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PubMed2000

A systems model of clinical preventive care: the case of breast cancer screening among older women. For the NCI Breast Cancer Screening Consortium.

BACKGROUND: In older women covered by Medicare, relationships among physician recommendation, mammography in the past 2 years, and clinical breast examination (CBE) in the past year were systematically explored with a variety of predisposing, enabling, and situational factors identified in the Systems Model of Clinical Preventive Care. METHODS: A population-based survey of women age 65 years and older was conducted in five National Cancer Institute's Breast Cancer Screening Consortium geographic areas. Analyses focused on women with a regular physician and site of care (n = 5318). RESULTS: Physician recommendation and mammography use declined with women's increasing age and increased with income, education, and insurance. CBE and mammography increased with number of physicians and breast cancer family history; mammography use decreased with worsening health status. Recommendations were higher among physicians who were younger, female, and internists. Family practitioners were older and male; women who saw family practitioners reported characteristics associated with decreased screening-lower income, education, and insurance-and seeing only one physician. CONCLUSIONS: Public policy and health system changes that create a uniform system of finance and service performance expectations may reduce the persistent discrepancy in physician recommendation and mammography use due to sociodemographics and physician specialty.

Adult↗
PubMed2001

To screen or not to screen: the issue of breast cancer screening in older women.

INTRODUCTION: The United States Preventive Services Task Force (USPSTF) recommends that women aged 50-69 receive timely breast cancer screening, but does not make a recommendation for women aged 70 and older. Our purpose is to assess the relationship between age and breast cancer screening trends, and to consider the issue of breast cancer screening of women 70 years of age and older in light of demographics, disease burden, life expectancy, and activity level. METHODS: Data were analyzed from the state-based Behvioral Risk Factor Surveillance System (BRFSS) and the National Health Interview Survey (NHIS) on breast cancer screening practices and activity limitation status of women 50 and older. RESULTS: The percentage of women who reported receiving mammography and clinical breast examination within two years was lower among older women compared with younger women, and the gap has widened over time. In 1991-92, 61.4% of women 50-69 received screening within two years, compared to 49.5% of women 70 and above, while in 1997-98, the percentages were 71.1 and 56.7, respectively. Among both age groups and in both time periods, those unable to perform a major activity of daily living were less likely to report receiving mammography within two years than those with no limitation, and the gap was much wider in the elderly. Most (62.7%) women 70 and older reported having no activity limitation; only 5.5% reported being unable to perform a major activity. DISCUSSION: These results suggest that elderly women are less likely than younger women to receive timely breast cancer screening. The USPSTF does not recommend continued screening in elderly women because most studies of breast cancer efficacy included inadequate numbers of these women. Few, if any, studies have yielded evidence that screening is ineffective in women 70 and over. Given the higher breast cancer incidence and mortality seen in elderly women, as well as the increased life expectancy with little or no activity limitation seen among today's elderly, consideration should be given to including elderly women in the recommendation to receive timely breast cancer screening. Since surgical and adjuvant therapy for breast cancer in older women has less complications than therapy for other cancers of the elderly, the cost-benefit ratio for breast cancer screening in this age group may prove to be more promising.

Activities of Daily Living↗
PubMed2005

Prostate cancer screening.

Prostate cancer is the leading noncutaneous cancer in men of the Western world. Because of its prevalence and ability to cause morbidity and mortality,prostate cancer screening continues to be an important area of focus in health care. This article covers the sensitivity and specificity of prostate-specific antigen and current techniques used to improve the test's validity, the importance of detecting clinically important cancers with screening, as well as the downward stage migration, decreased disease-specific mortality, and decreased metastases rate seen inpatients screened and treated for prostate cancer.

Cost-Benefit Analysis↗
PubMed1992

Efficacy of lung cancer screening; comparison of results from a case-control study and a survival analysis. The Japanese Lung Cancer Screening Research Group.

