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Maillart, Lisa M., Julie Simmons Ivy, Scott Ransom i Kathleen Diehl. "Assessing Dynamic Breast Cancer Screening Policies". Operations Research 56, nr 6 (grudzień 2008): 1411–27. http://dx.doi.org/10.1287/opre.1080.0614.
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Gocgun, Y., D. Banjevic, S. Taghipour, N. Montgomery, B. J. Harvey, A. K. S. Jardine i A. B. Miller. "Cost-effectiveness of breast cancer screening policies using simulation". Breast 24, nr 4 (sierpień 2015): 440–48. http://dx.doi.org/10.1016/j.breast.2015.03.012.
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Urbain, J. L. "Breast cancer screening, diagnostic accuracy and health care policies". Canadian Medical Association Journal 172, nr 2 (18.01.2005): 210–11. http://dx.doi.org/10.1503/cmaj.1041498.
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Herrmann, Christian, Penelope Vounatsou, Beat Thürlimann, Nicole Probst-Hensch, Christian Rothermundt i Silvia Ess. "Impact of mammography screening programmes on breast cancer mortality in Switzerland, a country with different regional screening policies". BMJ Open 8, nr 3 (marzec 2018): e017806. http://dx.doi.org/10.1136/bmjopen-2017-017806.
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IntroductionIn the past decades, mortality due to breast cancer has declined considerably in Switzerland and other developed countries. The reasons for this decline remain controversial as several factors occurred almost simultaneously, including important advances in treatment approaches, breast cancer awareness and the introduction of mammography screening programmes in many European countries. In Switzerland, mammography screening programmes (MSPs) have existed in some regions for over 20 years but do not yet exist in others. This offers the possibility to analyse its effects with modern spatiotemporal methodology. We aimed to assess the spatiotemporal patterns and the effect of MSPs on breast cancer mortality.SettingSwitzerland.ParticipantsThe study covers breast cancer deaths of the female population of Switzerland during the period 1969–2012. We retrieved data from the Swiss Federal Statistical Office aggregated on a small-area level.DesignWe fitted Bayesian hierarchical spatiotemporal models on death rates indirectly standardised by national references. We used linguistic region, degree of urbanisation, duration of population-based screening programmes and socioeconomic index as covariates.ResultsIn Switzerland, breast cancer mortality in women slightly increased until 1989–1992 and declined strongly thereafter. Until 2009–2012, the standardised mortality ratio declined to 57% (95% CI 54% to 60%) of the 1969–1972 value. None of the other coefficients of the spatial regressions had a significant effect on breast cancer mortality. In 2009–2012, no region had significantly elevated or reduced breast cancer mortality at 95% credible interval level compared with the national mean.ConclusionThere has been a strong reduction of breast cancer mortality from the 1990s onwards. No important spatial disparities were observed. The factors studied (urbanisation, language, duration of population-based MSP and socioeconomic characteristics) did not seem to have an influence on them. Low participation rates and opportunistic screening use may have contributed to the low impact of MSPs.
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Kong, Qingxia, Susana Mondschein i Ana Pereira. "Effectiveness of breast cancer screening policies in countries with medium-low incidence rates". Revista de Saúde Pública 52 (29.01.2018): 7. http://dx.doi.org/10.11606/s1518-8787.2018052000378.
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Chile has lower breast cancer incidence rates compared to those in developed countries. Our public health system aims to perform 10 biennial screening mammograms in the age group of 50 to 69 years by 2020. Using a dynamic programming model, we have found the optimal ages to perform 10 screening mammograms that lead to the lowest lifetime death rate and we have evaluated a set of fixed inter-screening interval policies. The optimal ages for the 10 mammograms are 43, 47, 51, 54, 57, 61, 65, 68, 72, and 76 years, and the most effective fixed inter-screening is every four years after the 40 years. Both policies respectively reduce lifetime death rate in 6.4% and 5.7% and the cost of saving one life in 17% and 9.3% compared to the 2020 Chilean policy. Our findings show that two-year inter-screening interval policies are less effective in countries with lower breast cancer incidence; thus we recommend screening policies with a wider age range and larger inter-screening intervals for Chile.
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Rajendram, Priyanka, Prachi Singh, Kok Teng Han, Vasuki Utravathy, Hwee Lin Wee, Anand Jha, Shyamala Thilagaratnam i Swathi Pathadka. "Barriers to breast cancer screening in Singapore: A literature review". Annals of the Academy of Medicine, Singapore 51, nr 8 (29.08.2022): 493–501. http://dx.doi.org/10.47102/annals-acadmedsg.2021329.
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Introduction: Breast cancer is a leading cause of cancer death among women, and its age-standardised incidence rate is one of the highest in Asia. We aimed to review studies on barriers to breast cancer screening to inform future policies in Singapore. Method: This was a literature review of both quantitative and qualitative studies published between 2012 and 2020 using PubMed, Google Scholar and Cochrane databases, which analysed the perceptions and behaviours of women towards breast cancer screening in Singapore. Results: Through a thematic analysis based on the Health Belief Model, significant themes associated with low breast cancer screening uptake in Singapore were identified. The themes are: (1) high perceived barriers versus benefits, including fear of the breast cancer screening procedure and its possible outcomes, (2) personal challenges that impede screening attendance and paying for screening and treatment, and (3) low perceived susceptibility to breast cancer. Conclusion: Perceived costs/barriers vs benefits of screening appear to be the most common barriers to breast cancer screening in Singapore. Based on the barriers identified, increasing convenience to get screened, reducing mammogram and treatment costs, and improving engagement with support groups are recommended to improve the screening uptake rate in Singapore. Keywords: Barriers, breast cancer, mammography, screening programme
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Yala, Adam, Peter G. Mikhael, Constance Lehman, Gigin Lin, Fredrik Strand, Yung-Liang Wan, Kevin Hughes i in. "Optimizing risk-based breast cancer screening policies with reinforcement learning". Nature Medicine 28, nr 1 (styczeń 2022): 136–43. http://dx.doi.org/10.1038/s41591-021-01599-w.
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Madadi, Mahboubeh, Shengfan Zhang i Louise M. Henderson. "Evaluation of breast cancer mammography screening policies considering adherence behavior". European Journal of Operational Research 247, nr 2 (grudzień 2015): 630–40. http://dx.doi.org/10.1016/j.ejor.2015.05.068.
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Seely, Jean M., Peter R. Eby i Martin J. Yaffe. "The Fundamental Flaws of the CNBSS Trials: A Scientific Review". Journal of Breast Imaging 4, nr 2 (1.03.2022): 108–19. http://dx.doi.org/10.1093/jbi/wbab099.
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Abstract Although the two Canadian National Breast Screening Study (CNBSS) trials were performed 40 years ago, their negative findings continue to heavily influence screening policies around the world. These policies, based on underestimates of the mortality reduction attributable to mammography particularly for women in the 40–49-year age range, contribute to increased mortality and morbidity from breast cancer. This review summarizes principles of a randomized controlled trial (RCT) and evaluates the compliance of the CNBSS1 and CNBSS2 RCTs in the context of these principles. We describe the fundamental flaws of the CNBSS trials, which failed to demonstrate mortality benefit of screening mammography and contribute to their being the only two outlier studies of eight screening mammography RCTs. The most significant flaws of the trials are (1) inadequate power to detect significant differences in breast cancer mortality; (2) very poor quality mammography with low sensitivity and cancer detection rates; (3) inclusion of women with symptoms of breast cancer; and (4) study design that allowed for violation of the randomization of the allocation process. Finally, we demonstrate that the conditions of the screening intervention in the CNBSS do not reflect the environment of modern population-based screening mammography programs.
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Halpern, Michael T., Melissa A. Romaire, Susan G. Haber, Florence K. Tangka, Susan A. Sabatino i David H. Howard. "Impact of Medicaid reimbursement and eligibility policies on receipt of cancer screening." Journal of Clinical Oncology 31, nr 15_suppl (20.05.2013): 6514. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.6514.
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6514 Background: State Medicaid programs cover receipt of cancer screening services. However, coverage of cancer screening tests does not guarantee access to these services. Medicaid beneficiaries are less likely to be screened for cancer and more likely to present with advanced stage cancers. State-specific variations in Medicaid program eligibility requirements and reimbursements for medical services may affect cancer screening rates among Medicaid enrollees. This study examined how eligibility and reimbursement policies affected receipt of breast, cervical, colorectal, and prostate cancer screening. Methods: We examined 2007 Medicaid data for individuals age 21-64 enrolled in fee-for-service Medicaid for at least 4 months from 46 states and the District of Columbia. We examined the association of state-specific Medicaid cancer screening test and office visit reimbursements, income and financial asset eligibility requirements, physician copayments, and frequency of Medicaid eligibility renewal on receipt of cancer screening. Analyses used multivariate logistic regressions with generalized estimating equations to control for correlation between beneficiaries within a state. Results: Increased Medicaid screening test reimbursements were significantly associated with small increases in receipt of colonoscopy, mammograms, and PSA tests. Increased reimbursements for office visits were associated with increased receipt of colonoscopy, FOBT, Pap tests, and mammograms. Greater asset thresholds for Medicaid eligibility increased the likelihood of all screening tests except FOBT. Beneficiaries in states requiring more frequent (<12 month) renewal of Medicaid eligibility were more likely to receive FOBT, PSA, or mammograms, but less likely to receive Pap tests. Conclusions: Increasing Medicaid reimbursement rates and asset policies was generally associated with increases in cancer screening. As proposed Medicaid eligibility expansions will almost certainly increase the number of enrollees in this program, it is crucial to provide adequate reimbursements and develop eligibility policies to promote cancer screening and thereby increase early cancer detection among this underserved population.
