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PubMedDate not supplied

American Cancer Society guidelines for the early detection of cancer.

Each year the American Cancer Society publishes a summary of existing recommendations for early cancer detection, including updates, and/or emerging issues that are relevant to screening for cancer. In last year's article, the guidelines regarding screening for the early detection of prostate, colorectal, and endometrial cancers were updated, as was the narrative pertaining to testing for early lung cancer detection. Although none of the ACS's guidelines were updated in 2001, work is proceeding on an update of screening recommendations for breast and cervical cancer and an update of these guidelines will be announced in the January/February 2003 issue of CA. As in previous issues, we review recommendations for the "cancer-related check-up," in which clinical encounters provide case-finding and health counseling opportunities. Finally, we provide an update of the most recent data pertaining to participation rates in cancer screening by age, gender, and ethnicity from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System (BRFSS) and National Health Interview Survey (NHIS).

Breast Neoplasms↗
PubMed2000

The role of prostate-specific antigen velocity in prostate cancer early detection.

Prostate-specific antigen velocity (PSAV) is the rate of change in prostate-specific antigen (PSA) values with repeated measurement over time. Accurate use of PSAV for prostate cancer early detection requires the use of two or more PSA levels collected over approximately 1.5 to 2 years. When these specimen collection criteria are met, more than 95% of men without prostate cancer will have a PSAV less than 0.75 ng/mL/y, whereas approximately 70% of men with prostate cancer will have a PSAV above this threshold. PSAV is thus more specific than routine PSA testing for the presence of prostate cancer, because few men (< 5%) without prostate cancer have a PSAV sufficient to trigger prostate biopsy. The use of PSAV in the increasing number of men with lengthy PSA histories obtained in systematic efforts at prostate cancer early detection may aid in diagnosing prostate cancer and spare some men unnecessary prostate biopsy. This review briefly summarizes the theoretic basis and clinical utility of PSAV in prostate cancer early detection.

Humans↗
PubMed2003

Psychological issues related to the use of spiral CT for lung cancer early detection.

Although the NCI is presently investigating whether enhanced detection of lung tumors via spiral CT reduces lung cancer mortality, use of this technology for lung cancer screening is already widespread in the US. Few data are available concerning level of interest in, or awareness of, spiral CT for lung cancer screening, correlates of participation in screening, or potential reactions to screening results (i.e. smoking cessation) among high-risk individuals. One-hundred-and-seventy-two current or former smokers with no personal cancer history were queried about their awareness of spiral CT for lung cancer screening, received information about the procedure, and completed a survey that assessed interest in screening, correlates of screening interest (i.e. demographic, health, psychological), and expected effects of screening results on smoking. Seventy-seven percent of respondents were unaware of spiral CT for lung cancer screening and 62% expressed high interest in screening. Screening interest was positively related to screening self-efficacy, knowledge of asymptomatic illness, and perceived lung cancer risk. In the face of a positive scan, 52% of smokers said that they would quit, 43% said they would consider quitting, and 3% would continue smoking. If the scan was negative, 19% of smokers said that they would quit, 61% said they would consider quitting, and 20% would continue smoking. Finally, 59% of smokers were interested in smoking cessation counseling, with screening. These findings can help guide the design of psychological interventions to promote the utilization of spiral CT for early lung cancer detection as well as the development of protocols to promote behavior change within lung cancer screening programs, should future studies indicate that spiral CT screening can effectively reduce the overall lung cancer mortality rate.

Adult↗
PubMed1999

African American men, prostate cancer early detection examination use, and informed decision-making.

It is well known that African American men are more likely to be diagnosed with metastatic prostate cancer than White men. Racial variation in the use of prostate cancer early detection modalities (ie, digital rectal examination [DRE] and prostate-specific antigen [PSA] testing) has been suggested as a major reason for this differential. Several factors may help to explain the reported low levels of DRE and PSA test utilization among African American men, including background sociodemographic characteristics, medical history, and cognitive and psychosocial perceptions. In this review, the impact of these characteristics on prostate cancer early detection examination utilization is explored. Findings from studies showing race-related differences in cognitive and psychosocial factors are presented. Preparatory education for informed decision-making is suggested as an approach to help minimize racial differences in cognitive and psychosocial factors that influence the use of prostate cancer early detection modalities. The need to facilitate informed decision-making along the continuum of care is highlighted.

Black or African American↗
PubMed2000

African-American men and intention to adhere to recommended follow-up for an abnormal prostate cancer early detection examination result.