A case-control study to evaluate the efficacy of lung cancer screening conducted by us showed that lung cancer screening may reduce the mortality of the disease up to 28%. Assuming this efficacy is unbiased, and that the screening rate is 51.6%, which was observed in the control group in the above study, the number of lung cancer deaths prevented by screening in the study period was calculated to be 47 for males and females combined. In the same study population, screen-detected lung cancer patients (N = 207) in the same study period were followed and the 7-year survival rate (46.9%) was compared to the 5-year survival rate (11.3%) obtained by the Osaka Cancer Registry, in which screen-detected lung cancer patients were only 1.8%. The number of lung cancer deaths prevented by screening, estimated by the difference in the above two survival rates, was 74 (95% confidence interval; 55-93). The number of lung cancer deaths prevented by screening estimated from the case-control study was significantly lower than that estimated from the survival analysis. This indicates that the efficacy of lung cancer screening estimated by the case-control study was within the range that could be explained by the actual long-term survivors among the screen-detected patients in the study population.

Adult↗
PubMed1995

Breast and cervical cancer screening among underserved women. Baseline survey results from six states. The National Cancer Institute Cancer Screening Consortium for Underserved Women.

OBJECTIVE: To characterize breast and cervical cancer screening rates in selected underserved populations and to compare the rates with objectives for the year 2000. DESIGN: Six random-sample surveys were conducted in underserved populations between 1991 and 1993. Two of the surveys were random-digit-dial telephone surveys; four were conducted using in-person interviews. SETTINGS: The studies were conducted in the following target populations: (1) low-income and minority women residing in urban areas in Minnesota, Rhode Island, and North Carolina; (2) Hispanic women residing in urban communities in Texas; and (3) women residing in rural West Virginia and Wisconsin. PARTICIPANTS: A total of 6648 noninstitutionalized women aged 40 years or older were interviewed. MAIN OUTCOME MEASURES: Self-reported knowledge and practices related to mammograms and Papanicolaou smears. RESULTS: Between 35% and 79% of women had ever had a mammogram, and between 27% and 66% reported having a mammogram in the past 2 years. Between 82% and 95% of women had ever had a Papanicolaou smear, and between 55% and 74% reported having a Papanicolaou smear in the past 3 years. Women with low levels of education, below 200% of the poverty level, with no health insurance, 80 years or older, residing in Appalachian West Virginia, and Hispanic women residing in urban Texas have the farthest to go to reach the cancer screening objectives for the year 2000. CONCLUSIONS: Although access to health care is high among the women studied, screening rates are uneven. Objectives for the year 2000 clearly are attainable for some populations of underserved women, though much work needs to be done if objectives are to be met for all subgroups.

Adult↗
PubMed2003

Current capacity for endoscopic colorectal cancer screening in the United States: data from the National Cancer Institute Survey of Colorectal Cancer Screening Practices.

PURPOSE: There is a national goal in the United States to increase the level of colorectal cancer screening, but there is currently little information on resources for the delivery of endoscopic screening and follow-up diagnostic and surveillance procedures. The purpose of this study was to provide nationally representative data on endoscopic resources at the provider level. METHODS: A nationally representative survey of primary care physicians, general surgeons, and gastroenterologists that was conducted during 1999 to 2000 provided data from survey responses by 1235 primary care physicians, 349 gastroenterologists, and 316 general surgeons. RESULTS: We estimated that 65% of all sigmoidoscopy procedures were performed by primary care physicians, 25% by gastroenterologists, and 10% by general surgeons. Only 30% of all primary care physicians performed any procedures, and average volume among those who did was relatively low (seven per month). Gastroenterologists performed two thirds of all colonoscopy procedures, with most of the remainder performed by general surgeons. CONCLUSION: There is potential to increase the capacity to perform screening sigmoidoscopy procedures through primary care delivery. However, without careful consideration of organizational factors, this could result in increased cost and quality control problems. Increasing the capacity for screening colonoscopy is feasible, but will require attention to other problems, such as avoiding overfrequent (e.g., annual or biennial) procedures in low-risk patients.

Academies and Institutes↗
PubMed2006

Validity of self-reported smoking status among participants in a lung cancer screening trial.

