中国2013年35~69岁女性人群子宫颈癌和乳腺癌筛查率及影响因素研究

目的 分析中国35~69岁女性人群子宫颈癌与乳腺癌筛查率并探讨其主要影响因素。方法 利用2013年全国慢性病与危险因素监测数据,分别纳入女性35~64岁66 130人和35~69岁72 511人分析子宫颈癌和乳腺癌筛查率。基于复杂抽样和加权方法估计筛查率及95% CI;采用Rao-Scott χ²检验不同人群筛查率差异;构建混合效应logistic回归模型分析筛查与主要影响因素关联性。结果 分析的样本中分别有26.7%（95% CI：24.6%~28.9%）接受过子宫颈癌筛查和22.5%（95% CI：20.4%~24.6%）接受过乳腺癌筛查,城市高于农村,东部地区高于中、西部（P<0.000 1）。≥ 50岁女性筛查率低于35~49岁。低教育水平、未就业、低家庭收入和无医保女性接受筛查的可能性显著低于高社会经济水平女性（P<0.000 1）;居住在农村、西部地区与子宫颈癌筛查相关性无统计学意义,而与乳腺癌筛查可能性较低相关（P<0.05）。结论 应提高人群子宫颈癌和乳腺癌筛查覆盖率,重点提高≥ 50岁及低社会经济地位人群的筛查率。     

Breast cancer screening in Tel Aviv

Optimal breast cancer screening includes both physical examination and mammography. In anticipation of the addition of routine mammographic screening to Israel's 25-year-old early breast cancer detection program, we examined the demographic characteristics of almost one thousand women attending a breast cancer screening examination in Tel Aviv for the first time. The specific objective of the survey was to see whether women attending screening were those who stood a good chance of benefiting from it. Only half the women were aged 40 or older, and there was a preponderance of women of Western origin. Almost half had a breast-related complaint at the time of the visit. Targeted public education and appropriate administrative measures are necessary to ensure that women who can benefit from screening attend screening clinics and that clinics are not filled to capacity by women needing diagnostic evaluation and followup rather than routine screening. Tel Aviv general practitioners appeared to be aware of the advantages of breast cancer screening.     

我国乳腺癌筛查卫生经济学研究的系统评价

目的 了解我国大陆地区乳腺癌筛查的卫生经济学评价进展。方法 系统检索PubMed、中国知网、万方数据知识服务平台和维普网1995年1月至2015年12月收录文献,对纳入研究基本信息、人群项目参与率及检出率、模型研究方法学、经济学评价方法及结果等信息进行摘录和比较,采用卫生经济学评价报告规范（CHEERS）评价报告质量（总分24分）。结果 共检索356篇文献,最终纳入13篇,均发表于近4年（2012-2015年）,其中11篇基于人群、3篇基于模型研究。筛查起始年龄为18～45岁,终止年龄均≥59岁;筛查技术包括临床检查、超声和钼靶单一或联合筛查。有7篇报道了研究角度,其中为政府等服务提供方5篇,社会角度2篇;仅有5篇研究进行了成本和（或）效果贴现。11篇成本-效果分析中,有9篇提供了评价指标检出1例乳腺癌的成本,为5.0～229.3（M=14.5）万元。以质量调整生命年（QALY）或伤残调整生命年（DALY）为指标的成本-效用分析仅4篇,相应增量成本效果比（ICER）为0.3万元～27.1万元（2015年我国人均GDP为4.9万元）。13篇文献平均得分14.5（9.5～21.0）分,总分24分,其中研究角度、贴现率、ICER及不确定性等维度得分较低。结论 我国大陆地区乳腺癌筛查的经济学研究尚处于起步阶段,尤其是模型研究;各研究间方法及结果可比性一般,报告质量有待加强。应从社会角度全面核算成本后对筛查项目开展以QALY或DALY为指标的成本-效用分析。     

Rates of Change to a Positive Result in Subsequent Screening Mammography in Korean Women: A Retrospective Observational Study

Objectives:

This retrospective cohort study aimed at calculating some parameters of changes in the findings of the subsequent screening mammography (SSM) in female Korean volunteers.

