating practices. Questionnaires were sent to practices that had been involved in the Pilot between 6 weeks and 1 year previously. They were sent to a random sample of 59 practices in Scotland and 60 practices in England between February 2001 and March 2002. Audit forms were sent prospectively to 60 practices involved in the Pilot between May 2001 and September 2002. RESULTS: Sixty-seven per cent of GPs, 82% of practice managers, 69% of practice nurses, and 70% of receptionists responded to the questionnaire. Of 60 practices contacted to take part in the workload audit, 38 returned completed 'workload impact audit' forms. Most practice staff indicated they spent 2% or less of their time during the screening period on Pilot-related activities. Forty per cent of GPs thought that a national colorectal cancer screening programme would substantially impact on the workload in primary care. However, there were variations by country: practice staff in Scotland were more likely to think that it would substantially impact on workload than practice staff in England (44.7% versus 26.6%). CONCLUSIONS: The surveys and audit demonstrate that the Pilot has had a discernible, albeit modest, impact on workload in primary care. Workload of particular significance to primary care personnel includes increases in paperwork, administration, and information provision to patients. The majority of primary care staff support the introduction of a colorectal cancer screening programme. However, there is a strong perception, particularly among GPs, that a national programme of faecal occult blood test screening will impact significantly on workload in primary care, and that primary care-based activities generated through screening should be adequately resourced and remunerated.

Aged↗

PubMed2006

Older adults' attitudes about continuing cancer screening later in life: a pilot study interviewing residents of two continuing care communities.

BACKGROUND: Individualized decision making has been recommended for cancer screening decisions in older adults. Because older adults' preferences are central to individualized decisions, we assessed older adults' perspectives about continuing cancer screening later in life. METHODS: Face to face interviews with 116 residents age 70 or over from two long-term care retirement communities. Interview content included questions about whether participants had discussed cancer screening with their physicians since turning age 70, their attitudes about information important for individualized decisions, and their attitudes about continuing cancer screening later in life. RESULTS: Forty-nine percent of participants reported that they had an opportunity to discuss cancer screening with their physician since turning age 70; 89% would have preferred to have had these discussions. Sixty-two percent believed their own life expectancy was not important for decision making, and 48% preferred not to discuss life expectancy. Attitudes about continuing cancer screening were favorable. Most participants reported that they would continue screening throughout their lives and 43% would consider getting screened even if their doctors recommended against it. Only 13% thought that they would not live long enough to benefit from cancer screening tests. Factors important to consider stopping include: age, deteriorating or poor health, concerns about the effectiveness of the tests, and doctors recommendations. CONCLUSION: This select group of older adults held positive attitudes about continuing cancer screening later in life, and many may have had unrealistic expectations. Individualized decision making could help clarify how life expectancy affects the potential survival benefits of cancer screening. Future research is needed to determine whether educating older adults about the importance of longevity in screening decisions would be acceptable, affect older adults' attitudes about screening, or change their screening behavior.

Age Factors↗

PubMed2005

A review of breast, cervical, and colorectal cancer screening interventions in older women.

Although cancer-screening guidelines recommend periodic testing for women 50 years of age and older, these tests are underused. A search of databases identified 156 community-based breast, cervical, and colorectal cancer screening intervention studies published before April 2003. Most were conducted in the United States. More than half used randomization procedures or pre-post measures, and one third used both. Most reported significant intervention effects. Cervical and combined cervical and breast studies had higher rates of pre-post designs, and breast studies had the highest percentage using randomization. Although effective community-based breast and cervical interventions have been conducted, there is an urgent need for amplification of colorectal cancer screening.

Aged↗

PubMed1994

Preferences of community physicians for cancer screening guidelines.

OBJECTIVE: To assess factors related to consensus among community physicians regarding appropriate screening intervals for eight cancer screening procedures for which guidelines have been published. DESIGN: Interviews were conducted with a national random sample of 3436 physicians in family practice, internal medicine, general surgery, and gynecology by mail or telephone or both. The overall response rate was 67%. MEASUREMENTS: Consensus by specialization and by physician and practice characteristics on the appropriate screening intervals for early detection of cancers of the breast, cervix, colon and rectum, and lung for asymptomatic adults at normal risk. RESULTS: More than 60% of the physicians surveyed agreed on the length of the screening intervals for six of eight procedures. Consensus most closely followed American Cancer Society- and National Cancer Institute-recommended screening intervals for all procedures except chest roentgenogram. Acceptance of screening intervals was not related to the extent of agreement among published guidelines. Surgeons tended to favor more aggressive screening than family physicians and internists; gynecologists most consistently favored aggressive screening for cancers occurring in women. Older physicians and those in solo practice tended to favor outmoded procedures such as routine chest roentgenograms and to be more conservative about screening intervals. CONCLUSIONS: Physicians stated that they follow the American Cancer Society and National Cancer Institute guidelines for cancer screening more than the guidelines published by their own specialty societies, but they also reported procedures not recommended in any guidelines. These findings suggest that changing physician screening practices will be difficult.