Lung cancer remains a devastating disease associated with substantial morbidity and mortality. Recent research has suggested that lung cancer screening with spiral computed tomography scans might reduce lung cancer mortality. Studies of lung cancer screening have also suggested that significant numbers of participants quit smoking after screening. However, most have relied solely on self-reported smoking behavior, which may be less accurate among participants in lung cancer screening. To assess the validity of self-reported smoking status among participants in a lung cancer screening trial, this study compared self-reported smoking status against urinary cotinine levels. The sample included 55 consecutive participants enrolled in a randomized clinical trial comparing annual spiral computed tomography and chest X-ray for lung cancer screening. Participants were a mean of 59 years of age and predominantly Caucasian (96%) and male (55%). Self-reported smoking status was assessed before and after participants learned of the purpose of the biochemical verification study. Using urinary cotinine as the "gold standard," the sensitivity and specificity of self-reported smoking status were 91% and 95%, respectively (kappa = 0.85, P < 0.001, 95% confidence interval = 0.71-0.99). Total misclassification rate was 7%. However, three of the four misclassified participants reported concurrent use of nicotine replacement strategies. Eliminating these cases from the analysis revealed sensitivity of 100% and specificity of 95% (kappa = 0.96, P < 0.001, 95% confidence interval = 0.88-1.00). In conclusion, self-reported smoking status among participants in a lung cancer screening trial was highly consistent with urinary cotinine test results.

Adult↗
PubMed1975

Implications of suspicious findings in breast cancer screening.

Breast cancer screening, performed on asymptomatic women over 35 years of age, has identified 32 breast cancers in 30 of 4,500 women screened. Screening included a physical examination by trained technologists, thermography, and xeromammography. This represents 26 percent of the biopsies performed (116). Results of xerommammography were suspicious in 24 cases (80 percent), and results of physical examination were suspicious in 11 (37 percent). Only six were suspicious by both methods, with one other having changes that were considered benign. Fourteen (44 percent) were microinvasive or noninvasive. Only two (6 percent) had axillary metastases. Breast cancer detected by screening is in its "early" stages and is usually well localized. Operative management, including removal of the entire breast, has a significant potential for cure. Thirty patients with changes considered suspicious have not yet had biopsies. Improved overall survival depends on appropriate management of all patients screened.

Adult↗
PubMedDate not supplied

From guaiac to immune fecal occult blood tests: the emergence of technology in colorectal cancer screening.

Colorectal cancer is the second leading cause of cancer deaths in the United States for both men and women. Colorectal cancer screening is an important means for reducing morbidity and mortality. The American Cancer Society recommends five different screening regimens for adults of average risk, age 50 years and older. The optimal effectiveness of a screening program is dependent on the accuracy of the screening test used. An accurate screening test would have high sensitivity (positive) when an adenomatous polyp or cancer is present and high specificity (negative) in their absence. In April 2002, the American Cancer Society Colorectal Cancer Advisory Group concluded that the immunochemical fecal occult blood test has some advantages that merit revision of their guideline statement for fecal occult blood testing, to include the immunochemical fecal occult blood test. The advantages cited were the possibility of improved sensitivity and specificity and the lack of required dietary restrictions, which make it a more patient-friendly test. Several types of immunochemical fecal occult blood tests are discussed in this article, including their advantages and disadvantages compared with those of the traditional guaiac fecal occult blood testing.

Age Factors↗
PubMed2002

Large-scale randomized prostate cancer screening trials: program performances in the European Randomized Screening for Prostate Cancer trial and the Prostate, Lung, Colorectal and Ovary cancer trial.

