Guidelines for cervical cancer screening from the american cancer society: the Earth is moving.
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Journal Article↗
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Results for “Cancer screening”
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Physician screening practices and colorectal cancer screening prevalence among the Rhode Island population.
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Adult↗
Screening for squamous cervical cancer--the duration of low risk following negative results in cervical cytology test: introduction. IARC Working Group on Cervical Cancer Screening.
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Canada↗
[Prostate cancer screening (II): is prostate cancer a public health problem? Update of incidence and mortality figures in France from 1982 to 1990].
OBJECTIVE: To describe the epidemiological situation of prostatic cancer in France on the basis on a large population sample. MATERIAL AND METHODS: This study uses incidence data derived from French cancer registers, and mortality data obtained from death certificates. Crude rates and rates standardized for the world population are calculated. The variation of these rates is analysed by a log-linear model (adjusted for age, department and period). RESULTS: The incidence of prostatic cancer in France in 1990 was 200 to 300/100,000 between the ages of 60 and 70 years and more than 600/100,000 after the age of 70 years. 73% of cases were diagnosed after the age of 70 years. The incidence increased annually by 8.76% between 1982 and 1990. An estimated 22,600 cases were diagnosed in France in 1990. The increased incidence of localized or local stages is due to the use of diagnostic tests (PSA and ultrasound-guided biopsies), as this increase accelerated after 1987. The crude mortality rate was 33.4/100,000 (384/100,000 between the ages of 75 and 85 years). It increased by 2.56% per annum from 1982 to 1990, but essentially for men over the age of 75 years. CONCLUSION: These findings tend to make prostatic cancer a public health priority, but this affirmation must be moderated by the fact that this disease has a low impact on loss of life expectancy.
Age Distribution↗
Coordination and management of a large multicenter screening trial: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial.
The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial is a large and complex multi-institutional, multifaceted organization with a 20-year horizon. The implementation of the trial began with the creation of an organizational structure that supports strong leadership, cooperation, and effective communication among the trial collaborators including an operational framework for the development, review, and pretest of instruments, data collection, and management procedures; the setting of high-quality standards for training of trial staff; and the development of a comprehensive assessment plan for evaluation of all trial activities. This paper describes the process and methods used in the coordination and management of the PLCO trial. These include the role of the steering committee and its subcommittees and working groups, the establishment of regular and ad hoc communications among collaborators, the training of screening center coordinators and examiners, the PLCO manual of operations and procedures, and the development and implementation of a comprehensive quality assurance plan.
Colorectal Neoplasms↗
Compliance of average- and intermediate-risk women to semiannual ovarian cancer screening.
OBJECTIVE: To report rates of compliance with an ovarian cancer screening protocol using serum CA125 and transvaginal sonography (TVS), performed semiannually on an alternating schedule, among participants at average or intermediate risk for developing ovarian cancer. METHODS: Two hundred ninety-two women at average or intermediate risk for developing ovarian cancer were randomly assigned to arms of a controlled clinical trial in which they received ovarian cancer screening consisting of serum CA125 alternating with TVS performed semiannually over 18 months, either alone or in combination with ovarian cancer risk education. A computerized tracking system generated screening appointment reminder letters and monitored adherence to scheduled screening. Participants overdue for scheduled screens received follow-up telephone calls consisting of up to four reminder messages left at 1-week intervals, and one to two interim attempts to reach participants between messages. The compliance rate for each screen was calculated as a ratio of the number of participants successfully completing the screen relative to the number expected to attend. Compliance rate by screen was: screen 1 (CA125) (97.3%), screen 2 (TVS) (82.5%), screen 3 (CA125) (79.0%), and screen 4 (TVS) (64.5%). One hundred seventy-two women completed all four screens and were classified as adherent to the screening protocol. Analysis by screening modality suggests that participants were more compliant to screens involving CA125. Age, educational background, distance from screening center, personal or family history of cancer, perceived risk of ovarian cancer, pre-enrollment ovarian cancer screening behavior, receiving an abnormal screen test result, and participation in ovarian cancer risk education sessions were not associated with adherence to the screening protocol or compliance to any of the screens. CONCLUSIONS: Despite extensive follow-up, compliance of average- and intermediate-risk women to an ovarian cancer screening protocol requiring semiannual screening diminishes rapidly. We propose that a semiannual ovarian cancer screening protocol, particularly one including TVS, may be too intensive for use in this population.
