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PubMed2000

Breast and cervical cancer screening: associations with personal, spouse's, and combined smoking status.

The objective of this study was to examine the association of women's cancer screenings with both personal and spouses' smoking status, as well as with the broader context of household smoking, in a United States national-level sample of women aged 42-75 years. Data were from the 1994 National Health Interview Survey Health Promotion Supplement. The sample included 1586 women who reported they were married and living with a spouse in a two-person household. Three measures of smoking status were used: personal smoking status, smoking status of spouse, and household smoking status (self and spouse smoked, spouse only smoked, self only smoked, and both nonsmokers). Using logistic regression modeling, associations were examined between the smoking status measures and three cancer screening indicators: mammogram < or =2 years, clinical breast exam < or =2 years, and Pap test < or =3 years. The both nonsmokers group consistently had the highest screening rates for all three exams. The spouse only smoking group was 10-12% less likely to obtain all three cancer screening tests compared to the both nonsmokers group. The self and spouse group was less likely to report a recent mammogram and clinical breast exam. The self only group did not differ significantly from the both nonsmokers group on any of the cancer screening measures. Results suggest that smoking status of a spouse may be an important correlate of women's cancer screenings.

Adult↗

PubMed1987

Perspectives in cancer screening in the elderly.

The concern is whether physicians and the health care system make cancer screening available to the elderly. This question has special meaning in this population as it is apparent that problems in screening for cancer have not been addressed. First, primary care physicians do not emphasize cancer prevention and early diagnosis in the elderly. Second, there is a need to educate the American population about cancer prevention, methods of early diagnosis, and the problems and realities surrounding cancer. The elderly are less aware of and use significantly fewer of the available screening resources. When this is coupled with a health system that does not provide funding for preventive and screening services (Medicare, Medicaid, and most third-party insurance carriers), the potential to deal with this problem becomes extremely difficult. High-quality primary care is the key to cancer screening in the elderly. The physician must take responsibility for health promotion while concentrating on screening. Two good rules of thumb are 1) to screen all patients for cancer and other diseases on a routine basis based upon screening recommendations in the current literature; and 2) to evaluate a normal patient who comes to the physician with a complaint (to assure early diagnosis). It is difficult to decide when an aggressive work-up is needed since older patients are at risk of complications from diagnostic procedures. The elderly are singularly under-represented in most studies of screening and prevention. We are therefore left with the reality that, no matter what set of recommendations is put forward, the physician is acting from incomplete information. The published guidelines are not directed at the elderly. Omission of the elderly from these studies leaves unknown the risks, benefits, and even the actual ability to screen. There is a need for better screening methods. There is evidence in the literature that both the physician and the patient need to be educated. The need for research in screening efficacy is coupled with a need to define methodologies to educate the provider and the patient and to determine how to reach high-risk populations. In the interim, the implementation of the guidelines discussed, with consideration of the current literature, is recommended to the physician as a rational approach.

Age Factors↗

PubMed1991

[An analysis of participation rates for health and cancer screenings in Wakabayashi ward of Sendai].

Persons who were non-employed as determined from the 1985 census were assumed to be the target population for health and cancer screenings, comprising 54.8% and 55.5% of both the male and female population over 40 years of age in Sendai and in Wakabayashi ward respectively. Similar mean participation rates were obtained for health screening from 1986 to 1989 of 24.0% in Sendai and 23.3% in Wakabayashi ward. However, mean participation rates differed for gastric cancer screening, being 18.2% in Sendai and 15.8% in Wakabayashi ward. Both screening rates increased from 1986 to 1989 in Sendai as well as in Wakabayashi ward. Rates for both screenings were high in the suburbs and low in metropolitan Wakabayashi ward. The target population for uterine and breast cancer screenings were 69.8% and 70.1% of women over 30 years of age in Sendai and in Wakabayashi ward respectively. Mean participation rates for uterine cancer screening from 1986 to 1989 were 33.8% in Sendai and 35.1% in Wakabayashi ward, and showed an overall decrease from 1987 to 1989 in both Sendai and Wakabayashi ward. The rate was high in the suburbs and low in metropolitan Wakabayashi ward. Mean participation rates for breast cancer screening from 1988 to 1989 were 13.9% in Sendai and 13.6% in Wakabayashi ward, with rates being low in both the suburbs as well as metropolitan. Wakabayashi ward in 1988 (the beginning year of the screening), but increasing significantly in the suburbs during the following year.