Two large-scale randomized screening trials, the Prostate, Lung, Colorectal and Ovary (PLCO) cancer trial in the USA and the European Randomized Screening for Prostate Cancer (ERSPC) trial in Europe are currently under way, aimed at assessing whether screening reduces prostate cancer mortality. Up to the end of 1998, 102,691 men have been randomized to the intervention arm and 115,322 to the control arm (which represents 83% of the target sample size) from 7 European countries and 10 screening centers in the USA. The principal screening method at all centers is determination of serum prostate-specific antigen (PSA). The PLCO trial and some European centers use also digital rectal examination (DRE) as an ancillary screening test. In the core age group (55-69 years), 3,362 of 32,486 men screened (10%) had a serum PSA concentration of 4 ng/ml or greater, which is 1 cut-off for biopsy (performed in 84%). An additional 6% was referred for further assessment based on other criteria, with much less efficiency. Differences in PSA by country are largely attributable to the age structure of the study population. The mean age-specific PSA levels are lower in the PLCO trial (1.64 ng/ml [in the age group 55-59 years], 1.80 [60-64 years] and 2.18 [65-69 years) than in the ERSPC trial (1.28-1.71 [55-59], 1.75-2.87 [60-64] and 2.48-3.06 [65-69 years]). Detection rates at the first screen in the ERSPC trial range from 11 to 42/1,000 men screened and reflect underlying differences in incidence rates and screening procedures. In centers with consent to randomization design, adherence in the screening arm is 91%, but less than half of the men in the target population are enrolled in the trial. In population-based centers in which men were randomized prior to consent, all eligible subjects are enrolled, but only about two-thirds of the men in the intervention arm undergo screening. Considerable progress has been made in both trials. Enrollment will be completed in 2001. A substantial number of early prostate cancers have been detected. The differences between countries seem to reflect both underlying prostate cancer incidence and screening policy. The trials have the power to show definitive results in 2005-2008.

Aged↗
PubMed1992

Breast cancer screening among women from 65 to 74 years of age in 1987-88 and 1991. NCI Breast Cancer Screening Consortium.

OBJECTIVE: To compare breast cancer screening rates from the 1991 survey with data from 1987-88 for women aged 65 to 74. DESIGN: Surveys of women from five communities. SETTINGS: Five control communities of the National Cancer Institute's Breast Cancer Screening Consortium. PARTICIPANTS: White, non-Hispanic women, ages 65 to 74; 499 in 1987-88 and 2156 in 1991. Response rates for the first survey wave ranged by area from 65% to 77% and for the second survey wave, from 62% to 85%. MAIN OUTCOME MEASURE: Mammogram and clinical breast examination during the past year and performance of monthly breast self examination, with the screening rates in wave 2 directly standardized to the income and education distribution of wave 1 in each area. RESULTS: Mammography use between waves increased significantly (P < 0.05 after adjusting for education, income, and age) in all but one area (from 19% to 33% in wave 1 to 35% to 59% in wave 2). Among women who had a mammogram, the percent who also had a clinical breast examination decreased between waves from 95% to 85% (P = 0.001). CONCLUSIONS: Mammography in older women increased dramatically over 3 years, although the use of clinical breast examination may be decreasing.

Aged↗
PubMed2000

[Nationwide breast cancer screening fully accomplished; results from the implementation phase 1990-1997. National Evaluation Team for Breast Cancer Screening].

OBJECTIVE: To present an overview of the main results of the nationwide breast cancer screening programme implemented in the Netherlands from 1990 to 1997 and providing a biennial mammography for all women aged 50-69 years. METHOD: Data on screening examinations were provided by the 9 regional screening organisations; data on interval cancers and on breast cancers in unscreened women were provided by the regional cancer registries after linkage of registry data with data on screened women. The results observed were compared with the expectations used in the cost effectiveness analysis before the start of the population screening. RESULTS: Of almost 4 million women invited, 78.5% attended for screening. The screening resulted in 13.1 referrals, 9.2 biopsies and 6.1 breast cancers detected per 1,000 initially screened women, and in 6.9 referrals, 4.5 biopsies and 3.5 detected breast cancers per 1,000 subsequently screened women. All these parameters showed a clear variation at regional level. In the first 2 years after initial screens 0.96 interval cancers per 1,000 women-years were diagnosed (0.93 per 1,000 women-years after subsequent screens). Of all screen-detected cancers 76% were ductal carcinomas in situ (13%) or invasive cancers < or = 20 mm in size (63%); 26% of the invasive cancers were lymph node positive. This stage distribution was clearly more favourable than that of interval cancers and of the breast cancers diagnosed in unscreened women. The detection of breast cancer at subsequent screening was lower than expected and the staging of the carcinomas was less favourable than expected; the other results were largely in accordance with the expectations.

