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At least 163 records · Page 9Linked to original sources
PubMed2004

Disaggregating data on Asian and Pacific Islander women to assess cancer screening.

BACKGROUND: Although incidence of cancer is increasing among Asian-American and Pacific-Islander (AAPI) women, their low cancer screening rates are inadequately addressed. Furthermore, the traditional approach of studying the diverse AAPI nationalities as one group hides important intra- and inter-group ethnic differences in cancer screening, as well as lack of representativeness because the surveys are not administered in any AAPI language. To address these problems, this study compared cancer screening rates among particular AAPI groups and non-AAPIs living in an ethnically diverse region. METHODS: This study was conducted in 2001-2002 using data from the 1999-2000 Los Angeles County Health Survey, a population-based telephone survey that relied on random-digit-dialing techniques. Cervical and breast cancer-screening rates were measured, and key determinants of screening using bivariate analyses and multivariate logistic regression were assessed. RESULTS: AAPIs had lower screening rates than whites, with significant variation among AAPI subgroups. Moreover, AAPI women were less likely to have undergone cervical cancer screening compared to white women, independent of major demographic, socioeconomic, and health status factors. Determinants for receipt of cancer screening differed for AAPIs and whites. Immigration factors were significant barriers to cancer screening for AAPIs. CONCLUSIONS: These findings support the evidence of disparities in receipt of cancer screening services among subgroups of AAPI women. Additionally, these findings highlight the importance of disaggregating the heterogeneous AAPI population to identify higher-risk subgroups and facilitate development of effective targeted interventions.

Adult↗
PubMedDate not supplied

Age-related disparities in cancer screening: analysis of 2001 Behavioral Risk Factor Surveillance System data.

PURPOSE: Although few studies have explored age-related health care disparities, some researchers have asserted such disparities uniformly disfavor the elderly and are largely attributable to ageism in the health care system. We compared age-related patterns of screening for colorectal cancer with those for breast and prostate cancer in persons aged 50 years and older. METHODS: We analyzed data for all adults aged 50 years and older (N = 88,213) in the 2001 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative, telephone-administered survey of personal health behaviors. Main outcome measures were adjusted prevalence by 5-year age-groups of colorectal cancer screening using fecal occult blood testing, flexible sigmoidoscopy, or colonoscopy for men and women; rates of mammography screening for women; and rates of prostate-specific antigen (PSA) screening for men. RESULTS: After adjustment for race/ethnicity, education level, income, health insurance, and self-rated health, predicted reported colorectal cancer screening (all modalities) increased significantly from when patients reached age 50 years until 70 to 74 years (66.0%, standard error [SE] 0.8%), remained constant until age 80 years, and then declined. The age-related gain in colorectal cancer screening was confined to whites among patients older than 60 years. Reported PSA screening increased until age 75 to 79 years (79.3%, SE 1.1%) and then declined, whereas reported mammography screening peaked at age 55 to 59 years (83.3%, SE 1.2%) and then declined. CONCLUSIONS: Significant age-related disparities appear to exist for both evidence-based and non-evidence-based cancer-screening interventions. The issue of age-related disparities in cancer screening is complex, with the direction of disparity favoring the elderly for some services yet disfavoring them for others.

Age Factors↗
PubMed1997

Evaluation of oral cancer screening.

BACKGROUND: Oral cancer screening procedures are designed to collectively allow early detection of cancers in a body area accessible to visual and physical examination, as well as to facilitate timely treatment, awareness, and the ongoing education of the public. METHODS: A state fair was selected for this activity because of the availability of a random population compatible with meeting these goals. A total of 1,151 individuals participated in this free elective activity. RESULTS: Of this number 4.17% were deemed to have oral pathologic states necessitating professional intervention, and 1.82% were clinically diagnosed as having potential dysplastic or precancerous lesions. No clinical oral cancer was detected in this population. Nevertheless, by virtue of screening and detecting clinically premalignant lesions, the screening test advanced the diagnosis of potential oral cancers. CONCLUSIONS: The outcome adds support to oral cancer screening as a procedure applicable in reducing morbidity and mortality from oral cancers.

Adult↗
PubMed2003

Estimating the cumulative risk of false positive cancer screenings.