Adult↗

PubMed2003

A critical look at prevention: colorectal cancer screening.

This case-colorectal cancer screening-is one of a series of teaching cases in the Case-Based Series in Population-Oriented Prevention (C-POP). It has been developed for use in medical school and residency prevention curricula. The complete set of cases is presented in this supplement to the American Journal of Preventive Medicine. This preventive medicine teaching case discusses the concepts of diagnostic test evaluation, prevention, and screening using the example of colorectal cancer screening. Features of the case include a health policy exercise concerning community screening programs and an exercise in clinical prevention decision making.

Colorectal Neoplasms↗

PubMed2005

Three-dimensional ultrasonography and power Doppler in ovarian cancer screening of asymptomatic peri- and postmenopausal women.

AIM: To determine whether introducing three-dimensional (3D) ultrasonography with power Doppler facilities as a secondary screening test, preceded by annual transvaginal grayscale ultrasonography (TVUS) (followed by transvaginal color Doppler (TVCD) in selected cases) as a primary screening test for ovarian cancer improves the accuracy of ovarian cancer screening studies. METHODS: Annual TVUS was performed on 3,201 peri- and postmenopausal asymptomatic women aged > or =50 years from March 1, 2001 to June 30, 2003. Cystic ovarian lesions in perimenopausal women were routinely reevaluated by TVUS and TVCD at 4-6 week intervals to avoid unnecessary surgical intervention for physiological cysts. Any multiloculated, complex or solid ovarian mass, as well as persistently cystic mass >5 cm in diameter, in which the echo architecture and/or blood flow pattern was not highly suggestive of a benign histology, was categorized malignant. In these cases, TVUS and TVCD findings were obtained in no more than 2 weeks and supplemented by secondary screening, including 3D ultrasonography, and 3D power Doppler, in combination with serum CA 125 determination. After detailed ultrasonographic examination, surgical removal of the tumor and pathohistological classification were completed. RESULTS: Twenty-five patients (0.8%) with persisting ultrasonographic abnormalities after primary and secondary screening underwent surgery to remove the ovarian tumor. Five epithelial ovarian cancers were detected: 3 stage IA, 1 stage IB, and 1 stage IC. Three stage I patients had a palpable abnormality on clinical examination. Furthermore, in three patients with stage I disease, CA 125 serum value was elevated (> or =35 U/mL). Three-dimensional ultrasonography and power Doppler, as well as TVUS findings were indicative of malignancy in all 5 patients with stage I ovarian cancer, whereas TVCD finding was false-negative in 2 patients with stage I disease. Screening test (primary+secondary screening) had the sensitivity of 100%, specificity of 99.4%, positive predictive value of 20%, and negative predictive value of 100%. CONCLUSION: Application of 3D ultrasonography and power Doppler imaging in patients with "positive" standard ultrasound tests (annual TVUS, followed by TVCD in selected cases) represents a novel approach for the early and accurate detection of ovarian cancer through screening.

Aged↗

PubMed1999

The MISCAN-COLON simulation model for the evaluation of colorectal cancer screening.

A general model for evaluation of colorectal cancer screening has been implemented in the microsimulation program MISCAN-COLON. A large number of fictitious individual life histories are simulated in each of which several colorectal lesions can emerge. Next, screening for colorectal cancer is simulated, which will change some of the life histories. The demographic characteristics, the epidemiology and natural history of the disease, and the characteristics of screening are defined in the input. All kinds of assumptions on the natural history of colorectal cancer and screening and surveillance strategies can easily be incorporated in the model. MISCAN-COLON gives detailed output of incidence, prevalence and mortality, and the results and effects of screening. It can be used to test hypotheses about the natural history of colorectal cancer, such as the duration of progressive adenomas, and screening characteristics, such as sensitivity of tests, against empirical data. In decision making about screening, the model can be used for evaluation of screening policies, and for choosing between competing policies by comparing their simulated incremental costs and effectiveness outcomes.

Colorectal Neoplasms↗

PubMed2006

Colorectal cancer screening among the medically underserved.

