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At least 109 records · Page 6Linked to original sources
PubMed2005

Effects of false-positive prostate cancer screening results on subsequent prostate cancer screening behavior.

OBJECTIVES: Little is known about screening behavior following a false-positive prostate cancer screening result, which we have defined as a screening result with "abnormal/suspicious" labeling that did not result in a prostate cancer diagnosis within 14 months. The purpose of this analysis was to examine whether age, race, education, or previous false-positive prostate cancer screening results via prostate-specific antigen or digital rectal exam predict decision to obtain subsequent prostate cancer screening. METHODS: Data were drawn from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. The study sample consisted of 2,290 older men (mean age, 62.8 years; range, 55-75 years) who had false-positive (n = 318) or negative (n = 1,972) prostate-specific antigen or digital rectal exam baseline prostate cancer screening results. Multivariable logistic regression was used to assess the effect of false-positive results on subsequent prostate cancer screening behavior, adjusting for all covariates. RESULTS: The multivariable model showed that being African American (P = 0.016), and having a high school education or less (P = 0.007), having a previous false-positive prostate cancer screening result (P < 0.001), were predictive of not returning for prostate cancer screening in the following screening trial year. CONCLUSION: The study results highlight the importance of shared decision making between patients and their providers regarding the risks and benefits of prostate cancer screening, and follow-up options for abnormal prostate cancer screening results. Shared decision making may be especially important for African American men, whom prostate cancer disproportionately affects.

Black or African American↗
PubMed1996

Controversies in prostate cancer screening. Analogies to the early lung cancer screening debate.

The current debate regarding early detection and aggressive treatment of prostate cancer is fueled by the absence of controlled studies defining the risks and benefits of prostate cancer screening, and by the lack of adequately powered trials demonstrating the benefit of curative treatment for early-stage prostate cancer. Pending the results of clinical trials in 10 to 15 years, advocates of early detection of prostate cancer with digital rectal examination and prostate-specific antigen have compared prostate cancer screening with the effective strategy of breast cancer screening, implying that prostate cancer screening should similarly reduce cancer mortality. They have also cited the high burden of disease, the acceptable operating characteristics of digital rectal examination and prostate-specific antigen, a stage shift among cases detected by screening, and the theoretical curability of early-stage disease as sufficient reasons to proceed with screening. These arguments, however, are reminiscent of earlier arguments in favor of lung cancer screening with chest x-ray examination and sputum cytology, a practice ultimately proven ineffective in clinical trials. We reviewed published articles on lung and prostate cancer screening and identified many parallels. While prostate cancer screening may one day prove effective, analogies between the current prostate cancer screening controversy and the older lung cancer screening debate should inject some caution regarding widespread dissemination of prostate cancer screening without experimental evidence that such screening does more good than harm.

Clinical Trials as Topic↗
PubMed2005

Randomised controlled trial of mammographic screening in women from age 40: results of screening in the first 10 years.

Debate continues over the effectiveness of screening by mammography in women below age 50. We report here on results of screening in the first 10 years of a randomised trial to study the effect on breast cancer mortality of invitation to annual mammography from age 40 to 41 compared to first invitation to the 3-yearly UK national programme at age 50-52. The trial is taking place in 23 NHS breast screening centres. Between 1991 and 1997, 160 921 women were randomised in the ratio 1 : 2 to intervention and control arms. Screening is by two views at first screen and single view subsequently; data on screening up to and including round five are now complete. Uptake of invitation to screening is between 68 and 70% at all but the latest screening rounds. Rates of referral for assessment are 4.6% at first screen and 3.4% at subsequent screens. Invasive cancer detection rates are 0.09% at first screen, and similar at rescreens until the sixth and later screens. There is little evidence of regular mammography in the trial control arm. The setting of this trial within the NHS breast screening programme should ensure applicability of results to a national programme.

Adult↗
PubMed2005

Volume of screening mammography and performance in the Quebec population-based Breast Cancer Screening Program.