OBJECTIVES: To assess the intention of African-American men to have the recommended follow-up in the event of an abnormal prostate cancer early detection examination and to identify the variables that help to explain adherence intention. METHODS: In the spring of 1995, we selected a random sample of 548 African-American men who were patients at the University of Chicago Health Service. The sample included men who were 40 to 70 years of age, did not have a personal history of prostate cancer, and had a working telephone number. A total of 413 men who completed the telephone survey received an invitation to consider undergoing a prostate cancer early detection examination. The survey provided data on personal background characteristics, knowledge, attitudes, and beliefs related to prostate cancer and early detection. Respondents were asked whether they would choose to have the recommended follow-up in the event of an abnormal early detection examination result. Univariate and multivariate analyses of intention to have follow-up were performed. RESULTS: An intention to have the recommended follow-up was reported by 77% of the survey respondents. The results of multivariate analyses revealed that the intention to have the follow-up was positively associated with education beyond high school (odds ratio [OR] 1.9); perceived self-efficacy related to prostate cancer screening (OR 2.1); the belief that prostate cancer can be cured (OR 3.3); the belief that prostate cancer screening should be done in the absence of prostate problems (OR 2.3); and physician support for prostate cancer screening (OR 2.1). CONCLUSIONS: African-American men who have a high school education or less may be at risk of nonadherence to recommended follow-up. Adherence also may be low among men who do not have favorable views of early detection or do not perceive strong physician support for early detection. Research is needed to determine whether intention and other factors predict actual adherence to follow-up in this population group.

Adult↗
PubMed1985

[The Health and Medical Services Law for the elderly and early cancer detection].

Anti-cancer measures in Japan were started in the 1950s, and programs for the early detection of stomach and cervical cancer supported by the National Government were begun in 1966 and 1967, respectively. In 1983 the Health and Medical Services Law for the Elderly was enacted, and under this law nationwide early detection programs for stomach and cervical cancer have been under taken and the number of people screened has been steadily increasing. Accuracy control programs for these cancer detection systems are now being established by prefectural governments. The examination of programs for the early detection of lung cancer and breast cancer will be necessary when suitable methods have been established.

Aged↗
PubMed1998

Strategies for providing follow-up and treatment services in the National Breast and Cervical Cancer Early Detection Program--United States, 1997.

The Breast and Cervical Cancer Mortality Prevention Act of 1990 authorized CDC to establish the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to increase screening services for women at low income levels who are uninsured or underinsured. Although the NBCCEDP covers most diagnostic services that women need after receiving an abnormal mammography or Papanicolaou (Pap) test result, the program does not reimburse for breast biopsies. In addition, the Act prohibits the use of NBCCEDP funds for cancer treatment. Participating health agencies must ensure that NBCCEDP clients receive timely, appropriate diagnostic and treatment services. In 1996, CDC began a case study to determine how early detection programs in seven participating states (California, Michigan, Minnesota, New Mexico, New York, North Carolina, and Texas) identified resources and obtained diagnostic and treatment services. This report summarizes the results of the study, which indicate that respondents in these states reported that treatment had been initiated for almost all NBCCEDP clients in whom cancer was diagnosed. However, respondents also considered the strategies used to obtain these services as short-term solutions that were labor-intensive and diverted resources away from screening activities.

Breast Neoplasms↗
PubMed2005

Use of intensified early cancer detection in high-risk patients with familial breast and ovarian cancer.

A prospective follow-up study was carried out to evaluate the influence of risk and genetic counselling on use of early cancer detection. Five hundred and fifty-six subjects who fulfilled inclusion criteria for a genetic analysis of the BRCA1/2 genes (the high-risk group A) and 205 who did not fulfil the inclusion criteria (the lower risk group B) attended primary consultation in the interdisciplinary cancer genetic clinic. Information about participation in the early cancer detection programme was documented. Information about changes in use after consultation could be evaluated from 349 women (94 group B and 255 group A). Methods such as monthly self-palpation, breast palpation by gynaecologist, ultrasound of the breast, transvaginal ultrasound and pelvic examination had all been commonly used. Consultees at higher risk used mammography less often than women at lower risk. Magnetic resonance imaging of the breast was used rarely. Most methods were used more often at the recommended interval by women at higher risk during the follow-up period. In conclusion, at present intensified early cancer detection programmes for women at risk provide a less invasive option than chemoprevention or prophylactic surgery. Although the methods are used at high frequency it seems feasible to motivate women at risk to participate. This can be done by providing information and counselling in the cancer genetic clinic.

Adult↗
PubMed1992

Update: National Breast and Cervical Cancer Early Detection Program, July 1991-July 1992.

Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer deaths among women in the United States. During 1992, breast cancer will be diagnosed in 180,000 women, and an estimated 46,000 women will die from the disease (1). In addition, invasive cervical cancer will be diagnosed in an estimated 13,500 women and will cause approximately 4400 deaths (1). Many of these deaths could be prevented through routine, high-quality mammography screening and use of the Papanicolaou (Pap) test (2,3). This report describes cancer screening in three women who received these services through CDC's National Breast and Cervical Cancer Early Detection Program and the implementation of this comprehensive screening program for low-income women through cooperative agreements with state health agencies during July 1991-July 1992.

