The French breast cancer screening programme: Epidemiological and economic results of the first round of screening

This paper presents the epidemiological and economic resultspertaining to the first round of breast cancer screening programmesin France. Breast cancer screening is based within existingradiologic facilities in the private and public sector and on-goingcompetition exists between organized and spontaneous screening.The mean screening attendance rate was 36.7%, the mean recallrate was 10.4%, the positive predictive value (PPV) for thescreening test 5.8% and the biopsy rate 1.2%. There were 5.1carcinomas detected per 1,000 women screened. Of these, 30.7%were smaller than 10 mm in diameter and 69.0% had no nodal involvementA retrospective resource-based cost analysis revealed a meancost of US$63 per woman screened. This cost includes all directprogramme costs excluding diagnostic testing and treatment costs.Organizational as opposed to technical aspects of screeningaccounted for 38% of this cost in the first round. These resultsreveal discrepancies in the quality, cost and estimated efficacybetween the district programmes during the first screening round.Overall, epidemiological indicators reach European target values,with the exception of a low PPV for both the screening testand biopsy. In addition to the strict adherence to quality controland interpretation protocols, the shift of French women awayfrom individual screening practices towards organized screeningbehaviour will be necessary to enable the French breast cancerscreening programmes to reach their optimal efficacy.     

Compliance after 17 years of breast cancer screening: Factors associated with reattendance for periodic breast screening

The motives and reasons for regular attendance, irregular attendanceand drop-out were studied in women who were enrolled in a biennialbreast screening programme in 1975 and who were invited to eachsubsequent screening round until 1992. Three compliance groupswere compared: ‘attended all rounds’ (group A, n=79),‘missed 1 or 2 rounds’ (group B, n=73) and ‘missedmore than 2 rounds’ (group C, n=64). The groups did notdiffer with respect to background variables such as sociodemographiccharacteristics, actual health problems or preventive healthorientations, but significant differences were found in generalattitudes to breast screening and to the organizational aspectsof screening procedures. The results suggest that during thecourse of a screening programme, for a substantial group ofnot strongly motivated women, the recurring negative aspectsof mammography (pain and anxiety) are increasingly becominga burden. ‘Circumstantial factors’ like waitingfor one's turn, the distance to the screening centre and incidentaldissatisfaction with handling by screening staff, appear totrigger the decision to skip screening rounds or to drop outof the programme. From the perspective of maintaining a regularattendance throughout the programme this is an important group.Special efforts must be made to encourage these women to stayin the programme.     

Economic evaluation of a mammography-based breast cancer screening programme in Spain

The aim of the study was to perform a cost-effectiveness analysisof a breast cancer (BC) mammography screening programme, comparedto a do-nothing alternative, In Spain. Screening consisted ofa biennial mammography performed on all women 50–65 yearsold. A marginal analysis including women 45–49 years oldwas also performed. With the aid of a decision tree model, thenumbers of BC cases diagnosed through screening, BC cases missedby screening and false-positive BC cases were calculated. Costswere calculated by feeding local data into Markovian modelsand the cost-effectiveness ratio calculation was performed ina computer spread sheet. A sensitivity analysis was also conducted.Results were presented in ECUs of 1993. The cost-effectivenessratio per avoided death is 115,500 ECUs and per saved life year7,300 ECUs. Including women 45–49 years old in the programmeraises this ratio to 229,000 and 9,400 ECUs respectively. Thesensitivity analysis showed the efficacy of mammography, complianceof the programme and screening costs to be the more sensitivevariables.     

Lower costs of hospital treatment of breast cancer through a population-based mammography screening programme

BACKGROUND: The objective of this study was to evaluate the hospital treatment costs of invasive breast cancer in relation to the mode of detection, i.e. by mammography screening, between screenings or without screening during a population-based mammography screening programme, which started in 1987 among 36,000 women aged 40 to 74 years in the city of Turku, Southwest Finland. METHODS: The treatment costs and survival days of 556 women diagnosed with invasive breast cancer at the age of 40 to 74 years in 1987 to 1993 were followed up for five years from diagnosis or until death, whichever occurred first. RESULTS: Screen-detected cancers had the lowest average costs. The mean treatment costs per patient were 1.4-fold for clinical cancers and 1.3-fold for interval cancers compared to screen-detected cancers (p<0.001). The corresponding ratios in the mean treatment costs per survival day were 3.5 for clinical cancers and 1.9 for interval cancers (p<0.001). The mean treatment costs per patient were 1.3-fold for the non-screened group (clinical cancers) compared to the screened group (screen-detected and interval cancers) (p<0.001). The corresponding ratio was 3, when the mean treatment costs per survival day were compared (p<0.001). The estimated savings resulting from early treatment were 26-30% measured as a proportion of the screening costs for 1987 to 1993. CONCLUSION: The treatment costs of screen-detected cancers are lower than those of cancers detected by other methods. The study shows the potential for reducing treatment costs through early detection of breast cancer by mammography screening.     