BACKGROUND: In the Quebec Breast Cancer Screening Program (Programme quebecois de depistage du cancer du sein [PQDCS]), radiologists' and facilities' volumes of screening mammography vary considerably. We examined the relation of screening-mammography volume to rates of breast cancer detection and false-positive readings in the PQDCS. METHODS: The study population included 307,314 asymptomatic women aged 50-69 years screened during 1998-2000. Breast cancer detection rates were analyzed by comparing all women with screening-detected breast cancer (n = 1709) and a 10% random sample of those without (n = 30,560). False-positive rates were analyzed by comparing the 3159 women with false-positive readings and the 27,401 others in the 10% random sample. Characteristics of participants, radiologists and facilities were obtained from the PQDCS information system. Data were analyzed by means of logistic regression. RESULTS: The rate of breast cancer detection appeared to be unrelated to the radiologist's screening-mammography volume but increased with the facility's screening-mammography volume. The breast cancer detection rate ratio for facilities performing 4000 or more screenings per year, compared with those performing fewer than 2000, was 1.28 (95% confidence interval [CI] 1.07-1.52). In contrast, the frequency of false-positive readings was unrelated to the facility's screening volume but was inversely related to the radiologist's screening volume: the rate ratio for readers of 1500 or more screenings per year compared with those reading fewer than 250 was 0.53 (95% CI 0.35-0.79). INTERPRETATION: Radiologists' and facilities' caseloads showed independent and complementary associations with performance of screening mammography in the PQDCS. Radiologists who worked in larger facilities and read more screening mammograms had higher breast cancer detection rates while maintaining lower false-positive rates.

Aged↗
PubMed1999

Instrumental variables when evaluating screening trials: estimating the benefit of detecting cancer by screening.

When evaluating the benefit of detecting cancer by screening we try to answer the question, 'what would a screen detected subject's outcome have been if his/her cancer had progressed to clinical detection'. By 'outcome' we mean survival time, cancer size and stage, lead time effects and more. Because only an unethical study can answer it directly, researchers have attempted to answer the question indirectly using data from randomized cancer screening studies (subjects randomized to study (screened) or control (not screened)). Inferences are made by first selecting the cancer cohort (those subjects who are found to have cancer), then comparing subjects having screen detected cancers to subjects having clinically detected cancers. However, there are two difficulties with this approach: (i) because screening (intends to) detect cancers early, at the trial's end the study group contains more cancer cases than the control group and so the cancer cohort has some unidentified control subjects missing (that is, subjects having cancer during the screening period that have not yet been clinically detected); (ii) because screen detected cancers (may) differ from clinically detected cancers, the comparison group should include only a (non-identified) subset of the cancer cohort's control subjects (that is, only those control subjects having cancers that would have been screen detected). Statistical literature acknowledges these difficulties and attempts to solve them separately, but without success; those methods do not yield meaningful causal inferences and admit substantial bias. Recently, Angrist, Imbens and Rubin and Imbens and Rubin provide a framework for instrumental variable methods that we interpret as allowing us to make causal inferences with incompletely identified comparison groups. We apply their framework to evaluating cancer screening trials and find that we may simultaneously accommodate both difficulties while giving a meaningful answer to the question posed above. Using data from a breast cancer screening trial we demonstrate the general method with a variety of outcome measures and extensions.

Adult↗
PubMedDate not supplied

Fetal Down syndrome screening: a cost effectiveness analysis of alternative screening programs.