Breast Neoplasms↗
PubMed1998

The National Breast and Cervical Cancer Early Detection Program: report on the first 4 years of mammography provided to medically underserved women.

OBJECTIVE: We describe results from 284,503 mammographic examinations and associated diagnostic workups provided to medically underserved women in an ongoing nationwide breast cancer early detection program. MATERIALS AND METHODS: We report the results of mammographic examinations and diagnostic workups on 230,143 medically underserved women 40 years old or older who underwent at least one mammographic examination from July 1991 through June 1995. Mammograms were obtained in hundreds of mammography and clinical facilities throughout the United States, including community health centers, health department clinics, private practitioners' offices, university based facilities, and mobile mammography units. Our analysis included rates of mammograms with abnormal findings (reported according to the categories of the American College of Radiology Breast Imaging Reporting and Data System), breast cancer detection rates, numbers of diagnostic procedures performed, stage and size distribution of breast cancers, and positive predictive value of mammograms and biopsies with abnormal findings--all presented according to screening round and 10-year age intervals. RESULTS: Mammograms with abnormal findings constituted 5% of mammograms in the first round and 4% in subsequent rounds, both proportions declining by approximately one third from the youngest (40-49 years) to the oldest (70 years and older) age group. Breast cancer detection rates per 1000 mammographic examinations were 5.1 for the first round and 2.0 for subsequent rounds; from the youngest to the oldest age group, the first-round rates doubled and the subsequent-round rates tripled. Early-stage cancers accounted for 54% of first-round cancers and 81% of subsequent-round cancers. Percentage of invasive cancers at least 2 cm in size declined from 51% in the first round to 33% in subsequent rounds: however, we found little change in the proportion of lesions smaller than 1 cm. Positive predictive values declined from 9.5 cancers per 100 mammograms with abnormal findings in the first round to 5.6 cancers per 100 mammograms with abnormal findings in the subsequent rounds. CONCLUSION: A large nationwide breast cancer early detection program conducted through hundreds of diverse facilities has provided results that, although not a statistically representative sample of mammography services, are probably the best available characterization of the current state of breast cancer screening practices as they actually occur in the 1990s in the United States. These results should be useful to clinicians, researchers, and public health personnel in counseling patients, planning new studies, and improving efforts to control breast cancer.

Adult↗
PubMed1996

Attitude of women towards early cancer detection and estimation of the compliance to a screening program for cervix and breast cancer.

Before the start of a feasibility study for cervical and breast cancer screening in two towns (Genoa and Rome) in Italy, a random sample (N = 349) of the target population was interviewed with the aim of evaluating (i) the degree of knowledge as to the purpose of the screening tests; (ii) the attitude towards early detection of these cancers; and (iii) the potential compliance to the program. Pap test: 48.7% of women were correctly informed about the object of the test; information was associated with the degree of education (p < 0.0001). Periodic Pap test was reported by 77.9% of women: the proportion was higher among younger (p = 0.013) and married women (p = 0.001). A 1-year interval between two tests was more frequently reported by younger women (p < 0.001). Estimated participation in the cervical cancer screening program was 63.3%. Increasing age (OR = 0.78; CI = 0.6-1.0), the married status (OR = 0.39; CI = 0.18-0.83) and lack of knowledge of the object of the test (OR = 0.47; CI = 0.25-0.87) hindered participation in the program. Mammography: 53.3% of women reported that it is a method used for early detection of breast cancer. Well-educated women were more likely to be correctly informed (p < 0.0001). Previous mammography was reported by 49.3% of women aged 50 to 69 years who never experienced breast cancer symptoms; married women more frequently reported having had the test (p = 0.02). Estimated participation in the breast cancer screening program was 59%. Women aged 60 years and over were less prone to participate (OR = 0.44; CI = 0.22-0.89). Increasing age was the most relevant barrier to participation in screening programs, and strong efforts should be made to involve older women, due to their greater chance of getting cancer.

Adult↗
PubMed1996

Evaluation of the American Academy of Dermatology's National Skin Cancer Early Detection and Screening Program.