Methods:

The study included screenees aged 30 to 79 years who underwent SSM voluntarily after testing negative in the baseline screenings performed between January 2007 and December 2011. A change to a positive result was defined as category 4 or 5 by using the American College of Radiology Breast Imaging Reporting and Data System. The proportion of results that had changed to positive (CP, %) was calculated by dividing the number of cases with results that were positive in the SSM by the total number of study participants. The rate of results that had changed to positive (CR, cases per 100 000 screenee-months) was calculated by dividing the number of cases with results that were positive in the SSM by the total number of months of the follow-up period.

Results:

The overall CP and CR in all age groups (n=77 908) were 2.26% and 93.94 cases per 100 000 screenee-months, respectively. The median CP interval in the subjects who had positive SSM results was 30 to 36 months, while that in the age group of 30 to 39 years was shorter.

Conclusions:

Different screening intervals should be considered among women aged between 30 and 59 years. In addition, a strategy for a screening program should be developed for the age group of 30 to 39 years, in particular.     

Effect of a national population-based breast cancer screening policy on participation in mammography and stage at breast cancer diagnosis in Taiwan

In Taiwan, a Cancer Screening Quality Improvement Program (CAQIP), implemented in 2010, provides financial support to qualified hospitals to improve accessibility. This study examined whether the CAQIP program increased participation in mammography and achieved more early stage diagnosis of breast cancer. We utilised a natural experiment to compare outcomes of interest in women aged 50–69 years with their first mammography date in two different phases, 2005–2009 and 2010–2014. Propensity score matching was used to match comparable cohorts in each phase. In total, 468,259 matched participants in phases 1 and 2 were analyzed. Patient-level logistic regressions were used and adjusted for patient risk factors. Compared with phase 1, our findings indicated women in phase 2 were more likely to have repeat mammography participation (OR, 1.33; 95 % CI, 1.32–1.34), and be diagnosed with early stage breast cancer (OR, 1.15 times; 95 % CI, 1.05–1.26). Women living in rural areas were less likely to repeatedly participate mammography (OR, 0.86; 95 % CI, 0.85–0.86) and experience early diagnosis (OR, 0.90, 95 % CI, 0.81–0.99). Women at low socioeconomic status were less likely to experience early diagnosis, and those with reproductive and hormonal risk factors were less likely to repeatedly participate mammography. Our findings provide evidence of potential benefits of health policy intervention to improve accessibility on participation in mammography and early stage diagnosis of breast cancer.     

Breast and cervical cancer screening for women between 50 and 69 years of age: what prompts women to screen?

The objective of this study was to examine mammography and cervical cancer screening rates among women aged 50 to 69 and to understand which prompts are effective for improving screening compliance. A self-administered survey was sent to 800 randomly selected participants in a health region in a relatively poor, rural province in Eastern Canada with a universal health care system. Since 1995, New Brunswick has instituted a biannual self-referral mammography screening program for women between 50 and 69 years of age. The response rate to the survey was 66%. Mammography screening compliance was 73% and was most significantly associated with annual clinical breast examinations, compliance with cervical cancer screening, and physician suggestion (p <.001). Cervical cancer screening compliance was 91% and was significantly associated with annual clinical breast examinations, compliance with mammography screening, and physician suggestion (p<.001). Contact with a physician is most effective for promoting screening compliance.     

Association between documented family history of cancer and screening for breast and colorectal cancer

Background

Previous research on ascertainment of cancer family history and cancer screening has been conducted in urban settings.

Purpose

To examine whether documented family history of breast or colorectal cancer is associated with breast or colorectal cancer screening.

Methods

Medical record reviews were conducted on 3433 patients aged 55 and older from four primary care practices in two rural Oregon communities. Data collected included patient demographic and risk information, including any documentation of family history of breast or colorectal cancer, and receipt of screening for these cancers.

