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PubMed2005

Men's experiences of physical exams and cancer screening tests: a qualitative study.

BACKGROUND: American men have lower overall rates of cancer screening than women. This study was designed to elicit men's health care experiences and knowledge of testicular, prostate, and colorectal cancer (CRC) screening. METHODS: Fifty-three men participated in eight physician-led semistructured focus groups in Rhode Island and New Hampshire. Four groups (ages 18-35; N = 20) discussed testicular cancer screening. Four groups of older men (ages 40-79; N = 33) discussed prostate and colorectal cancer screening. RESULTS: Men in this study prefer physicians who establish interpersonal relationships with male patients. Lack of explanations during physical exams resulted in negative experiences. Men were eager to learn more about their health, but commonly complained that they received neither appropriate cancer screening nor sufficient explanations from their physicians. When PSA screening was offered, discussion was often inadequate. Although men expressed interest in participating in the PSA decision, sole responsibility for this complex decision was seen as undesirable. These men desired more discussion and better sources of health information during medical encounters. CONCLUSIONS: Clinician attention to communication, relationship building, patient education, and consideration for patient privacy and modesty are important for the care of male patients especially with sensitive exams and topics important to men's cancer screening.

Adult↗

PubMedDate not supplied

Cancer screening in the community. Taking the show on the road.

PURPOSE: The authors describe the efforts involved in improving cancer screening of an underserved population using a mobile clinic to bring these services to the community. The background, methods, results, and implications are discussed, as are the logistics of packing, scheduling, and providing follow-up. OVERVIEW: Members of the University of Pittsburgh Cancer Institute Cancer Prevention and Early Detection Program developed a cancer screening program to serve the underserved communities in the Pittsburgh area. The African American Cancer Screening Program has presented the staff with significant challenges. The most significant of those challenges has been taking the most comprehensive screening program to the areas convenient to clients. Although coordinating staff, materials, and transportation was a challenge, the logistical problems involved were resolved, allowing for the opportunity to "take the show on the road". CLINICAL IMPLICATIONS: Because the mortality rate from some cancers is higher in black Americans, early cancer screening and detection is crucial in this population. The establishment of a mobile cancer screening clinic allows underserved communities access to these services. The physical screening, educational counseling, scheduling of mammographies and flexible sigmoidoscopies, and meticulous follow-up provided through the mobile clinic may lead to a greater awareness and reduced morbidity and mortality from cancer in these communities.

Black or African American↗

PubMed2002

Colorectal cancer screening with double-contrast barium enema: a national survey of diagnostic radiologists.

OBJECTIVE: This article describes diagnostic radiologists' colorectal cancer screening activities and beliefs about screening effectiveness and future capacity for screening with double-contrast barium enema, and compares radiologists' opinions about colorectal cancer screening with those of primary care physicians. MATERIALS AND METHODS: We surveyed a nationally representative sample of diagnostic radiologists. Of 381 eligible radiologists, 312 (82%) responded. Descriptive statistics and chi-square tests were used to assess radiologists' opinions about double-contrast barium enema volume and capacity and to compare radiologists' beliefs about colorectal cancer screening with those of primary care physicians. Logistic regression was used to identify characteristics of radiologists who receive referrals for or perform a higher volume of screening double-contrast barium enema and of those who expect the volume of double-contrast barium enemas to increase. RESULTS: Seventy-five percent of radiologists said that double-contrast barium enema is a "very effective" colorectal cancer screening procedure compared with 33% of primary care physicians. Although 86% of radiologists reported performing one or more screening double-contrast barium enema procedures during a typical month, only 27% indicated that they did so 11 or more times. Fifteen percent of radiologists said that their double-contrast barium enema volume had increased over the past 3 years, and 50% expect an increase over the next 3 years. Only 8% said that the capacity of facilities and personnel to meet the demand for double-contrast barium enemas in their geographic area of practice is inadequate. Geographic region and belief in double-contrast barium enema efficacy were predictors of double-contrast barium enema volume and referrals. CONCLUSION: Most diagnostic radiologists perform colorectal cancer screening with double-contrast barium enema, but procedure volumes are modest. Because primary care physicians view double-contrast barium enema less positively than do radiologists, radiologists' expectations for an increased volume of double-contrast barium enemas over the next few years may not be realized.