Uptake in breast cancer screening: A sociogeographical analysis

During the period 1992 to 1994, the female population aged 40to 69 years old and living in Gent, Belgium, was invited througha personal letter to participate in a breast cancer screeningprogramme. The women were asked to consult a physician beforereferral to a local radiologist. After six months, a reminderletter was sent. The eligible population amounted to 40,713women. Of these, 22.5% were recorded to have attended for ascreening mammography. The uptake levels were analysed per statisticalsector, which is a more or less homogeneous quarter in socialrespect. The age-standardized participation ranged from 6 to42% among the 150 sectors taken into account. The participationwas definitely highest in well-to-do neighbourhoods and lowestin the poorer inner-city quarters. In a multivariate analysis,social exclusion indicators such as percentage of persons onwelfare and percentage of unoccupied dwellings ranked first.On condition that this social gradient is confirmed on an individualbasis, sociogeographical analysis may well be a powerful toolin area-based health promotion campaigns.     

2012年新疆农村妇女宫颈癌和乳腺癌筛查项目结果分析

目的：分析2012年度新疆农村妇女宫颈癌和乳腺癌检查结果,探讨新疆“两癌”流行趋势与特点,为在新疆推广筛查工作提供科学依据。方法对筛查项目结果进行描述性分析。结果妇科常见疾病检出患病人数20．1万人（56．10％）,检出率较高依次为塔城地区（74．56％）、阿克苏地区（64．35％）和伊犁州（61．42％）。新疆农村妇女宫颈癌和癌前病变检出率为0．10％,宫颈癌早诊率为85．05％,检出率高的为巴州（0．26％）和博州（0．18％）。妇女乳腺癌检出率为0．05％,检出率高的为吐鲁番地区（0．27％）和克州（0．25％）。结论新疆妇女宫颈癌和乳癌检出率高于全国同期平均水平,加强重点人群“两癌”防治知识健康教育,积极参加“两癌”筛查,是提高“两癌”早诊早治的关键。     

Exploring breast cancer screening barriers among Barbadian women: a focus group study of mammography in a resource-constrained setting

Breast cancer affects women worldwide. Early detection strategies, notably mammography, aim to reduce mortality from breast cancer. However, mammography is a costly screening tool, generates controversy in terms of its impact and adverse effects, and its uptake remains low among some populations. This qualitative study (12 focus groups with 110 participants) explored experiences with mammography among Barbadian women by investigating how barriers are negotiated in a setting of resource-constrained health care provision without a national screening programme. The study findings indicate that, firstly, Barbadian women have to actively seek understanding of both breast cancer and the mammography process. Women described how, with little public awareness and knowledge, they borrow from available public health information on diabetes and HIV/AIDS to give meaning to mammographic screening. Secondly, many women expressed their fear about mammography and its potential consequences, such as experiencing social stigma and losing a romantic relationship after diagnosis. Thirdly, the cost of screening for women who opted for the more reliable private facilities was discussed, along with the potential cost of health care following a diagnosis and the emotional cost of enduring the societal taboo of breast cancer. If breast cancer screening is to be acceptable for this or similar populations, there should be provision of additional services to ensure better access to free screening or alternative strategies, as well as post-diagnostic social and financial support. The policies to develop these services must also address women’s concerns about screening and breast cancer, and provide comprehensive information to allow informed decisions about screening.     

2015-2018年广东省农村妇女乳腺癌筛查结果分析

目的 分析2015-2018年广东省农村妇女乳腺癌筛查数据,了解广东省农村妇女乳腺癌筛查情况及乳腺疾病的检出情况,为妇女保健工作提供依据.方法 回顾性分析2015-2018年广东省35～64岁农村妇女乳腺癌筛查资料,了解乳腺疾病的检出情况.按照乳腺癌筛查流程,接受检查的所有妇女进行乳腺临床检查和乳腺彩超检查,对乳腺彩超...     

