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PubMed1997

Enhancing breast cancer screening in the university setting.

Mammography, physical examination by a health care professional, and breast self-examination (BSE) may increase the probability of detection of breast cancer at an early stage and thus increase long-term survivor rates. The purpose of this study was to investigate the effectiveness of supportive coaching as an intervention to enhance compliance with these breast cancer screening guidelines. The following research questions were identified: (a) what are the attitudes of women toward breast cancer screening? (b) what are the barriers to compliance identified by women in breast cancer screening? and (c) what are the effects of supportive interventions by a professional nurse and of compliance with breast cancer screening in women? A quasi-experimental design was used to study the research questions. The population chosen for the study included female employees in a state university setting. Participants were randomly assigned to one of two groups. All participants were asked to complete a prestudy questionnaire measuring attitudes and beliefs, gathering demographic and health information, and surveying breast cancer screening practices. The experimental group then received coaching and supportive interventions over the course of the academic year. The remainder of the sample served as a control group. A poststudy questionnaire was then sent to the entire sample to identify behaviors related to breast cancer screening. A variety of beliefs and attitudes were observed in the groups. No significant difference was found between the experimental and control groups on compliance with mammography and the clinical breast examination. A difference was noted on compliance with BSE by the experimental group evidencing more compliance.

Adult↗

PubMed1998

Using an office system intervention to increase breast cancer screening.

OBJECTIVE: To evaluate an innovative approach to continuing medical education, an outreach intervention designed to improve performance rates of breast cancer screening through implementation of office systems in community primary care practices. DESIGN: Randomized, controlled trial with primary care practices assigned to either the intervention group or control group, with the practice as the unit of analysis. SETTING: Twenty mostly rural counties in North Carolina. PARTICIPANTS: Physicians and staff of 62 randomly selected family medicine and general internal medicine practices, primarily fee-for-service, half group practices and half solo practitioners. INTERVENTION: Physician investigators and facilitators met with practice physicians and staff over a period of 12 to 18 months to provide feedback on breast cancer screening performance, and to assist these primary care practices in developing office systems tailored to increase breast cancer screening. MEASUREMENTS AND MAIN RESULTS: Physician questionnaires were obtained at baseline and follow-up to assess the presence of five indicators of an office system. Three of the five indicators of office systems increased significantly more in intervention practices than in control practices, but the mean number of indicators in intervention practices at followup was only 2.8 out of 5. Cross-sectional reviews of randomly chosen medical records of eligible women patients aged 50 years and over were done at baseline (n = 2,887) and follow-up (n = 2,874) to determine whether clinical breast examinations and mammography, were performed. Results for mammography were recorded in two ways, mention of the test in the visit note and actual report of the test in the medical record. These reviews showed an increase from 39% to 51% in mention of mammography in intervention practices, compared with an increase from 41% to 44% in control practices (p = .01). There was no significant difference, however, between the two groups in change in mammograms reported (intervention group increased from 28% to 32.7%; control group increased from 30.6% to 34.0%, p = .56). There was a nonsignificant trend (p = .06) toward a greater increase in performance of clinical breast examination in intervention versus control practices. CONCLUSIONS: A moderately intensive outreach intervention to increase rates of breast cancer screening through the development of office systems was modestly successful in increasing indicators of office systems and in documenting mention of mammography, but had little impact on actual performance of breast cancer screening. At follow-up, few practices had a complete office system for breast cancer screening. Outreach approaches to assist primary care practices implement office systems are promising but need further development.

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PubMed1995

U.S. farm women's participation in breast cancer screening practices.