American Cancer Society↗

PubMed2000

Videotape-based decision aid for colon cancer screening. A randomized, controlled trial.

BACKGROUND: Rates of colon cancer screening in the United States are low, in part because of poor communication between patients and providers about the availability of effective screening options. OBJECTIVE: To test whether a decision aid consisting of an educational video, targeted brochure, and chart marker increased performance of colon cancer screening in primary care practices. DESIGN: Randomized, controlled trial. SETTING: Three community primary care practices in central North Carolina. PATIENTS: 1657 consecutive adult patients 50 to 75 years of age were contacted. Of these, 651 (39%) agreed to participate; 249 of the 651 participants (38%) were eligible. Eligible patients had no personal or family history of colon cancer and had not had fecal occult blood testing in the past year or flexible sigmoidoscopy, colonoscopy, or barium enema in the past 5 years. INTERVENTION: The 249 participants were randomly assigned to view an 11-minute video about colon cancer screening (intervention group) or a video about automobile safety (control group). After viewing the video, intervention group participants chose a color-coded educational brochure (based on stages of change) to indicate their degree of interest in screening. A chart marker of the same color was attached to their charts. Controls received a generic brochure on automobile safety, and no chart marker was attached. MEASUREMENTS: Frequency of screening test ordering as reported by participants and frequency of completion of screening tests as verified by chart review. RESULTS: Fecal occult blood testing or flexible sigmoidoscopy was ordered for 47.2% of intervention participants and 26.4% of controls (difference, 20.8 percentage points [95% CI, 8.6 to 32.9 percentage points]). Screening tests were completed by 36.8% of the intervention group and 22.6% of the control group (difference, 14.2 percentage points [CI, 3.0 to 25.4 percentage points]). CONCLUSION: A decision aid consisting of an educational video, brochure, and chart marker increased ordering and performance of colon cancer screening tests.

Aged↗

PubMed2005

Results of breast cancer screening in first generation migrants in Northwest Netherlands.

To determine breast cancer screening results according to country of birth data were used from the breast cancer screening organization of the Comprehensive Cancer Centre Amsterdam, The Netherlands. Overall (age-adjusted) attendance of the breast cancer screening was 76% for women aged 50-69. Attendance was significantly lower for women born in non-western countries (Surinam 59%, Turkey 44% and Morocco 37%) and for women with residence in Amsterdam (68%). Referral and detection rates for women from non-western countries were 5.1 and 2.2 per 1000 screened women, respectively, compared with 8.8 and 4.0 for women born in The Netherlands (P<0.05). The positive predictive value was 45% for women born in The Netherlands and western countries and 43% for women born in non-western countries. Although women born in non-western countries attend breast cancer screening less frequently than women born in The Netherlands, they also have a low detection rate. The latter finding justifies a passive attitude towards the low attendance.

Aged↗

PubMed2000

Cost-effectiveness of lung cancer screening in Japan.

BACKGROUND: Because the mortality rate from lung cancer is increasing sharply in Japan, lung cancer screening is being performed actively to assure early diagnosis and early treatment. However, its effectiveness is not clear, because it is extremely difficult to diagnose early microcarcinoma of the lungs (< 1 cm in greatest dimension) with the indirect X-rays that are used in mass screening. Therefore, the authors compared differences in the study population by gender and by age and economic class with the present method for mass screening of lung cancer as well as with computed tomography (CT) screening from the standpoint of cost-effectiveness. METHODS: The cost-effectiveness of lung cancer screening was analyzed using the deterministic mathematical model developed by T. Iinuma. The total cost for one life saved (Y/N) and the total cost for the mean life expectancy of a patient saved (Y/NT) were compared for each three cases: mass screening of the type used in 1983, mass screening of the present type, and mass screening using CT in 1993. RESULTS: For the present mass screening method, the results show that costs are reduced when patients are males age - 55 years and females age > or = 65 years. There was almost no difference between 1983 and 1993, and the percentage increased slightly with the introduction of CT. The cost-effectiveness was observed using two values, Y/N and Y/NT. The cost of screening in 1993 for females age < or = 50 years was lower than that in 1983, but there was no major difference in males from the other age groups. The Y/NT value became even lower when CT was introduced. CONCLUSIONS: The results show that the present method used in lung cancer screening is cheaper, but its effectiveness is also low; and, although the cost of screening by CT is higher than that of the present screening method, it is much more effective. Lung cancer screening by CT should become the most appropriate screening method with respect to cost-effectiveness.

Adult↗

PubMed2003

Breast and cervical cancer screening: sociodemographic predictors among White, Black, and Hispanic women.

