广州市173 335名农村妇女乳腺癌筛查分析

摘 要：［目的］ 了解广州市农村妇女乳腺癌的患病情况,评价乳腺临床检查联合超声补充X线方法在人群乳腺癌筛查中的应用效果。［方法］ 筛查对象为广州市35～64岁的农村妇女,所有对象均接受乳腺临床检查和超声检查,检查结果阳性者进行组织病理学检查,检查结果可疑者补充乳腺X线检查,X线检查异常者行组织病理学检查。使用χ2检验比较各年龄组检出率的差异,使用灵敏度、特异性、约登指数进行不同筛查模式的比较。［结果］ 共筛查农村妇女173 335名,乳腺超声检查阳性率为1.15%,可疑率为5.76%,各年龄组差异有统计学意义（χ2=1492.10,P<0.001）,40～44岁组阳性率最高,60～64岁组阳性率最低。2764名农村妇女接受了组织病理学检查,共检出124例乳腺癌,乳腺癌检出率为71.54/10万,各年龄组乳腺癌检出率差异有统计学意义（χ2=12.097,P=0.034）,45～49岁组最高,35～39岁组最低。比较不同筛查模式发现,临床检查联合超声补充X线、临床检查联合超声、单独超声、单独临床检查的约登指数分别为0.98、0.78、0.76和0.31。［结论］ 乳腺超声检查有较强的乳腺癌检出效能,临床检查联合超声补充X线的方法适用于我国大人群的妇女乳腺癌筛查。     

Knowledge,Attitudes, and Practices Pertaining to Lung Cancer Screening Among Primary Care Physicians in a Public Urban Health Network

IntroductionLung cancer screening (LCS) with annual low-dose computed tomography in high-risk groups decreases the mortality related to lung cancer. Its implementation rate has been low, and knowledge relating to LCS has not been assessed in providers treating underserved populations.Materials and MethodsAn institutional review board-approved anonymous survey was sent to primary care physicians of the Cook County Health system, a safety-net healthcare system. The survey assessed the knowledge pertaining to LCS guidelines, providers’ experience with LCS, and their recommendations for quality improvement using 24 questions. The predictors of LCS within the previous 6 months were identified using logistic regression analysis.ResultsOf the 152 survey responses, 43% were from nontrainees with diverse training backgrounds. Adequate knowledge of LCS was demonstrated by 72% of the respondents, and pretest counseling was the domain most often answered incorrectly in the questionnaire. LCS had been ordered in the previous 6 months by 57% of the respondents. However, 88% estimated that they had screened < 50% of eligible patients. Higher patient volume, more experience, and family medicine training predicted for ordering LCS in the previous 6 months. In addition, 82.2% indicated that prompts in the electronic medical records would increase LCS, and 78.3% reported that receiving statistics about their LCS practice would increase LCS performance.ConclusionsPrimary care physicians in the hospital healthcare system had reasonable knowledge of LCS, but the implementation rate was low. We have identified areas for improvement relating to LCS implementation.     

Attitudes and Knowledge of Primary Care Physicians Regarding Prostate Cancer Screening

Recently, several prospective randomized prostate cancer screening studies have been reported. We report the results of a questionnaire administered to primary care physicians (PCPs) to determine their attitudes on prostate cancer screening and compared these results to those obtained when the same questionnaire was administered to a different large cohort of PCPs in 2006 prior to the reporting of these randomized studies. A 24-item questionnaire designed to assess prostate cancer knowledge and screening attitudes was administered to PCPs within central Florida and those PCPs attending a state conference. Completed surveys were returned and analyzed. All reported p values were two-sided, and those p values less than 0.05 were considered to be statistically significant. Seven hundred and eighty PCPs received the study questionnaire, and 168 (22 %) PCPs returned the completed questionnaire. Sixty-eight percent of responders stated that they recommend prostate cancer screening to >75 % of their patients over the age of 50 years, up from 47 % in 2006 (p?<?0.001). Seventy-four percent of responders felt screening was effective. The overall mean score of the knowledge survey was 66 %, which was similar to the cohort from 2006. Knowledge scores were not associated with screening attitudes and behaviors. On multivariate analysis, practice setting and percentage of Medicaid patients in the practice were associated with attitude scores. Our current findings imply that despite the recent landmark studies published on prostate cancer screening, PCPs’ screening attitudes have changed minimally over the past 5 years.     

