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At least 451 records · Page 25Linked to original sources

PubMed2000

Breast cancer screening use by African Americans and Whites in an HMO.

OBJECTIVE: To examine racial differences in breast cancer screening in an HMO that provides screening at no cost. DESIGN: Retrospective cohort study of breast cancer screening among African-American and white women. Breast cancer screening information was extracted from computerized medical records. SETTING: A large HMO in New England. PATIENTS/PARTICIPANTS: White and African-American women (N = 2,072) enrolled for at least 10 years in the HMO. MAIN RESULTS: Primary care clinicians documented recommending a screening mammogram significantly more often for African Americans than whites (70% vs 64%; P <.001). During the 10-year period, on average, white women obtained more mammograms (4.49 vs 3.93; P <.0001) and clinical breast examinations (5.35 vs 4.92; P <.01) than African-American women. However, a woman's race was no longer a statistically significant predictor of breast cancer screening after adjustment for differences in age, estimated household income, estrogen use, and body mass index (adjusted number of mammograms, 4.47 vs 4.25, P =.17; and adjusted number of clinical breast examinations, 5.35 vs 5. 31, P =.87). CONCLUSIONS: In this HMO, African-American and white women obtained breast cancer screening at similar rates. Comparisons with national data showed much higher screening rates in this HMO for both white and African-American women.

Adult↗

PubMed2006

CDC-funded intervention research aimed at promoting colorectal cancer screening in communities.

BACKGROUND: Although strong scientific evidence has shown that screening for colorectal cancer saves lives, most U.S. adults who are at the recommended age are not being screened. Prior studies suggest that barriers to routine screening vary by race, ethnicity, socioeconomic status, urban/rural residence, health insurance status, and factors related to health care providers and the health care environment. Relatively few studies, however, have identified and tested intervention approaches to promote routine colorectal cancer screening among diverse populations. METHODS: The Division of Cancer Prevention and Control at CDC has funded ongoing projects to develop and test interventions to promote routine colorectal cancer screening among medically underserved populations in Appalachia, the Lower Rio Grande Valley in Texas, the High Plains region of Colorado, and other U.S. communities. RESULTS: This article provides an overview of colorectal cancer screening intervention studies currently funded by CDC that focus on a wide range of populations, including medically underserved persons who live in predominately rural areas, Hispanic and non-Hispanic persons, urban African Americans, persons with low health literacy, and persons enrolled in managed care organizations. CONCLUSIONS: These CDC-funded intervention research projects are likely to contribute importantly to evidence about what works to promote colorectal cancer screening in diverse U.S. communities. .

Black or African American↗

PubMed2000

Cervical cancer screening in Italy.

Until recently cervical cancer screening in Italy has been mainly spontaneous, with only a few organised programmes. This resulted in low coverage and high frequency of tests in screened women (mostly every year). The situation is, however, rapidly changing. In 1996 nationwide organised programmes, on a regional basis, were recommended. National guidelines recommend personal invitation of women aged 25-64 years for a Pap-test every third year. At the end of 1999 34% of the Italian population 25-64 years old was included in organised programmes. Most organised programmes have fail-safe systems for women referred for colposcopy, protocols for diagnostic work-up and treatment and reference centres for such phases, according to the recommendations of national and European guidelines. However the size of laboratories is frequently smaller than recommended. Most organised programmes implement quality assurance processes for cytology interpretation, that have been intensive in some centre, but there is no nationwide standardisation. In recent years data for monitoring screening activity have been collected in a standardised way by most organised programmes, in the framework of GISCi (Italian Group for Cervical Cancer Screening) allowing internal and external comparisons. In some cases strong improvements of coverage after the introduction of an organised activity have been documented. Data, however, suggest a relevant heterogeneity of criteria for cytology interpretation, requiring actions to increase consistency. The impact of these transformations on incidence of cervical cancer will be observed in the future: preliminary results suggest a reduction in older programmes.

Adult↗

PubMed2004

Some methodologic lessons learned from cancer screening research.

Credible and useful methodologic evaluations are essential for increasing the uptake of effective cancer screening tests. In the current article, the authors discuss selected issues that are related to conducting behavior change interventions in cancer screening research and that may assist researchers in better designing future evaluations to increase the credibility and usefulness of such interventions. Selection and measurement of the primary outcome variable (i.e., cancer screening behavior) are discussed in detail. The report also addresses other aspects of study design and execution, including alternatives to the randomized controlled trial, indicators of study quality, and external validity. The authors conclude that the uptake of screening should be the main outcome when evaluating cancer screening strategies; that researchers should agree on definitions and measures of cancer screening behaviors and assess the reliability and validity of these definitions and measures in different populations and settings; and that the development of methods for increasing the external validity of randomized designs and reducing bias in nonrandomized studies is needed.