OBJECTIVES: We evaluated the relationship between breast and cervical cancer screening and a variety of variables across race/ethnicity groups. METHODS: Using logistic regression models, we analyzed data from the 1998 National Health Interview Survey to assess the relative importance of the independent variables in predicting use of cancer screening services. RESULTS: Having a usual source of care was the most important predictor of cancer screening use for all race/ethnicity groups. Health insurance was associated with an increased likelihood of cancer screening. Smoking was associated with a decreased likelihood of cancer screening. CONCLUSIONS: Regardless of race/ethnicity, most women follow mammography and cervical cancer screening guidelines. The identification of specific factors associated with adherence to cancer screening guidelines may help inform screening campaigns.

Adult↗

PubMed2006

[Cervical cancer screening: current status and perspectives].

Cervical cancer screening with Pap cytology has effectively reduced the incidence of morbidity and mortality from invasive cervical cancer. However, Pap cytology has important limitation and is not completely protective. Invasive cervical cancers are still diagnosed and main reasons are an insufficient coverage rate and presence of false-negative results. HPV testing has greater sensitivity than Pap cytology for detecting high-grade lesions and cancer and is clearly one of the most promising new screening tools. It has the potential to improve cervical cancer screening effectiveness. The aim of our study was to discuss the current situation of cervical cancer screening in Switzerland, limitations of Pap cytology as well as the benefice expected with HPV testing and vaccienes.

Europe↗

PubMed1994

Prediction of the effects and costs of breast-cancer screening in Germany.

Although breast-cancer screening programmes are now being introduced it is still debated whether this is an appropriate policy for all European countries. Taking into account empirical data from 2 regional pilot screening projects, this study has evaluated the effects and costs of a nationwide breast-cancer screening programme in Germany. Special attention was paid to the decentralized German health-care system and to the influence of attendance, interval and age group. The recent results of the analysis of the Swedish randomized screening trials were used to estimate the improvement in prognosis after early detection of breast cancer. Our analysis shows that a programme providing for the screening of women aged 50-69 at 2-year intervals might be expected to result in a decrease in mortality from breast cancer estimated at 11% for the total German population, representing 2,100 deaths from breast cancer prevented each year. The cost per life-year gained was assessed at between DM 18,800 and DM 25,300 for this scenario; 2 to 3 times less favourable than in the UK and The Netherlands. The sensitivity of mammography was estimated to be 12% lower than in The Netherlands and the attendance rate was calculated at 47% on average. A greater effort to ensure the quality of the screening programme and to improve the invitation system might finally lead to much better results. The mortality reduction might be as much as 18% if the attendance and the sensitivity of the screening could be improved to the Dutch level.

Aged↗

PubMed1997

Cancer screening in general practice.

Screening for cancer is the focus of increasing interest and activity in general practice. Where clear evidence and guidelines are available, the GP has a key role in the promotion of screening. Where the evidence is inconclusive, GPs are faced with the more difficult task of negotiating screening decisions with their patients which reflect this uncertainty and incorporate patients' preferences. GPs play a central role in cancer screening in Australia, whether or not they actually provide the tests. Critical activities include the provision of information and coordination of the screening process. On-going education and skill development in this area is, therefore, a high priority for Australian GPs.

Australia↗

PubMed2005

[Factors associated with cancer screening participation, Korea].

OBJECTIVES: We wanted to identify those factors associated with stomach, colon, breast and cervix cancer screening. METHODS: A population-based telephone survey was conducted for 2 weeks (the 9th-23th of July, 2004) by trained interviewers with using a questionnaire. 2,598 respondents (females aged 30 years or over, and the males aged 40 years or over) were selected by random-digit dialing that was based on the 2000 Population and Housing Census. The data on socio-demographic, health behavior and enabling factors were collected. 2,571 respondents were included in analysis. The cancer screening rate was classified into 2 categories: the life time screening rate and the screening rate with recommendations. RESULTS: For the 2,571 respondents, the life time screening rate was as follows: 52.0% (Stomach), 25.3% (Colon), 55.9% (Breast) and 76.8% (Cervix). The screening rate with recommendation was as follows: 39.2% (Stomach), 20.6% (Colon), 42.5% (Breast) and 58.3% (Cervix). On a multiple logistic regression analysis of the life time screening, statistically significant relationships were observed for the screening intention, the health exam, the disease history, the age of the patients and the cancer screening rates. On a multiple logistic regression analysis of the screening with recommendation, statistically significant relationships were observed for the screening intention, the health exam, the age of the patients, the concern about the risk of cancer, the voluntary health insurance for cancer and the cancer screening rates. CONCLUSIONS: The results of this study suggest that the cancer screening intention, the health exam and the age of the patients are the most important factors to participate in life time cancer screening and also screening with recommendations. A positive association was also observed for the concern about the risk of cancer, the voluntary health insurance for cancer. It is hoped that this study will be a base line data for suggesting the representative cancer screening rate in Korea.

Adult↗