Adult↗

PubMed2004

Colorectal cancer screening knowledge, attitudes, and beliefs among veterans: does literacy make a difference?

PURPOSE: To evaluate whether lower literacy is associated with poorer knowledge and more negative attitudes and beliefs toward colorectal cancer screening among veterans without recent colorectal cancer screening. PATIENTS AND METHODS: Three hundred seventy-seven male veterans, age 50 years and older, who had not undergone recent colorectal cancer screening, were surveyed about their knowledge, attitudes, and beliefs regarding colorectal cancer screening. Patients' literacy was assessed with the Rapid Estimate of Adult Literacy in Medicine, an individually administered screening test for reading. RESULTS: Thirty-six percent of the 377 men had an eighth grade literacy level or higher. Men with lower literacy were 3.5 times as likely not to have heard about colorectal cancer (8.8% v 2.5%; P =.006), 1.5 times as likely not to know about screening tests (58.4% v 40.9%; P =.0001), and were more likely to have negative attitudes about fecal occult blood testing (FOBT), but not about flexible sigmoidoscopy. Specifically, men with lower literacy skills were two times as likely to be worried that FOBT was messy (26.7% v 13.3%; P =.008), 1.5 times as likely to feel that FOBT was inconvenient (28.7% v 18%; P =.05), and four times as likely to state they would not use an FOBT kit even if their physician recommended it (17.9% v 4.0%; P =.02). CONCLUSION: Limited literacy may be an overlooked barrier in colorectal cancer screening among veterans.

Aged↗

PubMed1999

Cervical cancer screening knowledge, behaviors, and beliefs of Vietnamese women.

PURPOSE/OBJECTIVES: To describe the knowledge, beliefs, and practices of cervical cancer screening of Vietnamese women who have migrated to the United States. DESIGN: Exploratory, descriptive. SETTING: Five Vietnamese churches in southeastern Louisiana. SAMPLE: Nonprobability sample of 96 adult Vietnamese migrant women. METHODS: Data were collected by a bilingual nurse during face-to-face interviews conducted in the language preferred by the subjects (English or Vietnamese). MAIN RESEARCH VARIABLES: Cervical cancer screening knowledge, behaviors, and beliefs. FINDINGS: Three fourths of the Vietnamese women interviewed could not correctly explain what a Pap test is used for, and few were aware that the most commonly occurring cancer in Vietnamese females in the United States is cervical cancer. Most believed that their risk of cervical cancer was low. Less than half reported ever having had a Pap test and cited not having a gynecologist, cost, and fear of the test as reasons for not ever having had the test done. CONCLUSIONS: The number of Vietnamese women who adhere to cervical cancer screening guidelines is low. Cultural beliefs and structural barriers influence the choices that Vietnamese women make regarding Pap test utilization. IMPLICATIONS FOR NURSING PRACTICE: When planning programs to promote cervical cancer screening, nurses must target those at greatest risk--Vietnamese women. Culturally sensitive educational interventions and cervical cancer screening programs for Vietnamese women are needed to increase Pap test utilization and the early detection of cervical cancer.

Adolescent↗

PubMed2003

Finding and interpreting cancer screening guidelines: an oncology nursing challenge.

It is our hope that increased awareness of cancer screening recommendations will initiate a dialogue between individuals and their health care providers. Organizational screening recommendations differ as a result of evolving technology, financial and ethical considerations, and impact on mortality. It is through discussions with informed health care providers that patients and families will determine the most effective personal cancer screening strategies. We are hopeful that this discussion of cancer screening recommendations will encourage other oncology nurses to identify their provincial screening guidelines and to address them in discussions with people living with cancer, family members, community groups, and friendship circles. For those cancers where early detection correlates with improved survival, regular screening may have a direct impact on individual lives. We challenge you to implement strategies to incorporate cancer screening information in your professional and personal relationships.