Prevalence of physician recommendation and patient completion of colorectal cancer screening was investigated among Federally Qualified Health Centers (FQHC) serving low-income neighborhoods in Chicago. Medical records of 3,416 patients receiving primary care services at 1 of 31 FQHCs were randomly chosen for review. In all, 642 patients were identified by age and family history as eligible for colorectal cancer screening and included in this study. Patient demographic information and colorectal cancer screening history were collected. The physician screening recommendation rate was 9.2% (n=59); 7.0% (n=45) of patients were determined to have been appropriately screened for colorectal cancer, primarily by Fecal Occult Blood Test (94.1%, n=43). Among patients who received a recommendation from their physician, 76.2% had completed a screening test. Older patients were more likely than their younger counterparts to have received a recommendation from their physician (p<.05) and to have been screened (p<.01). Organizational interventions are needed to support physicians in medically underserved areas and to promote recommended screening practices.

Aged↗

PubMed1990

Breast cancer screening: its impact on clinical medicine.

Breast cancer screening is generally accepted as an effective means of reducing breast cancer mortality in post-menopausal women. In this analysis the impact of nationwide screening on clinical medicine and the effects for the women involved are quantified. Effect estimates are based on results from screening trials in Utrecht (DOM-project) and Nijmegen, and on bi-annual screening of women aged 50-70. The consequences for health care are based on generally accepted assessment and treatment policies. The number of assessment procedures for non-palpable lesions will increase by 12% per year in the build-up period, and will remain slightly higher. The total number of biopsies in a real population is expected to decrease. Screening will lead to a shift in primary treatment modalities, as 15% of mastectomies will be replaced by breast conserving therapy. The temporary increase in the demand for primary treatment in the first years will be followed by a decrease in the demand for treating women with advanced disease. Favourable effects outweigh the inevitable unfavourable effects, with high quality screening and an appropriate invitation system. Breast cancer screening can also be recommended after considering other consequences than mortality reduction.

Aged↗

PubMed1991

Preliminary results of skin cancer screening in West Virginia.

Although skin cancer screening is theoretically of value, its effectiveness has not been firmly established because few studies have systematically followed persons with a positive screen to obtain pathologically confirmed diagnoses. From the 799 persons screened at Charleston Area Medical Center in 1988 and 1989, 153 screenees with suspected skin cancer, dysplastic nevi, and congenital nevi were followed to determine their final diagnosis. Follow-up was done by letter and telephone calls to both the individuals who screened positive and their treating physicians. Eighty-four (54 percent) then sought medical attention as a result of letters and calls. Thirty-one basal cell carcinomas, three squamous cell carcinomas, three dysplastic nevi, two melanomas, and one congenital nevus were pathologically confirmed. The predictive value positive of the screenings was 32 percent to 60 percent for non-melanoma skin cancer, 9 percent to 25 percent for dysplastic nevi, and 15 percent for melanoma. This study suggests that post-screening follow-up of those with suspected premalignant and malignant skin lesions is feasible and should be encouraged so that more definitive evaluation and treatment can potentially be performed and skin cancer screenings more accurately assessed.

Adolescent↗

PubMed2006

Communication and colorectal cancer screening among the uninsured: data from the Health Information National Trends Survey (United States).

OBJECTIVE: Colorectal cancer screening allows for both prevention and early detection of the disease, with early detection often resulting in improved prognosis. Too few Americans over 50 are screened for colorectal cancer, but among certain subpopulations screening rates are particularly low for various reasons. We examined the role of communication factors and insurance, with a specific focus on the uninsured to examine disparities in colorectal cancer screening. METHODS: We used Health Information National Trends Survey data to examine: disparities in colorectal cancer screening, by calculating proportions of subpopulations screened; and the association between communication and screening among the uninsured, by performing chi-square tests and simple logistic regression to examine the potential factors associated with screening. RESULTS: The uninsured were 64% less likely to be screened than the insured. Provider recommendation was the only significant communication measure, with the uninsured lacking a recommendation 98.5% less likely to be screened than those with one. CONCLUSION: These data suggest expansion of programs of screening among the uninsured and more aggressive communication campaigns to promote the awareness and provider recommendation of screening as possible ways to increase screening and reduce mortality of colorectal cancer.

Appointments and Schedules↗

PubMed1997

Employee response to a company-sponsored program of colorectal and prostate cancer screening.