Biomedical Research↗

PubMed2006

[Practice patterns of general practitioners in the Loire-Atlantique region and their patients' knowledge of prostate cancer screening].

OBJECTIVE: The objective of this study was to analyse the practices of general practitioners in the Loire-Atlantique region and their patients' knowledge about prostate cancer screening. MATERIAL AND METHODS: A "doctor" questionnaire focussing on prostate cancer screening practices was sent by mail to 1,086 general practitioners of the Loire-Atlantique region. "Patient" questionnaires were enclosed to be completed by 5 consecutive male patients over the age of 50. RESULTS: The doctor participation rate was 4.7%. Prostate cancer screening was performed by 98% of doctors. However 63% of doctors performed digital rectal examination and PSA annually, but only 27% in the specific age-group from 50 to 75 years. The "patient" questionnaire was completed in 233 cases. 88% of patients were informed about prostate cancer screening, essentially by their doctor or the media. 33% of patients indicated digital rectal examination and 23% indicated PSA as prostate cancer screening methods. Only 33% of patients declared to know one of the treatments for prostate cancer, reporting surgery in 78% of cases and radiotherapy in 32% of cases. CONCLUSION: General practitioners answering the questionnaire performed prostate cancer screening, but according to AFU guidelines only in 1/3 of cases. The majority of patients considered that they had been informed about prostate cancer screening, but with many imperfections.

Aged↗

PubMedDate not supplied

Cancer screening for the primary care physician.

Cancer screening guidelines are developed by numerous agencies. These guidelines are often conflicting leaving the primary care physician in a difficult position. He (she) is requested to choose the best test for his or her patients taking into consideration the principles of screening, the test cost and most importantly the patient's emotional and physical well-being. Screening for some cancers, like lung cancer, has been considered of no benefit. Other cancers, like breast, colon, cervix and prostate, have been the subject of numerous recommendations: For breast cancer, clinical examination and mammography are recommended every 1-2 years for women between 50 to 70 years. For cervical cancer, PAP smear is suggested every 1-3 years and for colorectal cancer, a yearly fecal occult blood, sigmoidoscopy or colonoscopy every 5-10 years. Annual serum prostate specific antigen (PSA) and digital rectal examination screening for prostate cancer are still controversial.

Adolescent↗

PubMed2005

Are the breast cancer screening recommendations clear or confusing?

The American public is convinced that cancer screening tests are valuable. Breast cancer screening recommendations have recently received a great deal of attention. Careful review of the available data reveals that combined annual mammography and clinical breast examination is the appropriate breast cancer screening program for most women over the age of 40. However, a small group of women with a genetic susceptibility for breast cancer may benefit from additional imaging. In this article, the criteria for a good screening program are identified.

Adult↗

PubMed2006

Breast cancer screening, outside the population-screening program, of women from breast cancer families without proven BRCA1/BRCA2 mutations: a simulation study.

PURPOSE: We assessed the cost-effectiveness of mammography screening for women under the age of 50, from breast cancer families without proven BRCA1/BRCA2 mutations, because current criteria for screening healthy women from breast cancer families are not evidence-based. METHODS: We did simulation studies with mathematical models on the cost-effectiveness of mammography screening of women under the age of 50 with breast cancer family histories. Breast cancer screening was simulated with varying screening intervals (6, 12, 18, and 24 months) and screening cohorts (starting at ages 30, 35, 40, and 45, and continuing to age 50). Incremental costs of screening were compared with those of women ages 50 to 52 years, the youngest age group currently routinely screened in the nationwide screening program of the Netherlands, to determine cost-effectiveness. Sensitivity analyses were done to explore the effects of model assumptions. The cost-effectiveness of breast cancer screening for women over the age of 50 was not debated. RESULTS: The most effective screening interval was found to be 12 months, which, however, seems only to be cost-effective in a small group of women under the age of 50 with at least two affected relatives, including at least one affected in the first degree diagnosed under the age of 50. Significantly, early breast cancer screening never seemed to be cost-effective in women with only one affected first-degree or second-degree relative. CONCLUSION: Annual breast cancer screening with mammography for women under the age of 50 seems to be cost-effective in women with strong family histories of breast cancer, even when no BRCA1/BRCA2 mutation was found in affected family members.