BACKGROUND: Surveys of women in the general population indicate that women are being screened for breast cancer at a much lower rate than recommended. There has been a concern that women living in rural areas may be screened for breast cancer even less often than women in urban or suburban areas because of reduced access to health practitioners. METHODS: A random sample of farm women age 40 years or older from 4 rural counties in Michigan was surveyed on knowledge, attitudes, and use of breast cancer screening. RESULTS: Six hundred eighty farm women completed a questionnaire. This was a response rate of 63.8%. The percentages of farm women who reported ever having had a mammogram, having had a mammogram in the past 3 years, and having had a mammogram in the last year were 80.6, 73.7, and 51.9%, respectively. The frequency of clinical breast examinations parallelled mammography usage at slightly higher percentages. Mammogram usage increased with higher education, income, and insurance coverage. Usage decreased in women age 75 years or older (ever 63.1%, in the last 3 years 58.2%, and in the last year 40.4%). Farm women were generally knowledgeable about symptoms and signs of breast cancer and understood the benefit of screening. There was, however, a range of answers on when to start or stop having a mammogram. Among farm women who reported not having a mammogram recently, the most important reasons were: haven't had any problems (29.4%), wasn't recommended by a doctor (14.3%), and procrastinated (11.3%). CONCLUSIONS: Farm women in this survey reported having had breast cancer screening at rates similar to or above those in the general population. Because of a limited response rate (63.5%) and the relative affluence of the farming community in the 4 counties surveyed, these results are probably not generalizable to all populations of farm or rural women.

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PubMed2000

The role of the nurse in developing cancer screening programs.

PURPOSE/OBJECTIVE: To describe and provide an overview of the role that nurses can play in developing cancer screening programs. DATA SOURCES: Published articles, book chapters, and clinical experience. DATA SYNTHESIS: Many approaches and considerations are available for developing cancer screening programs. Planning considerations include needs assessment, patient-education strategies, funding, recruitment issues, follow-up strategies, staffing, policy development, and evaluation. An understanding of these considerations may lead to more effective cancer screening programs. CONCLUSIONS: Nurses can play an integral role in the development and management of cancer screening programs. Careful program planning may enhance this process. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses need to consider a wide range of issues when developing cancer screening programs, including the purpose of the program, how the program will be implemented, the population being served, and the potential impact on individuals being served.

Financial Support↗

PubMed2004

[A survey regarding the implementation of cancer screening among municipalities in Japan].

OBJECTIVE: The objective of this study was to conduct a survey regarding implementation of cancer screening in all municipalities in Japan. METHODS: In February 2003, we sent out a questionnaire regarding cancer screening to all 3,242 municipalities in Japan. RESULTS: A total of 2,342 municipalities (72.2%) completed and returned the questionnaire. In the year 2002, the percentages of municipalities which implemented each cancer screening were 49.4% for breast cancer using mammography, 33.7% for prostate cancer, 20.3% for cervical cancer for women younger than 30 years old, 5.7% for lung cancer using helical CT, 5.0% for gastric cancer using the PG method and 4.8% for ovarian cancer. CONCLUSIONS: Screening for breast cancer using mammography, as recommended by the 4-th plan for Health Services for the Aged, was implemented by less than half of the municipalities. Parameters, including eligible age group, target group, and method, widely differed among the municipalities. A standardized system for cancer screening programs should be recommended.

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PubMed2004

The Quebec Association of Gastroenterology position paper on colorectal cancer screening - 2003.

Colorectal cancer is a leading cause of death and the third most common cancer in Canada. Evidence suggests that screening can reduce mortality rates and the cost effectiveness of a program compares favourably with initiatives for breast and cervical cancer. The objectives of the Association des gastro-entérologues du Québec Task Force were to determine the need for a policy on screening for colorectal cancer in Quebec, to evaluate the testing methods available and to propose one or more of these alternatives as part of a formal screening program, if indicated. Fecal occult blood testing (FOBT), endoscopy (including sigmoidoscopy and colonoscopy), barium enema and virtual colonoscopy were considered. Although most clinical efficacy data are available for FOBT and sigmoidoscopy, there are limitations to programs based on these strategies. FOBT has a high false positive rate and a low detection yield, and even a combination of these strategies will miss 24% of cancers. Colonoscopy is the best strategy to both detect and remove polyps and to diagnose colorectal cancer, with double contrast barium enema also being a sensitive detection method. The Task Force recommended the establishment, in Quebec, of a screening program with five- to 10-yearly double contrast barium enema or 10-yearly colonoscopy for individuals aged 50 years or older at low risk. The program should include outcome monitoring, public and professional education to increase awareness and promote compliance, and central coordination with other provincial programs. The program should be evaluated; specific billing codes for screening for colorectal cancer would help facilitate this. Formal feasibility, effectiveness and cost-effectiveness studies in Quebec are now warranted.