Results

A positive breast cancer family history was associated with an increased likelihood of being up-to-date for mammography screening (OR 2.09, 95% CI 1.45–3.00 relative to a recorded negative history). A positive family history for colorectal cancer was associated with an increased likelihood of being up-to-date with colorectal cancer screening according to U.S. Preventive Services Task Force low risk guidelines for males (OR 2.89, 95% CI 1.15–7.29) and females (OR 2.47, 95% CI 1.32–4.64) relative to a recorded negative family history. The absence of any recorded family cancer history was associated with a decreased likelihood of being up-to-date for mammography screening (OR 0.70, 95% CI 0.56–0.88 relative to recorded negative history) or for colorectal cancer screening (OR 0.75, 95% CI 0.60–0.96 in females, OR 0.68, 95% CI 0.53–0.88 in males relative to recorded negative history).

Conclusion

Further research is needed to determine if establishing routines to document family history of cancer would improve appropriate use of cancer screening.     

全球肺癌筛查卫生经济学研究的系统评价

目的 了解全球肺癌筛查的卫生经济学评价研究进展,为我国相关研究和筛查工作开展提供参考。方法 系统检索PubMed、EMbase、The Cochrane Library、中国知网及万方数据知识服务平台自建库至2018年6月30日间肺癌筛查卫生经济学研究相关文献,摘录其经济学评价方法及结果等信息,并进行质量评价。成本统一货币单位后计算增量成本效果比（ICER）后计算与当年当地人均GDP比值。结果 共纳入23项研究（1项基于人群随机对照试验,20项完全基于模型评价）,整体质量较好;22项来自发达国家,11项筛查起始年龄为55岁,18项目标人群考虑了吸烟史;评价的筛查技术全部涉及低剂量螺旋CT（LDCT）,筛查频率以每年1次（17项）和终生1次（7项）居多。22项研究可获得与未筛查相比的ICER,其中17项研究报道的ICER低于3倍当年当地人均GDP。各有15项和7项研究可获得每年1次和终生1次的ICER,其中各有12项和7项支持其经济有效,且终生1次略优于每年1次;不同筛查起始年龄和吸烟包年的经济有效性优劣差异不明显。结论 发达国家多开展基于模型LDCT肺癌筛查卫生经济学评价,并结合年龄和吸烟史进行高危人群选择,初步提示该方案经济有效;可为证据有限的欠发达地区提供参考,但实施需结合当地卫生资源现状;预算有限时低频次LDCT筛查更佳,而筛查起始年龄和吸烟史等细节确定需结合人群特征进行精准评价。     

成都市双流县子宫颈癌筛查及早诊早治意愿的现况研究

目的了解成都市双流县妇女子宫颈癌筛查及早诊早治的意愿,为成都市双流县更好地开展子宫颈癌防治工作提供依据。方法在成都市双流县采用整群抽样方法选取研究对象,对符合要求的30～59岁妇女开展子宫颈癌筛查,现场采取一对一方式进行子宫颈癌筛查及早诊早治意愿情况的问卷调查。结果 2000份有效问卷被纳入统计学分析,仅有15.7%的人知道子宫颈癌早期发现能治好,对于早期子宫颈癌治疗后能活至少10年,以及HPV主要通过性行为传播的知晓率则更低,分别为2.7%和0.8%;仅有一半左右的人(50.9%)是因关注自己健康而参加本次筛查;87.8%的调查对象认为每年进行1次免费筛查可以接受;92.5%的人愿意支付一定的筛查费用;如果筛查后有可疑病症,98.1%的人会去医疗机构进一步诊治,其中,65.3%的人会选择县级医疗机构、26.0%选择乡镇卫生院。结论成都市双流县适龄妇女对子宫颈癌相关知识的知晓率有待提高,可通过健康教育大众宣传等提高妇女对子宫颈癌相关知识的知晓率,使其关注自身健康,以促进子宫颈癌筛查和早诊早治项目的开展。     