Breast Neoplasms↗

PubMed2001

Cancer screening in elderly patients: a framework for individualized decision making.

Considerable uncertainty exists about the use of cancer screening tests in older people, as illustrated by the different age cutoffs recommended by various guideline panels. We suggest that a framework to guide individualized cancer screening decisions in older patients may be more useful to the practicing clinician than age guidelines. Like many medical decisions, cancer screening decisions require weighing quantitative information, such as risk of cancer death and likelihood of beneficial and adverse screening outcomes, as well as qualitative factors, such as individual patients' values and preferences. Our framework first anchors decisions through quantitative estimates of life expectancy, risk of cancer death, and screening outcomes based on published data. Potential benefits of screening are presented as the number needed to screen to prevent 1 cancer-specific death, based on the estimated life expectancy during which a patient will be screened. Estimates reveal substantial variability in the likelihood of benefit for patients of similar ages with varying life expectancies. In fact, patients with life expectancies of less than 5 years are unlikely to derive any survival benefit from cancer screening. We also consider the likelihood of potential harm from screening according to patient factors and test characteristics. Some of the greatest harms of screening occur by detecting cancers that would never have become clinically significant. This becomes more likely as life expectancy decreases. Finally, since many cancer screening decisions in older adults cannot be answered solely by quantitative estimates of benefits and harms, considering the estimated outcomes according to the patient's own values and preferences is the final step for making informed screening decisions.

Aged↗

PubMed1995

Cancer knowledge, self-efficacy, and cancer screening behaviors among Mexican-American women.

Latina women are at significantly greater risk of death from cancer than Anglo women in the United States. Reasons for this include a lack of knowledge regarding cancer, lack of access to cancer screening services, and feelings of fatalism. This study was designed to determine the relationship between cancer knowledge and cancer screening self-efficacy in this population. One hundred twelve Mexican-American women living in southern Texas were surveyed regarding their self-efficacy toward engaging in age-appropriate cancer screening activities. Each subject answered questions related to knowledge and self-efficacy in four topical areas; general cancer knowledge, cervical cancer and Pap smears, breast cancer and breast self-examination (BSE), and colorectal cancer and sigmoidoscopy. A majority of the responders had significant misconceptions related to cancer causation, symptoms, and treatment and expressed feelings of little control over prevention of the disease. Only a minority felt that they could undergo the appropriate screenings, even if they were available. There were strong relationships between all of the knowledge variables examined, and between knowledge and self-efficacy related to BSE and colorectal cancer screening. Strong relationships were not found for the areas of Pap smears and general cancer knowledge. The results suggest that increased knowledge is associated with increased self-efficacy for cancer screening.

Female↗

PubMed1999

Mammography requests in general practice during the introduction of nationwide breast cancer screening, 1988-1995.

Introducing an organised breast cancer screening programme for certain age groups in a population might induce opportunistic screening in adjacent (non-invited) age groups and influence health behaviour in the target population. We analysed the effect of the start of the Dutch national screening programme on the number of mammographies requested by 43-45 general practices for the age groups 30-39, 40-49, 50-69 and 70+ years, using logistic regression analysis. In all age groups an immediate increase was observed in the number of mammography requests after the start of the screening, which was largest and statistically significant in the target population of the screening programme (age 50-69 years). More than 2 years after the start of screening, the number of mammography requests in all age groups had decreased to the level before the start and in the age group 50-69 years the number of mammographies was significantly lower than before the screening started. The unexpected increase in mammographies after the start of the breast cancer screening programme might be related to registry problems or to the process of building up the screening programme. Eventually there was a decrease in the number of mammographies in the target population, probably an effect of the introduction of the national screening programme. Opportunistic screening was not clearly demonstrated in adjacent age groups.