Age Distribution↗
PubMed1994

Contradictions in women's health care provision: a case study of attendance for breast cancer screening.

Breast cancer screening facilities operated by the Ontario Breast Screening Program (OBSP) have recently been added to the existing geography of diagnostic mammography facilities in hospitals and private clinics in Eastern Ontario. While diagnostic facilities require a physician's referral for access, the new centres offer mammograms by self-referral. Other work has shown the utilization of mammography screening services to be quite low despite widespread acceptance of early diagnosis through mammographic screening as the best method to lower breast cancer mortality. Major findings are that spatial variation does exist in attendance rates in the townships and census tracts surrounding the screening centre. At the regional level, physician referral patterns and the presence of local diagnostic mammography units appear to affect the uptake of screening at the Kingston facility. The individual level analysis confirms the importance of the primary care physician's referral with two-thirds of the client sample indicating that they were referred for screening by their family physician. The sample of clients are also very mobile women who have comparatively greater access to financial resources than other women of screening age. The results of ecological and individual level analyses of attendance at OBSP's Kingston Centre reveal contradictions in the provision of this service. Spatially, the centres follow a location pattern of a much higher order health facility yet women are expected to include screening as part of their routine care. Attenders at the Centre were found to be of higher socioeconomic status, married and have access to a private automobile. The finding that the primary care physician's referral is an important prerequisite for attendance raises questions about the feasibility of providing health care for women which encourages individual responsibility for health within the existing paternalistic health care system.

Aged↗
PubMed1998

Evaluation of the effect of breast cancer screening by record linkage with the cancer registry, The Netherlands.

OBJECTIVE: To evaluate the effect of a breast cancer screening programme by record linkage with the cancer registry. SETTING: Breast cancer screening programme in mid- and southern Limburg, the Netherlands. METHODS: The data files of the breast cancer screening programme and the Maastricht Cancer Registry were linked in order to evaluate the effect of breast cancer screening. Only the first primary breast tumour was included in the evaluation. RESULTS: From 1990 until 1995 90 001 women participated in the first round of the breast cancer screening programme and 64 637 in subsequent rounds. After the introduction of screening the annual number of breast cancer diagnoses increased by almost 50%. The incidence decreased to previous levels after completion of the first screening round. Record linkage detected 219 interval cancers (within two and a half years of a screening), a proportionate incidence of 31% in the first year and 60% in the second year of the two-year interval between screenings. The incidence of node positive breast cancer was 1% lower in 1994 and 15% lower in 1995 than the incidence in the period 1987-90. CONCLUSIONS: Evaluation of the effect of breast cancer screening in the Netherlands can be performed using routinely available cancer registry data. The results of this evaluation seem promising, but further studies are necessary to find ways to reduce the incidence of interval cancer.

Adult↗
PubMed1998

Perceived benefits: a predictor of participation in prostate cancer screening.

Prostate cancer is the most frequently diagnosed major cancer and the second cause of cancer-related deaths among men. With early detection through screening and timely treatment, 9 out of 10 men will survive a minimum of 5 years. However, with late diagnoses, only 3 out of 10 men will have a 5-year minimum survival rate. Guided by a conceptual map, this correlational research examined perceived benefits as a predictor of participation in free prostate cancer screening. Perceived benefits are the personal belief and valuing of screening for early detection of prostate cancer. All subjects received one of four educational interventions: traditional, peer educator, client navigator, or combination. Participation in prostate cancer screening was measured by compliance with the American Cancer Society's Guidelines, which included a digital rectal exam (DRE) and/or a prostate-specific antigen (PSA) blood test. The purposive sample (n = 1,522) of men, ages 40 to 70 years, was recruited from randomly selected churches, barbershops, industries, housing projects, and car dealerships in a southeastern state. Seventy-two percent of the sample was African American. Predictors of participation in free prostate cancer screening were these: perceived benefits, being white, having at least a high school education, being married, and receiving the client navigator or combination educational intervention. The Benefits Scale was significant (p = 0.013, odds ratio (OR) = 1.059) as a predictor for participation in screening when all demographic variables and educational interventions were controlled. Practice implications for nursing are discussed and recommendations for future research are presented.

Adult↗