中山市35～59岁妇女免费乳腺癌普查模式及结果分析

目的通过对2011年35~59岁妇女免费乳腺癌普查模式及结果分析,从中发现本模式乳腺癌普查管理中的薄弱环节,为完善本地乳腺癌筛查管理及政府乳腺癌防治提供依据。方法由调查员对普查妇女进行相关资料的询问填写,采用临床触诊加高频B超相结合筛查方法,同时现场进行信息录入,阳性妇女及时追踪。结果 47 768例普查妇女中BI-RADS分级中未见异常共29 755例,占62.29%。发现异常18 013例,占37.71%。复诊率25.3%;活检154例,活检率0.32%,其中良性病变112例,占72.73%;癌前病变11例,占7.14%;乳腺癌31例,占20.13%,乳腺癌检出率64.89/10万,早期癌19例,占61.29%。本次普查高频超声敏感性达到80.65%,阴性预测值达到93.88%。结论临床触诊与高频超声相结合模式筛查乳腺癌具有较高的敏感性及阴性预测值,经济方便,适宜于中小城市及农村推广;中山市乳腺癌发病率仍处于较高水平,复诊率偏低,信息化管理可以及时随访阳性妇女,同时加强健康宣教,建立乳腺癌普查的长效机制,提高早诊早治率。     

Participation in annual skin cancer screening among women seeking routine mammography

BACKGROUND: Early detection of skin cancer is associated with improved prognosis. The American Cancer Society's current skin cancer screening (SCS) recommendation states that adults over the age of 40 should receive an annual skin examination conducted by a health professional. However, little is known about the psychosocial factors related to participation in annual SCS, which remains relatively low among the general public. METHODS: Data were collected from women, aged 50 and older, seeking routine mammography at a large, urban, breast diagnostic facility. RESULTS: A total of 253 eligible women completed the survey. Overall, 20.2% of women reported receiving annual clinical SCS. Physician recommendation, self-efficacy, perceived susceptibility, and age were significantly associated with participation in annual skin screening. CONCLUSIONS: Similar to previously reported findings in the literature, our rates of participation in annual clinical skin screening were lower than reported rates for other types of cancer screening. Among older women, multiple covariates for participation in annual skin cancer screening were determined and may serve to guide future health education interventions to promote screening. Our findings suggest that participation could improve through increasing physician recommendation, screening self-efficacy, and individuals' sense of perceived susceptibility to skin cancer.     

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.     

Contextual factors associated with uptake of breast and cervical cancer screening: A systematic review of the literature

ABSTRACT

Existing research on barriers to breast and cervical cancer screening uptake has focused primarily on socio-demographic characteristics of individuals. However, contextual factors, such as service organization, as well as healthcare providers’ training and practices, are more feasibly altered to increase health service use. The objective of the authors in this study was to perform a critical systematic review of the literature to identify contextual factors at the provider- and system-level that were associated with breast and cervical cancer screening uptake. Studies published from 2000 to 2013 were identified through PubMed and PsycInfo. Methodologic quality was assessed, and studies were examined for themes related to provider- and system-level factors associated with screening uptake. Thirteen studies met the inclusion criteria. Findings revealed a positive association between patients’ receipt of provider recommendation and uptake of breast and cervical cancer screening. Uptake was also higher among patients of female providers. Facilities with flexible appointment times and reminders had higher mammography and Pap test uptake. Similarly, greater organizational commitment to quality and performance had higher breast and cervical cancer screening rates. Knowledge provided in this review could be used in future research to inform the development of public health policy and clinical programs to improve screening uptake.     

Breast cancer literacy and health beliefs related to breast cancer screening among American Indian women

ABSTRACT

The purpose of this article is to examine the health beliefs and literacy about breast cancer and their relationship with breast cancer screening among American Indian (AI) women. Using the Health Belief Model (HBM) and hierarchical logistic regression with data from a sample of 286 AI female adults residing in the Northern Plains, we found that greater awareness of breast cancer screening was linked to breast cancer screening practices. However, perceived barriers, one of the HBM constructs, prevented such screening practices. This study suggested that culturally relevant HBM factors should be targeted when developing culturally sensitive breast cancer prevention efforts.     