Adult↗

PubMed2005

Persistent demographic differences in colorectal cancer screening utilization despite Medicare reimbursement.

BACKGROUND: Colorectal cancer screening is widely recommended, but often under-utilized. In addition, significant demographic differences in screening utilization exist. Insurance coverage may be one factor influencing utilization of colorectal cancer screening tests. METHODS: We conducted a retrospective analysis of claims for outpatient services for Washington state Medicare beneficiaries in calendar year 2000. We determined the proportion of beneficiaries utilizing screening fecal occult blood tests, flexible sigmoidoscopy, colonoscopy, or double contrast barium enema in the overall population and various demographic subgroups. Multiple logistic regression analysis was used to determine the relative odds of screening in different demographic groups. RESULTS: Approximately 9.2% of beneficiaries had fecal occult blood tests, 7.2% had any colonoscopy, flexible sigmoidoscopy, or barium enema (invasive) colon tests, and 3.5% had invasive tests for screening indications. Colonoscopy accounted for 41% of all invasive tests for screening indications. Women were more likely to receive fecal occult blood test screening (OR 1.18; 95%CI 1.15, 1.21) and less likely to receive invasive tests for screening indications than men (OR 0.80, 95%CI 0.77, 0.83). Whites were more likely than other racial groups to receive any type of screening. Rural residents were more likely than urban residents to have fecal occult blood tests (OR 1.20, 95%CI 1.17, 1.23) but less likely to receive invasive tests for screening indications (OR 0.89; 95%CI 0.85, 0.93). CONCLUSION: Reported use of fecal occult blood testing remains modest. Overall use of the more invasive tests for screening indications remains essentially unchanged, but there has been a shift toward increased use of screening colonoscopy. Significant demographic differences in screening utilization persist despite consistent insurance coverage.

Age Distribution↗

PubMed2000

Colorectal cancer screening and surveillance practices by primary care physicians: results of a national survey.

OBJECTIVE: Screening for colorectal cancer reduces its morbidity and mortality and is cost-effective. Screening is usually the responsibility of primary care physicians who may be unsure about its implementation. We aimed to assess primary care physicians' knowledge and practice regarding colorectal cancer screening, and to compare their responses with those of three national experts and with published guidelines. METHODS: We mailed a postal questionnaire to 2,310 primary care physicians regarding demographics, nature of practice, use of screening tests, and six hypothetical patients who may have been candidates for screening or surveillance. We used published national guidelines and the collective opinions of the three external experts as the so-called "gold standard." RESULTS: Of all respondents, 85.1% offered colorectal cancer screening. Most used suitable tests, starting at an appropriate age; 49.8% continued screening indefinitely irrespective of patients' age and 43.6% performed fecal occult blood testing without appropriate dietary advice to patients. Also, respondents frequently performed this test for inappropriate indications. Only 51.8% would follow a positive fecal occult blood test with colonoscopy. CONCLUSIONS: Colorectal cancer screening practices by primary care physicians vary considerably from those recommended. Many offer screening to individuals in whom it is not appropriate, and continue it into advanced age. Frequent, inappropriate use of fecal occult blood tests will produce many false positives. Primary care physicians often do not appropriately follow a positive test. Further educational efforts are needed in an attempt to improve practice and further reduce the morbidity and mortality from colorectal cancer.

Colorectal Neoplasms↗

PubMed1994

Accuracy of self-report for stomach cancer screening.

Limited evidence is available regarding the accuracy of recall for cancer screenings. We compared the self-report of stomach cancer screening with medical records in 337 residents of a rural town in northeastern Japan, who were eligible for annual screening offered by the town. Frequencies of attendance within the last 5 years were asked in a self-administered questionnaire, and determined from the records of the organization conducting the screening. When the frequencies were dichotomized as ever/never screened within 5 years, the self-report agreed substantially with medical records, but tended to overestimate the actual attendance (kappa = 0.68, sensitivity = 100%, specificity = 75.6%). Past history of gastroduodenal diseases and family history of stomach cancer were associated with the overreport. Although the population studied was highly selective (rural Japanese volunteers), review of the previous studies on mammography and Pap smear also showed that self-reports tended to be exaggerated. Self-report of cancer screening should be regarded as an overestimated indicator of its true prevalence.

