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PubMedDate not supplied

Report on the UICC workshops on breast cancer screening in premenopausal women in developed countries. Union Internationale Contre le Cancer.

At the recent UICC Meeting on Breast Cancer Screening in Premenopausal Women, three workshops were held to address issues concerning the evaluation of the efficacy of screening, current strategies in research and practice, and future directions in breast cancer control. The authors report on the results of these workshops, including a proposal for a multinational clinical study of breast cancer screening in premenopausal women.

Adult↗

PubMed1999

Breast and cervical cancer screening practices among American Indian and Alaska Native women in the United States, 1992-1997.

BACKGROUND: Recent studies suggest that American Indian and Alaska Native women have important barriers to cancer screening and underuse cancer screening tests. METHODS: We examined the breast and cervical cancer screening practices of 4,961 American Indian and Alaska Native women in 47 states from 1992 through 1997 by using data from the Behavioral Risk Factor Surveillance System. RESULTS: About 65.1% [95% confidence interval (CI) 60.2 to 69.9%] of women in this sample aged 50 years or older had received a mammogram in the past 2 years. About 82.6% (95% CI 80.1 to 85.2%) of women aged 18 years or older who had not undergone a hysterectomy had received a Papanicolaou test in the past 3 years. Older women and those with less education were less likely to be screened. Women who had seen a physician in the past year were much more likely to have been screened. CONCLUSIONS: These results underscore the need for continued efforts to ensure that American Indian and Alaska Native women who are elderly or medically underserved have access to cancer screening services.

Adolescent↗

PubMed1999

Patterns of breast cancer screening among lesbians at increased risk for breast cancer.

BACKGROUND: Women with a family history of breast cancer (i.e., in a mother, sister or daughter) are at increased risk for this disease. Previous data also suggest that lesbians are at increased risk for breast cancer. While the screening behaviors of women with a family history have been described, little is known about factors that influence screening behaviors of lesbians with the same risk factor profile. PURPOSE: The purpose of this study was to characterize the perceptions of susceptibility to breast cancer and describe factors that influence adherence to breast cancer screening guidelines in a sample of lesbians with a first-degree relative with a diagnosis of breast cancer. METHODS: Structured telephone interviews were conducted on a sample of 139 self-identified lesbians who had a first-degree relative with a diagnosis of breast cancer, were between the ages of 35 to 75 and had no previous history of cancer. Cross-sectional data obtained, included socio-demographics, breast cancer risk factors, breast cancer screening patterns, breast cancer perceptions, worries, and knowledge, and barriers and access to health care factors. Individual subject characteristics were examined for their association with adherence to mammography guidelines followed by a multivariate analysis to evaluate the most important combinations of factors. Outcome measures were age-specific adherence to ACS guidelines for both mammography and overall adherence (i.e., mammography, clinical breast examination and breast self-examination). RESULTS: The 139 lesbians interviewed for this study were young (mean age = 43), almost exclusively white (94%), highly educated (78% = college graduate and beyond), and partnered (68%). In the bivariate analysis of individual factors, being employed and reporting breast cancer worries were significantly and positively associated with adherence to mammography guidelines. Higher income and insurance type were significantly associated with mammography adherence. No factors were significantly associated with overall adherence. Multivariate logistic regression analyses revealed that only income level and degree of breast cancer worries were significantly and positively associated with mammography adherence. However, since there was a high correlation between income level and employment status, a regression model with employment status and worry was also significantly related to mammography adherence. CONCLUSIONS: In lesbians who are at an increased risk for breast cancer because of family history, breast cancer worries may motivate, rather than deter, adherence for mammography use. High income levels also appear to enable adherence in this population. IMPLICATIONS: Additional studies are needed to validate these findings, identify the prevalence of lesbians in general samples of women at increased risk for breast cancer, and prospectively test lesbian sensitive educational intervention strategies designed to facilitate adherence to mammography screening guidelines in this population.

Adult↗

PubMed1998

Worksite breast cancer screening programs: a review.

1. Breast cancer is a major health problem amenable to secondary prevention for reducing morbidity and mortality. 2. Given the large and increasing numbers of women in the workplace, breast cancer prevention and control measures should be included in workplace health promotion programs. However, despite the increasing prevalence of worksite health promotion programs in the United States, the prevalence of breast cancer programs in the workplace has been decreasing. 3. Despite the limited evaluative research of worksite breast cancer screening programs, a number of important conclusions conducted thus far. 4. Additional scientifically rigorous evaluation studies of worksite health programs for the early detection of breast cancer are needed, and additional innovative workplace programs aimed at increasing breast cancer screening need to be developed.