OBJECTIVE: To compare the efficacy and cost effectiveness of different screening programs for fetal Down syndrome (DS). METHODS: Screening tools evaluated included maternal age, triple screening (TS), and ultrasound (U/S) for fetal markers of DS. Sensitivities used were TS: 55% <35 years, 80% > or = 35 years; U/S: 70%. Average regional fees used were TS: $80, U/S: $200, amniocentesis (AM): $1,000. Five screening programs were evaluated: 1) <35 years, no screening; > or = 35 years, AM; 2) <35 years, TS with AM for screen-positive subjects; > or = 35 years, AM; 3) all patients, TS with AM for screen-positive subjects; 4) <35 years, TS followed by U/S for screen-positive women, AM for women with fetal markers of DS on U/S; > or = 35 years TS with AM for screen-positive subjects; 5) all women, TS followed by U/S for screen-positive women, AM for women with fetal markers of DS on U/S. The sensitivity, total cost, cost/case DS detected (Cost/DS), AM losses, and residual risk (RR, undetected DS fetuses/women not receiving AM) were calculated for each screening program. Population analysis was performed using 1988 IL delivery statistics. RESULTS: It was estimated that 260 cases of DS would occur in the population of 167,654 women (8.4% > or = 35 years at delivery). Sensitivity for programs 1-5 was 30, 69, 62, 51, and 36 percent, respectively, and cost/DS was 181,000, 203,000, 162,000, 151,000, and 194,000 dollars, respectively. CONCLUSIONS: DS screening incorporating TS in all patients with program #4 and without program #3 selective U/S in women <35 years yield the best combination of sensitivity and cost effectiveness while minimizing the number of AM-related losses.

Adult↗
PubMed2003

Mammography screening matters for young women with breast carcinoma: evidence of downstaging among 42-49-year-old women with a history of previous mammography screening.

BACKGROUND: Breast carcinoma is the leading cause of death for women between the ages of 40 and 49 years, yet questions linger regarding the effectiveness of screening mammography in reducing mortality rates among women of this age. In the current study, the authors report on the association between cancer stage at diagnosis and a history of mammography screening in a clinical setting that has emphasized informed choice regarding mammography screening for women in this age group. METHODS: Previous mammographic screening for 247 breast cancer patients 42-49 years of age who were diagnosed at Kaiser Permanente Colorado during 1994-2000 was evaluated relative to cancer stage. Cancer stage was dichotomized into early (American Joint Committee on Cancer [AJCC] Stages 0 and I) and late (AJCC Stages II-IV) and previous screening was defined as at least one normal screening mammogram within 24 months before the breast carcinoma diagnosis. RESULTS: Women who were screened were less likely to be diagnosed at a late stage than were women who were not screened (40% vs. 52% late stage, respectively). Adjusted for age, year of diagnosis, and family history, screened women were 0.56 (95% confidence interval = 0.32-0.97) times as likely as unscreened women to be diagnosed at a late stage. CONCLUSIONS: Women 42-49 of years with breast carcinoma who undergo regular screening mammography have a more favorable cancer stage than do women with breast carcinoma who do not undergo regular screening. This downstaging of breast carcinoma is likely to translate into improved breast carcinoma survival resulting from screening mammography for women 40-49 years of age.

Adult↗
PubMedDate not supplied

Participation in a breast cancer screening program: influence of past behavior and determinants on future screening participation.

BACKGROUND: This study analyzed the relationship between past screening behavior, determinants, intention, and future screening participation in the Dutch national breast cancer screening program. METHODS: Participation at the first and second screening rounds was monitored. Furthermore, between the first and the second screening rounds, women received a questionnaire (response 58%, n = 395). The questionnaire was based on the ASE model, including attitude (consequences, anticipated regret, and moral obligation), social influence (support and modeling), and self-efficacy. Other distal variables assessed were previous screening behavior, evaluation of screening characteristics, and demographics. RESULTS: Participants at the second screening differed from nonparticipants on all ASE determinants. Stepwise multiple regression analyses showed that for previous participants and nonparticipants different ASE determinants and distal variables explained the variance in intention to participate in the next screening (30 to 45%). Logistic regression analyses showed that past behavior and intention (which mediated the effects of the ASE variables) were significant predictors of participation in the second screening. CONCLUSIONS: Differences between previous participants and nonparticipants in determinants of intention and future screening behavior can be used to improve participation and adherence to breast cancer screening.