Older immigrant Tamil women and their doctors: attitudes toward breast cancer screening

Cultural beliefs have been hypothesized to be powerful barriers to breast cancer screening in minority women and physician recommendation is consistently reported to be the strongest incentive. This study investigated (1) beliefs regarding breast cancer and (2) the perception of barriers to mammography and clinical breast examination in a sample of immigrant Tamil women, as well as in a sample of primary care physicians. Three focus groups, each consisting of 10 immigrant Tamil women from Sri Lanka aged 50 years or over were conducted and 52 primary care physicians who serve this population completed mailed surveys. The most common barriers to screening reported by the women were (1) lack of understanding of the role of early detection in medical care, (2) religious beliefs and, (3) fear of social stigmatization. Physicians reported the most common barriers to their screening recommendations for this group of women to be (1) women's episodic care, (2) unrelated presenting problems and, (3) women refusing to be screened. Interventions to increase screening in this and other minority groups requires an elaborated understanding of utilization barriers for both women and their doctors.     

Health beliefs and illness attitudes as predictors of breast cancer screening attendance

BACKGROUND: This paper considers the breast cancer screening programme in the autonomous community of Navarre, Northern Spain. Women from different areas of Northern, Central and Southern Navarre are involved. METHODS: A sample of 512 women participants and 196 non-participants was taken from a total of 60,908 women between 45 and 65 years of age who received an invitation to attend the breast cancer screening programme. The participants were asked to fill in an individual structured questionnaire in their local Health Centre and the non-participants in their homes. This was done retrospectively. RESULTS: The response rate was 100% for participants and 83.9% for non-participants. This study investigates the attitude profiles of the women attending mammography mass screening, with non-attending women (matched in educational and occupational levels) as controls. Subjects were assessed on dimensions such as attitudes towards health and illness. The results support Rosenstock's 1974 model that perceived severity of breast cancer and perceived susceptibility to breast cancer are related to participation in screening. Furthermore, results demonstrated that hypochondriacal beliefs, disease phobia and feared effects of symptoms were related to decreased participation levels. CONCLUSION: This study has explored the implication of health belief attitudes and the attitudes toward illness variables with women's participation in a breast cancer screening programme. It assesses the relative contribution of these variables to levels of participation, and the results of the study indicate that belief sets and attitudes are important components of women's cancer prevention behaviours.     

大庆市乳腺癌患病情况调查

目的 了解大庆地区乳腺癌的发病趋势,寻找提高乳腺癌早期检出率的方法.方法 收集大庆市城区2000年～2005年妇女病普查的乳腺普查资料.根据乳腺癌的检出情况、年龄分布、临床分期、职业分布、发病趋势等情况进行调查分析.结果 检出乳腺癌患者49例,乳腺癌患病率平均为38.92/10万.按照年龄分组40～49岁组检出19例占检出比例的38.78%,为本地区乳腺癌高发年龄段(x2=19.11,P=0.001＜0.05);按照职业分为干部组和工人组,工人组乳腺癌患病率高,检出36例(73.5%),x2=4.313,P=0.038＜0.05.结论 应教会妇女乳腺自检方法,定期开展妇女乳腺癌普查.应用近红外线乳腺扫描仪检测,可提高乳腺癌的检出率.     

Uptake of screening for breast cancer in South Lancashire

Study objective: To describe and explain variation among general practices in the uptake of screening for breast cancer.Design: Analysis of the variation in uptake of screening by general practice. Uptake rates are calculated and related to a social deprivation score created for each practice, and to the presence of at least one female general practitioner.Setting: South Lancashire Health Authority, England.Patients: All women aged 50–64 y registered with Lancashire Family Health Services Authority and resident in South Lancashire in 1988–1995.Main results: Variation in the uptake of screening for breast cancer during Round 1 of the national programme is explained partly by a deprivation score for each practice and by the presence of at least one female general practitioner. In Round 2 the deprivation index continues to explain variation, but the effect of a female GP has diminished. The number of hours worked by practice nurses has no effect on uptake of breast screening.Conclusions: Variation in the uptake of breast cancer screening is closely related to social deprivation. Results suggest that the presence of a female general practitioner has a beneficial effect on uptake.     

"I have no time for potential troubles": Russian immigrant women and breast cancer screening in Israel

The author's earlier study of Russian immigrant women's attitudes and practices related to the early detection of cancer has shown their low participation in breast screening activities, from BSE to mammography. Most respondents were educated women who acknowledged their personal risk, understood the role of screening, but still avoided preventive action. In this qualitative research, the gap between cognitions and behavior is explored further by means of in-depth interviews and focus groups with 34 women aged 50–74 who moved to Israel after 1990. All Israeli women of this age are entitled for screening mammography free of charge once every 2 years. The findings point to a low place of preventive health concerns in the personal agenda of female immigrants, loaded by the more immediate survival needs (income, housing, support of other family members, etc.). Other barriers include the lack of referral from primary care providers, fear of cancer diagnosis, apprehensions of irradiation and pain involved in mammography, fatalist general attitude towards health and illness, and mistrust of current cancer therapy. Many older women (60+), whose risks are actually higher, shared a false belief that breast cancer strikes younger women and they are already past the age of concern. Older informants avoided gynecological clinics because of male gender of most gynecologists, their poor command of Hebrew, and a belief that gynecological checkups are irrelevant and even shameful in their age. It is concluded that female immigrants, especially older ones, must be a special target group for preventive health interventions.     