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Yaffe, Martin J., Jean M. Seely, Paula B. Gordon, Shushiela Appavoo i Daniel B. Kopans. "The randomized trial of mammography screening that was not—A cautionary tale". Journal of Medical Screening 29, nr 1 (23.11.2021): 7–11. http://dx.doi.org/10.1177/09691413211059461.
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Two randomized trials were conducted in Canada in the 1980s to test the efficacy of breast cancer screening. Neither of the trials demonstrated benefit. Concerns were raised regarding serious errors in trial design and conduct. Here we describe the conditions that could allow subversion of randomization to occur and the inclusion of many symptomatic women in a screening trial. We examine anomalies in data where the balance would be expected between trial arms. “Open book” randomization and performance of clinical breast examination on all women before allocation to a trial arm allowed women with palpable findings to be mis-randomized into the mammography arm. Multiple indicators raising suspicion of subversion are present including a large excess in poor-prognosis cancers in the mammography trial arm at prevalence screen. Personnel described shifting of women from the control group into the mammography group. There is compelling evidence of subversion of randomization in Canadian National Breast Screening Study. Mis-randomization of even a few women with advanced breast cancer could markedly affect measured screening efficacy. The Canadian National Breast Screening Study trials should not influence breast screening policies.
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Shapiro, S. "Breast cancer screening programmes in 22 countries: current policies, administration and guidelines. International Breast Cancer Screening Network (IBSN) and the European Network of Pilot Projects for Breast Cancer Screening". International Journal of Epidemiology 27, nr 5 (1.10.1998): 735–42. http://dx.doi.org/10.1093/ije/27.5.735.
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Changkun, Zhu, Ghose Bishwajit, Lu Ji i Shangfeng Tang. "Sociodemographic correlates of cervix, breast and oral cancer screening among Indian women". PLOS ONE 17, nr 5 (11.05.2022): e0265881. http://dx.doi.org/10.1371/journal.pone.0265881.
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Introduction Cervix, breast and oral cancers account for about one-third of all cancers in India which as a group is a major contributor to all non-communicable disease-related morbidity and mortality among women. Existing evidence suggests that early diagnosis plays a pivotal role in the prevention and intervention of these cancers, and many community-based early screening and awareness programs have been in place in developed countries. Currently, there is not enough research evidence regarding the sociodemographic correlates of cervix, breast and oral cancer screening among Indian women. In the present study, we aimed to assess the self-reported percentage and sociodemographic factors associated with the use of these three types of cancer screening services among Indian women aged 15–49 years. Methods Data were collected from National Family Health Survey conducted during 2015–16. Sample population was 699,686 women aged 15–49 years. Associations between self-reported cervical, breast and oral cancer screening status and the associated sociodemographic factors were analyzed using multivariable logistic regression methods. Results The percentage of screening for cervical (21%), breast (8.95%), and oral cancers (13.45%) varied significantly across the population sub-groups. Higher age, urban residence, higher education, having employment, health insurance, use of electronic media, higher household wealth quintile, having healthcare autonomy, showed a positive effect on taking screening services. Further analyses revealed that the strength of the associations varied considerably between urban and rural residents, denoting the need for region-specific intervention strategies. Sex of household head, age, watching TV, using radio, and having health insurance were the most significant contributors to the outcome effects. Conclusions The present study provides important insights regarding the current scenario of seeking cancer screening services among women in India. These findings could inform policy analysis and make an avenue for further in-depth analysis for future studies. Our findings conclude that cancer prevention policies should focus on leveraging the positive effects of better socioeconomic status, employment, health insurance ownership, exposure to electronic media, and better healthcare autonomy to improve the cancer screening service uptake among Indian women.
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Luciani, Silvana, Lianne Vardy, Eugenio Paci, Isaac Adewole, Annie Sasco i Tania Calvacante. "Cancer prevention and population-based screening". Tumori Journal 95, nr 5 (wrzesień 2009): 597–609. http://dx.doi.org/10.1177/030089160909500503.
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Cancer prevention, screening and early detection can provide some of the greatest public health benefits for cancer control. In low resource settings, where cancer control is challenged by limited human, financial and technical resources, cancer prevention and screening are of utmost importance and can provide significant impacts on the cancer burden. Public policies, social, environmental and individual level interventions which promote and support healthy eating and physical activity can lower cancer risks. Tobacco use, a significant cancer risk factor, can be reduced through the application of key mandates of the World Health Organization Framework Convention on Tobacco Control. In addition, cancer screening programs, namely for cervical and breast cancers, can have a significant impact on reducing cancer mortality, including in low resource settings. Comprehensive cancer control programs require interventions for cancer prevention, screening and early detection, and involve sectors outside of health to create supportive environments for healthy ways of life. Sharing experiences in implementing cancer control programs in different settings can create opportunities for interchanging ideas and forming international alliances.
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Gagnon, J., E. Lévesque, F. Borduas, J. Chiquette, C. Diorio, N. Duchesne, M. Dumais i in. "Recommendations on breast cancer screening and prevention in the context of implementing risk stratification: impending changes to current policies". Current Oncology 23, nr 6 (22.12.2016): 615. http://dx.doi.org/10.3747/co.23.2961.
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In recent years, risk stratification has sparked interest as an innovative approach to disease screening and prevention. The approach effectively personalizes individual risk, opening the way to screening and prevention interventions that are adapted to subpopulations. The international perspective project, which is developing risk stratification for breast cancer, aims to support the integration of its screening approach into clinical practice through comprehensive tool-building. Policies and guidelines for risk stratification—unlike those for population screening programs, which are currently well regulated—are still under development. Indeed, the development of guidelines for risk stratification reflects the translational aspects of perspective.Here, we describe the risk stratification process that was devised in the context of perspective, and we then explain the consensus-based method used to develop recommendations for breast cancer screening and prevention in a risk-stratification approach. Lastly, we discuss how the recommendations might affect current screening policies.
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Shafik, Nourhan, Pauliina Ilmonen, Lauri Viitasaari, Tytti Sarkeala i Sirpa Heinävaara. "Flexible transition probability model for assessing cost-effectiveness of breast cancer screening extension to include women aged 45-49 and 70-74". PLOS ONE 18, nr 6 (23.06.2023): e0287486. http://dx.doi.org/10.1371/journal.pone.0287486.
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Breast cancer is the most common cancer among Western women. Fortunately, organized screening has reduced breast cancer mortality. New recommendation by the European Union suggests extending screening with mammography from 50–69-year-old women to 45–74-year-old women. However, before extending screening to new age groups, it’s essential to carefully consider the benefits and costs locally as circumstances vary between different regions and/or countries. We propose a new approach to assess cost-effectiveness of breast cancer screening for a long-ongoing program with incomplete historical screening data. The new model is called flexible stage distribution model. It is based on estimating the breast cancer incidence and stage distributions of breast cancer cases under different screening strategies. The model parameters, for each considered age group, include incidence rates under screening/non-screening, probability distribution among different stages, survival by stages, and treatment costs. Out of these parameters, we use the available data to estimate survival rates and treatment costs, while the modelling is done for incidence rates and stage distributions under screening policies for which the data is not available. In the model, an ongoing screening strategy may be used as a baseline and other screening strategies may be incorporated by changes in the incidence rates. The model is flexible, as it enables to apply different approaches for estimating the altered stage distributions. We apply the proposed flexible stage distribution model for assessing incremental cost of extending the current biennial breast cancer screening to younger and older target ages in Finland.
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Pilarski, Robert T., Stephanie Noble, Lily Hoang, Randy Hew, Stephanie Gandomi, Holly LaDuca i Jill Dolinsky. "Abstract P2-09-19: Inequitable access to genetic testing leads to missed screening and prevention opportunities for individuals at risk for hereditary breast and ovarian cancer". Cancer Research 82, nr 4_Supplement (15.02.2022): P2–09–19—P2–09–19. http://dx.doi.org/10.1158/1538-7445.sabcs21-p2-09-19.