Barium Sulfate↗

PubMed2000

Performance of screening mammography in organized programs in Canada in 1996. The Database Management Subcommittee to the National Committee for the Canadian Breast Cancer Screening Initiative.

BACKGROUND: The results of randomized trials show that breast cancer screening by mammography reduces breast cancer mortality by up to 40% in women aged 50-69 years. Because of these results, by 1998, 22 countries, including Canada, had established population-based organized screening programs. This paper presents the results of screening mammography in 1996 for 7 provincially organized breast cancer screening programs in Canada. METHODS: Analyses of interim performance indicators for screening mammography have been calculated from data submitted to the Canadian Breast Cancer Screening database. The data set consisted of data from 7 provincial programs and was limited to mammographic screens for women aged 50-69 years (n = 203,303). Screening outcomes and performance indicators were calculated for abnormalities detected by screening mammography only. RESULTS: The abnormal recall rate was 9.5% for first screens and 4.6% for subsequent screens, and the cancer detection rate per 1000 women screened was 6.9 for first screens and 3.8 for subsequent screens. The positive predictive value (i.e., the proportion of women who tested positive by mammography who were found to have breast cancer on screen-initiated diagnostic work-up) increased from 7.2% at the first screen to 8.2% at subsequent screens. Estimated participation rates within organized programs varied from 10.6% to 54.2%, depending on the province. INTERPRETATION: For 1996, organized breast cancer screening programs met or exceeded many of the interim measures used in international programs. It is possible to translate the benefits of breast cancer screening by mammography, as demonstrated in randomized trials, into population-based community programs. Screening mammography through organized programs should increase to allow more comprehensive monitoring in Canada.

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PubMed2001

Ethnic influences on body awareness, trait anxiety, perceived risk, and breast and gynecologic cancer screening practices.

PURPOSE/OBJECTIVES: To examine ethnic influences on body awareness, trait anxiety, perceived risk, and breast and gynecologic cancer screening practices. DESIGN: Descriptive, correlational secondary analysis. SETTING: Urban and rural home and community populations. SAMPLE: 233 women: 138 (59%) Caucasian, 37 (17%) African American, 29 (12%) Hispanic, and 29 (12%) American Indian women (X = 46.86 years) were recruited through mailings, churches, and community organizations. METHODS: Structured questionnaires. MAIN RESEARCH VARIABLES: Body awareness, trait anxiety, perceived risk, and breast and gynecologic cancer screening practices. FINDINGS: Ethnicity predicted breast and gynecologic cancer screening practices (except clinical breast examination), body awareness, trait anxiety, and perceived risk. Hispanic and American Indian women reported greater breast self-examination frequency than Caucasian and African American women. Caucasian and African American women reported more mammogram use than Hispanic and American Indian women. Increased body awareness was related to fewer gynecologic exams for American Indian women. CONCLUSIONS: Women of different ethnic backgrounds respond differently to breast and gynecologic cancer screening practices. The influence of psychosocial variables on these practices varied with different groups. IMPLICATIONS FOR NURSING PRACTICE: Nursing interventions to increase breast and gynecologic cancer screening should be ethnic-specific, with particular attention to the meaning of body awareness to American Indian women and trait anxiety and perceived risk to African American women.

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PubMed2005

Prostate cancer screening attitudes and continuing education needs of primary care physicians.

BACKGROUND: In May 2003, a survey questionnaire was distributed to all licensed primary care physicians in Newfoundland and Labrador. The objective was to examine the attitudes, self-reported practices, and continuing medical education (CME) preferences of primary care physicians as they pertain to prostate cancer screening. METHODS: Data was obtained from 485 primary care physicians using self-reports of prostate cancer screening practices, attitudes towards prostate cancer screening, and CME preferences. Respondents' characteristics were also collected (eg, gender, years of experience). RESULTS: A majority of respondents screen asymptomatic male patients for prostate cancer. Screening behaviour was related to high volume practice settings, fee-for-service and increased with patient age. Most common reasons for screening were family history, age of patient, and patient request. Majority of physicians agreed that prostate screening should be routinely performed on all men beginning at age 50, however half of physicians believe there is lack of evidence to support digital rectal examination (DRE) and one-third of physicians do not believe the prostate-specific antigen (PSA) nor DRE are accurate screening tests. Areas of greatest interest for CME included topics related to prostate cancer screening effectiveness, strategies for prevention, sexual dysfunction, available treatments and their side effects, and management options. CONCLUSION: Physicians are supportive of the value of screening, however the reliability of and evidence to support DRE and PSA as prostate cancer screening tests are in question. CME which addresses issues surrounding prostate screening and areas related to patient education and counselling are of greatest need.