Patient- and system-related diagnostic delay in breast cancer

Background: Breast cancer patients in developing countries usuallyseek treatment at a more advanced-stage of disease. This workwas aimed at evaluating the avoidable risk factors related todiagnostic delay of breast cancer (patient- and system-related)in Alexandria, Egypt. Methods: Data were collected from 565incidents, histologically confirmed cases of breast cancer,recruited from nine hospitals in Alexandria, reflecting differentpatterns of health care delivery during the period July 1997–June1998. Results: Patient-related delay (interval between firstsymptom and first medical consultation > three months) wasfound in 38.1%, while system-related delay (interval betweenfirst medical consultation and final diagnosis > four weeks)was found in 12.9% of cases. A significant association betweendelay in seeking medical advice and late stage at diagnosiswas detected; in fact, while 26.3% of women with less than threemonths delay were at stage III and IV, the corresponding proportionamong women with more than three months delay was 72.1% (²1=109.6,p<0.0001). Regarding patient-related delay, age >40 years,lower educational level and not conducting breast self examinationwere independent risk factors associated with diagnostic delay.As for the system-related factors, place of first visit (generalpractitioner), absence of a palpable lump and lack of healthinsurance were significant predictors for delay. Conclusion:The patient's role in diagnostic delay of breast cancer is veryimportant in Egypt. Also, Interactive training directed to generalpractitioners to rationalise their approach to cases with breastlumps should be promoted to reduce system-related delay.     

Impact of a community-based breast cancer screening program on Hopi women

Objective

To examine changes in breast cancer knowledge, attitudes, beliefs and behaviors following implementation of a tribal run CDC Breast and Cervical Cancer Program (BCCP), we report 2006 survey results from Hopi women and contrast findings with 1993 survey data and BCCP reports.

Methods

Community meetings, focus groups, and researchers jointly developed a culturally appropriate survey instrument. Hopi women randomly selected from Tribal enrollment lists were interviewed in-person by Hopi interviewers; 250 women ≥ age 18 participated (87% response) between June and December, 2006.

Results

Among women 40+, 77.5% reported ever having had a mammogram and 68.9% reported having done so within the past 2 years, an increase from 45.2% and 46% self-reported in 1993. Compared to 1993, more women in 2006 (88.1% vs. 59%) believed that a mammogram can detect cancer and more than 90% now believe that early detection of cancer can save lives. Women reported a preference (60%) for receiving health care at the Hopi BCCP. Survey results were validated using programmatic data which estimated 76.6% of Hopi women had received mammography screening.

Conclusion

Implementation of a tribal run BCCP has resulted in a substantial increase in mammography screening on the Hopi reservation.     

Alcohol drinking, consumption patterns and breast cancer among Danish nurses: a cohort study

BACKGROUND: The aim of this study was to analyse the impact of alcohol intake and drinking pattern on the risk of breast cancer. METHODS: A total of 17 647 nurses were followed from 1993 until the end of 2001. At baseline participants completed a questionnaire on alcohol intake and other lifestyle-related factors. Data were analysed using Cox's proportional hazard model. RESULTS: During follow-up 457 women were diagnosed with breast cancer. The relative risk of breast cancer was 2.30 [Confidence interval (CI): 1.56-3.39] for alcohol intake of 22-27 drinks per week, compared to 1-3 drinks per week. Among alcohol consumers, weekly alcohol intake increased the risk of breast cancer with 2% for each additional drink consumed. Weekend consumption increased the risk with 4% for each additional drink consumed friday through sunday. Binge drinking of 4-5 drinks the latest weekday increased risk with 55%, compared with consumption of one drink. A possible threshold in risk estimates was found for consumption above 27 drinks per week. CONCLUSIONS: For alcohol consumption above the intake most frequently reported, the risk of breast cancer is increased. The risk is minor for moderate levels but increases for each additional drink consumed during the week. Weekend consumption and binge drinking imply an additional increase in breast cancer risk.     