Adult↗
Assessment of cervical cancer screening and follow-up programs.
There is essentially no debate about the benefits of cervical cancer screening. The current debate centers around periodicity, the appropriate interval for repeated testing, and the age at which screening should be discontinued. As the frequency of screening is increased within a defined population, there is a gain in survival (life-years) depending upon the risk status of the population segment screened. However, each increment in survival comes at an increasingly high cost. Significant gains have been made in improving screening and detection services through widespread availability of the Papanicolaou test. However, there has been concern raised that the cost-effectiveness of cervical cancer screening has not been clearly demonstrated. This report analyzes the current status of the literature on screening for cervical cancer with a focus on cost-effectiveness and cost-benefit analyses of screening using the Pap test. A relatively small group of studies was located which directly addressed the cost-effectiveness question. All of the studies cited attempted in some manner to describe the relationship between benefits of cervical cancer screening and costs. Two studies reported a program design with net positive monetary benefits, while one estimated that the direct cost of medical care avoided through screening was approximately equal to the cost of the screening program. In general, however, screening for cervical cancer is viewed as an investment in extending life (a net cost per year of life gained). Most analysts ascribe a net monetary cost to cervical cancer screening programs. Then the question becomes one of cost-effectiveness--designing a program so as to optimize the result obtained. With respect to optimizing screening, the literature leaves no doubt of the value of cervical cancer screening in general. From a cost-effectiveness perspective, screening no more frequently than every 3-5 years appears reasonable. It is important to think in terms of a total program and how effectively the population at risk is being reached. The literature reviewed spans a period of more than twenty years and reflects studies across the globe. While the quality is uneven, from this body of work a consensus emerges: screening is effective, but the frequency of screening in the United States is probably too high. In addition, those who are most intensively screened are probably at the lowest risk. Outreach and targeting of at-risk population groups needs to be addressed in order to improve cost-effectiveness of cervical cancer screening. The effectiveness of the screening technology (the Pap test) is taken for granted, but this may be a mistake.(ABSTRACT TRUNCATED AT 400 WORDS)
Cost-Benefit Analysis↗
[Reattendance of women for breast cancer screening programs. A review].
BACKGROUND: In France, breast cancer is the most frequently occurring cancer and the leading cause of cancer deaths in women. Breast cancer screening has been shown to reduce breast cancer mortality by 30% provided attendance rate is 70% and re-screening interval is two to three years. Maintaining a high rate of reattendance is also important. The decline with time of completion rates of re-screening will lessen the benefits of a breast cancer screening program. METHODS: A review of published studies examining factors associated with attendance and reattendance to breast cancer screening. RESULTS: Positive views about initial screening are determining factors in reattendance: mammography should not be painful and embarrassing, appointments should be punctual and clinic staff courteous and supportive. Psychological factors influencing attendance also influence reattendance as does intention to participate, a major predictor of repeat participation and as do perceived susceptibility of breast cancer, perceived benefits of mammography, absence of emotional barriers. These factors can be modified by experience of previous screening. Other predicting factors of attendance continue to influence reattendance: practice of other preventive health behaviors, outside support from physicians, knowledge of breast cancer and screening. CONCLUSION: A better understanding of factors influencing attendance is necessary to increase the impact of breast cancer screening. Field studies are necessary to support the elaboration of publicity campaigns aimed at increasing participation.
Attitude to Health↗
Telephone care management to improve cancer screening among low-income women: a randomized, controlled trial.
