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PubMedDate not supplied

Breast and cervical cancer screening for women between 50 and 69 years of age: what prompts women to screen?

The objective of this study was to examine mammography and cervical cancer screening rates among women aged 50 to 69 and to understand which prompts are effective for improving screening compliance. A self-administered survey was sent to 800 randomly selected participants in a health region in a relatively poor, rural province in Eastern Canada with a universal health care system. Since 1995, New Brunswick has instituted a biannual self-referral mammography screening program for women between 50 and 69 years of age. The response rate to the survey was 66%. Mammography screening compliance was 73% and was most significantly associated with annual clinical breast examinations, compliance with cervical cancer screening, and physician suggestion (p <.001). Cervical cancer screening compliance was 91% and was significantly associated with annual clinical breast examinations, compliance with mammography screening, and physician suggestion (p<.001). Contact with a physician is most effective for promoting screening compliance.

Aged↗

PubMed2001

Receipt of cancer screening procedures among Hispanic and non-Hispanic health maintenance organization members.

BACKGROUND: Hispanic Americans have been shown to receive fewer cancer screening procedures than nonminority populations. Although lack of insurance or a regular source of care appear to be important determinants, cultural factors also have been suggested. This study examines whether Hispanic patients receive cancer screening at the same rate as the non-Hispanic population when both groups have equivalent insurance and a regular source of care. METHODS: Receipt of five cancer screening procedures (mammography, Pap test, fecal occult blood testing, breast examination, and rectal examination) was determined for adult health maintenance organization (HMO) members who met appropriate age and gender criteria. Rates of receipt were compared for 2 cohorts over a 2-year period: Hispanic members identified by surname and a comparison group, a 10% random sample of the non-Spanish surnamed members. Only members with at least one HMO contact over the study period were included. Logistic regression was used to test whether being in the Hispanic group was associated with decreased likelihood of receiving the procedure at least once over the 2 years, adjusting for potential confounders. RESULTS: Among the comparison group, a high proportion received each recommended procedure at least once (0.70-0.86). The proportions were very similar for the Hispanic group (0.67-0.84). None of the rates differed statistically for the two groups. CONCLUSIONS: Hispanic HMO members received cancer screening at the same high rate as non-Hispanics, suggesting that insurance coverage and continuity of care are more important than cultural factors in determining rates of cancer screening receipt.

Adult↗

PubMed2006

Recent improvement in lung cancer screening: a comparison of the results carried out in two different time periods.

To evaluate recent improvements in lung cancer screening, we compared the results of recently conducted lung cancer screening with those of a previous screening. This study compared the survival of lung cancer patients detected by lung cancer screening conducted between 1976 and 1984 (early period) with that conducted between 1989 and 1997 (late period). Two hundred seventy-six patients with lung cancer were detected in the early period and 541 patients with lung cancer were detected in the late period. The median survival time (late : 49.8 vs. early : 27.8 months) and the 5-year survival rate (late : 47.8 vs. early : 34.8%) of the patients with lung cancer detected in the late period were significantly better than those in the early period (p = 0.0054). Among patients undergoing resection, the proportion of pathological stage I patients in the late period was significantly higher than that in the early period (late : 60.8 vs. early : 54.9%, p = 0.005). Multivariate analysis showed that the screening time period was a significant prognostic factor (hazard ratio = 0.685, 95% confidence interval : 0.563-0.832, p = 0.0002). These results were consistent with the findings of case-control studies of lung cancer screening programs in the late period recently conducted in Japan, which also showed a greater efficacy for screening than for previous case-control studies in the early period.

Adult↗

PubMed1993

Cancer screening. Knowledge, recommendations, and practices of physicians.

BACKGROUND: Americans visit their primary care physicians several times a year. These visits provide physicians with many opportunities to reduce cancer risk in their patients by recommending periodic cancer screening. There is evidence of noncompliance among primary care physicians and their patients with regard to periodic cancer screening. Barriers to screening may be perceived by physicians and patients. RESULTS: The authors found that when physicians recommended cancer screening tests, the compliance among patients was relatively high. CONCLUSION: Primary care physicians can take the opportunity to recommend cancer screening tests during routine patient visits, and this strategy may well increase cancer screening rates in the population.

Adult↗

PubMed2006

Factors of breast cancer screening among Korean immigrants in the United States.