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Abstract Background: The National Comprehensive Cancer Network guideline on Genetic/Familial High Risk: Breast, Ovarian and Pancreatic Cancer (NCCN) recommends offering increased screening and risk-reduction options to women with a pathogenic/likely pathogenic variant (PV/LPV) in 8 clinically-actionable hereditary breast and ovarian cancer (HBOC) genes: ATM, BRCA1, BRCA2, CDH1, CHEK2, PALB2, PTEN, and TP53. These options range from biannual clinical breast exams and annual breast MRI screening to risk-reducing mastectomy (RRM) and salpingo-oophorectomy (RRSO). Yet health insurance company policies addressing the medical necessity of genetic testing for these genes vary widely. While some payers have adopted the NCCN testing criteria verbatim, others have made specific changes or have developed their own criteria. We sought to quantify the potential impact of this variability on access to enhanced medical management for carriers of PV/LPV in these 8 HBOC genes in a large cohort of patients undergoing genetic testing at a single commercial laboratory. Methods: We reviewed clinical and family histories for patients undergoing multigene panel testing that included testing for the 8 genes of interest and identified 107,344 patients who met NCCN testing criteria (excluding prostate cancer criteria, which were not assessed in this study) for HBOC (v.2.2021). We then compared the histories of these patients to testing criteria for 3 different payer groups: Aetna, Blue Shield of California/Federal Blue Cross-Blue Shield, and eviCore (used by over 30 payers including AmeriHealth, Highmark and Horizon). These are the largest payer groups in our cohort and together represent 19% of patients tested. For each patient we determined whether they met testing criteria for the 3 payer groups. For individuals found to have a PV/LPV we determined the potential missed management opportunities for those who would not have been tested under each payer’s criteria. In addition, we sought to estimate the maximal impact of this missed management for patients with BRCA PV/LPV (not accounting for patient age or medical history). Results: Among patients meeting NCCN testing criteria for HBOC, 10,10,477 (9.8%) were found to have PVs/LPVs in one of the 8 genes. Under the three payer policies 2% to 10.3% of all patients, and up to 4.0% (n=423) of PV/LPV carriers, would not have been eligible for genetic testing. Based on NCCN management guidelines, up to 423 eligible patients would not have been offered annual breast MRI, 208 patients would not have been offered RRM, and 163 eligible patients would not have been offered RRSO. This lack of testing access due to misaligned medical policies also represents missed opportunities for offering potentially life-saving screening and risk reduction measures to these patients as well. Assuming lifetime cancer risks of 85% for breast cancer and 40% for ovarian cancer, and risk-reduction of 95% with RRM and 80% with RRSO. Had all policies matched NCCN testing criteria, up to 132 breast cancers could have potentially been detected earlier or prevented and 52 ovarian cancers could potentially have been prevented in our cohort. Conclusions: In addition to complicating clinical practice, varying testing guidelines have broader implications. Our data show that a significant number of mutation carriers are being missed by payer policies that deviate from NCCN testing criteria. In turn, this represents missed opportunities to offer proactive screening and risk-reduction options that could potentially save lives for those at risk for hereditary cancer. Based on findings from other studies, these actions would likely reduce health insurer costs as well. Citation Format: Robert T Pilarski, Stephanie Noble, Lily Hoang, Randy Hew, Stephanie Gandomi, Holly LaDuca, Jill Dolinsky. Inequitable access to genetic testing leads to missed screening and prevention opportunities for individuals at risk for hereditary breast and ovarian cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-09-19.
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Ajayi, Mofoluwake P., Emmanuel O. Amoo, Tomike I. Olawande, Tunde C. Iruonagbe i Olujide A. Adekeye. "Awareness of Breast and Cervical Cancer among Women in the Informal Sector in Nigeria". Open Access Macedonian Journal of Medical Sciences 7, nr 14 (13.07.2019): 2371–76. http://dx.doi.org/10.3889/oamjms.2019.259.
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BACKGROUND: There are no general consensuses on why the lifetime risk of dying from breast and cervical cancer in African is several times higher than that of developed countries. However, a notable window of opportunity for prevention and treatment are often wasted where there are little or no awareness and low level of screening.
AIM: To specifically highlight the awareness, knowledge and determinants of participation in the screening exercise for possible prevention or control of the diseases. To also provide insights on the development of contextual and relevant timely detection for effective early interventions.
METHODS: A cross-sectional study was conducted in southern and northern geopolitical zones of Nigeria. The respondents, which consisted of 1,023 women aged 15-49 years, completed a 116-item questionnaire assessing the correlation between cancer awareness and participation in screening. Nineteen, In-depth interviews were also conducted for this study. The outcome measured included awareness of breast and cervical cancer, how it can be prevented or detected, and the availability and actual participation in screening exercises.
RESULTS: While women are familiar with breast cancer, little is known about cervical cancer, and the awareness of the former is not correlated with participation in screening. The lack of enthusiasm to seek screening exercise is rooted in three key factors: lack of specific information, belief, economic and inadequate screening facilities.
CONCLUSION: The study thus recommends that policies and programs aimed at the breast and cervical cancers awareness and early intervention should address the underlying problems.
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Rojnik, Klemen, Klemen Naveršnik, Tatjana Mateović-Rojnik i Maja PrimicŽakelj. "Probabilistic Cost-Effectiveness Modeling of Different Breast Cancer Screening Policies in Slovenia". Value in Health 11, nr 2 (marzec 2008): 139–48. http://dx.doi.org/10.1111/j.1524-4733.2007.00223.x.
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Mandrik, Olena, Alesya Yaumenenka, Rolando Herrero i Marcel F. Jonker. "Population preferences for breast cancer screening policies: Discrete choice experiment in Belarus". PLOS ONE 14, nr 11 (1.11.2019): e0224667. http://dx.doi.org/10.1371/journal.pone.0224667.
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Özkoç, Hatice. "Demographic variables affecting participation in mammography screening: a cross-sectional study". Volume 1, Issue 1 1, nr 1 (26.07.2021): 19–27. http://dx.doi.org/10.53753/jame.1.1.02.
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Breast cancer is one of the most common cancers among women. There are three commonly used diagnostic methods in this cancer type, in which the survival rate can be quite high with early diagnosis. Compared to breast self-examination and clinical examination, mammography stands out as a more accurate diagnostic method. Although there are health policies regarding mammography screening in many countries, mammography screening behavior has not reached the desired level worldwide. In this study, we tried to reveal the demographic factors affecting the frequency of women getting mammograms in Turkey. The frequency of mammography screening was estimated with a generalized logit model using the microdata of TURKSTAT Turkey Health Survey. As a result of the model, it was observed that mammography screening differentiated in different age and income groups. It was determined that the disease status increased the frequency of mammography screening, however, marital status and employment status did not have a significant effect.
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Aljohar, Bashaier Abdullah, i Mohammed Ahmedhani Kilani. "Breast Cancer in Europe: Epidemiology, Risk Factors, Policies and Strategies. A Literature Review". Global Journal of Health Science 10, nr 11 (13.10.2018): 1. http://dx.doi.org/10.5539/gjhs.v10n11p1.
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INTRODUCTION: Breast cancer is the most commonly diagnosed cancer in European women, accounting for 28.8% of the total number of cancer diagnosis in Europe. Over the past few decades, several factors have led to remarkable improvements in overall breast cancer outcomes in Europe, such as early detection, screening, and progresses in treatment. However, breast cancer remains the most common cancer in females in Europe, yet more there is an increase in the incidence and mortality rates in some European countries. This research summarizes the current status of breast cancer in Europe, including epidemiology, risk factors, policies, and strategies. The results can help to better identify this health problem, which could help in developing better breast cancer control or prevention strategies and policies.
METHODS: A literature review was conducted using five electronic databases (PubMed, Google Scholar, ProQuest, Eurostat, BioMed) and the European Commission reports for studies that reported on epidemiology and risk factors of breast cancer, or policies and strategies that target it in Europe. In addition, the Social Ecological Model (SEM) was used in categorizing the breast cancer risk factors into different levels.
RESULTS: Europe and North America have the highest rate of breast cancer globally. Incidence and prevalence of breast cancer vary across Europe, and so does its mortality rates. Breast cancer was found to be associated with a number of risk factors, including but not limited to aging, use of hormone therapy, older age at the first birth, and smoking which are common in Europe. Cancer in general, and breast cancer have attracted specific attention, and the European Union has focused many of the resources and expertise on the topic.
CONCLUSION & RECOMMENDATIONS: Breast cancer remains a major public health issue in Europe, despite the efforts and actions being taken. Therefore, current efforts against breast cancer in Europe need to be revisited and improved.
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Staib, James, Rashna Soonavala, Stacey Dacosta Byfield, Kimberly Badal, Kierstin Catlett, Liz Maffey, Mi-Ok Kim, Kenneth Wimmer, Yiwey Shieh i Laura J. Esserman. "Abstract P5-04-08: Breast cancer screening using ultrasound increases recall, biopsy, and cancer detection rates". Cancer Research 83, nr 5_Supplement (1.03.2023): P5–04–08—P5–04–08. http://dx.doi.org/10.1158/1538-7445.sabcs22-p5-04-08.