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PubMed2004

Factors associated with colorectal cancer screening in a population-based study: the impact of gender, health care source, and time.

INTRODUCTION: The effectiveness of colorectal cancer screening in reducing incident colorectal cancer and the risk of death has been shown. Despite campaigns to promote the benefits of and use of colorectal cancer screening, most people are not participating in screening. In this paper, we examine factors associated with screening behavior over time, by health care provider, and by gender and report associations between screening and development of colorectal cancer after adjusting for diet and lifestyle factors. METHODS: Data from two population-based case-control studies of colorectal cancer were used to examine risk associations with nonparticipation in colorectal cancer screening. Study participants were identified for the first study between 1991 and 1994 (N = 1,346 cases and 1,544 controls) and for the second between 1997 and 2001 (N = 952 cases and 1,205 controls) and were asked to complete a detailed in-person interviewer-administered diet and lifestyle questionnaire. The control population is used to examine changes in screening behavior and associations with screening over time. RESULTS: Significantly, fewer people reported fecal occult blood test (FOBT) in 1997-2001 than in 1991-1994 (62.5% in 1991-1994 vs. 47.2% in 1997-2001); a slight nonsignificant increase in sigmoidoscopy screening was reported for these periods among controls (33.9% vs. 36.6%). In the control population, during these periods, there was a statistically significant increase in the number of people who reported having had a sigmoidoscopy for screening rather than for problems (72.6% in 1997-2001 vs. 63.8% in 1991-1994). There were differences in factors associated with screening behavior by time, by sex, and by health care provider, although having a family history of colorectal cancer, having more education, and being male was associated with more screening in all settings. After adjusting for diet and lifestyle factors, we observed that non-sigmoidoscopy screening significantly influenced risk of incident cancer (rectal OR: 2.9; 95% CI, 2.3-3.7; distal tumor OR: 1.8; 95% CI, 1.4-2.3); proximal tumor: 1.4; 95% CI, 1.1-1.8). Nonuse of FOBT also was associated significantly with tumors in the rectal (OR: 1.6; 95% CI, 1.3-1.9) and distal (OR: 1.4; 95% CI, 1.1-1.8) sites. SUMMARY: These data reinforce the importance of screening to reduce risk of colorectal cancer development. However, flexible sigmoidoscopy screening is increasing only modestly over time, and primarily in settings where a significant investment in screening has been made. FOBT screening, which is effective for rectal cancer prevention, is actually decreasing.

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PubMed1998

Prostate cancer screening--a physician survey in Missouri.

This study investigated prostate cancer screening practices using prostate specific antigen testing (PSA), digital rectal examination (DRE), and transrectal ultrasonography (TRUS) by primary care physicians in Missouri. In 1993, a mail survey was sent to a stratified random sample of 750 physicians whose primary specialty was general practice, family practice, or internal medicine. Three separate mailings resulted in an overall adjusted response rate of 60 percent. Ninety-five percent of physicians were more inclined to use PSA compared with three years previously, with only 45 percent of physicians more inclined to use DRE. An increase in the use of PSA following a negative DRE was reported by 85 percent and a greater inclination to use TRUS following a positive PSA was reported by 90 percent Eighty-six percent agreed with the American Cancer Society (ACS) guidelines on prostate cancer screening. Using logistic regression adjusted across levels of demographic and practice factors, prevalence odds ratios were derived with results indicating that agreement with ACS guidelines and being in private practice are strong predictors of a physician's inclination to routinely screen asymptomatic patients for prostate cancer. Our findings have provided baseline information on prostate cancer screening in Missouri and suggest that primary care physicians view PSA testing as a useful procedure and appear to be using it in a manner similar to the general pattern seen across the country.