BACKGROUND: Minority and low-income women receive fewer cancer screenings than other women. OBJECTIVE: To evaluate the effect of a telephone support intervention to increase rates of breast, cervical, and colorectal cancer screening among minority and low-income women. DESIGN: Randomized, controlled trial conducted between November 2001 and April 2004. SETTING: 11 community and migrant health centers in New York City. PATIENTS: 1413 women who were overdue for cancer screening. INTERVENTION: Over 18 months, women assigned to the intervention group received an average of 4 calls from prevention care managers and women assigned to the control group received usual care. Follow-up data were available for 99% of women, and 91% of the intervention group received at least 1 call. MEASUREMENTS: Medical record documentation of mammography, Papanicolaou testing, and colorectal cancer screening according to U.S. Preventive Services Task Force recommendations. RESULTS: The proportion of women who had mammography increased from 0.58 to 0.68 with the intervention and decreased from 0.60 to 0.58 with usual care; the proportion who had Papanicolaou testing increased from 0.71 to 0.78 with the intervention and was unchanged with usual care; and the proportion who had colorectal screening increased from 0.39 to 0.63 with the intervention and from 0.39 to 0.50 with usual care. The difference in the change in screening rates between groups was 0.12 for mammography (95% CI, 0.06 to 0.19), 0.07 for Papanicolaou testing (CI, 0.01 to 0.12), and 0.13 for colorectal screening (CI, 0.07 to 0.19). The proportion of women who were up to date for 3 tests increased from 0.21 to 0.43 with the intervention. LIMITATIONS: Participants were from 1 city and had access to a regular source of care. Medical records may not have captured all cancer screenings. CONCLUSIONS: Telephone support can improve cancer screening rates among women who visit community and migrant health centers. The intervention seems to be well suited to health plans, large medical groups, and other organizations that seek to increase cancer screening rates and to address disparities in care.
Aged↗
Approaches to breast cancer screening among nurse practitioners.
PURPOSE: To determine nurse practitioners' (NPs') knowledge and reported practices regarding breast cancer screening in a climate of conflicting guidelines. DATA SOURCE: A descriptive, cross-sectional survey design was used to examine approaches to cancer screening among NPs in western New York. CONCLUSIONS: Among the 175 NP respondents, agreement with the accepted answers for the individual breast cancer-screening items ranged from 51% to 80%; responses did not vary by age group or gender. Overall, 54% demonstrated agreement with three or more of four breast cancer-screening items. IMPLICATIONS FOR PRACTICE: These findings suggest the need to implement educational interventions as one means of decreasing variation in breast cancer screening among NPs. Also, the development and endorsement of a single set of evidence-based breast cancer-screening guidelines would promote adoption of a single screening recommendation.
Adult↗
Results of compliance with prostate cancer screening guidelines.
PURPOSE: Current guidelines of the American Cancer Society and the National Comprehensive Cancer Network recommend offering annual prostate cancer screening with prostate specific antigen (PSA) and digital rectal examination (DRE) beginning at age 50 (age 45 in high risk men). There are limited data concerning outcomes if all men followed screening guidelines. We report early outcome data on men who entered a prostate cancer screening study, complied with the screening guidelines and were subsequently diagnosed with prostate cancer. MATERIALS AND METHODS: We reviewed records of men 45 to 59 years old at study entry with a PSA less than 2.6 ng/ml and benign DRE who underwent annual DRE and PSA testing in a screening study between 1991 and 2001. Of 10,174 men with these characteristics, 232 (2.3%) were subsequently diagnosed with prostate cancer. We evaluated PSA, Gleason score, clinical and pathological tumor stage, and treatment outcomes in these men. RESULTS: Median PSA at diagnosis was 3.1 ng/ml (range 0.4 to 9.6). Gleason scores ranged from 4 to 9. All patients had clinically localized disease. Management included predominantly radical prostatectomy (87%) and radiation therapy (10%). Of cancers in which tumor volume was assessed 13% were considered possibly harmless tumors by previously published criteria and 2% were considered possibly rapidly progressive tumors by criteria we set in this study. CONCLUSIONS: Prostate cancer screening using some current guidelines results in the detection of cancers that are organ confined in 79% of patients, possibly harmless in less than 15% and possibly rapidly progressive in 2%.
Guideline Adherence↗
Cancer screening decisions.