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Abstract Background: Ultrasound is often used as an adjunct to mammography for breast cancer (BC) screening. Usage of screening ultrasound (US) varies by state, likely due to differences in state-specific breast density notification laws and mandates requiring insurance coverage of supplemental screening for women at elevated risk of breast cancer. Screening US can increase cancer detection rates among women with dense breasts, but may increase recalls and benign biopsies. As more states adopt policies mandating insurance coverage for “medically necessary” breast cancer imaging, it is important to understand the impact to screening US utilization and subsequent service utilization. This analysis examines use of screening US by state as well as associated rates of recall, biopsy, and cancer detection. Methods: We analyzed deidentified administrative claims. We included women aged 18-74 years with ≥1 claim for screening mammography in 2018. First claim was index date. Continuous enrollment was required in a commercial (COM) or Medicare Advantage (MA) plan from 1/2016 to index date (baseline period) and from index date to 6 months after (follow-up period). Recall, biopsy, and cancer detection rates were calculated for the follow-up period. Recall was defined as ≥1 claim for mammography, diagnostic ultrasound, or MRI in the follow-up period. We used CPT/HCPCS codes to identify procedures. Screening US was identified by CPT 76641 (complete) with modifier 50 (bilateral) or LT/RT (left/right). Using ICD codes, cancer detection was defined as ≥1 claim for DCIS or invasive BC. We examined screening US rates by insurance type, state, and age. Proportions were compared with chi-squared tests. Results: 939,410 women met study criteria (70% COM, 30% MA; Tables 1-2). In the COM population, recall, biopsy, and cancer detection rates with screening US were approximately two-fold higher than without (recall: 26.1% vs. 11.8%; biopsy: 5.0% vs 1.6%; cancer detection: 1.0% vs. 0.4%). In the MA population, recall, biopsy, and cancer detection rates with screening US were roughly three-fold higher than without (recall: 23.6% vs 9.0%; biopsy: 5.2% vs 1.6%; cancer detection: 1.9% vs 0.7%). In NY, NJ, and CT, the rate of screening US usage was > 14 times higher than in all other states (29.1% vs 1.9%). These three states had higher recall and biopsy rates, but similar cancer detection rates compared to all other states (recall: 14.4% vs. 11.4%; biopsy: 2.5% vs 1.7%; cancer detection: 0.6% vs. 0.5%). All proportion differences reached statistical significance (p < 0.001). Conclusion: Screening US was associated with increases in recall and biopsy, but modest increases in absolute cancer detection rates. Observed state by state variation of screening US is likely driven by laws requiring zero patient payment insurance coverage of “medically necessary” imaging which, as is the case with NY, NJ, and CT, is interpreted to include screening US. Our results demonstrate that screening US may lead to a large increase in recall rates and biopsies without consequentially improving the cancer detection rate. Table 1: Recall, biopsy, and cancer detection rates by age with and without use of adjunctive breast screening ultrasound in a commercially insured U.S. population * values are suppressed to comply with requirements for data release Table 2: Recall, biopsy, and cancer detection rates by age with and without use of adjunctive breast screening ultrasound in a Medicare Advantage (MA) U.S. population * values are suppressed to comply with requirements for data release Citation Format: James Staib, Rashna Soonavala, Stacey Dacosta Byfield, Kimberly Badal, Kierstin Catlett, Liz Maffey, Mi-Ok Kim, Kenneth Wimmer, Yiwey Shieh, Laura J. Esserman. Breast cancer screening using ultrasound increases recall, biopsy, and cancer detection rates [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-04-08.
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Banta, H. David, Wija Oortwijn i Richard Cranovsky. "HEALTH POLICY, HEALTH TECHNOLOGY ASSESSMENT, AND SCREENING IN EUROPE". International Journal of Technology Assessment in Health Care 17, nr 3 (lipiec 2001): 409–17. http://dx.doi.org/10.1017/s0266462301106124.
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Objective: To present a summary of the papers in this volume, illustrating the links between health technology assessment (HTA), health policies and specifically policies toward prevention and screening, and implementation of screening tests in the case of three screening methods: mammography screening for breast cancer, screening for prostate cancer, and routine use of ultrasound in pregnancy.Method: To commission papers from eight European countries based on a set of questions to be answered, as well as a paper synthesizing the scientific literature on the three screening procedures.Results: Indicate that few of the countries examined have developed effective links between HTA, health policy, and implementation related to screening procedures. Only Sweden and the Netherlands appear to have developed such links. In the other countries, HTA has a limited role in determining health policy. It also seems to be uncommon for countries to have a specific prevention strategy.Conclusion: The major conclusion is that countries of Europe need to develop HTA as part of prevention policies.
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Lange, Jane M., Charlotte Gard, Ellen O’meara i Ruth Etzioni. "Abstract P4-03-03: Elevated Risk of Breast Cancer Diagnosis in Women with Dense Breasts reflects a similarly Elevated Risk of Breast Cancer Onset that is Robust to the Effect of Density on Mammography Sensitivity". Cancer Research 83, nr 5_Supplement (1.03.2023): P4–03–03—P4–03–03. http://dx.doi.org/10.1158/1538-7445.sabcs22-p4-03-03.
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Abstract Dense breasts are associated with a higher risk of breast cancer diagnosis, which has impacted risk prediction tools and patient notification policies. However, given that mammography is less sensitive for women with dense breasts and these women may be subject to different confirmation testing pathways, the true association between breast density and cancer risk is unknown. We investigated the relationship between breast density and onset using a natural history model that accounts for differential sensitivity and rates of exams by breast density. Data consisted of Breast Cancer Surveillance Consortium mammogram and cancer outcomes among women aged 40-54 with a first digital mammogram between 2000-2018 (N=33,542). Of these, 15,092 had non-dense (almost entirely fatty or scattered fibroglandular densities) and18,450 had dense (heterogeneously dense or extremely dense) breasts. We estimated the empirical sensitivity of mammograms in dense and non-dense breasts (fraction of diagnosed cancers that were screen detected) and examined rates of mammograms by density. We estimated the relative risk of breast cancer diagnosis five years after the first exam using Kaplan Meier methods and the relative risk of breast cancer onset from a natural history model, assuming density-specific sensitivity was equal to the empirical sensitivity. Empirical sensitivity was .88 in women with non-dense and .78 in women with dense breasts. Mammogram utilization was somewhat higher in women with dense breasts (HR for subsequent mammograms 1.10 (95% CI [1.07, 1.12]). The relative risk of diagnosis for dense versus non-dense breasts was 1.80 (95% CI [1.46,2.57]); based on the natural history model the relative risk of onset was 1.73 [1.43,2.25]. The estimated relative risk of onset ranged from 1.67 to 2.03 under assumptions that the relative sensitivity of the screening episode for dense versus non-dense breasts was 1.0 to 0.4. In conclusion, the association of risk of breast cancer onset with breast density is robust to assumptions about the relative sensitivity in dense and non-dense breasts. Citation Format: Jane M. Lange, Charlotte Gard, Ellen O’meara, Ruth Etzioni. Elevated Risk of Breast Cancer Diagnosis in Women with Dense Breasts reflects a similarly Elevated Risk of Breast Cancer Onset that is Robust to the Effect of Density on Mammography Sensitivity [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-03.
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Okonkwo, Quirine Lamberts, Gerrit Draisma, Arno der Kinderen, Martin L. Brown i Harry J. de Koning. "Breast Cancer Screening Policies in Developing Countries: A Cost-effectiveness Analysis for India". JNCI: Journal of the National Cancer Institute 100, nr 18 (17.09.2008): 1290–300. http://dx.doi.org/10.1093/jnci/djn292.
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Autier, Philippe, Cécile Pizot, Mathieu Boniol i Peter Boyle. "Cervical and breast cancer mortality trends in neighboring countries with different screening policies." Journal of Clinical Oncology 34, nr 15_suppl (20.05.2016): 1571. http://dx.doi.org/10.1200/jco.2016.34.15_suppl.1571.
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Ayer, Turgay, Oguzhan Alagoz, Natasha K. Stout i Elizabeth S. Burnside. "Heterogeneity in Women’s Adherence and Its Role in Optimal Breast Cancer Screening Policies". Management Science 62, nr 5 (maj 2016): 1339–62. http://dx.doi.org/10.1287/mnsc.2015.2180.
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Corpes, Erilaine de Freitas, Kauane Matias Leite, Denise Montenegro da Silva, Ana Cínthia Silva Alves, Régia Christina Moura Barbosa Castro i Andrea Bezerra Rodrigues. "Impact of the COVID-19 pandemic on breast cancer screening and early diagnosis". Rev Rene 23 (20.09.2022): e78620. http://dx.doi.org/10.15253/2175-6783.20222378620.
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Objective: to analyze the impacts of the COVID-19 pandemic on breast cancer screening and early diagnosis. Methods: an ecological retrospective study of data from the Department of Informatics of the Unified Health System collected between 2016 and 2020 was carried out. The data collection was guided by a semi-structured script, and the impact of the pandemic on breast cancer screen and diagnosis was established by using a formula and comparing the period of interest to 2020. Results: in Brazil, there was a significant drop in mammograms performed during the COVID-19 pandemic, with a decrease of 361,855 exams from 2016 to 2020. Most diagnostic investigations were conducted with patients between 50 and 59 years, and there was a significant drop in mammograms in women aged under 40 years. Conclusion: the COVID-19 pandemic has negatively impacted screening and early diagnosis of breast cancer due to reduced availability. Contributions to practice: the study reinforces the importance of investing in public policies to face the pandemic scenario so that screening and treatment protocols be well targeted to guarantee better care for cancer patients.
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Coldman, Andrew J., Norm Phillips, Ivo A. Olivotto, Paula Gordon, Linda Warren i Lisa Kan. "Impact of changing from annual to biennial mammographic screening on breast cancer outcomes in women aged 50–79 in British Columbia". Journal of Medical Screening 15, nr 4 (grudzień 2008): 182–87. http://dx.doi.org/10.1258/jms.2008.008064.
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Objectives The objective of this study was to compare breast cancer outcomes among women subject to different policies on mammography screening frequency. Setting Data were obtained for women participating in the Screening Mammography Programme of British Columbia (SMPBC) for 1988–2005. The SMPBC changed its policy for women aged 50–79 years from annual to biennial mammography in 1997, but retained an annual recommendation for women aged 40–49 years. Methods Breast cancer outcomes were compared for women participating in the programme before and after 1997 for two groups: ages 40–49 and 50–79 years. Results There were data on 658,151 women. Comparing pre-1997 and post-1997, the median interscreen interval increased by 11.1 months in women 50–79 but by only 0.3 months in women aged 40–49. Excluding those detected at initial screen, 6291 breast cancers were identified. Comparing pre-1997 and post-1997: the relative rates (RR) of screen detected cancer increased in women aged 40–49 (RR = 1.32) and the rate of invasive cancers ≥20 mm at diagnosis decreased (RR = 0.83); the rate of cancers with axillary node involvement increased in women aged 50–79 (RR = 1.23). Cancer survival improved after 1997 for women diagnosed at ages 40–49 (hazard ratio = 0.62), but was unchanged for women aged 50–79. Breast cancer mortality rates did not change between the periods in either age group. Conclusion The proximal cancer outcomes considered (staging and survival) improved in women aged 40–49 but this was offset in women aged 50–79 associated with the change in screen frequency. These changes did not result in alterations in breast cancer mortality rates in either age group.