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PubMed2006

Lower risk of death from gastric cancer among participants of gastric cancer screening in Japan: a population-based cohort study.

OBJECTIVE: This study aimed to investigate the association between gastric cancer screening and mortality from gastric cancer. METHODS: In 1990, 47,605 Japanese subjects were recruited and completed a questionnaire about participation in gastric cancer screening and life-style. We followed up their vital status through December 2001. In this cohort, 41,394 subjects without a history of cancer were allocated to the screened group or the unscreened group according to their response to the question about gastric cancer screening. We estimated the relative risk (RR) of death from gastric cancer, death from any cause except gastric cancer, and incidence of gastric cancer with adjustment for potential confounding variables. RESULTS: The risk of death from gastric cancer among the screened group was significantly lower than that among the unscreened group. The multivariate RR of death from gastric cancer for screened individuals compared with those not screened was 0.54 (95% confidence interval [CI]: 0.38, 0.77). The RR of death from any cause except gastric cancer was 0.83 (95% CI: 0.77, 0.90), and the RR of incidence of gastric cancer was 0.94 (95% CI: 0.79, 1.13). CONCLUSION: Our data suggest that gastric cancer screening or factors associated with it may be associated with lower mortality from gastric cancer.

Adult↗

PubMed2001

Breast cancer screening discussions for women in their forties.

Studies of the effectiveness of breast cancer screening for women in their forties show that the probability of benefit is relatively small and, for some women, may be outweighed by the probability of harm. Thus, screening for breast cancer in this age group is a "close call" on which reasonable women may disagree. Many women in their forties, however, are being screened. We suggest that few truly understand the issues involved in this decision. In this paper, we examine the potential benefits and harms of breast cancer screening for women ages 40-49 and consider a strategy for helping women make informed decisions about screening: shared decision making. Shared decision making involves framing breast cancer screening as a decision that could reasonably be decided either for or against screening; giving the patient evidence-based information about the decision in an understandable format; and assisting the patient to use her values to close on a decision. We believe that this approach will eventually become the standard of care not only for breast cancer screening for women in their forties, but for older women (and other issues), as well.

Journal Article↗

PubMed1994

Effect of social networks on cancer-screening behavior of older Mexican-American women.

BACKGROUND: Previous studies have determined that Hispanic women and, in particular, Mexican-American women have the lowest rates of cancer screening of any race and ethnic group in the United States. In the development of cancer control strategies for this population, little attention has been given to factors that encourage Mexican-American women to seek cancer preventive care. Recent studies suggest that social networks can have a positive influence on cancer-screening participation. PURPOSE: We determined the extent to which differences in social networks account for variations in breast and cervical cancer-screening practices among low-income Mexican-American women. METHODS: The data analyzed in this study were obtained from a baseline survey of knowledge, attitudes, and cancer-screening practices conducted prior to implementation of community interventions designed to improve Pap smear and mammography screening in low-income Mexican-American women 40 years old and older living along the U.S.-Mexican border in El Paso County, Texas. A random selection of 1300 households served as a sampling frame to identify Mexican-American women 40 years old and older for personal interviews. Of the 549 households identified as having at least one eligible female, 450 women completed the personal interviews that provided the data for this study. Personal interviews solicited information on age, income, marital status, place of birth, education, health insurance coverage, Pap smear- and mammogram-screening practices, and six questions relating to social network. A social network score was assigned to each woman by summation of the following six variables: number of confidants, number of close friends, number of close relatives, frequency of contact with these close friends or relatives per month, church membership, and church attendance. Women were grouped into three linear strata of social network (low, medium, high) based on tertiles of the scores. Cancer-screening history was also ascertained during the interview. RESULTS: The 2-year prevalence of Pap smear and mammography use increased with social network. For each gain in social network level (low, medium, high), adjusted for sociodemographic factors, the odds ratio for Pap smear use was 1.33 (95% confidence interval = 1.02-1.73); it was 1.40 (95% confidence interval = 1.02-1.93) for mammogram use. Of the six social network components, the number of close friends was the most important predictor of mammography (P = .002) and Pap smear (P = .025) screening. CONCLUSION: Social networks appear to be an important determinant of cancer-screening behavior among low-income, older Mexican-American women.