The purpose of this paper is to assess breast cancer screening rates and explore factors related to all three measures of breast cancer screening, mammography, clinical breast examination (CBE), and breast self-examination (BSE), among Korean immigrants in the United States. A telephone survey was conducted with 189 Korean women aged 40 and older in Cook County, Illinois. Of this group, 78% had had a mammogram at some point, and 38.6% had had one within the previous year. Fifty-three percent had had a CBE, while 26.1% had had one within the previous year. Whereas 58.1% had examined their breasts before, 46.3% did monthly BSE. Korean women's breast cancer screening rates are improving even though the rates are still lower than screening rates in the United States. Having a regular check-up and being married were strongly related to all three measures of cancer screening. Further in-depth research is suggested to understand KA women's perspectives on having access to care.

Adult↗

PubMedDate not supplied

Screening mammography participation and invitational strategy: the Quebec Breast Cancer Screening Program, 1998-2000.

In the Quebec Breast Cancer Screening Program, a personalized letter signed by a regional program physician is sent to every woman in the province 50 to 69 years of age, inviting her to have a screening mammogram. A reminder letter is also frequently sent. The aim of this study was to evaluate the influence of this screening invitational strategy on rates of participation. The population studied was comprised of 684,028 women in Quebec aged 50-69. The baseline (expected) monthly mammography screening rate was estimated from the rate of screening mammograms recorded between the date a woman became eligible for screening and the mailing date of her personalized invitational letter; the observed monthly mammography screening rate was calculated after the mailing of the letter. Compared to baseline (expected) screening rates, observed rates were substantially increased (p<.05). The ratios of observed to expected rates were respectively 3.05 and 2.23 in the second and fourth months, respectively, after the letter mailing, coinciding with the mailing of the initial and reminder letters. In the twelve months after the mailing, the ratio of observed to expected rates was 1.68 (95% CI: 1.67-1.69). Twelve months following the mailing, 30 percent of the women who were letter recipients had undergone a screening mammography, compared to an expected cumulative probability of 20 percent for women not receiving a letter. The strength of this effect was similar to one seen in randomised controlled trials.

Aged↗

PubMedDate not supplied

Promotion of breast cancer screening in a work site population.

We investigated whether attitudes, intentions, and practices regarding breast cancer screening by mammography and clinical breast examination could be positively influenced through a brief educational intervention administered to women employees at diverse work sites. The educational intervention involved the mailing of American Cancer Society brochures that discussed breast cancer screening and contained guidelines on the recommended frequency for each screening modality according to age. Effects of the intervention were measured through pre/post questionnaires. The results were positive for the entire group of women who participated, as evidenced by their increased perception of the importance of mammography and clinical breast examination and of the priority of getting a mammogram regularly, their decreased perception of mammography as an uncomfortable procedure, and the increased frequency of discussions of breast cancer screening at work. Employers, particularly large corporations and agencies, must realize that by introducing effective work site cancer screening programs they not only fulfill their social responsibility to contribute to their employees' health, but also achieve reductions in health care costs.

Adult↗

PubMed2003

Implementation of systems strategies for breast and cervical cancer screening services in health maintenance organizations.

OBJECTIVE: To describe the systems strategies used to reduce failures in delivery of breast and cervical cancer screening services in HMOs with high performance rates for these services. STUDY DESIGN: Multiple case study. PARTICIPANTS AND METHODS: Seven HMOs participated in an assessment of their breast and cervical cancer screening policies and procedures. Current clinical practice guidelines were analyzed, and key informants were interviewed about organizational policies and procedures that ensure initial screening and follow-up of abnormal results. Data were analyzed across plans for several theoretically relevant domains, including leadership and policies, clinical decision support, delivery system design, clinical information systems, and patient self-management support. RESULTS: Practice guidelines were fundamentally similar across plans for both cancer screenings, although operationalization of risk and formatting of the written documents differed. These plans adopted a wide array of strategies, particularly in the clinical decision support, clinical information systems, and patient self-management support domains, but there is room for improvement. Differences among plans and between strategies for breast and cervical cancer screening provide new understanding of how to approach this problem. CONCLUSIONS: Organizations seeking to improve performance of breast and cervical cancer screening should consider multiple strategies aimed at multiple targets and should ensure that strategies used for one type of cancer are considered for others.

Breast Neoplasms↗

PubMed2006

An overview of innovative techniques to improve cervical cancer screening.