Female↗

PubMedDate not supplied

Flexible sigmoidoscopy as a colorectal cancer screening test in the general population: recruitment phase results of a randomized controlled trial in Lombardia, Italy.

UNLABELLED: A two arm multicentre randomized controlled trial is in progress to evaluate the efficacy of flexible sigmoidoscopy (FS) as a screening test for colorectal cancer in the general population. AIMS: To determine the acceptance rate and feasibility of FS as a colorectal cancer screening test in average-risk asymptomatic volunteers. Average-risk, asymptomatic subjects, aged 55-64 years and assisted by 244 general practitioners (GPs) in Lombardy, Italy, were invited by postal questionnaire (PQ) to enter a study for the prevention of colorectal cancer and asked to indicate their interest in, and willingness to undergo, screening: those responding positively were randomized to the intervention or control arms. GPs were trained in colorectal cancer screening and proposed free FS to their patients randomized to the intervention arm. All sigmoidoscopies were performed by experienced endoscopists. Small polyps were removed at FS. Colonoscopy was indicated for high risk polyps (size more than 5 mm, more than two adenomas, villous histology, severe dysplasia or malignancy). 40,945 subjects were invited. 667 PQs were returned undelivered due to postal failure. 7,892 (19.59%) subjects responded, 2,116 of whom (26.81%) were not included, presenting 1 or more exclusion criteria. We randomized 5,778 volunteers and performed 1,582 sigmoidoscopies out of 2,885 subjects in the intervention arm (54.84% acceptance rate). Although the screening procedure had a good attendance rate in the intervention group, involvement of the people invited was lower than expected. Future FS screening programmes will require a keener focus on recruitment strategies, mainly with participation of GPs.

Colorectal Neoplasms↗

PubMed1995

The limitations of breast cancer screening for first-degree relatives of breast cancer patients.

Bitter controversy surrounds the recommendation of mammographic breast-cancer screening for women aged 40 and 49 years of average risk. This paper considers the case for screening women in their 40s with higher risk, specifically women who have one or more first-degree relatives with breast cancer. A review of the literature and of current knowledge suggests that screening such women is more cost-effective, in the sense of having a higher yield per mammogram and better predictive value, than screening women of average risk in this age group. However, there is no evidence that screening is more efficacious in reducing mortality in this subgroup than in other women in their 40s.

Adult↗

PubMed1998

The association between health care coverage and the use of cancer screening tests. Results from the 1992 National Health Interview Survey.

OBJECTIVES: The authors investigated whether utilization of six different cancer screening tests (mammography, clinical breast exam, Pap smear, Fecal Occult Blood Test, and Digital rectal exam) varied according to type of health care coverage. METHODS: Data on the use of cancer screening tests and coverage in two age groups from a 1992 nationally representative cross-sectional survey of approximately 9,400 adults were analyzed. Multiple logistic regression analysis was used to estimate proportions of persons screened according to type and extent of coverage, adjusted for socioeconomic, demographic, and health status characteristics. RESULTS: Persons aged 40 to 64 years with Medicaid coverage were equally as likely to receive five of six cancer screening tests as those with private fee-for-service coverage, and both groups were much more likely to be screened (70% higher for all six tests) than those who had no coverage. In contrast, persons aged 65 years and older who had supplemental private fee-for-service insurance in addition to Medicare were more likely to receive five of six tests than those with Medicare and Medicaid or those with Medicare only. For all six screening tests, managed care enrollees at all ages were approximately 10% more likely to be screened than persons enrolled in private fee-for-service plans. Fecal Occult Blood Test (25% versus 20%) and digital rectal exams (44% versus 38%) in persons aged 40 to 64 years and mammography (59% versus 48%) and Fecal Occult Blood Test screening (38% versus 30%) in the elderly were significantly more frequent for persons in managed care plans. CONCLUSIONS: The extent of fee-for-service insurance coverage in the traditional indemnity US health care system was positively associated with the use of cancer screening tests. The authors found less difference in use of cancer screening between managed care and fee-for-service care in 1992 than we expected based on earlier research comparing use of preventive services in health maintenance organizations with fee-for-service care.