Quality varies across clinical practice guidelines for mammography screening in women aged 40-49 years as assessed by AGREE and AMSTAR instruments

Objective

To assess the quality of clinical practice guidelines providing recommendations on the frequency of mammography screening in asymptomatic, average-risk women 40-49 years of age.

Study Design and Setting

We searched the National Guideline Clearinghouse and MEDLINE for guidelines published from 2005 to 2010. Five independent assessors rated the quality of each guideline and its underlying evidence review using the Appraisal of Guidelines for Research and Evaluation (AGREE) and Assessment of Multiple Systematic Reviews (AMSTAR) instruments, respectively.

Results

Eleven guidelines were appraised. Ten referenced an underlying evidence review; two referenced the same review. Three reviews were rated good, one was moderate, and five were rated poor quality. On overall assessment of the quality of the guidelines, two were strongly recommended, two were recommended with provisos, and seven were either not recommended or the assessors were unsure whether to recommend it. Most guidelines clearly presented their recommendations, but the rigor of development, applicability, and stakeholder involvement varied. Seven guidelines recommended mammography screening as part of a periodic health examination and four recommended individualized screening in the target population. The latter four guidelines were based on good-quality reviews and three were recommended by the assessors.

Conclusion

Guideline users need to be aware of the variability in quality and identify the high-quality guidelines that meet their needs.     

Intrauterine device use among women with ovarian cancer: a systematic review

Background

Fertility-sparing treatment may be an option for women with early stage ovarian cancer and certain tumor types. This systematic review evaluated the evidence on the safety of intrauterine device (IUD) use by women with ovarian cancer.

Study Design

We searched the PubMed database for peer-reviewed articles relevant to IUD (copper or levonorgestrel-releasing) use and ovarian cancer published in any language from database inception through August 2009. We sought studies that examined outcomes among women using an IUD at or after ovarian cancer diagnosis.

Results

Of the 250 articles identified by our search strategy, none provided evidence (direct or indirect) regarding the safety of IUD use among women with ovarian cancer.

Conclusions

No evidence on the safety of IUD use among women with ovarian cancer was identified. While there are some theoretical concerns that IUD use might affect monitoring of disease progression of sex cord-stromal tumors, or increase risk of pelvic infection or vaginal bleeding among women undergoing chemotherapy, we did not find any data to suggest that IUD use would lead to worsening of primary ovarian cancer.     

Breast cancer screening among shift workers: a nationwide population-based survey in Korea

We aimed to examine the association between shift work types and participation in breast cancer screening (BCS) programs by comparing rates of participation for BCS among regular daytime workers and alternative shift workers using data from a nationally representative, population-based survey conducted in Korea. In addition, the results were analyzed according to sociodemographic factors, including occupation, education, income, private health insurance, age, and number of working hours a week. This secondary cross-sectional analysis used data from the 2012 Korean National Health and Nutritional Examination Survey. The target population included women aged ≥ 40 years who responded as to whether they had undergone BCS in the previous year. Accordingly, we analyzed survey data for a total of 1,193 women and used a multivariate logistic regression analysis to evaluate the differences in factors affecting BCS between regular daytime and alternative shift workers. A logistic regression analysis was performed considering private health insurance as a significant sociodemographic factor for BCS among regular daytime shift workers. In contrast, none of the tested variables could significantly predict adherence to BCS among alternative shift workers. The results of this study suggest the need for the development of comprehensive workplace breast cancer prevention programs by considering shift work types. More attention should be given to female workers with low education levels, those who are uninsured, and young workers to improve the participation rate for BCS at the workplace.     