This review focuses on why people decide to obtain or to avoid screening for cancer. We discuss three topics: (a) physician prompts that may elicit compliant screening behavior, (b) the independent and joint effects of risk perceptions and worry, and (c) the costs and benefits of getting screened. Overall, the data suggest that each of these factors will influence screening. So, for example, people are more likely to seek screening if a physician recommends the behavior, if they feel personally vulnerable and worry a little about cancer, if insurance covers the screening, and if they believe that the test is an effective early detection procedure. Future research needs include studies comparing theories, longitudinal rather than cross-sectional studies, and true experiments. We also need to know more about why physicians are such powerful change agents and the trade-offs of increasing personal risk versus exacerbating worry. Practical recommendations for promoting cancer screening include encouraging physician interventions, explaining risk, and lowering the costs while emphasizing the benefits of screening.
Decision Making↗
Disability and preventive cancer screening: results from the 2001 California Health Interview Survey.
OBJECTIVE: We sought to evaluate preventive cancer screening compliance among adults with disability in California. METHODS: We used data from the 2001 California Health Interview Survey to compare disabled and nondisabled adults for differences in preventive cancer screening behaviors. Compliance rates for cancer screening tests (mammography, Papanicolaou test, prostate-specific antigen, sigmoidoscopy/colonoscopy, and fecal occult blood test) between the 2 subpopulations were evaluated. RESULTS: Women with disabilities were 17% (Papanicolaou tests) and 13% (mammograms) more likely than women without disabilities to report noncompliance with cancer screening guidelines. Interactions between disability and reports of a doctor recommendation on cervical cancer screening were significant; women with disabilities had a lower likelihood of receiving a recommendation. Men with disabilities were 19% less likely than men without disabilities to report a prostate-specific antigen test within the last 3 years. CONCLUSIONS: secondary to structural and/or clinical factors underpinning the differences found.
California↗
[Cancer screening in Japan--a critique from the epidemiological viewpoint].
The present status of cancer screening in Japan has been critically reviewed from an epidemiological point of view. Cancer screening programs for stomach cancer and uterine cervical cancer were introduced in the 1960s on the basis of the naive belief of many clinicians that early diagnosis is beneficial: Many studies now show that this belief unfounded. Therefore, before the introduction of screening programs as a general policy, epidemiological evaluation is essential. The general principles involved in evaluation of cancer screening were discussed. In contrast to stomach cancer and uterine cervical cancer, cancers of the lung, breast and colorectum are increasing in Japan. In the case of lung cancer, primary prevention, i.e., smoking control, should be preferred, because lung cancer screening has not yet been shown to be effective. In the case of breast cancer and colorectal cancer, screening trials should be designed and appropriate evaluations should be conducted before their implementation as cancer control measures.
Female↗
Prostate cancer screening. What family physicians believe is best.
OBJECTIVE: To determine current family physician beliefs concerning prostate cancer screening. DESIGN: Two hundred eighty-six Oklahoma family physicians were surveyed by mail. Fifty-three percent of physicians returned the questionnaire. Physicians were questioned on what tests they order for prostate screening, the reasons for ordering a serum prostate-specific antigen (PSA) test, what test results would cause a urologic referral for further evaluation of prostate cancer, and whether prostate cancer screening would decrease the patient's mortality or improve quality of life. RESULTS: Most physicians (74%) believed that both a digital rectal examination and a serum PSA determination are appropriate for prostate cancer screening. Physicians' primary reasons for ordering a PSA test were to decrease patient mortality and morbidity. Sixty-two percent of physicians believed that prostate cancer screening would decrease mortality and 69% agreed that screening would improve quality of life. Approximately 90% of physicians would refer patients with a PSA level greater than 12 micrograms/L or a PSA level of 5 micrograms/L and an indurated prostate. Significant variation was found between groups of physicians in their beliefs about prostate cancer screening. CONCLUSION: Although the literature has been inconclusive on the benefit of prostate cancer screening, the majority of Oklahoma family physicians would choose to screen their patients and believe that patients' mortality and morbidity are decreased by early identification of prostate cancer.
Adult↗
Are tri-ethnic low-income women with breast cancer effective teachers of the importance of breast cancer screening to their first-degree relatives? Results from a randomized clinical trial.