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de Koning, H. J., Rijnsburger, G. Draisma, M. M. A. Tilanus-Linthorst, J. C. Oosterwijk, H. M. Zonderland, R. A. Manoliu, C. Boetes, E. J. T. Rutgers i J. G. M. Klijn. "Screening women with a familial or genetic predisposition to breast cancer: costs and effects of alternative screening policies". European Journal of Cancer Supplements 4, nr 2 (marzec 2006): 49. http://dx.doi.org/10.1016/s1359-6349(06)80038-8.
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Near, Aimee M., Jeanne S. Mandelblatt, Clyde B. Schechter i Michael A. Stoto. "Using Simulation Modeling to Inform Strategies to Reduce Breast Cancer Mortality in Black Women in the District of Columbia". Epidemiology Research International 2012 (15.07.2012): 1–10. http://dx.doi.org/10.1155/2012/241340.
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Background. Black women in the District of Columbia (DC) have the highest breast cancer mortality in the US. Local cancer control planners are interested in how to most efficiently reduce this mortality. Methods. An established simulation model was adapted to reflect the experiences of Black women in DC and estimate the past and future impact of changes in use of screening and adjuvant treatment. Results. The model estimates that the observed reduction in mortality that occurred from 1975 to 2007 attributable to screening, treatment, and both was 20.2%, 25.7%, and 41.0% respectively. The results suggest that, by 2020, breast cancer mortality among Black women in DC could be reduced by 6% more by initiating screening at age 40 versus age 50. Screening annually may also reduce mortality to a greater extent than biennially, albeit with a marked increase in false positive screening rates. Conclusion. This study demonstrates how modeling can provide data to assist local planners as they consider different cancer control policies based on their individual populations.
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Glanz, Karen, Barbara K. Rimer, Caryn Lerman i Patricia McGovern Gorchov. "Factors Influencing Acceptance of Mammography: Implications for Enhancing Worksite Cancer Control". American Journal of Health Promotion 7, nr 1 (wrzesień 1992): 28–36. http://dx.doi.org/10.4278/0890-1171-7.1.28.
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Purpose. The purposes of this article are to review what is known about participation in mammography programs and to propose several elements that warrant consideration in planning mammography screening programs in occupational settings. Breast cancer is the most common female cancer. Regular screening programs including mammography, clinical breast examination, and monthly breast self-examination can reduce breast cancer deaths by as much as 35%. However, mammography is underutilized. This review examines factors affecting acceptance of mammography and possible worksite-based strategies to increase its appropriate use. Search Methods. We identified the sources cited in this review through a combination of literature searches of computerized data bases, backward searches of reference lists, and contacts with active investigators. The article includes a selected subset of the most recent and relevant references. Summary of Important Findings. A variety of individual factors, environmental influences, health care system factors, and employer factors influence the acceptance of mammography. Workplace mammography programs can be especially important in reducing access barriers. Major Conclusions. Six program elements which are central to planning successful worksite mammography programs are discussed: location and facilities; health professional involvement; the range of services; education and referral; employer policies, and plans for follow-up and repeat screening.
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Dharamdasani, Tina, i Jaya M. Satagopan. "Abstract 5933: Mining multiple national resources to predict adverse effect of poor screening mammography rates and to identify determinants of poor adherence to screening". Cancer Research 82, nr 12_Supplement (15.06.2022): 5933. http://dx.doi.org/10.1158/1538-7445.am2022-5933.
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Abstract Background: Breast cancer screening plays an integral role in achieving health equity. We apply an inexpensive and scalable data fusion strategy to predict the adverse effect of poor screening mammography rates and to identify the determinants of poor adherence to screening by combining multiple large national databases. Methods: Using 2008-2010 screening mammography rates in 3,110 U.S. counties from the National Cancer Institute State Cancer Profiles, we created tertiles of counties having poor, medium, and superior screening rates. Using the 2000-2016 Surveillance, Epidemiology, and End Results (SEER) 18 registries covering 612 U.S. counties, we abstracted a listing of breast cancer cases of multiple race/ethnicities, female sex, and diagnosed at age 40 years or above. We linked these data to assign screening rate category to each breast cancer case. We used breast cancer stage categorized as regional/distant and localized as the outcome to examine the adverse effect of poor screening. Using the National Health Interview Survey (NHIS) between 2000 and 2015, we obtained data on adherence to screening (i.e., having mammogram within 2 years) and factors corresponding to the Anderson Model for Healthcare Utilization from survey participants of multiple race/ethnicities, female sex, and age 40 years or above. We applied race/ethnicity-stratified logistic regression models to estimate the risk of regional/distant relative to localized stage breast cancer in relation to screening categories, adjusting for age and tumor characteristics, and to identify factors associated with adherence to screening. Results: Among 645,755 breast cancer cases in SEER (72% Non-Hispanic (NH) White, mean [SD] age of 62 [12] years), 36% had regional/distant stage disease. Poor screening rate was associated with increased risk of regional/distant stage for NH White (OR=1.06, 95% CI: 1.05, 1.08), Hispanic (OR=1.12, 95% CI: 1.07, 1.16), and South Asian cases (OR=1.26, 95% CI: 1.08, 1.48). Among 68,519 women in NHIS (73% non-Hispanic [NH] White, mean [SD] age of 53 [18] years), higher education (OR= 1.55, 95% CI: 1.43, 1.68) and insurance coverage (OR= 2.21, 95% CI: 1.97, 2.49) increased adherence to screening in NH Whites. Similar results were found in NH Black and Hispanic women. Living in the U.S. for at least 10 years was a key determinant of adherence in South Asian women (OR= 3.57, 95% CI: 1.66, 7.68). Being overweight or obese was a key deterrent to adherence in Chinese women (OR=0.36, 95% CI: 0.23, 0.56). Conclusion: Mining large databases identified the effect of screening on breast cancer stage and unique factors for adherence to screening in distinct racial/ethnic groups. Further studies of determinants of screening and their associations with breast cancer characteristics may provide targets for breast cancer prevention policies to achieve health equity. Citation Format: Tina Dharamdasani, Jaya M. Satagopan. Mining multiple national resources to predict adverse effect of poor screening mammography rates and to identify determinants of poor adherence to screening [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5933.
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Hsu, C. "Screen-Round–Based Risk Strategies for Population-Based Mammography Screening". Journal of Global Oncology 4, Supplement 2 (1.10.2018): 205s. http://dx.doi.org/10.1200/jgo.18.82800.
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Background: The widespread use of organized screening strategies of mammography screening at population level stood a chance of reducing the threat to women's life from breast cancer. However, such a population-wide strategy is often faced with the questions like “How many rounds of mammography screening are require before detecting cancer in question?” and “Can the attendee be classified the low risk after several negative screening rounds?” In addition to the concerns on resource allocation for the purpose of planning an efficient population-based screening program, the recent emergence in precision medicine also makes it attractive for considering such a risk-based decision on breast cancer prevention under the context of mass screening. Aim: To quantify number of screen rounds required for detecting an asymptomatic cancer in question and dispensing with further invitation to screen. Methods: By applying a series of Bayesian negative–binomial family–based stochastic process models taking sensitivity and specificity into account, we elucidated the aforementioned issues based on the empirical data on population-based breast cancer screening program in Finland with international collaboration. The Finnish nationwide biennial mammographic screening program was implemented and targeted to women aged 50-59 years since 1988. The panel data on the regular invitation of eligible population by Pirkanmaa screening center excluding the women who had been diagnosed by breast cancer before their first invitation were enrolled in this study. Results: Based on the estimated results, we are able to determine the rounds of screens required before detecting an asymptomatic breast cancer according to the risk profile determined by age and the performance of screening tool. Based on the empirical data, an average of 2.77 (95% CI, 2.61-2.91) screen rounds will be required to detect an asymptomatic breast cancer cases. A woman may not be invited after a series of negative findings of 8 rounds of screen. Considering the sensitivity of 83% (95% CI, 61%–95%), the required screen rounds become 2.81 (95% CI, 2.65-2.94). The screening rounds required for the young (<55 years) and the old (≥55 years) age group, the corresponding figures was 2.81 (95% CI, 2.55-3.11) and 2.76 (95% CI, 2.43-3.05). Conclusion: We quantified the screen round, 2.77 on average, required to detect an asymptomatic breast cancer and 8 rounds of screen to dispense with further invitation based on the risk and the performance of screening tool. The findings may aid in risk-based interscreening interval determination but also provide information on resources required by different screening policies with target population with different risk levels.
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Melnikow, Joy, Daniel J. Tancredi, Zhuo Yang, Dominique Ritley, Yun Jiang, Christina Slee, Svetlana Popova, Phillip Rylett, Kirsten Knutson i Sherie Smalley. "Program-Specific Cost-Effectiveness Analysis: Breast Cancer Screening Policies for a Safety-Net Program". Value in Health 16, nr 6 (wrzesień 2013): 932–41. http://dx.doi.org/10.1016/j.jval.2013.06.013.