Adult↗

PubMed1993

How cost-effective is breast cancer screening in different EC countries?

Should the decision to start breast cancer screening in the Netherlands and in the U.K. be followed by other EC countries? This question has been addressed in an exploratory analysis of the differences in cost-effectiveness of breast cancer screening in Spain, France, the U.K. and the Netherlands. A detailed cost-effectiveness analysis of breast cancer screening in the Netherlands has been used as the starting point. Country specific data on incidence, mortality, demography, screening organisation and price levels in health care have been used to predict the costs and effects of nationwide screening programmes, in which women aged 50-70 are invited for 2-yearly mammographic screening. The relative effect of screening is highest in the U.K. (16.55 life-years gained per 1000 screens) and lowest in Spain (8.23 life-years gained per 1000 screens). The cost per screen is highest in Spain (38 pounds) and lowest in the U.K. (18 pounds). In comparison with the yearly health expenditures per capita, the cost per life-year gained is 2.8 times higher in the Netherlands, 3.1 times higher in the U.K., 6.5 times higher in France and 20.6 times higher in Spain. These marked differences show that no uniform policy recommendations for breast cancer screening can be made for all countries of the EC.

Aged↗

PubMed2002

Cost effectiveness in new technology in cervix cancer screening.

The new techniques in cervix cancer screening are reviewed. Literature relevant to the performance and cost effectiveness of these technologies is reviewed. Literature relevant to cost effectiveness of other techniques used for cervix cancer screening is reviewed. Prospective trials of competing technology are proposed to resolve the question utilizing contemporaneous methods of assessing cost effectiveness.

Cost-Benefit Analysis↗

PubMedDate not supplied

Cancer fatalism and breast cancer screening in African American women.

Despite significant advances in science, medicine, and technology African American women are more likely to die from breast cancer than Caucasian women. There is a growing body of literature that describes strategies to improve breast cancer screening among African American women. However, data suggest that African American women, compared to Caucasian women, are less likely to participate in regular breast cancer screening. The belief that a diagnosis of cancer will result in death has been identified as a potential barrier to cancer screening in African American population groups. However, research examining the degree to which perceptions of fatalism influence breast cancer screening in culturally and ethnically diverse population groups is scant. This repot describes the outcomes of a study undertaken to examine relationships between perceptions of cancer fatalism and breast cancer screening in African American women. Findings support the postulation that fatalism negatively influences health promoting practices such as breast cancer screening. However, contrary to prior research findings age was observed to be inversely associated with cancer fatalism.

Adult↗

PubMed2004

Skin cancer screening among U.S. adults from 1992, 1998, and 2000 National Health Interview Surveys.

BACKGROUND: Relatively little is known about the prevalence of skin cancer screening in the context of inconsistent skin cancer screening recommendations. METHODS: To determine the prevalence and predictors of skin cancer screening rates in the U.S. adult population, we used self-reported data from the 1992, 1998, and 2000 National Health Interview Surveys, a nationally representative survey of civilian noninstitutionalized adults. RESULTS: The percentage of the U.S. adult population who had ever had a skin examination conducted by a doctor was 20.6% in 1992, 20.9% in 1998, and 14.5% in 2000. The percentage with a recent skin examination was 10.3% in 1992, 11.0% in 1998, and 8.0% in 2000. White non-Hispanics reported being screened more frequently than persons in other racial or ethnic groups. Recent skin cancer screening exams were more common among white persons who had a family history of melanoma, had higher education, had usual place of care, and were older (> or =50 years). Frequent use of sunscreen and hats was associated with a recent skin cancer exam. CONCLUSIONS: In the past decade, skin cancer screening rates have been consistently low. Continued monitoring of skin cancer examination is important given conflicting current research results and potentially evolving science.

Adult↗

PubMed2005

Cancer screening: the importance of outcome measures.