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PubMed1999

Breast cancer screening among African American women: addressing the needs of African American women with known and no known risk factors.

Breast cancer is the single most common form of cancer observed in African American women. Yet, in spite of the advances that have been made in the area of breast cancer detection and treatment, breast cancer continues to be their leading cause of cancer death. Many experts believe that breast cancer mortality among African American women could be significantly reduced if breast cancer screening recommendations were more effectively used. However, little is known about the breast cancer screening behaviors of women with known and no known risk factors. An exploratory study was therefore undertaken to gain a broader understanding of the breast cancer screening behaviors of African American women. Attempts were also made to determine if age, type of medical services used, breast cancer risk factors, or provider discussions influenced compliance with screening guidelines. Breast cancer screening procedures were found to be markedly under-used by the African American women in the study sample. However, the data suggested that if health care providers provide women with information regarding their personal breast cancer risk and make a personalized recommendation for their breast cancer screening, greater compliance with screening guidelines would occur.

Adult↗

PubMed1998

Associations of demographic and health-related characteristics with prostate cancer screening in Washington State.

This report describes associations of demographic and health-related characteristics with use of prostate cancer screening. Data are from a random-digit dial survey of Washington State residents. Analyses are restricted to men ages 40-79 years (n = 332) and examine both digital rectal examination (DRE) and blood tests for prostate-specific antigen (PSA) in the previous 2 years. Results are adjusted to be representative of the state's population. In 1996, 53.6% of men received either DRE, PSA, or both. Among those screened, 42% received DRE alone, 15% PSA alone, and 43% both PSA and DRE, and the percentages of men receiving PSA increased markedly with age (30%, ages 40-49 years; 58%, ages 50-59 years; and 77%, ages 60-79 years). After control for other demographic characteristics, the relative odds for any prostate cancer screening were 5.5 for ages 60-79 versus 40-49 years, 2.4 for 16+ versus < or = 12 years of education, and 4.0 for 2+ versus no physician visits in the previous 2 years (all P < 0.05). Characteristics generally associated with good health, including regular exercise and low fat and high fruit and vegetable intakes, were also significantly associated with prostate cancer screening. In conclusion, in 1996, approximately one-half of the men in Washington State over age 40 years had received prostate cancer screening in the previous 2 years. Few men were screened with PSA alone, and the use of PSA as part of prostate cancer screening increased markedly with age. Because PSA screening increases detection of prostate cancer, epidemiological studies of health behavior and cancer risk must carefully control for screening history to avoid detection bias.

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PubMed2006

Predictors of breast cancer screening among immigrant Iranian women in California.

OBJECTIVE: This study examined the predictors of age-specific breast cancer screening participation among immigrant Iranian women aged 30 years and older. METHODS: Logistic regression was used to identify predictors of women's breast cancer screening. The logistic regression results appear as odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: In general, screening rates for clinical breast examinations (CBE) and mammography among the participants in the current study were higher than levels set in the year 2010 Health Objectives and those reported for women nationally. These findings are inconsistent with previous studies on immigrant women living in the United States. However, the low rate of breast self-examinations (BSE) is consistent with previous findings of other immigrant women breast cancer screening studies. CONCLUSIONS: This study is the first of its kind to explore predictors of Iranian immigrant women's breast cancer screening behaviors. This study provides valuable information to healthcare providers as well as researchers and public health educators. The findings can make a significant difference in designing guidelines for culturally sensitive interventions and educational material to improve breast cancer screening behaviors.

Adult↗

PubMed2006

Cancer screening in older adults in an era of genomics and longevity.

OBJECTIVES: To provide an overview of cancer genomics and cancer screening in older adults with a focus on breast, prostate, and colon cancers. DATA SOURCES: Journal articles, research articles, and web sites. CONCLUSION: Cancer screening in older populations is often in the context of one or more co-morbid conditions, cancer survivorship, genomic information, and competing health priorities. The field of cancer screening has outgrown the tools available to enable health care providers and older adults to make informed cancer screening decisions. Research is needed to develop clinical screening tools that integrate age, cancer risk, life expectancy, and comorbidity. IMPLICATIONS FOR NURSING PRACTICE: Health care providers are faced with opportunities and challenges in the prevention and early detection of cancer in older Americans.

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