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Thrift-Perry, M., F. Cardoso, A. Cabanes, K. Moose Hunt, K. Faircloth i T. Araújo Cruz. "Supporting Breast Cancer Early Detection and Diagnosis: A Global Metastatic Breast Cancer Policy Analysis and Promising Practice From Brazil". Journal of Global Oncology 4, Supplement 2 (1.10.2018): 143s. http://dx.doi.org/10.1200/jgo.18.31600.
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Background and context: Control of metastatic breast cancer (mBC) is an area with high unmet need. Along the patient journey, policy development remains limited and varied across countries, particularly in detection, diagnosis and treatment. Multistakeholder engagements aim to address these policy gaps. Aim: 1. Understand breast cancer (BC)/mBC policy development in 16 countries and identify opportunities for improvement. 2. Illustrate promising practices spearheaded by civil society (NGOs and academia) that demonstrate success addressing identified gaps and exemplify models for replication. 3. Establish the importance of stakeholder collaboration to implement policies that support timely BC/mBC detection and treatment initiation. Strategy/Tactics: An analysis of National Cancer Control Plans (NCCPs), policies and programs was conducted across 16 countries representing different healthcare systems. Key BC diagnosis policy components were identified and evaluated, using standardized criteria on adoption and implementation of NCCP goals, and BC/mBC-specific policies and programs. Promising practices, spearheaded by civil society, that demonstrate success at filling policy gaps were identified. Their objective was to develop an information resource that other organizations can use as practice-based evidence. An example implemented in Brazil is presented. Program/Policy process: Although mBC screening is ineffective, national BC screening programs (NSPs) implementation promotes BC education and encourages prompt symptom reporting. Structured diagnosis guidelines and upskilled healthcare professionals (HCPs) also facilitate timely detection, as evidenced in Brazil, where diagnosis delays are prevalent. Outcomes: Despite policy efforts, gaps persist for timely BC/mBC detection and diagnosis. Implementation of official NSPs, diagnosis guidelines and HCP educational initiatives varied across countries. In Brazil, the Integrated Approach to Improving Oncology Care project brought together various stakeholders. The initiative aimed to use existing community resources as a pivot to address and improve BC diagnosis gaps, including HCP oncology education/training, capacity building in community health centers and increasing patient support. The initiative provided training to over 150 BC HCPs. Upskilled HCPs were supported to improve skills and system capacity to facilitate timely diagnosis. What was learned: Disparities in BC policy development exist across and within countries. Progress in BC policy is skewed toward the early part of the patient journey e.g., awareness, with key gaps remaining in diagnosis. Although national official action is indispensable, collaboration between different stakeholders is critical to address BC/mBC patient unmet needs. As exemplified in Brazil, we see that policy initiatives and promising practices demonstrate successful multistakeholder engagement to inform further advocacy and policy development.
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Nwankwo, E. "MetaPink Program: Simplifying the Breast Cancer Journey for Patients With Advanced Stage Breast Cancer in Nigeria". Journal of Global Oncology 4, Supplement 2 (1.10.2018): 170s. http://dx.doi.org/10.1200/jgo.18.38600.
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Background and context: Breast cancer is the number one diagnosed cancer in Nigeria. 75% of these breast cancer diagnosis are at stage 3 and 4. This is due in part to lack of awareness of the signs and symptoms, inadequate screening and diagnostic facilities, insufficient policies and guidelines, and fear. Metastatic breast cancer patients do not have the time nor the strength to deal with the stress, delay, and confusion of trying to find adequate care. Run For a Cure Africa (RFCA) wishes to establish a program that helps navigate metastatic breast cancer patients in Lagos state, and surrounding states in Nigeria toward breast cancer care and resources. Aim: The MetaPink program empowers and educates patients with advanced stage breast cancer by providing them with timely and relevant information and resources on their disease and how they, the patient, can improve their quality of life and overall prognosis. Additionally, RFCA creates greater awareness of metastatic breast cancer in the community and the necessity for regular screenings. Strategy/Tactics: This project is being implemented by RFCA. RFCA is working work with the health care professionals (HCP) in the oncology and community health department at the Lagos University Teaching Hospital (LUTH) in addition to their organization mentors, The Rose Foundation in Houston, Texas. RFCA is also working with community associations, drama troupes, and groups to create sensitization in hard to access areas. Patients and participants of the MetaPink program have a support team, through the monthly support group, with whom they fellowship, ask advice, gain insight, and just off load any looming concerns. Program/Policy process: RFCA enrolls metastatic patients through our supported clinics, call ins, and our screening outreaches. Each patient enrolled in the program gets a starter pack. RFCA hosts monthly support groups and Q&A sessions anchored by medical professionals, RFCA also hosts community outreach events via the radio, market drama skits, and musical awareness presentations. Periodically we follow-up and communicate with MetaPink program participants via MetaPink WhatsApp, telephone, in-person meetings/visits, and support group meetings. Outcomes: The objective of the MetaPink program is to simplify the breast cancer journey for metastatic breast cancer patients in Nigeria and give them the emotional support and confidence to understand and navigate through their personal breast cancer journey. RFCA also creates larger community awareness of advanced stage breast cancer in a method that is culturally appealing and resonates with the environment. What was learned: As the program progresses, RFCA will learn how to effectively navigate patients in this resource-poor environment. This will contribute to their quality of life and improved breast cancer management in Nigeria. [Figure: see text]
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Tahir, Talha, Melanie Wong, Rabia Tahir i Michael Wong. "The Cost-Effectiveness of Mammography-Based Breast Cancer Screening in Canada". Canadian Journal of General Internal Medicine 16, nr 4 (19.12.2021): 39–52. http://dx.doi.org/10.22374/cjgim.v16i4.520.
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Background: The current literature on female breast cancer screening is largely focused on the health out-comes that result from screening. There is comparatively little data on the cost-effectiveness of the screening. Methods: This systematic review sought to identify all studies published within the last 10 years that analyzed the cost-effectiveness of mammography-based female breast cancer screening policies in Canada. Results: Seven studies were included, and four were applicable to the average-risk Canadian women. Triennial screening for average-risk women aged 50–69 years was the most cost-effective in terms of cost per QALY. The use of MRI with mammography for women with the BRCA1/2 mutation was cost-effective, while annual mammography-based screening for women with dense breasts was cost-ineffective. Conclusion: Analyses of the cost-effectiveness of mammography-based screening within Canadian populations are few in numbers and have heterogeneous methodologies. The existing data suggest that Canada’s current screening policy to screen average-risk women aged 50–74 years, biennially or triennially is cost-effective. RésuméContexte : La documentation actuelle sur le dépistage du cancer du sein chez la femme est principalement axée sur les résultats cliniques qui découlent du dépistage. Il existe relativement peu de données sur le rapport coût/efficacité du dépistage. Méthodologie : Cette revue systématique a tenté de repérer toutes les études publiées au cours des dix dernières années qui ont analysé la rentabilité des politiques de dépistage du cancer du sein par mammogra-phie chez la femme au Canada. Résultats : Sept études ont été retenues, et quatre d’entre elles s’appliquent aux femmes canadiennes à risque moyen. Le dépistage triennal chez les femmes à risque moyen âgées de 50 à 69 ans est le plus rentable en ce qui concerne le coût par AVAQ. L’utilisation de l’IRM couplée à la mammographie chez les femmes présentant la mutation BRCA1/2 est rentable, tandis que le dépistage annuel par mammographie chez les femmes aux seins denses ne l’est pas. Conclusion : Les analyses du rapport coût/efficacité du dépistage par mammographie au sein des populations canadiennes sont peu nombreuses et leurs méthodologies sont hétérogènes. D’après les données existantes, la politique actuelle du Canada en matière de dépistage, qui consiste à faire subir une mammographie de dépi-stage aux femmes à risque moyen âgées de 50 à 74 ans tous les deux ou trois ans, est rentable.
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Rengaswamy, S., i I. Fadhil. "Early Detection of Cancer: Recommendations for Eastern Mediterranean Region Background and Context". Journal of Global Oncology 4, Supplement 2 (1.10.2018): 238s. http://dx.doi.org/10.1200/jgo.18.95700.
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Background and context: Increasing cancer burden in EMR is of major concern to all member states and is a priority for WHO. Almost all countries in EMR, have gaps in cancer control programs. Policymakers are looking for concrete advice on how to address these gaps and meet the increasing needs and demands for cancer care. Aim: To draw on the experience of WHO/EMRO in developing guidance for member states to establish early detection program for 5 priority cancers (breast, colorectal, cervical, oral, prostate). Strategy/Tactics: Implementation of suitable and effective cancer control policies including early detection of cancer that benefit from effective treatment. Program/Policy process: In the EMR, the most common cancers amenable to early diagnosis/screening are breast, colorectal, cervix, prostate and oral cancers. Work to develop early detection policy statements for EMR countries draws on the recommendations of a series of consultative meetings/process conducted throughout 2014-2016, taking into consideration the various health system levels and profile of cancer in the region. Outcomes: A strategic approach to strengthen cancer early detection focusing on the 5 priority cancers by level of development of health system in EMR countries. What was learned: Half of all cancers in EMR are amenable to early detection and potential cure with adequate treatment and follow-up. Early diagnosis is critical and should be implemented in all countries irrespective of level of income/health system development. Primary care professionals have a great role to advance cancer early detection programs. It is important to pilot any screening programs prior to national roll-out.