Studies done in the mid-1970s documented increased risk for respiratory cancer and leukemia among employees in a chemical company manufacturing plant where chloromethyl ethers were used in production from 1948 to 1971. In the late 1980s, the company informed current and former employees about the results of follow-up studies which showed a moderation of risk of respiratory cancer and leukemia. New data showing elevated rates of mortality from colorectal, prostate, bladder, and pancreatic cancer in the population were also reported. Via mailed correspondence, the company made a no-cost program of colorectal and prostate cancer screening available to employees upon request; and information about bladder and pancreatic cancer was made available. Thirteen percent of employees in the population indicated interest in colorectal and prostate cancer screening (response). Thirty-one percent of these responders were screened (adherence). Multivariate analyses showed that education and length of employment in the plant were positively associated with response. Being white was positively associated with response for younger workers; while among older workers being male was positively associated with response. In terms of adherence, we found that older, more highly educated workers were more likely to have a screening examination. Findings indicate that employee participation in workplace-sponsored colorectal and prostate cancer screening can vary according to worker sociodemographic factors and length of employment in areas of potential exposure.

Age Factors↗

PubMed2006

Cutting cost and increasing access to colorectal cancer screening: another approach to following the guidelines.

CONTEXT: Through medical decision making, physicians in the U.S. influence the spending of >$1.3 trillion or 15% of the gross domestic product. U.S. physicians are challenged to identify areas of clinical practice to improve while cutting cost and increasing access. Primary screening for colorectal cancer is a good example to illustrate this point. OBJECTIVE: To apply a population-based method of medical decision making in the area of primary screening for colorectal cancer in order to illustrate a reduction in health care costs while increasing access and maintaining quality of care. DESIGN: We used a combination of (a) census population data, (b) National Cancer Institute Survey data on screening rates, and (c) charge data to estimate the current costs of colorectal cancer screening. We also estimated cost and capacity increases that would occur under various other screening scenarios. These included all currently screened subjects receiving annual fecal occult blood testing (FOBT), all currently unscreened individuals undergoing either colonoscopy every decade or annual FOBT, and all eligible subjects undergoing annual FOBT. MAIN OUTCOME MEASURES: Cost and access differences between current screening activity and other potential scenarios compliant with guidelines. RESULTS: Screening for colorectal cancer with yearly, six-window, rehydrated FOBT for all normal-risk individuals over the age of 50 has the potential to screen 3,813,095 more Americans for colon cancer yearly than are currently being screened, while costing $8.7 billion less per decade than what is currently being spent on screening a fraction of the population. Looking into the future, it is possible to increase screening rates from 50% to 100%, while saving almost $10 billion per decade by using FOBT for all eligible Americans. In practice, some proportion of these benefits would be realized as the calculations assume a 100% patient compliance rate. CONCLUSIONS: Considering a population-based approach and the balance among quality, accessibility, and cost parameters, we recommend primary screening for colorectal cancer to be based on yearly six-window, rehydrated FOBT. Colonoscopy due to cost and access issues should be relegated to secondary screening and case finding.

Colonoscopy↗

PubMed2004

How do older Chinese women view health and cancer screening? Results from focus groups and implications for interventions.

OBJECTIVE: To qualitatively assess Chinese American women's views of health and illness and the potential influences of culture and language on cancer screening behavior. DESIGN: Data were generated by five focus groups, each consisting of 9-12 Chinese American women aged 50 and older. Participants responded to open-ended questions assessing their perceptions of health and illness, knowledge about cancer, beliefs about and barriers to cancer screening, and screening and healthcare experiences in the USA. All conversations were tape-recorded and analyzed in the context of PRECEDE framework concepts of predisposing, enabling, and reinforcing factors. RESULTS: The 54 participants had a mean age of 65 years, with an average age of immigration to the USA at 51 and average length of residence in the USA of 15 years. Participants considered outdoor exercise in the morning for fresh air and a hot-cold balanced diet as important means to health. None mentioned the importance of regular medical checkups or cancer screening. When talking about cancer prevention, a sense of fatalism was evident, such as 'no control of life and death' and 'what will happen will happen'. Lack of English capability was a major enabling barrier to healthcare. In addition, these women reported the need for help with transportation, especially for those living in suburban areas where public transportation is not readily available. Physician recommendation was identified as the most important reinforcing factor for cancer screening. CONCLUSION: Our results suggest traditional Chinese beliefs, such as those pertaining to fatalism, self-care, and the hot and cold balance, influence the perceptions of older Chinese women regarding health, illness, and use of preventive healthcare. Interventions to improve cancer screening in this population should be tailored to the specific predisposing, enabling, and reinforcing factors of this population, including cultural views, language barriers, doctor-patient communication, and access to healthcare.

Aged↗

PubMed1999

Variation in recommendations for cancer screening among primary care physicians in New Mexico.