Cancer screening is attracting greater attention as a growing number of studies and practice guidelines exhort physicians to screen for an increasing number of malignancies. Central to the evaluation of these studies is both the quality of the evidence and the impact of screening upon clinically relevant outcomes. Although much has been written about the optimal study design for screening studies, surprisingly little has been written about evaluating specific outcome measures employed in such studies. This paper reviews the strengths and limitations of common outcomes employed in cancer screening studies. The relationship between study design and outcome measure is explored. Three key biases (lead-time, length-time, and volunteer) associated with screening studies and methods to minimize them are also reviewed. Potential harms associated with screening are outlined. Although disease-specific mortality may be the most robust and relevant traditional outcome measure, increasing attention is being paid to composite health outcome measures for older populations, including quality of life and cost-based measures.

Cost-Benefit Analysis↗

PubMed1999

Cancer screening practices among primary care physicians serving Chinese Americans in San Francisco.

Previous research has reported a lack of regular cancer screening among Chinese Americans. The overall objectives of this study were to use a mail survey of primary care physicians who served Chinese Americans in San Francisco to investigate: a) the attitudes, beliefs, and practices regarding breast, cervical, and colon cancer screening and b) factors influencing the use of these cancer screening tests. The sampling frame for our mail survey consisted of: a) primary care physicians affiliated with the Chinese Community Health Plan and b) primary care physicians with a Chinese surname listed in the Yellow Pages of the 1995 San Francisco Telephone Directory. A 5-minute, self-administered questionnaire was developed and mailed to 80 physicians, and 51 primary care physicians completed the survey. A majority reported performing regular clinical breast examinations (84%) and teaching their patients to do self-breast examinations (84%). However, the rate of performing Pap smears was only 61% and the rate of ordering annual mammograms for patients aged 50 and older was 63%. The rates of ordering annual fecal occult blood testing and sigmoidoscopy at regular intervals of three to five years among patients aged 50 and older were 69% and 20%, respectively. Barriers (patient-specific, provider-specific, and practice logistics) to using cancer screening tests were identified. The data presented in this study provide a basis for developing interventions to increase performance of regular cancer screening among primary care physicians serving Chinese Americans. Cancer screening rates may be improved by targeting the barriers to screening identified among these physicians. Strategies to help physicians overcome these barriers are discussed.

Asian↗

PubMed2004

Lessons learned from community-based cancer screening intervention research.

Behaviors associated with cancer screening have been the focus of intensive research over the past 2 decades, primarily in the form of intervention trials to improve screening based in both clinical and community settings. Meta-analyses and literature reviews have synthesized and organized the resulting literature. From the accumulated work, this review distilled lessons learned from cancer screening intervention research in community settings. The authors posed the question, "What do we know about the development of effective community-based interventions (the level of good over harm achieved in real-world conditions)?" Framed around the concept of focal points (the simultaneous combination of target population, behavioral objective, and setting for an intervention), 13 lessons were derived. One lesson was cross-cutting, and the other lessons addressed the three focal-point components and the major intervention categories (access-enhancing strategies, mass media, small media, one-on-one and small-group education, and combinations of these categories). To build more systematically on existing research, recommendations are made for new directions in basic behavioral and intervention research.

Biomedical Research↗

PubMed1996

Evaluation of the regular practice of breast cancer screening in a health area.

Breast cancer screening has proved to be efficacious only in clinical trials or structured programs. However, little is known of its effectiveness as a regular practice. This study is an assessment of breast cancer screening in regular practice in a Spanish area of 350,000 inhabitants through analysis of existing sources of information. It is evident that this screening is insufficient, inefficient, very variable, nonspecific, and probably ineffective, although there is insufficient information to prove it. The immediate implementation of a well-structured and accredited screening program is essential to overcome the current limitations.

Adult↗

PubMed2000

Organizational systems used by California capitated medical groups and independent practice associations to increase cancer screening.