BACKGROUND: When evaluating cancer screening it is important to estimate the cumulative risk of false positives from periodic screening. Because the data typically come from studies in which the number of screenings varies by subject, estimation must take into account dropouts. A previous approach to estimate the probability of at least one false positive in n screenings unrealistically assumed that the probability of dropout does not depend on prior false positives. METHOD: By redefining the random variables, we obviate the unrealistic dropout assumption. We also propose a relatively simple logistic regression and extend estimation to the expected number of false positives in n screenings. RESULTS: We illustrate our methodology using data from women ages 40 to 64 who received up to four annual breast cancer screenings in the Health Insurance Program of Greater New York study, which began in 1963. Covariates were age, time since previous screening, screening number, and whether or not a previous false positive occurred. Defining a false positive as an unnecessary biopsy, the only statistically significant covariate was whether or not a previous false positive occurred. Because the effect of screening number was not statistically significant, extrapolation beyond 4 screenings was reasonable. The estimated mean number of unnecessary biopsies in 10 years per woman screened is.11 with 95% confidence interval of (.10,.12). Defining a false positive as an unnecessary work-up, all the covariates were statistically significant and the estimated mean number of unnecessary work-ups in 4 years per woman screened is.34 with 95% confidence interval (.32,.36). CONCLUSION: Using data from multiple cancer screenings with dropouts, and allowing dropout to depend on previous history of false positives, we propose a logistic regression model to estimate both the probability of at least one false positive and the expected number of false positives associated with n cancer screenings. The methodology can be used for both informed decision making at the individual level, as well as planning of health services.

Adult↗
PubMed2004

New Mexico's capacity for increasing the prevalence of colorectal cancer screening with screening colonoscopies.

INTRODUCTION: Colorectal cancer screening rates are low throughout the United States. Colonoscopy has been recommended as a cost-effective strategy for colorectal cancer screening and prevention. We evaluated New Mexico's capacity to increase the prevalence of colorectal cancer screening using colonoscopy. METHODS: We identified New Mexican gastroenterologists from state licensing data and from endoscopic manufacturers. We surveyed gastroenterologists on their weekly number of colonoscopies, capacity for additional screening colonoscopies, and barriers to increasing capacity. We used census data, published data on the yield of screening colonoscopy, and professional society guidelines for cancer/polyp surveillance to estimate the additional colonoscopies required to increase the state's prevalence of endoscopic screening. RESULTS: Forty gastroenterologists, representing all 11 group practices in the state, and nine of 12 solo practitioners responded. They estimated that their weekly procedure capacity could be increased by 41%, from 832 to 1174 colonoscopies. We estimated an annual capacity increase of 14,880 procedures, which could increase the prevalence of endoscopic colorectal cancer screening from the current 35% to about 50% over five years. Lack of support staff, space, and physicians were barriers to increasing screening. CONCLUSION: Implementing a screening colonoscopy strategy could achieve the goal of a higher level of colorectal screening. However, achieving more universal screening would require additional testing modalities.

Colonoscopy↗
PubMed2006

[Cost-effectiveness of colorectal cancer screening].

Colorectal cancer (CRC) screening in France is based on a faecal occult blood test every two years in average risk subjects 50-74 years of age while other endoscopic or non-endoscopic screening methods are used in Europe and in the USA. Beside the reduced incidence of and mortality from CRC found in available studies, cost-effectiveness data need to be taken into account. Because of the delay between randomized controlled trials and clinical results, transitional probabilistic models of screening programs are useful for public health policy makers. The aim of the present review was to promote the implementation of cost-effectiveness studies, to provide a guide to analyze cost-effectiveness studies on CRC screening and, to propose a French cost effectiveness study comparing CRC screening strategies. Most of these trials were performed by US or UK authors and demonstrate that the incremental cost-effectiveness ratio varies between 5 000 and 15 000 US dollars/one year life gained, with wide variations: these results were highly dependent on the unit costs of the different devices as well as the predictive values of the screening tests. Although CRC screening programs have been implemented in several administrative districts of France since 2002, and the results of these randomized controlled trials using fecal occult blood have been updated, cost-effectiveness criteria need to be integrated; especially since the results of screening campaigns based on other tools such as flexible sigmoidoscopy should be available in 2007.

Aged↗
PubMed2006

Raising awareness and providing free screening improves cervical cancer screening among economically disadvantaged Lebanese/Armenian women.

Women need to practice cervical screening regularly to reduce morbidity and mortality. The purpose of this study was to examine the impact of an intervention program on knowledge, attitude, and practice of cervical screening in the population of Lebanese/Armenian women. The design was a cross-sectional, quasi-experimental posttest survey following a year long intervention program. The sample included 176 women, who were members of the Armenian Relief Cross in Lebanon. Interventions consisted of educational classes, media messages, and free screening. The instrument was a self-administered questionnaire. Knowledge of women with intervention was higher (p > .05) and practice rate increased between intervention and comparison groups. No difference in attitude was noted. The study was successful in raising awareness and increasing screening in the sample. It is recommended to continue helping women to overcome barriers for cervical screening.

Adolescent↗