The acceptance of age-appropriate cancer screening as an integral part of primary care has grown among physicians over the past decade. We conducted a mailed survey of all primary care physicians in New Mexico in order to better understand their current cancer screening practices. We found a high rate of self-reported screening, particularly for prostate and colorectal cancer. The screening rates were influenced only slightly by the introduction of evidence-based guidelines, with younger physicians and those with university affiliations more likely to follow recommendations. Female physicians and obstetrician-gynecologists endorsed breast and cervical cancer screening among all age groups and were less likely to follow recommendations for less frequent screening in women as they age. Since a physician's practice beliefs influence his/her attitude toward testing, tailoring education by physician specialty may be more effective than using generic messages in encouraging compliance with the most recent evidence-based guidelines.

Adult↗

PubMedDate not supplied

Simulation of breast cancer screening: quality assessment of two protocols.

Healthcare professionals must make breast cancer screening decisions without the help of clear answers in current medical knowledge. This study used computer simulation to evaluate two screening protocols. The American Cancer Society (ACS) protocol comprising self-breast examination, professional breast examination and annual mammography was evaluated versus annual mammography alone. The effective frequency of mammography and the cost in the ACS protocol doubles the cost of mammography alone. Breast self-examination and clinical breast examination contributes to increased cost without any added health effects. These study results could be applied by healthcare professionals to assist their decision making for breast cancer screening.

Adult↗

PubMed2000

Cervical cancer screening in Sweden.

Organised cervical cancer screening was implemented in Sweden in the mid-1960s. A marked decline in cervical cancer incidence could be attributed to the time-point of start of screening. Squamous cell carcinoma has declined by 60%, whereas adenocarcinoma has increased. About 950000 papanicolaou (Pap) smears are taken annually. Only 31% of the smears taken in the organised screening programme. As of 1998, the screening guidelines are 3-yearly tests between 23 and 50 years of age and 5-yearly tests between 50 and 60 years of age. The article reviews the screening practise in Sweden, the current efforts to improve the quality of the screening programme, as well as the ongoing randomised evaluations of organised primary screening for cervical human papilloma virus (HPV) infection.

Adult↗

PubMed2004

Community-based cancer screening programs in older populations: making progress but can we do better?

BACKGROUND: Older individuals have higher rates of most types of cancer. Community-based cancer screening programs offer one avenue for addressing the need to prevent or detect cancers in early stages in this population. Identifying characteristics of successful interventions can assist researchers in the development of future studies. METHODS: A comprehensive literature review of community-based cancer screening interventions was undertaken and 114 behavioral interventions for breast, cervical and colorectal cancer screening published prior to 2000 and 42 studies published during 2000-2003 were identified. From these, 17 studies were identified as model interventions that were effective in significantly increasing screening rates among older populations. RESULTS: Effective interventions employed a variety of strategies including the use of social networks and lay health care workers, mass media, community-based education, reminder notices/behavioral cues, and health care provider assistance. CONCLUSION: Although subgroups of individuals still have lower rates of screening, the results indicate that older populations can be encouraged to engage in appropriate cancer screening behaviors through community-based interventions. The next round of interventions could be strengthened by evaluating intervention components, integrating theory and community participation into designs, focusing on those most at need, and considering program sustainability and costs.

Aged↗

PubMed2002

Increasing fruit and vegetable intake among adults attending colorectal cancer screening: the efficacy of a brief tailored intervention.

Fruits and vegetables appear to confer protection against several cancers, but most adults in the United Kingdom eat substantially less than the recommended amounts. Cancer screening services could provide a valuable context in which to provide advice on increasing fruit and vegetable intake. This study examined the efficacy of a brief, tailored, psycho-educational intervention for increasing fruit and vegetable intake, carried out in a cancer screening clinic. The study was a randomized, controlled trial. 742 participants, 55-64 years of age, recruited from three cancer screening clinics, completed a baseline questionnaire. They were assigned either to the tailored intervention group or to an untreated control group. The primary outcome measure was self-reported consumption of fruit and vegetables. At 6 week follow-up there were significant increases in daily servings of fruit and vegetables in the tailored intervention group (CI, 0.87-1.25) compared with the untreated group (CI, 0.08-0.43). These results support the efficacy of a simple, written message, which is tailored to the intake and knowledge levels of the individual, for modifying cancer-protective dietary behaviors, at least in the short term. They also suggest that cancer screening clinics may be a good context for providing this service.

Adult↗