Adolescent↗

PubMed2006

The role of GPs in increasing compliance to colorectal cancer screening: a randomised controlled trial (Italy).

AIMS: To assess the effect of the provider (GPs versus hospital) on the compliance in returning the faecal occult blood test. To analyse the characteristics of the GP associated with high compliance among his beneficiaries. METHODS: A questionnaire about screening attitudes was mailed to the 1192 GPs working in 13 districts of the Lazio region. We asked the GPs to participate in a randomised trial, we sampled 130 GPs and about 1/10 of the GPs' 50-75 year old beneficiaries (n = 3657) were invited to be screened at the GP office and 1/10 (3675) at the nearest gastroenterology centre. RESULTS: 58.5% of the GPs completed the questionnaire and 22.7% agreed to participate in the trial. The compliance in the GP arm was 50%, in the hospital arm 16% (RR 3.4; 95% CI: 3.13-3.70). There was a high variability in the compliance obtained by the GPs. GPs with more than 25 patients visited/day and those incorrectly recommended screening of colorectal cancer obtained a lower compliance (OR 0.74, 95% CI: 0.57-0.95 and OR 0.76, 95% CI: 0.59-0.97, respectively). CONCLUSIONS: The involvement of GPs in colorectal cancer screening can be very effective to enhance the compliance, but the effectiveness is dependent on their willingness to be involved.

Aged↗

PubMed2000

Cervical cancer screening in Ireland.

Screening for cervical cancer commenced in Ireland on an opportunistic basis in the late 1960s. The Data Protection Act was recently amended to allow access to specific databases for the purpose of setting up an age sex register for breast and cervical cancer screening. A pilot cervical screening programme is planned for women aged 25-60 years living in the Mid Western Area Health Board region.

Adult↗

PubMed2004

Subjective and objective analysis of the prevalence of Peyronie's disease in a population of men presenting for prostate cancer screening.

PURPOSE: In this study we defined the prevalence of Peyronie's disease in a cohort of men being screened for prostate cancer in the United States. The association between Peyronie's disease, and medical comorbidities and patient self-reported erectile dysfunction was also defined. MATERIALS AND METHODS: A total of 534 men presenting to 1 of 3 prostate cancer screening centers provided a complete medical history, underwent physical examination performed in all by a urologist and completed the Sexual Health Inventory for Men (SHIM) questionnaire. This population was chosen because of the access to a large number of subjects combined with the fact that subjects were not presenting with a specific urological complaint. The diagnosis of Peyronie's disease was based on a palpable penile plaque. Data were assessed using univariate analysis, multivariate logistic regression and Pearson chi-square analysis. RESULTS: A total of 48 patients were found to have a palpable penile plaque on physical examination for a prevalence rate of 8.9%. The mean age of men with Peyronie's disease was 68.2 years compared to a mean of 61.8 years in men without Peyronie's disease (p <0.0001). On univariate analysis hypertension (p = 0.02) and diabetes (p = 0.007) were present with significantly increased frequency in patients with Peyronie's disease. Patients diagnosed with Peyronie's disease had significantly lower values for responses to each of the 5 questions on the SHIM survey. An increase in age and decrease in total SHIM score remained significantly associated with a greater probability of Peyronie's disease on multivariate analysis. CONCLUSIONS: We found the prevalence of Peyronie's disease to be greater than in most previously reported series. We also noted a significant association between Peyronie's disease aging, hypertension, diabetes and self-reported erectile dysfunction.

Adult↗