BACKGROUND: Patients in health maintenance organizations (HMOs) appear to have higher utilization of cancer screening tests than patients with fee-for-service insurance. METHODS: The authors surveyed the medical directors of 174 physician organizations in a California network model HMO to obtain information regarding their organizational structure, implementation of guidelines, and use of systems to increase cancer screening. RESULTS: The majority of independent practice associations (IPAs) and medical groups (IMGs) in this California HMO had guidelines and office systems aimed at improving cancer screening. These activities were reported more frequently for mammography and Papanicolaou (Pap) smears than for colorectal carcinoma screening. IMGs reported using flow sheets more often than IPAs. Chart audits were performed more frequently for mammography (48% for IMGs and 40% for IPAs) and Pap smears (45% and 40%, respectively) than for colorectal carcinoma screening (38% and 30%, respectively). Approximately 50% of IPAs and IMGs reported mailing reminders to patients for mammography and Pap smears, but only a few did so for colorectal carcinoma screening. Annual fecal occult blood testing was believed by most medical directors to be a reasonable strategy for managed care patients (86% of IPAs and 96% of IMGs); however, fewer believed that screening sigmoidoscopy for patients ages 50-70 years was a reasonable expectation (71% and 78%, respectively). CONCLUSIONS: The majority of IPAs and IMGs in this California HMO reported using both guidelines and office systems to improve cancer screening rates. Further research is needed to understand the effect of these systems, as well their complex interactions with competing incentives, on cancer screening in managed care patients.

Adult↗

PubMed1998

Missed opportunities for cervical cancer screening of HMO members developing invasive cervical cancer (ICC).

OBJECTIVE: To identify potential missed opportunities and to suggest interventions for cervical cancer screening in members of a prepaid health plan by examining the membership histories and medical records of women who had no Pap smear performed in the 3 years prior to the diagnosis of ICC. METHODS: Medical records of all 642 members of a prepaid health plan developing ICC during the period from 1988 to 1994 were reviewed and details of patient interaction with the health care system were abstracted. Assessment of screening history and history of clinic visits was limited to the period 36 months prior to diagnosis, but excluded the last 6 months prior to diagnosis, so as to avoid including smears or visits which were part of the evaluation that led to the recognition of ICC. RESULTS: Of women developing ICC, 384/642 (60%) had not had a smear in the period from 36 months to 6 months preceding the diagnosis. Of these 384 unscreened women, 241 (63%) had been insured by our HMO for at least 30 of the 36 months prior to diagnosis. Contact with the medical system in one of the primary care outpatient clinics was documented in 180/241 (75%) of these long-standing members during the specified period. Considering only Internal Medicine and Family Practice clinic visits, 169/241 (70%) had been seen at least once and 101/241 (42%) had been seen 3 or more times. CONCLUSION: Most long-standing HMO members developing ICC without benefit of recent Pap smear screening were seen in primary care outpatient clinics in the 3 years preceding their diagnosis.

Female↗

PubMed1998

The rationale for skin cancer screening and prevention.

Skin cancer, the most common malignancy in the United States, accounts for considerable morbidity and mortality. Efforts at lessening the burden of this disease are possible through both primary and secondary prevention, although some barriers may detract from the ability of primary care physicians to perform skin cancer screening. Public education combined with increased vigilance by physicians and other health professionals may significantly alter the morbidity and mortality associated with this disease entity.

Europe↗

PubMed1999

[Participation factors in a occupational health colorectal cancer screening program].

A colorectal cancer screening campaign by Hemoccult test was carried out from January 1993 to December 1994 in collaboration with the company doctors of employees ages 45 and older in the companies of the Lot department of France. Of the 1311 employees to whom the test was offered, 811 actually had the test done, representing a rate of participation of 61.9%. Participation varied from 48.1% to 72.7% depending on the company doctor, and was higher for large companies. Managers participated less than other employees. People who never visit a dentist, who had not seen their doctor for over a year or who never give blood participated less than others. Thus, even though company doctors can play a true role by favouring the participation of general employees, their action is limited by the weak participation of people who already have little contact with the health care system.

Aged↗

PubMed1989

A case for colorectal cancer screening in Singapore.

Colorectal cancer is the second most common cancer in Singapore: it forms 11.9% of all cancers registered by the Singapore Cancer Registry compared with 18.4%, 10.4% and 8% for lung, stomach and liver respectively. Despite recent advances in surgery, radiotherapy and chemotherapy, more than half of those afflicted will die from their cancer. Arguments are presented for a colorectal cancer screening programme. To succeed it is necessary to appreciate the short-comings of testing for faecal occult blood, to evaluate and adopt new screening tests and to establish a well organised programme.

Colonic Neoplasms↗

PubMed1995

Update: cancer screening in women.

Current cancer screening recommendations for women have been reviewed. Controversies have been identified. Many additional references are available upon request.

Adult↗