Aged↗
PubMed2002

Women who participate in spontaneous screening are not at higher risk for cervical cancer than women who attend programme screening.

Up to 1995, programme screening for cervical cancer in The Netherlands was targeted at women between 35 and 54 years of age at 3-yearly intervals. Spontaneous screening in addition to programme screening was common practice. Our aim was to compare the underlying risk for cervical neoplasia for women involved in both types of screening. From the national pathological database, we retrieved all primary smears (n=693318) taken in 1994 in The Netherlands. Among the smears registered for screening purposes (39%), 79% was taken within the mass screening programme and 21% was taken for spontaneous screening. The underlying risk was studied from the detection rates of histologically confirmed severe dysplasia or worse, using a multivariate loglinear model, including age and screening history. The detection rate of at least severe dysplasia, adjusted for age and screening history, was equal for women who had a spontaneous smear and for those who had a programme smear (odds ratio (OR): 0.97; 95% Confidence Interval (CI): 0.84-1.14). In our data, women participating in spontaneous screening were not at a higher risk for cervical cancer than women who used programme screening. Therefore, all asymptomatic women in the Netherlands should follow the general guidelines for age-range and screening-interval.

Adult↗
PubMed2003

Is large-scale community memory screening feasible? Experience from a regional memory-screening day.

OBJECTIVES: To investigate whether a large-scale memory-screening program for community-dwelling elders would be successful in identifying individuals with a high probability of dementia in need of further assessment that would result in the earlier diagnosis of dementia. DESIGN: A descriptive study of experience with a volunteer sample. SETTING: Ten sites (e.g., senior centers, churches, clinics) throughout New England on October 29, 1999. PARTICIPANTS: Trained volunteer clinicians evaluated 497 community-dwelling individuals on the screening day. An additional 162 subjects who could not be accommodated on that day were subsequently screened at local sites by appointment during the following month. MEASUREMENTS: Subjects participated in a standardized format consisting of an educational lecture, followed by individual screenings with the 7-minute screen (7MS) with locally trained staff. Subjects were informed immediately of test results and counseled regarding follow-up options. A survey was conducted with these subjects and their primary care physicians over the following year. RESULTS: Because the groups tested at different times were not statistically different in terms of demographics, they were combined in the analysis. One hundred ten (16.7% of all screened) individuals received high/retest scores on the 7MS. They were advised to seek diagnostic evaluation and encouraged to have results sent to their primary care physicians (PCPs). Of those followed up, 64% reported that they followed up the screening results with their PCP. More than one-third (38%) of participants with a high/retest score on the 7MS had inconclusive findings on follow-up or were awaiting further diagnostic evaluation. Of those for whom follow-up data were available, 10 (9%) were diagnosed with probable Alzheimer's disease (AD), and an additional nine (8%) who had previous diagnoses of AD were correctly identified by the 7MS. Anecdotally, feedback from participants indicated a high level of satisfaction with the process. Participants reported that the educational talk and the possibility of early detection were the most helpful components of the screening program. Moreover, most individuals surveyed in follow-up would recommend the program to a friend or family member. CONCLUSION: A follow-up survey of participants and their physicians supported the conclusion that a community memory-screening program might detect individuals who were previously unknown to have cognitive problems. Furthermore, such a program was highly acceptable to participants. The small number of individuals diagnosed with dementia as a result of the screening program indicates that this form of screening may be inefficient as performed. Multiple obstacles to seeking follow-up care were identified and would need to be addressed in larger-scale programs to make this a worthwhile endeavor. The experience gained in this memory screening program might aid in the planning of better programs, which will be essential if early diagnosis is to keep pace with the growth of treatments for dementia.

Aged↗
PubMed2002

Differences between screening sites in a glaucoma screening program.