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Jiwa, Natasha, Zoltan Takats, Daniel R. Leff i Christopher Sutton. "Breast health screening: a UK-wide questionnaire". BMJ Nutrition, Prevention & Health 4, nr 1 (4.05.2021): 206–12. http://dx.doi.org/10.1136/bmjnph-2021-000266.
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BackgroundCurrently, there is an unmet clinical need in identifying and screening women at high risk of breast cancer, where tumours are often aggressive and treatment intervention is too late to prevent metastasis, recurrence and mortality. This has been brought into sharp focus by the SARS-CoV-2 global pandemic, constantly changing hospital policies and surgical guidelines in reducing access to established screening and treatment regimens. Nipple aspirate fluid (NAF), is thought to provide a unique window into the biological processes occurring within the breast, particularly in the context of a developing neoplasm. Evaluation of NAF in asymptomatic women, for novel chemical biomarkers of either early disease and/or cancer risk offers tremendous promise as a tool to facilitate early detection and to supplement screening. However, it is acceptability as a method of collection and screening by women is critical and yet unknown. A breast health questionnaire was disseminated to women through breast cancer charities, patient support groups and social media platforms, with the aim of collecting opinions on the acceptability of use of NAF as a potential screening tool.MethodFollowing ethical approval a questionnaire was prepared using online surveys consisting of four parts: (a) introduction on breast health screening in the UK, (b) core demographic data, (c) questions regarding screening and the acceptability of using NAF and (d) opinions about the process of collecting and using nipple fluid for screening. The voluntary and anonymous questionnaire was disseminated through social media, professional networks, charity websites and by individuals between October 2019 and December 2020. Survey responses were collected electronically, and the data analysed using online surveys statistical tools.ResultsA total of 3178 women completed the questionnaire (65.9% Caucasian, 27.7% Asian/British Asian, 0.6% black and 5.0% other). Of these, 2650 women (83.4%) had no prior knowledge of NAF and 89.4% were unaware that NAF can be expressed in up to 90% of all women. Concerning their risk of breast cancer, 89.8% of women were keen to know their future risk of breast cancer, 8.5% were unsure whether they wanted to know their risk and a further, 1.6% did not want to know. Regarding screening, 944 women (29.8%) were unaware of the lack of routine National Health Service Breast Screening for those under the age of 47 years. Furthermore, 53.0% of women were unaware that mammographic screening is affected by breast density. In terms of the acceptability of home testing for breast health, 92.0% were keen to undergo a home test. Both 79.7% and 70.9% stated they would consider hand massage and a breast pump to acquire nipple fluid samples, respectively. A further 48.6% of women would consider the use of a hormonal nasal spray for the same purpose. However, with regards to acquiring results from NAF testing, 42.6% of women would prefer to receive results at home and 34.2% in a medical facility. Finally, 91.6% of women believed that breast health should be incorporated as part of school education curriculum.ConclusionPublic awareness regarding breast screening protocols and limitations of mammography could be improved. Many women were unaware that NAF might be a useful biofluid for future risk prediction, and yet the concept of self-testing of nipple fluid, with either hand massage or a breast pump was well received. Efforts should be made to increase awareness of the benefits of alternative and supplementary tests, especially in the context of high-risk individuals and younger patients.
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Tshabalala, Gugulethu, Charmaine Blanchard, Keletso Mmoledi, Desiree Malope, Daniel S. O’Neil, Shane A. Norris, Maureen Joffe i Janan Janine Dietrich. "A qualitative study to explore healthcare providers’ perspectives on barriers and enablers to early detection of breast and cervical cancers among women attending primary healthcare clinics in Johannesburg, South Africa". PLOS Global Public Health 3, nr 5 (9.05.2023): e0001826. http://dx.doi.org/10.1371/journal.pgph.0001826.
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Low-and-middle income countries (LMICs) contribute approximately 70% of global cancer deaths, and the cancer incidence in these countries is rapidly increasing. Sub-Saharan African (SSA) countries, including South Africa (SA), bear some of the world’s highest cancer case fatality rates, largely attributed to late diagnosis. We explored contextual enablers and barriers for early detection of breast and cervical cancers according to facility managers and clinical staff at primary healthcare clinics in the Soweto neighbourhood of Johannesburg, South Africa. We conducted qualitative in-depth interviews (IDIs) between August and November 2021 amongst 13 healthcare provider nurses and doctors as well as 9 facility managers at eight public healthcare clinics in Johannesburg. IDIs were audio-recorded, transcribed verbatim, and entered into NVIVO for framework data analysis. Analysis was stratified by healthcare provider role and identified apriori around the themes of barriers and facilitators for early detection and management of breast and cervical cancers. Findings were conceptualised within the socioecological model and then explored within the capability, opportunity and motivation model of behaviour (COM-B) for pathways that potentially influence the low screening provision and uptake. The findings revealed provider perceptions of insufficient South African Department of Health (SA DOH) training support and staff rotations resulting in providers lacking knowledge and skills on cancer, screening policies and techniques. This coupled with provider perceptions of poor patient cancer and screening knowledge revealed low capacity for cancer screening. Providers also perceived opportunity for cancer screening to be undermined by the limited screening services mandated by the SA DOH, insufficient providers, inadequate facilities, supplies and barriers to accessing laboratory results. Providers perceived women to prefer to self-medicate and consult with traditional healers and access primary care for curative services only. These findings compound the low opportunity to provide and demand cancer screening services. And because the National SA Health Department is perceived by providers not to prioritize cancer nor involve primary care stakeholders in policy and performance indicator development, overworked, unwelcoming providers have little motivation to learn screening skills and provide screening services. Providers reported that patients preferred to go elsewhere and that women perceived cervical cancer screening as painful. These perceptions must be confirmed for veracity among policy and patient stakeholders. Nevertheless, cost-effective interventions can be implemented to address these perceived barriers including multistakeholder education, mobile and tent screening facilities and using existing community fieldworkers and NGO partners in providing screening services. Our results revealed provider perspectives of complex barriers to the early detection and management of breast and cervical cancers in primary health clinic settings in Greater Soweto. These barriers together appear potentially to produce compounding effects, and therefore there is a need to research the cumulative impact but also engage with stakeholder groups to verify findings and create awareness. Additionally, opportunities do exist to intervene across the cancer care continuum in South Africa to address these barriers by improving the quality and volume of provider cancer screening services, and in turn, increasing the community demand and uptake for these services.
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Schechter, Clyde B., Aimee M. Near, Jinani Jayasekera, Young Chandler i Jeanne S. Mandelblatt. "Structure, Function, and Applications of the Georgetown–Einstein (GE) Breast Cancer Simulation Model". Medical Decision Making 38, nr 1_suppl (19.03.2018): 66S—77S. http://dx.doi.org/10.1177/0272989x17698685.
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Background. The Georgetown University-Albert Einstein College of Medicine breast cancer simulation model (Model GE) has evolved over time in structure and function to reflect advances in knowledge about breast cancer, improvements in early detection and treatment technology, and progress in computing resources. This article describes the model and provides examples of model applications. Methods. The model is a discrete events microsimulation of single-life histories of women from multiple birth cohorts. Events are simulated in the absence of screening and treatment, and interventions are then applied to assess their impact on population breast cancer trends. The model accommodates differences in natural history associated with estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) biomarkers, as well as conventional breast cancer risk factors. The approach for simulating breast cancer natural history is phenomenological, relying on dates, stage, and age of clinical and screen detection for a tumor molecular subtype without explicitly modeling tumor growth. The inputs to the model are regularly updated to reflect current practice. Numerous technical modifications, including the use of object-oriented programming (C++), and more efficient algorithms, along with hardware advances, have increased program efficiency permitting simulations of large samples. Results. The model results consistently match key temporal trends in US breast cancer incidence and mortality. Conclusion. The model has been used in collaboration with other CISNET models to assess cancer control policies and will be applied to evaluate clinical trial design, recurrence risk, and polygenic risk-based screening.
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Neupane, Laxmi, Hari Prasad Upadhyay i Chandrakala Chhetri. "Awareness on breast cancer among females at Bharatpur metropolitan, Chitwan, Nepal". Journal of Gandaki Medical College-Nepal 16, nr 1 (3.07.2023): 35–40. http://dx.doi.org/10.3126/jgmcn.v16i1.55937.
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Introduction: Breast cancer is the most frequently diagnosed cancer in the world and second most common malignancy among Nepalese women with high prevalence. Countries with lower level of resources like Nepal, prevention of breast cancer is more important. The objective of the study was to find out the level of awareness on breast cancer among female at Bharatpur Metropolitan, Nepal. Methods: An analytical cross- sectional study was conducted among 263 female of Bharatpur Metropolitan city, Nepal. Non probability purposive sampling technique was used for data collection. Data was entered and analyzed by using SPSS-20, p-value <0.05 was considered as statistically significant. Results: The mean±SD of age was found 34.40±11.42 years. Study showed that 61.2% (with 95% CI as 55.32-67.1%) had good awareness on risk factors, 60.5% (with 95% CI as 54.54-66.36) had good awareness on warning sign and symptoms and only 44.5% (with 95% CI as 38.48-50.49) had good awareness on screening and prevention. Overall level of awareness on breast cancer was found poor (50.2%). The mean+SD of overall awareness of the respondents on breast cancer was 15.51±2.84. Statistical significant association was found between overall level of awareness and respondents’ education (p=0.039), husband education (p=0.011) and occupation (p=0.046) of the respondents. Conclusions: More than half of the respondents has poor level of awareness on breast cancer among women in Bharatpur, Chitwan, Nepal. Better health awareness among women in the community, breast cancer screening programmes and national policies to establish effective cancer literacy programs would cause a favorable and positive clinical picture in the country.