Although current cytomorphology-based cervical cancer screening has reduced the incidence of cervical cancer, Pap-smears are associated with high false positive and false negative rates. This has spurred the search for new technologies to improve current screening. New methodologies are automation of Pap-smear analysis, addition of new biological or molecular markers to traditional cytology or using these new markers to replace the current screening method. In this overview we will summarize data on cervical cancer epidemiology and etiology and the current cervical cancer screening approach. Available data on new screening approaches, such as quantitative cytochemistry, detection of loss of heterozygosity (LOH) and hypermethylation analysis will be reviewed. We discuss the potential of these approaches to replace or augment current screening. When available, data on cost-effectiveness of certain approaches will be provided. In short, Human Papillomavirus (HPV) DNA detection stands closest to implementation in nation-wide screening programs of all markers reviewed. However, specificity is low in women aged <35 years and the psychological effects of knowledge of HPV positivity in absence of cervical (pre) malignant disease are important drawbacks. In our opinion the results of large clinical trials should be awaited before proceeding to implement HPV DNA detection. New technologies based on molecular changes associated with cervical carcinogenesis might result in comparable sensitivity, but improved specificity. Hypermethylation analysis is likely to be more objective to identify patients with high grade squamous intra-epithelial lesions (HSIL) or invasive cancer with a higher specificity than current cytomorphology based screening.

Biomarkers, Tumor↗

PubMedDate not supplied

[Cancer screening. Concepts, trends, and practices].

A National Cancer Surveillance Program has begun in Portugal in 1990. However, it is unevenly applied throughout the country and is almost unknown to clinicians other than general practitioners. As potentially life-saving procedures, cancer screening and early detection have an important impact not only among physicians but also among the general public, making it absolutely necessary an harmony of rationale, guidelines and practices. The author summarizes the points in discussion concerning cancer prevention procedures, the different published guidelines and some numbers on its practices. The aim is a contribution to an improvement in cancer screening in Portugal, achievable through awareness, promotion of evidence evaluation and the pursuit of consensus in strategies.

Humans↗

PubMed1999

Skin cancer screening in primary care: prevalence and barriers.

BACKGROUND: Skin cancer incidence is increasing, but whether primary care providers routinely screen for skin cancer is not known. OBJECTIVE: We assessed whether primary care practitioners are performing skin cancer screening within the context of primary care and whether barriers exist that might act as impediments to the implementation of this practice. METHODS: A total of 465 primary care providers belonging to their respective county medical societies in either New Haven County, Connecticut, or Miami-Dade County, Florida were randomly selected and surveyed by mailed questionnaire regarding their skin cancer screening practices. RESULTS: Only 31% of responding physicians reported performing skin cancer screening on all of their adult patients. Of those not performing skin cancer screening on all adult patients, only 31% report performing screening on high-risk patients. Almost half of physicians reported that they do not perform skin cancer screening. We found that physicians' lack of confidence in identifying suspect lesions was a common barrier. Fear of patient embarrassment, inadequate lighting, or lack of studies demonstrating mortality benefits were not frequent deterrents. Furthermore, there was no statistical difference in screening rates between the more northern latitude and the more southern latitude. CONCLUSION: Skin cancer screening is not being performed within the context of primary care visits. Barriers exist that may impede skin cancer screening.

Adult↗

PubMed1988

Improving and sustaining outpatient cancer screening by medicine residents.

The sustained effectiveness in improving resident performance of breast, cervical, and colorectal cancer screening examinations in the medicine outpatient department (OPD) was studied. Residents were divided into two groups: an intervention group, which received lectures presenting cancer screening rationale and recommendations, followed by chart reminders for three months, and a control group with no intervention. Charts were reviewed for cancer screening performance before, and one and six months after the intervention. Results showed increased performance of Pap smears (50% vs 22%, P less than .04 at one month and 46% vs 23%, P less than .08 at six months) and rectal examinations (73% vs 58%, P less than 0.2 at six months) by the intervention group. There was no improvement in breast examination performance over baseline (39%). Other screening examinations were rarely done. Future outpatient practice will include preventive health care, and greater emphasis must be devoted to increasing and sustaining residents' cancer screening performance to improve these results.

Ambulatory Care Facilities↗

PubMed2003

[Colorectal cancer screening: a survey of French general practitioners].

AIM: To determine knowledge, beliefs, self-reported practices and wishes of French general practitioners regarding colorectal cancer screening before the start of an organized screening program. METHODS: A postal survey of the 600 general practitioners of the Haut-Rhin area was made in 2002. RESULTS: Response rate was 62%. Eighty-five% asked routinely their patients about their family history of colorectal cancer. Colorectal cancer screening was routinely proposed by 92% of practitioners to individuals with a family history (86% with colonoscopy) and by 20% to individuals without family history (69% with faecal occult blood test). Seventy-five% did not know French consensus conference guidelines on colorectal cancer screening. Fifty-three% ordered routinely faecal occult blood testing, mostly for the screening of individuals with family history and for the evaluation of symptoms, mainly iron-deficiency anemia and weight loss. Seventy-seven% would explore with colonoscopy subjects with positive faecal occult blood test. Fifty-four% had personally undergone screening. Fifty-six% considered that mass screening could reduce a lot colorectal cancer mortality and most of them agreed with the forthcoming organized colorectal cancer mass screening program. CONCLUSIONS: Screening for colorectal cancer is ordered less often than screening for female cancers. General practitioners are unaware of current guidelines. Beliefs and practices vary considerably and faecal occult blood testing is often inappropriately prescribed. Medical education concerning screening is needed. Colorectal cancer screening guidelines and policy should be clarified in France.