Adult↗

PubMed2000

Demographic predictors of cancer screening among Filipino and Korean immigrants in the United States.

BACKGROUND: Little is known about cancer-screening practices of various Asian subgroups, and even less is known about factors that may predict screening in these populations. DESIGN: Two independent surveys were conducted with 218 Filipino and 229 Korean female immigrants, aged 50 years and older, residing in Los Angeles. RESULTS: In these convenience samples, 48% of Filipino and 41% of Korean women reported receipt of a Pap smear within the past 2 years; 41% of Filipino and 25% of Korean women reported receipt of a mammogram and a clinical breast exam within the past 2 years; and 25% of Filipino and 38% of Korean women reported colorectal cancer screening (blood stool test within the past 12 months or sigmoidoscopy/colonoscopy within the past 5 years). Only 14% of Filipino and 10% of Korean women were adherent to cancer-screening guidelines for all three sites. These differences in screening rates were statistically significant in multivariate analyses of the combined sample, controlling for all demographic characteristics, including age, percent of lifetime in the United States, education, marital status, health insurance, employment, and ethnicity. The two variables that were most consistently independently associated with adherence to cancer screening in both samples were higher percentage of lifetime spent in the United States and ever having had a checkup when no symptoms were present. CONCLUSIONS: These two variables-percent of lifetime in the United States and ever having had a checkup when no symptoms were present-can alert a physician that cancer-screening tests may be overdue among Korean and Filipino immigrants in the United States. Future research should identify predictors of cancer screening among other Asian immigrant groups and U.S.-born Asian women to assist in targeting intervention efforts.

Acculturation↗

PubMed2002

Feasibility of mobile cancer screening and prevention.

Many areas have high cancer mortality rates and medically underserved populations. This study describes the feasibility (acceptability and costs) of an urban multiphasic (multiple cancers) screening van. Feasibility was evaluated by literature review and informant interviews. Costs were estimated by resource use from urban mobile screening units; decision analysis estimated the costs per cancer detected for breast, cervix, colorectal, and prostate cancer screening. Acceptability of a multiphasic van varied by the informant's perspective. Feasibility and costs were most sensitive to four parameters: age, prior screening history, risk factors, and volume of simultaneous examinations. Subsidized mobile screening facilities may have the potential to reduce cancer morbidity and mortality if they target hard-to-reach underscreened groups, maintain high volume, coordinate with primary care providers, and build on an infrastructure that provides diagnostic and treatment services regardless of ability to pay. It is unclear whether the investment required will translate into a reasonable cost per year of life saved.

Cost-Benefit Analysis↗

PubMed2003

Colorectal cancer screening: scientific review.

CONTEXT: Screening for colorectal cancer clearly reduces colorectal cancer mortality, yet many eligible adults remain unscreened. Several screening tests are available, and various professional organizations have differing recommendations on which screening test to use. Clinicians are challenged to ensure that eligible patients undergo colorectal cancer screening and to guide patients in choosing what tests to receive. OBJECTIVE: To critically assess the evidence for use of the available colorectal cancer screening tests, including fecal occult blood tests, sigmoidoscopy, colonoscopy, double-contrast barium enema, and newer tests, such as virtual colonoscopy and stool-based molecular screening. DATA SOURCES: All relevant English-language articles were identified using PubMed (January 1966-August 2002), published meta-analyses, reference lists of key articles, and expert consultation. DATA EXTRACTION: Studies that evaluated colorectal cancer screening in healthy individuals and assessed clinical outcomes were included. Evidence from randomized controlled trials was considered to be of highest quality, followed by observational evidence. Diagnostic accuracy studies were evaluated when randomized controlled trials and observational studies were not available or did not provide adequate evidence. Studies were excluded if they did not evaluate colorectal screening tests and if they did not evaluate average-risk individuals. DATA SYNTHESIS: Randomized controlled trials have shown that fecal occult blood testing can reduce colorectal cancer incidence and mortality. Case-control studies have shown that sigmoidoscopy is associated with a reduction in mortality, and observational studies suggest colonoscopy is effective as well. Combining fecal occult blood testing and sigmoidoscopy may decrease mortality and can increase diagnostic yield. CONCLUSION: The recommendation that all men and women aged 50 years or older undergo screening for colorectal cancer is supported by a large body of direct and indirect evidence. At present, the available evidence does not currently support choosing one test over another.

Aged↗

PubMed2005

Cancer screening in theory and in practice.