Uptake of screening for breast cancer in patients with mental health problems

OBJECTIVES: Mental illness is associated with physical illness and mortality from a variety of causes including cancer. There is little information on screening attendance among the mentally ill population. An audit was conducted of a breast screening service in inner London to determine uptake rates in women with mental illness. DESIGN: Cross sectional data linkage study of the local screening register and patients of the local psychiatric units. Screening uptake rates in all patients, those with a history of multiple detention in hospital, and those with psychosis were compared with the local reference population. SETTING: Women in three inner London boroughs. PARTICIPANTS: Screening records for 933 psychiatric patients and 44 195 women without mental health problems aged 50 to 64 years. MAIN RESULTS: Overall, psychiatric patients were as likely as the reference group to attend breast screening. Patients with a history of multiple detention were significantly less likely to attend (OR = 0.40, 0.29 to 0.55; p<0.001), as were patients with a diagnosis of psychosis (OR = 0.33, 0.18 to 0.61; p<0.01). Increasing age, a history of detention in hospital, and social deprivation remained independent predictors for non-attendance. CONCLUSION: Women with severe mental health problems may be less likely to attend national screening programmes such as breast screening, and action should be taken to overcome the barriers to attendance.     

澳门某机构女职工乳腺癌筛检影响因素分析

目的 了解澳门妇女乳腺癌筛检影响因素,为制定相关卫生教育和策略提供依据。方法 采用现况调查对某机构全体220名女职工进行乳腺癌普查,对乳腺癌筛检影响因素进行分析。结果 女职工平均年龄为44.2岁;82.1%已婚,76.9%已生育,子女中位数为2个,只有43.1%有喂哺母乳经验;平均初经年龄为13.6岁;35.4%女职工有亲友患过乳腺癌,78.5%从未患有乳房疾病;年龄(P=0.000)、初经年龄(P=0.032)、子女数(P=0.041)、婚姻(P=0.000)、生育子女(P=0.000)、喂哺母乳经验(P=0.006)、亲友患过乳腺癌(P=0.001)、乳房疾病(P=0.001)在是否进行乳腺癌筛检中差异有统计学意义;而年龄(OR=1.2,P=0.000)和未停经(OR=9.1,P=0.000)是促进乳腺癌筛检的因素,从未患有乳房疾病(OR=0.3,P=0.047)则是妨碍因素。结论 对年龄较轻及已停经的女职工,应加强乳腺癌筛检的宣传教育,以增加女职工乳腺癌的危机意识。     

Do different physicians' panels reach similar conclusions?: A case study on practice guidelines for limited surgery in breast cancer

This study was aimed at assessing the extent to which differentpanels of physicians produce similar recommendations and whethertheir agreement is greater when members of the panels practicein the same geographical area. A total of 34 physicians, organizedin 3 multispeciality and one monospeciality (all surgeons) panels,working at both specialized and community hospitals, participatedin the study. They were asked to rate the appropriateness ofan indication for limited surgery in breast cancer for 432 hypotheticalpatients described through clinical scenarios. The primary outcomeof the study was the reliability of appropriateness ratingsbetween the pairs of panels, measured as the percent absoluteagreement and kappa statistic. The agreement of the ratingsbetween pairs of panel of the same region was always quantitativelygood - panels I-II kappa = 0.58 (95% Cl: 0.50–0.67) andpanels III-IV kappa = 0.65 (95% Cl: 0.56–0.75) - and higherthan when panels from different regions were compared. We concludethat in our study an acceptable level of agreement was reachedwhen different panels of experts were asked to produce guidelinesusing a structured process which includes exposure to the relevantscientific literature. The fact that local (organizational,cultural, etc.) factors seemed to play a modulating role overscientific evidence has implications that should be consideredwhen deciding on the level (local versus central) where guidelinesare produced.     

Estimation of age-specific sensitivity and sojourn time in breast cancer screening studies

This study investigates statistical approaches to quantitatively describing the age effect on screening sensitivity and sojourn time distribution in breast cancer screening studies. Such an investigation is directly motivated by the need to understand the inherent relationships between age and these important quantities. We incorporate the age effect through generalized linear models under a progressive disease modelling framework and obtain the corresponding parameter estimators using the maximum likelihood method. Among a set of potential models, we use Akeike's information criterion and likelihood ratio test in model selection and inferences. Extensive simulation studies show that the estimators have reasonable accuracy and the model selection criterion works well. The proposed methods are illustrated using data from two large breast cancer screening trials. The results show that the screening sensitivity increases with age at screening examinations based on these two trials.