OBJECTIVE: To determine the differences in demographic variables, glaucoma risk factors, and visual acuity by type of screening site. METHODS: We conducted glaucoma screenings throughout the city of Baltimore. A questionnaire collected information about age, race, and risk factors: having a relative with glaucoma, having diabetes, having a past eye injury or surgery, and not having an eye examination within two years. We also tested visual acuity and visual fields. We categorized screening sites into work places, senior centers, health fairs, and church groups, and created age-race groups by combining age and race categories. RESULTS: This study is based on 1,366 people screened at 42 different sites. The majority of people screened were African-American (65%) and female (58%), with a mean age of 48 years. We found significant age and race differences between the screening sites. After stratifying by age-race groups, we found statistically significant associations between screening sites and not having a recent eye examination (P =.009) and visual acuity (P =.001). Health fairs had the largest percentage of people not having a recent eye examination, and senior centers had the largest percentage of people with poor visual acuity. CONCLUSIONS: Our data showed differences in age and race between screening sites. After conducting stratified analysis, differences between screening sites and recent eye examinations and visual acuity persisted. These differences in screening sites, as well as objectives of the vision screening, should be considered when planning a screening program to help focus the program on appropriate high-risk subgroups of the population.

Adolescent↗
PubMed1997

Fecal occult blood screening in the Minnesota study: sensitivity of the screening test.

BACKGROUND: In the Minnesota Colon Cancer Control Study, which used guaiac slides to annually screen stool samples for blood, mortality from colorectal cancer was reduced by 33.4%. The reported sensitivity of this test for colorectal cancer was about 90%. However, results from another study estimated the sensitivity to be 25%-33%; other investigators have reported intermediate values. Given these contradictions, we examined screening sensitivity for colorectal cancer in the Minnesota study by several direct and indirect methods. METHODS: In this reanalysis of data from the Minnesota study, we distinguished between sensitivity for colorectal cancer of the screening test (composed of six slides) and of the screening program (a series of such tests). We estimated screen sensitivity by adjusting the crude estimate from the final tests in each screening phase for colorectal cancer incidence in 5 years of follow-up, by modeling guaiac slide results at each screen as a function of the presence of occult blood, and by incorporating sensitive detection into a modification of a mathematical model developed by Lang and Ransohoff. Program sensitivity was estimated from the fraction of screen-detected cancers among all cancers diagnosed in screened individuals. RESULTS: The crude estimate of program sensitivity was 89.4%, whereas the modified Lang-Ransohoff model estimates screen sensitivities at 94.1%-96.2%, consistent with the estimates from the other methods. Indirect measures, such as the association between the number of positive slides among the six slides in each set and the positive predictivity for colorectal cancer, are consistent with these estimates. CONCLUSIONS: The Minnesota study reduced mortality from colorectal cancer through use of a screening test with average screen and program sensitivities of about 90%.

Colorectal Neoplasms↗
PubMed2005

Comparison of screen detected and clinically diagnosed prostate cancer in the European randomized study of screening for prostate cancer, section rotterdam.

PURPOSE: This report provides a comparison of characteristics detected in the screening and control arms of the European Randomized study of Screening for Prostate Cancer, section Rotterdam. MATERIALS AND METHODS: Between December 1993 and January 1999, 35,148 men 55 to 74 years old were randomized to European Randomized study of Screening for Prostate Cancer Rotterdam, including 17,635 in the screening arm and 17,513 in the control arm. Prostate specific antigen testing, digital rectal examination, transrectal ultrasound and sextant biopsies were offered to all participants in the screening arm according to 2 algorithms. All screening detected cancers and cancers found in the control arm were evaluated at the same cutoff point, that is January 1, 2003. To identify prostate cancer cases in the control arm yearly linkage was performed with the Rotterdam Cancer Registry database. Followup information was collected by chart review. RESULTS: By January 1, 2003, 1,269 cancers were detected in the screening arm and 336 were detected in the control arm. A shift to more favorable clinical stages and histological grades on biopsy was seen in the screening arm of the trial. T1C and T2 cancers were 5.8 and 6.2 times more often diagnosed, respectively, in the screening arm than in the control arm of the trial. Only 4.6% of control arm cancers were found through opportunistic screening. CONCLUSIONS: Although a favorable shift in prognostic factors was seen for the screening arm of the trial, these results do not provide evidence that prostate cancer screening has an effect on prostate cancer mortality.