Improvements in technology have led to a number of tests that can be used to suggest that a patient has a cancer. Advances in cancer biology and medical imaging have led to a number of cancer screening tests. Cancer screening is commonly advocated, but its complexity is often lost in guidelines that have sound-bite quality. It is commonly viewed as of no harm, when in fact there are harms associated with every known screening test. Indeed, many screening experts believe a screening test should only be used when the potential for benefit clearly outweighs the potential for harm. Cancer screening principles are classically within the realm of the epidemiologist. As more screening tests are developed, these principles have become more relevant to the practicing clinician. What is known and what is unknown about screening is distinctly different from what is believed by the public and many practicing clinicians. Many tests have both screening and diagnostic uses, and it is only the context in which these are used that determines whether they are screening or diagnostic. A screening test is done on asymptomatic individuals who receive the test principally because they are of the age or sex at risk for the cancer. A diagnostic test is done on an individual because of clinical suspicion of disease.

Adult↗

PubMed2002

Colon cancer screening in the ambulatory setting.

BACKGROUND: Despite evidence of decreased mortality, recommendations for colon cancer screening have not been widely implemented by physicians. The objective of this study was to determine patient and clinician factors associated with screening for colon cancer. METHODS: A retrospective review of computerized medical records from primary care practices in an academic medical center was performed. Patients comprised men and women aged 50-74 with at least one visit between July 1, 1995 and June 30, 1997. Measurements included Fecal occult blood testing in the past 1 or 2 years, sigmoidoscopy in the previous 5 or 10 years, or colonoscopy in the past 10 years. RESULTS: A total of 6,039 patients were included in the analysis. Fecal occult blood testing had been performed in 44% of patients and sigmoidoscopy in 26%. Fifty-three percent of patients had undergone some type of colon cancer screening. In multivariate analysis, patient factors predictive of fecal occult blood testing included age (odds ratio (OR) per 5 years 1.05; 95% confidence interval 1.04, 1.06), Asian ethnicity (OR 1.23; 1.08, 1.41), number of visits during the study period (OR 1.05; 1.04, 1.06), recency of the last visit (OR 1.03; 1.02, 1.04), and having private insurance (OR 1.65; 1.04, 2.62). Predictors of sigmoidoscopy were similar except that patients with a family history of colon cancer and those with managed care insurance were also more likely to undergo sigmoidoscopy. Patients of nurse practitioners were less likely to receive fecal occult blood testing than were patients of physicians (OR 0.78; 0.65, 0.93). Patients of residents were less likely to undergo sigmoidoscopy than were patients of faculty (OR 0.79; 0.66, 0.94). CONCLUSIONS: Among patients seen in primary care practices, rates of colon cancer screening remain low, especially in patients who are younger, who have been seen less frequently, who are uninsured, or who do not have managed care insurance. Future research should explore these differences and should focus on increasing screening in all patient groups, especially in those who are underscreened.

Academic Medical Centers↗

PubMed1991

A breast cancer screening program in a community hospital.

Breast cancer screening continues to be underutilized in the United States. The National Cancer Institute has set a goal of increasing screening by the year 2000. The American Cancer Society wants to identify programs that target asymptomatic women and economically disadvantaged women. The purpose of this study was to develop, implement and evaluate a comprehensive breast cancer screening program for women in a community setting. One case of infiltrating ductal carcinoma was detected from the 144 women who participated in the study. Following the educational component, the post test demonstrated a significant increase (p less than 0.01) in the women's awareness of breast cancer. Additionally, 100% of the women were able to demonstrate breast self examination to an oncology nurse after the educational component of the study. The majority of the women who participated were not economically disadvantaged which sheds new light on the scope of the problem of taking care of the unmet cancer needs of the disadvantaged through outreach programs. However 27% of the women had a household income less than $10,000 with 19% of the women having no insurance and 7% having Medicare/Medicaid. The results of this study could help future programs in bringing breast cancer screening to women in the community setting.

Adult↗

PubMed2004

Test sensitivity of prostate-specific antigen in the Finnish randomised prostate cancer screening trial.

We estimated the sensitivity of serum prostate-specific antigen (PSA) as a screening test for prostate cancer in the Finnish randomised, population-based prostate cancer screening trial. The study population consisted of 80,458 men aged 55-67 years identified from the national population registry and randomised to the screening or control arm of the trial. The screening algorithm was based on determination of serum PSA concentration. Test sensitivity was estimated based on interval cancer incidence during the first 4 years of follow-up among screening participants with a negative screening test. Interval cancers were defined as those occurring among men with a negative screening test. Altogether, 19 interval cancers were detected among 17,897 men with serum PSA < 3 ng/ml during the first screening interval. A further 5 cases were diagnosed among 811 men with PSA 3.0-3.9 ng/ml with a benign digital rectal examination or free total PSA ratio > or = 0.16. Test sensitivity based on serum PSA of 3 ng/ml was estimated to be 0.89 (95% confidence interval 0.84-0.93) and that based on PSA of 4 ng/ml combined with an ancillary test (digital rectal examination or free total PSA ratio in the PSA range 3.0-3.9) was 0.87 (0.82-0.92). Test sensitivity achieved with serum PSA in prostate cancer screening appears excellent in the context of a population-based effectiveness trial.