The purpose of this study was to determine the efficacy of women with breast cancer as teachers of the importance of breast cancer screening to their first-degree female relatives. The sample was restricted to low-income working age women recruited from four hospitals. The study design was a randomized clinical trial. At each hospital, breast cancer patients (probands) were randomized into one of two study groups: (i) intensive, individual educational training on breast cancer screening or (ii) standard clinic education on breast cancer screening. The probands were instructed to teach at least one of their first-degree female relatives (21+ years of age) about breast cancer screening techniques. Three to six months after the enrollment of the probands, their relatives were contacted by telephone to determine breast cancer screening practices. A total of 79 probands and 96 relatives participated in the study. Relatives in the education group when compared with the control group were: 1.25 times more likely to have clinical breast examination (p = 0.005), 2.83 times more likely to have scheduled a clinical breast examination (p = 0.046), and, 1.36 times more likely to have been told about performing breast self-examination (p = 0.05). Additionally, relatives in the education group were more likely to have received a pamphlet on breast cancer screening (RR = 1.58, p = 0.009) and have discussed the importance of breast cancer screening (RR = 1.33, p = 0.020) from the proband. Special education training did not impact mammography utilization of the relatives. From these findings, a tri-ethnic group of low-income women with breast cancer can be effective teachers of breast cancer screening practices, at least for promoting clinical breast examination and transmitting messaging for performance of breast self-examination if given the adequate training.
Adult↗
Strategies to improve cancer screening in general practice: are guidelines the answer?
BACKGROUND: GPs are ideally placed to recommend appropriate cancer screening for their patients. However, opportunities to discuss screening are often missed and screening procedures are not always recommended in accordance with national policy. The development of clinical practice guidelines represents one strategy for improving cancer screening in general practice. OBJECTIVE: We aimed to ascertain Australian GPs' ratings of current clinical practice guidelines and their views of the likely usefulness of 18 strategies to improve cancer screening in general practice. METHOD: A self-administered questionnaire was mailed to a national random sample of 1271 GPs in May 1996. Responders rated the usefulness of each of eight clinical practice guidelines current at the time of the survey. They then rated the usefulness of each of 18 strategies for support of cancer screening. RESULTS: We received 855 completed questionnaires (a 67% response rate). There was greatest support for guidelines already available on breast and cervical cancer. The most popular strategy to improve cancer screening was seminars with experts in preventive care, rated as 'very useful' by 658 (77%), followed by NHMRC guidelines (597, 70%) and pamphlets for patients (587, 69%). There was less support for more innovative strategies including assessment and feedback (35%), case finding by nurse practitioners (11%) and academic detailing (10%). CONCLUSION: Responders indicated that strategies involving passive dissemination of information would be most useful for improving cancer screening in general practice. Identification of an effective combination of acceptable initiatives is needed.
Attitude of Health Personnel↗
Cues to action in prostate cancer screening.
PURPOSES/OBJECTIVES: To describe factors that cue men of all ages to participate in prostate cancer screening programs and to explore the relationship of age to the rating of the cues. DESIGN: Exploratory survey. SETTING: A large community prostate cancer screening program in the Midwest. SAMPLE: 127 men (mean = 66.3 years of age) who participated in community prostate screening. METHODS: Subjects completed and returned by mail the 13-item Prostate Screening Follow-Up Questionnaire developed, piloted, and refined by the investigator for measuring the rating of the cues to action. MAIN OUTCOME MEASURES: Results of the rating of each cue to action, selected demographic variables, and comparison of the cue ratings by age group. FINDINGS: Appointment scheduling, reminder cards, a friend/family member with cancer, and newspaper promotion were perceived by the sample as most influential in their decision to have prostate cancer screening. No practical significant differences in cue ratings were found between the two age groups: 70 years of age and older and less than 70 years of age. CONCLUSION: Reminder cards, specific appointments, and newspaper promotion should be used when structuring community prostate cancer screening programs. Men who have a friend or family member with cancer may be more likely to participate in screening activities. IMPLICATIONS FOR NURSING PRACTICE: By incorporating influential cues to action into their everyday practice, nurses can be instrumental in reaching the population of men who are at risk for prostate cancer. Strategies for promoting prostate cancer screening should include: educating patients and family members about prostate cancer screening guidelines, using specific influential promotional practices when setting up prostate screening programs, and networking with seniors programs in the community.
Adult↗