胃癌筛查领域指南方法学质量和报告质量的系统评价

目的系统评价国内外现有胃癌筛查指南的方法学质量,为今后同类指南的制定和更新提供标准和参考依据。方法以“指南”“共识”“规范”“标准”“胃癌”“胃部肿瘤”“筛查”“筛检”“诊断”“Gastric Cancer”“Gastric Tumor”“guideline”“recommendation”“Early Detection of Cancer”“Screening”为检索关键词,系统检索中国知网、万方知识服务平台、中国生物医学文献数据库、中国临床指南文库、PubMed、The Cochrane Library、EMBASE、Web of Knowledge等数据库截止到2018年9月的中、英文文献,并同时检索美国预防服务工作组、美国癌症学会、国际癌症研究机构、澳大利亚癌症委员会、国际指南协作网的机构官网刊登的指南作为补充。纳入标准为胃癌筛查的独立指南文件,且符合美国医学研究所对指南的定义;排除标准包括指南的摘要、解读及评价类文献、重复发表、已更新的原始版指南以及胃癌临床治疗或实践指南。采用欧洲指南研究与评估工具(AGREEⅡ)和实践指南报告标准(RIGHT)对胃癌筛查指南的质量和报告规范程度进行比较和评价。结果共纳入5篇指南。AGREEⅡ质量评价结果显示,5篇指南整体质量参差不齐,其中推荐等级为“A”的有1篇,等级为“B”的有1篇,等级为“C”的有3篇;各指南在范围和目的、清晰性领域得分较高,在严谨性、独立性领域得分差异较大,在参与人员、应用性领域得分普遍较低。RIGHT评价结果显示,5篇指南报告质量有待提高,报告质量较差的6个条目分别为背景、证据、推荐意见、评审和质量保证、资金资助与利益冲突声明和管理以及其他方面。结论纳入的胃癌筛查指南的质量整体一般,规范性有待加强。     

Delayed presentation and diagnosis of breast cancer in African women: a systematic review

PurposeAfrica has low breast cancer incidence rates but high mortality rates from this disease due to poor survival. Delays in presentation and diagnosis are major determinants of breast cancer survival, but these have not been comprehensively investigated in Africa.MethodsMEDLINE, Embase, and Global Health were searched to identify studies reporting on delays in presentation and/or diagnosis of breast cancer published between January 1, 2000 and May 31, 2016. Data were synthesized in narrative, tabular, and graphical forms. Meta-analyses were not possible due to between-study differences in the way delays were reported.ResultsTwenty-one studies were included in the review. Study-specific average times between symptom recognition and presentation to a health care provider ranged from less than 1 to 4 months in North Africa and from less than 3 to greater than 6 months in sub-Saharan Africa. Study-specific average times from presentation to diagnosis were less than 1 month in North Africa but ranged from less than 3 to greater than 6 months in sub-Saharan Africa. Reported reasons for these delays included patient-mediated (e.g., socioeconomic factors) and health system–mediated factors (e.g., referral pathways).ConclusionsThis systematic review revealed marked delays in presentation and diagnosis of breast cancer in Africa. Identification of their drivers is crucial to the development of appropriate control strategies in the continent.     

广州市2015-2016年50~74岁社区人群大肠癌筛查结果分析

目的 分析广州市开展现行大肠癌筛查策略的效果。方法 收集、整理2015－2016年广州市大肠癌筛查数据,评价问卷调查、便隐血检查和全结肠镜检查的筛查效果。结果 2015－2016年广州市50～74岁重点人群完成初筛220 834人,初筛阳性37 040例（16.77%）。全结肠镜检7 821人,肠镜检查顺应率为21.12%（7 821/37 040）。发现各类肠道病变4 126例（52.76%）,其中进展性腺瘤614例（7.85%）、伴中/重度异型增生的其他病变73例（0.93%）,大肠癌230例（2.94%）;各类病变中男性检出率均高于女性（P<0.01）。病变早诊率为87.24%;筛查发现早期癌99例,占总大肠癌的46.26%。大肠癌筛查发现率为104.15/10万,明显高于相应年龄段（50～74岁）大肠癌监测发病率81.18/10万（P<0.001）,表现为≤69岁年龄段大肠癌发现率明显高于相应发病率,≥70岁年龄段则相反。结论 广州市大肠癌筛查策略可以发现大肠癌高危人群,提高全结肠镜病变检出率、癌前病变早诊率和早期大肠癌的诊断比例,≤69岁人群受益高于70～74岁人群,是大肠癌筛查重点关注人群,应需进一步促进高危人群肠镜检查顺应性。