Aged↗
PubMed2006

Cervical screening in HIV-positive women: characteristics of those who default and attitudes towards screening.

OBJECTIVES: To determine the characteristics of HIV-positive women who undergo cervical screening and to identify negative attitudes and experiences of these women to screening and the factors associated with these. METHODS: We compared the Royal Free Cohort data from 59 newly diagnosed HIV-infected women, 31 of whom did and 28 of whom did not attend for cervical screening in 2001, and from 227 women under active cervical screening follow-up (at least one cervical screen since June 2001) and 88 HIV-infected women lost to follow-up (not screened since January 2001). Attitudes to screening were investigated with the aid of a questionnaire given to all women attending clinic who had had a previous colposcopy. RESULTS: Of the 59 newly HIV diagnosed women, 31 (53%) underwent cervical screening. These 31 women were more likely to be heterosexual (100 vs 89%, P=0.05), to have lower median viral loads (< 50 vs 3210 HIV-1 RNA copies/mL) and to be receiving antiretrovirals (ARVs) (74 vs 54%, P=0.1) than those not screened. Of the 315 women who had at least one screen, 72% returned for further follow-up. There were no differences in age or ethnicity between these groups. Those under active follow-up had a higher CD4 count (P=0.04) and lower viral load (P=0.0001) at their last visit. They were also more likely to be on highly active antiretroviral therapy (HAART) (68 vs 52%, P=0.006). A total of 78 of 104 questionnaires (75%) were returned. Women participating in the questionnaire study were mainly of back ethnicity (68%), did not speak English as their first language (59%) and were taking ARVs (76%). Most agreed that regular smears and colposcopy were valuable. Women of white ethnicity, and those speaking English as a first language, were more likely to dislike colposcopy compared with those of nonwhite ethnicity (87 vs 25%, respectively, P=0.0007) and not speaking English as a first language (74 vs 26%, respectively, P=0.002). Those of white ethnicity were more likely to find smears and colposcopy painful (60 and 73%) compared with those of black ethnicity (46 and 51%, P=0.47 and 0.28, respectively). CONCLUSIONS: Our results suggest that women on HAART with better disease control, older women, and those of black African ethnicity are more likely to take up cervical screening. Cervical screening experience varies by ethnicity and language.

Adult↗
PubMed1997

Scintillating fiber optic screens: a comparison of MTF, light conversion efficiency, and emission angle with Gd2O2S:Tb screens.

The widespread effort in developing digital imaging systems has led to large area high pixel density photodetectors such as charge coupled devices (CCDs), amorphous silicon photodiode arrays, and complementary metal oxide semiconductor (CMOS) imagers. These photodetectors have different capabilities, characteristics, and requirements than conventional silver-halide-based film, and this fact had led to a new generation of exotic scintillators, including fiber optic screens made from scintillating glass. The scintillator performance characteristics of five different scintillating fiber optic screens and two conventional Gd2O2S:Tb screens (one 34 mg/cm2 and the other 60 mg/cm2) were measured and compared. The measurements that were made included the angular dependence of light emission relative to the normal, the modulation transfer function (MTF), and the absolute effective conversion efficiency (light photons per absorbed x-ray photon). It was found that the light emission of scintillating fiber optic screens is markedly forward peaked (depending on the sample) compared to conventional screens or Lambertian emitters. The MTFs of the five scintillating fiber optic screens measured were comparable and fell approximately midway between the two conventional screen MTFs. One of the scintillating fiber optic screens demonstrated light efficiency similar to the thick (60 mg/cm2) conventional screen, another had light output capabilities similar to the thin (34 mg/cm2) conventional screen, and the three others were less efficient than the thin screen. The non-Lambertian characteristics of the fiber optic scintillators will cause errors of up to 75% in lens efficiency calculations if a Lambertian source is assumed. The conventional screens were found to conform within about 5% of an ideal Lambertian emitter.