BACKGROUND: Increasing incidence and mortality rates from cutaneous melanoma are a major public health concern. As part of a national effort to enhance early detection of melanoma/skin cancer, the American Academy of Dermatology (AAD) has sponsored an annual education and early detection program that couples provision of skin cancer information to the general public with almost 750,000 free skin cancer examinations (1985-1994). OBJECTIVE: To begin to evaluate the impact of this effort, we determined the final pathology diagnosis of persons attending the 1992-1994 programs who had a suspected melanoma at the time of examination. METHODS: We directly contacted all such persons by telephone or mail and received pathology reports from those who had a subsequent biopsy. RESULTS: We contacted 96% of the 4458 persons with such lesions among the 282,555 screenings in the 1992-1994 programs. We obtained a final diagnosis for 72%, and the positive predictive value for melanoma was 17%. Three hundred seventy-one melanomas were found in 364 persons. More than 98% had localized disease. More than 90% of the confirmed melanomas with known histology were in situ or "thin" lesions (< or = 1.50 mm thick). The median thickness of all melanomas was 0.30 mm. The 8.3% of AAD cases with advanced melanoma (metastatic disease, regional disease, or lesions > or = 1.51 mm) is a lower proportion than that reported by the 1990 Surveillance, Epidemiology and End Result Registry. The rate of thickest lesions (> or = 4 mm) and late-stage melanomas among all participants was 2.83 per 100,000 population. Of persons with a confirmed melanoma, 39% indicated (before their examination) that without the free program, they would not have considered having a physician examine their skin. CONCLUSION: The 1992-1994 free AAD programs disseminated broad skin cancer educational messages, enabled thousands to obtain a free expert skin cancer examination, and found mostly thin, localized stage 1 melanomas (usually associated with a high projected 5-year survival rate). Because biases impose possible limitations, future studies with long-term follow-up and formal control groups should determine the impact of early detection programs on melanoma mortality.

Adult↗
PubMed2005

Perceptions of barriers and facilitators of cancer early detection among low-income minority women in community health centers.

African-American and Hispanic women receive fewer indicated cancer early detection services than do majority women. Low rates of cancer screening may, in part, explain the disproportionately higher rates of cancer deaths in this population. The aim of this qualitative study was to explore through individual interviews the perceptions of barriers and facilitators of colorectal, cervical and breast cancer screening among 187 low-income, primarily minority women in four New-York-City-based community/migrant health centers. We identified various barriers and facilitators within each of these categories. Clinician recommendation was the most commonly cited encouragement to cancer screening. Other facilitators of cancer screening identified by patients included personal medical history, such as the presence of a symptom. The perception of screening as routine was cited as a facilitator far more commonly for mammography and Pap tests than for either of the colorectal screenings. Less commonly cited facilitators were insurance coverage and information from the media. The most common barriers were a lack of cancer screening knowledge, patients' perception of good health or absence of symptoms attributable to ill health, fear of pain from the cancer test and a lack of a clinician recommendation. Using standard qualitative techniques, patients' responses were analyzed and grouped into a taxonomy of three major categories reflecting: (1) patients' attitudes and beliefs, (2) their social network experience and (3) accessibility of services. This taxonomy may serve as a useful framework for primary care providers to educate and counsel their patients about cancer screening behaviors.

Aged↗
PubMed1996

A model for describing low-income African American women's participation in breast and cervical cancer early detection and screening.

The article reports on data derived from two investigations. In one study, focus groups were used with low-income African American women to pilot test a teaching module developed to support the inclusion of culturally relevant content on breast and cervical health in teaching low-income African American women. A second study using individual interviews was undertaken to illuminate the lived experience of low-income African American women who participated in breast and cervical cancer early detection and screening services. Data analysis of group and individual interviews were performed using phenomenology as a methodological approach. Findings from the two studies, combined with information identified in the theoretical and literary contexts, supported the development of an Afrocentric model that describes the lived experience and decision making practices of low-income African American women's participation in breast and cervical cancer early detection and screening services.

Adolescent↗
PubMed2006

Meeting the mammography screening needs of underserved women: the performance of the National Breast and Cervical Cancer Early Detection Program in 2002-2003 (United States).

OBJECTIVE: To examine the extent to which the National Breast and Cervical Cancer Early Detection Program (Program) has helped to meet the mammography screening needs of underserved women. METHODS: Low-income, uninsured women aged 40-64 are eligible for free mammography screening through the Program. We used data from the U.S. Census Bureau to estimate the number of women eligible for services. We obtained the number of women receiving Program-funded mammograms from the Program. We then calculated the percentage of eligible women who received mammograms through the Program. RESULTS: In 2002-2003, of all U.S. women aged 40-64, approximately 4 million (8.5%) had no health insurance and had a family income below 250% of the federal poverty level, meeting Program eligibility criteria. Of these women, 528,622 (13.2%) received a Program-funded mammogram. Rates varied substantially by race and ethnicity. The percentage of eligible women screened in each state ranged from about 2% to approximately 79%. CONCLUSIONS: Although the Program provided screening services to over a half-million low-income, uninsured women for mammography, it served a small percentage of those eligible. Given that in 2003 more than 2.3 million uninsured, low-income, women aged 40-64 did not receive recommended mammograms from either the Program or other sources, there remains a substantial need for services for this historically underserved population.

Adult↗