Adult↗

PubMed1996

[Evaluation of individual breast cancer screening in the Alpes-Maritimes].

In the framework of the mass breast cancer screening program in the Alpes-Maritimes, a study was carried out among the radiologists to assess individual breast cancer screening, defined as mammography among women without clinical symptom or personal history of breast or genital cancer, outside an organized program. The survey was carried out in 1994; all private and public radiology clinics recorded all mammography information during one week at two different periods. Among women aged 50 to 69 years, the population targeted by mass screening program, the proportion of individual breast cancer screening among all mammographies was 31.8% and was similar to that of the organized programme. A steady evaluation of individual breast cancer screening is necessary when two ways of screening are concomitant, the aim being to substitute mass screening for individual screening.

Adult↗

PubMedDate not supplied

Current perspectives on physician barriers to breast cancer screening.

BACKGROUND: Despite reports of rising mammography utilization, breast cancer screening rates still lag behind national recommendations and goals, particularly for older women. This study explores current modifiable physician barriers to screening. METHODS: Family physicians and internists on the staff of 10 Long Island community hospitals were surveyed during three successive waves (1988, 1990, 1995) about breast cancer screening behavior. The final survey also assessed current attitudes and level of confidence in screening abilities and beliefs relating to cancer risk and screening of the elderly. RESULTS: The proportion of physicians reporting regularly referring all women aged 50 to 75 years for mammography increased significantly from 37 percent (1988) to 64 percent (1995), while the proportion reporting regularly performing clinical breast examinations remained stable at 56 percent. More than 25 percent of respondents to the 1995 survey were not aware that breast cancer risk increases with aging, and more than one half did not recognize that breast cancer detection by mammography is enhanced in older postmenopausal women. Some physicians reported lack of confidence in aspects of patient counseling, examination, and use of office systems to promote screening. CONCLUSION: Continuing medical education programs addressing knowledge deficits and perceived physician needs for enhancement of clinical breast examination skills are needed to promote continued improvement in inadequate mammography screening rates.

Adult↗

PubMed1985

Computer-assisted assessment of family physicians' knowledge about cancer screening guidelines.

The understanding and correct application of cancer screening guidelines is an important aspect of early cancer detection. Prior reports have indicated deficiencies in physicians' knowledge of the subject, promoting various educational activities aimed at primary care physicians. By using an interactive computer program to assess knowledge of the American Cancer Society cancer screening guidelines in a group of 306 family physicians, we found that knowledge of this subject continues to leave room for improvement.

Adult↗

PubMed1990

A model for breast cancer screening.

A model for breast cancer screening has been developed. When the appropriate screening policy is specified, the model reproduces the detection rates and the incidence of interval cancers as observed in the recent screening projects in Utrecht and Nijmegen, the Netherlands. The model-predicted mortality rate reduction is in accordance with the results of the Kopparberg/Ostergötland randomized trial in Sweden. Key parameters of the model are the duration of the preclinical stages and the sensitivity of mammography. The average duration is approximately 2 years at age 40 and increases to approximately 5 years at age 70. The sensitivity is high (approximately 95%) for tumors larger than 1 cm. The model is used in the prospective evaluation of effects and costs of various screening policies.

Adult↗

PubMed1990

Economic aspects of cervical cancer screening.

The results of a cost-effectiveness analysis of cervical cancer screening in The Netherlands are reported, emphasizing the analysis of the costs of screening and consequent diagnosis and treatment. Many organized screening policies are evaluated, differing in age-range and interval between screens. The cost estimates are based on organization charts, file studies and tariffs. The costs of screening itself are by far the most important cost component. Screening increases the costs of diagnosis. Costs for primary treatment only rise for large screening policies. Screening causes savings in costs of terminal treatment, but these are small compared with the costs of screening. The costs per life-year gained for the most efficient policies amount to DFL 24,000 for the policy with 7 invitations per woman in a lifetime and rise considerably in case of more than 10 invitations. Cervical cancer screening appears to be less cost-effective than breast cancer screening, but compared with other services the results are comparatively good. Implementing one of the efficient organized screening policies and discouraging spontaneous screening beyond that schedule leads to considerable savings. Moreover, many organized policies which are not efficient are still superior to spontaneous screening.

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