Biophysical Phenomena↗
PubMed2002

A randomised study of screening for colorectal cancer using faecal occult blood testing: results after 13 years and seven biennial screening rounds.

BACKGROUND: Three randomised trials have demonstrated reduction in mortality from colorectal cancer (CRC) by repeated screening with faecal occult blood tests, including the trial presented here, which is the only one still in progress. AIMS: To evaluate reduction in mortality after seven screening rounds and the possible influence of compliance on mortality from CRC. METHODS: At Funen in Denmark, random allocation to biennial screening with Hemoccult-II in 30 967 subjects aged 45-75 years and 30,966 controls was performed in 1985 from a population of 137,485 of the same age. Only participants who completed the first screening round were invited for further screening. Colonoscopy was offered if the test was positive. The primary end point was death from CRC, and the 10 year results were published in 1996. RESULTS: From the beginning of the first screening to the seventh round, mean age increased from 59.8 to 70.0 years in the screening and control groups, and the male/female ratio decreased from 0.92 to 0.81. Those who accepted screening were younger than non-responders. Positivity rates varied from 0.8% to 3.8%, the cumulative ratio of a positive test was 5.1% after seven rounds, and 4.8% of patients had at least one colonoscopy. Mortality from CRC was significantly less in the screening group (relative risk (RR) 0.82 (0.69-0.97)), and the reduction in mortality was most pronounced above the sigmoid colon. After seven rounds, RR was reduced to less than 0.70 compared with controls. Mortality rates from causes other than CRC did not differ. Non-responders had a significantly increased risk of death from CRC compared with those who accepted the full programme. Subjects who accepted the first screening, but not subsequent ones, demonstrated a tendency towards increased risk. CONCLUSIONS: The persistent reduction in mortality from CRC in a biennial screening program with Hemoccult-II, and a reduction in RR to less than 0.70 in those adhering to the programme, support attempts to introduce larger scale population screening programmes. The smaller effect on mortality from CRC in the rectum and sigmoid colon suggests evaluation by additional flexible sigmoidoscopy with longer intervals.

Aged↗
PubMed1998

Slippage in the NHS breast screening programme: an assessment of whether a three year screening round is being achieved.

BACKGROUND: The NHS breast screening programme (NHSBSP) was established in 1987 to screen women aged 50-64 every three years to achieve a significant reduction in breast cancer mortality. Ensuring that women are re-invited every three years (that is, a three year screening round is in operation) is becoming increasingly difficult as pressure on the service rises. Coverage measures the proportion of eligible women receiving a screen in the previous three years and is currently used as an NHS performance indicator, while uptake measures the proportion of invited women who attend for screening. Data for 1996/1997 for the West Midlands NHSBSP show that, although uptake among 50-64 year olds was in excess of the 70% target at 78%, coverage was 10% below this at 68%. The discrepancy between coverage and uptake is likely to in part reflect "round slippage" in which women are re-invited at three years or more from their previous screen. To investigate the extent to which slippage is occurring in the region a technique for assessing round length independently of coverage was developed. METHODS: Records for women receiving routine recall (incident) screens between 1994 and 1997 in the West Midlands NHSBSP were examined and the time between the most recent screen and the previous screen measured in months. FINDINGS: Of 73,785 women screened in 1996/1997, 46.3% had a round length of under three years, although 74.9% had been re-screened within 38 months of the previous screen. Overall the regional programme was estimated to have a round slippage of approximately two months. CONCLUSIONS: The West Midlands NHSBSP operates to high standards in terms of uptake and cancer detection, but round slippage must be reduced. The lack of quantitative data with which to assess round length has hindered assessment in the past. The simple technique developed in this study will allow assessment of round length to be used routinely as the key quality assurance measure for the programme.

Breast Neoplasms↗