Aged↗

PubMed1994

Explanatory models for cancer among African-American women at two Atlanta neighborhood health centers: the implications for a cancer screening program.

This paper examines cultural models for breast and cervical cancer among low-income African-American women over 40, in order to better understand how those models might affect cancer screening behavior. The study is part of The Community-Based Cancer Screening Project, which is sponsored by Emory University, Grady Memorial Hospital, and the American Cancer Society. The Screening Project attempts to increase the use of mammography, clinical and self-examination of the breast, and cervical Pap smear among women aged 40 or older in a predominantly African-American, low-income, low educational level population that is currently underserved by any screening activities. The study of cultural models of cancer within the project was prompted by the recognition that if screening programs targeted at specific, underserved, populations are to succeed, cultural as well as logistical barriers to screening must be overcome. Patients and clinicians must each understand how the other perceives cancer, its prevention, and its treatment. Only with this mutual understanding as a foundation, can physicians and their clients cooperate to improve cancer screening rates. Our research results indicate that the cancer models held by the patient population differ significantly from those held by clinicians. Women attending the clinics endure cancer screening tests that to them seem to serve only as heralds of a disease that will ultimately kill them. Most women doubt there is a cure for cancer, though some believe a person may live if the disease is caught in time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2000

Rural Mexican American men's attitudes and beliefs about cancer screening.

INTRODUCTION: Mexican American men are thought to receive fewer cancer screening services for prostate and colon cancer than the general male population; however, little is known about this group. METHODS: A population-based cross-sectional study was conducted to examine the knowledge, beliefs, attitudes, and use of cancer screening services among a sample of high-acculturated Mexican American, low-acculturated Mexican American, and non-Mexican American white men in Washington State. A total of 158 men (127 Mexican American; 31 non-Mexican American white) completed an in-person interview. RESULTS: The Mexican American men were more likely to report employment in agriculture and had completed fewer years of formal education compared with the non-Mexican American men, and were more likely than their non-Mexican American counterparts to have little knowledge about the causes of cancer and the need for cancer prevention practices. Further, the Mexican American men were more likely to report avoidant and fatalistic attitudes about cancer. CONCLUSION: Future research should address variables that are related to the low level of cancer screening among Mexican American men.

Adolescent↗

PubMed1999

Promoting cancer screening among the first-degree relatives of breast and colorectal cancer patients: the design of two randomized trials.

BACKGROUND: In this paper two large nationwide trials are described, both of which will test a comparable telephone-based counseling intervention to promote cancer screening among the first-degree relatives (FDRs) of breast and colorectal cancer patients. The unit of randomization will be the family unit of eligible FDRs. Access to FDRs will be obtained from their relatives with cancer. Selected intervention and design issues are reviewed, including how both projects will respond to FDRs who exhibit significant levels of cancer-specific anxiety or distress and how potential high-risk cancer families will be accommodated. METHODS: Pursuant to the development of both studies, two feasibility surveys were conducted to determine whether patients would grant access to their FDRs and whether the FDRS identified by these patients would be receptive to the telephone intervention. RESULTS: Approximately 80% (106 of 132) of breast cancer patients agreed to provide access to their eligible FDRs when contacted on-site at participating hospitals and clinics. Of those subsequently selected for telephone follow-up (n = 95 or 90%), 80% (n = 76) were successfully contacted by telephone, and of these 97% (n = 74) provided the names and telephone numbers of their FDRs. Among colorectal cancer patients contacted on-site (n = 46), 96% (n = 44) agreed to provide access to their FDRs, and of those contacted by telephone (n = 33 or 75%), 91% (n = 30) provided the requested information about their FDRs. Once contacted, 95% of breast cancer FDRs (55 of 58) and 91% of colorectal cancer patients (51 of 56) endorsed the intervention strategy. CONCLUSIONS: It is argued that this intervention, if proven effective, could provide an exportable strategy for reaching large numbers of high-risk individuals to promote cancer screening.

Algorithms↗