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Rennert, G. "Political interpretation of scientific evidence: Case study of breast cancer screening policies around the world". European Journal of Cancer 38, nr 11 (luty 2002): S20. http://dx.doi.org/10.1016/s0959-8049(02)80017-x.
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Berland, Lincoln L., Debra L. Monticciolo, Efren J. Flores, Sharp F. Malak, Judy Yee i Debra S. Dyer. "Relationships Between Health Care Disparities and Coverage Policies for Breast, Colon, and Lung Cancer Screening". Journal of the American College of Radiology 16, nr 4 (kwiecień 2019): 580–85. http://dx.doi.org/10.1016/j.jacr.2018.12.025.
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Fasano, Genevieve A., Yalei Chen, Solange Bayard, Melissa Davis, Vivian Bea, Michele B. Drotman, Elizabeth Kagan Arleo i in. "Adverse consequences of the COVID-19 pandemic on breast cancer stage distribution and breast cancer disparities." Journal of Clinical Oncology 39, nr 15_suppl (20.05.2021): 10555. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.10555.
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10555 Background: The COVID-19 surge in March 2020 resulted in a hiatus placed on screening mammography programs in support of shelter-in-place mandates and diversion of medical resources to pandemic management. The COVID-related economic recession and ongoing social distancing policies continued to influence screening practices after the hiatus was lifted. We evaluated the effect of the hiatus on breast cancer stage distribution on the diverse patient population of a health care system in New York City, the first pandemic epicenter in the United States. Methods: Breast cancer patients diagnosed January 1, 2019 to December 31, 2020 were analyzed, with comparisons of stage distribution and mammography screen-detection for three intervals: Pre-Hiatus, During Hiatus (March 15, 2020 to June 15, 2020), and Post-Hiatus. Results were stratified by African American (AA), White American (WA), Asian (As) and Hispanic/Latina (Hisp) self-reported racial/ethnic identity. Results: A total of 894 patients were identified; of these, 549 WA, 100 AA, 104 As, and 93 Hisp comprised the final race/ethnicity-stratified study population. Overall, 588 patients were diagnosed Pre-Hiatus, 61 During-Hiatus, and 245 Post-Hiatus. Nearly two-thirds (65.5%) of the Pre-Hiatus cases were screen-detected versus 49.2% During-Hiatus and 54.7% Post-Hiatus (p = 0.002). Frequency of tumors diagnosed < 1 cm declined from 41.9% Pre-Hiatus to 31.7% Post-Hiatus (p = 0.035). WA patients were more likely to have screen-detected disease compared to AA in the Pre-Hiatus period (69.1% vs. 56.1%; p = 0.05) but non-significantly more likely to have screen-detected disease compared to As and Hisp patients (66.2% vs. 56.9%; p = 0.08). In the Post-Hiatus period, the frequency of screen-detected disease was highest among WA patients (63.0%) compared to all other racial/ethnic groups (AA; 48.1%, As-33.3%, and Hisp-40%; p = 0.007). Similar patterns were observed for frequency of tumors diagnosed ≤1cm Pre-Hiatus (WA-44.3% vs AA-26%, p = 0.02; and vs. As-41.3%, Hisp-48%; p = 0.09), and Post-Hiatus (WA-37.7% vs. AA-18.2%, As-30.8%, Hisp-23.5%; p = 0.25). Conclusions: The 3-month pandemic-related mammography screening hiatus resulted in a more advanced stage distribution for New York City breast cancer patients, and worsened pre-existing race/ethnicity-associated disparities, especially for AA pts.
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LaVigne, A., S. Grover i S. Rayne. "Knowledge and Screening Practices of Breast and Cervical Cancer in Rural and Urban South Africa". Journal of Global Oncology 4, Supplement 2 (1.10.2018): 46s. http://dx.doi.org/10.1200/jgo.18.38000.
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Background: The South African government has recently released cancer policies for breast and cervical cancer—the most common types and causes of cancer-related death in South African women. Increased mortality rates and advanced disease at presentation in comparison with developed countries suggests a need for greater awareness of risk factors, screening and preventative methods individualized for the population at risk. Aim: To characterize and compare the knowledge base and perceptions of women in urban and rural settings, we assessed these factors in two different cohorts in South Africa. Methods: A cross-sectional sample was taken in South Africa of women invited to participate in a survey regarding breast and cervical cancer knowledge, and awareness of risk factors, prevention and screening. Participants were approached in shopping malls and health facilities in urban Johannesburg in 2015 (“urban”) and semirural Bushbuckridge, 450 km northeast of Johannesburg (“rural”) in 2016. Results: 600 total women were surveyed, with 300 from each cohort. 83% of the urban cohort completed matriculation or higher, versus 60% of rural participants for whom high school was their highest level of education. Both groups demonstrated comparable levels of cancer awareness, and > 70% felt that cervical cancer is preventable. While the urban cohort was more knowledgeable about Pap smears (76% vs. 66%, P = 0.004), > 75% of both cohorts were willing to get one. Although both groups were largely unfamiliar with the role of HPV in cervical cancer, rural women were more aware of HIV (38% vs. 59%, P < 0.0001), smoking (43% vs. 62%, P < 0.0001) and parity (39% vs. 54%, P = 0.00019) as risk factors. Nevertheless, urban participants were more knowledgeable about breast self exams (71% vs. 59%, P = 0.001) and mammograms (62% vs. 42%, P < 0.0001), and more likely to undergo one (79% vs. 66%, P = 0.0002). Both groups identified family history and genetics as risk factors, but rural women appeared more aware of the roles of diet (30.67% vs. 39.93%, P = .011), oral contraceptives (17.33% vs. 34.77%, P < .0001), alcohol (26.67% vs. 52.15%, P < .0001) and lack of exercise (8.67% vs. 55.12%, P < .0001). Conclusion: Overall knowledge of breast and cervical cancer did not differ between both groups, despite varying levels of education and geographic setting. Women in the rural cohort demonstrated more awareness of several oncologic risk factors. Yet, the greater familiarity with and uptake of screening methods, especially for breast cancer, among women in the urban cohort may point to the benefits of proximity to health care infrastructure, such as tertiary care centers. This data supports a need for further implementation and distribution of cancer care services within cancer policies, to capitalize on increasingly sufficient levels of awareness among South African women.
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Ayala-Marín, Alelí M., Vivian Colón-López, Camille Vélez-Álamo, Natalie Fernández-Espada, Angela Pattatucci i María E. Fernández. "Never Screened: Understanding Breast Cancer Nonadherence in Puerto Rico". Health Education & Behavior 48, nr 5 (5.03.2021): 559–66. http://dx.doi.org/10.1177/1090198120988248.
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Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death among women in Puerto Rico (PR). The purpose of this study was to identify factors associated with never screened status among a sample of women nonadherent to the 2013 American Cancer Society guidelines. The inclusion criteria for this study were being a woman (1) aged ≥40 years old and (2) nonadherent to breast cancer screening guidelines. We used baseline data from participants ( N = 300; aged ≥40 years old) enrolled in the intervention trial Cultivando la Salud, implemented in Canóvanas, Puerto Rico, from 2012 to 2014. We used multivariate logistic regression models to identify factors associated with never screening status, adjusting by sociodemographical variables and psychosocial constructs about mammography (self-efficacy, beliefs about mammography pros [benefits] and cons [disadvantages], and subjective norms) as well as by health care insurance, usual source of care, and Pap test adherence. Among nonadherent women, 18.0% reported never having a mammography. Never screened women were significantly younger than previously screened women (adjusted prevalence odds ratio [aPOR] = 7.32, 95% confidence interval (CI): [2.38, 22.50]) and almost four times as likely to have the governmental health plan (GHP; aPOR = 3.78, 95% CI: [1.15, 12.46]). In addition, never screened women perceived more cons (disadvantages) to mammography than previously screened women (aPOR = 1.81, 95% CI: [1.18, 2.78]). We found that women who were younger, had GHP insurance, and had higher levels of beliefs against mammography were more likely to have never been screened. Results from this study can be used to target never screened women with health education messages addressing perceived cons of mammography. Additionally, women with GHP insurance may experience disparities in health care access and should be targeted with policies that facilitate access to mammography screening.
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Team, Victoria, Lenore H. Manderson i Milica Markovic. "From state care to self-care: cancer screening behaviours among Russian-speaking Australian women". Australian Journal of Primary Health 19, nr 2 (2013): 130. http://dx.doi.org/10.1071/py11158.
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In this article, we report on a small qualitative scale study with immigrant Russian-speaking Australian women, carers of dependent family members. Drawing on in-depth interviews, we explore women’s health-related behaviours, in particular their participation in breast and cervical cancer screening. Differences in preventive health care policies in country of origin and Australia explain their poor participation in cancer screening. Our participants had grown up in the former Soviet Union, where health checks were compulsory but where advice about frequency and timing was the responsibility of doctors. Following migration, women continued to believe that the responsibility for checks was their doctor’s, and they maintained that, compared with their experience of preventive medicine in the former Soviet Union, Australian practice was poor. Women argued that if reproductive health screening were important in cancer prevention, then health care providers would take a lead role to ensure that all women participated. Data suggest how women’s participation in screening may be improved.