Colorectal Cancer Screening Practices in Alabama: A Survey of Primary Care Physicians

In order to inform efforts to increase screening rates for colorectal cancer (CRC), we conducted a survey of Alabama primary care physicians regarding CRC screening practices, educational preferences, and perceptions of obstacles to screening. A mail survey of 2,378 Alabama physicians in Family Medicine, Internal Medicine, and Obstetrics & Gynecology was conducted. Many physicians are not fully up-to-date with current CRC screening practices that could improve patient compliance with screening guidelines. One example is the potential use of high-sensitivity stool tests, such as the fecal immunochemical test, instead of the no longer recommended low-sensitivity guaiac fecal occult blood tests. In addition, enhanced multimedia and web-based approaches to educating physicians and patients could be more fully utilized. Further, greater use of health information technologies could increase screening rates. Enhancing primary care physicians' knowledge of screening modalities and increasing their use of electronic technology could significantly improve colorectal cancer screening outcomes.     

Perceived Barriers to Breast Cancer Screening among Saudi Women at Primary Care Setting

Introduction: Screening for breast cancer (BC) is of low rate in Saudi Arabia; although it is provided in the country free of charge to the population. This cross-sectional study aimed at investigating the perceived barriers towards BC screening in Al Hassa, Saudi Arabia. Participants and Methods: A total of 816 adult Saudi women aged ≥ 30 years attending for routine primary health services or accompanying patients at the selected primary health care centers (PHCs) were randomly selected from 12 PHCs (8 urban and four rural) using multi-stage sampling method. Participants were invited to personal interview using semi-structured data collection instrument including inquiries about socio-demographics, reproductive history, previous histories of diagnosed breast lesions and breast cancer. The perceived individual barriers towards screening, their attitudes, the reasons for not attending previously held screening campaigns in Al Hassa, were also included. Results: Low utilization of BC screening has being significantly associated with woman’s age (OR=2.55; 95% CI= 1.71-3.83), higher educational status (OR=2.98; 95% CI=2.05-4.34), higher family income (OR=1.96; 95% CI=1.31-2.93), using hormonal contraception (OR=1.46; 95% CI=0.99-2.13) and positive history of previous breast (OR=12.16; 95% CI=6.89-21.46), as shown by the results of the logistic regression model. Exploratory factor analysis showed that personal fears (especially fear of doctors/examiners, fear of hospitals and health facilities and fear of consequences/results) were the major factors that hinder women from utilizing the free of charge BC screening with high loading eigenvalue of 3.335, explaining 30.4% of the barriers. Conclusion: Educational interventions aim at improving breast cancer knowledge and addressing barriers should be incorporated as core component of the screening program in Saudi Arabia.     

Coping Strategies Among Couples Adjusting to Primary Breast Cancer

Abstract

In psychosocial oncology social support is a recognized factor in facilitating adaptation to cancer. Spouses are often the first source of support for each other. However, the adaptation process of couples dealing with cancer has been little explored. This article presents the results of a qualitative study carried out with 16 couples, in each of which the woman had breast cancer. The goal of this study was to better understand the manner in which the couple as a dyad deals with the disruptions and demands related to the disease and its treatments. This report highlights the principal issues that confront couples in the first year after diagnosis and the adjustment strategies they use to deal with these issues. A theoretical understanding of the adjustment process of couples dealing with breast cancer emerges as a result of this study.     

Physicians’ Approaches to Recommending Colorectal Cancer Screening: A Qualitative Study

Little is known about strategies that physicians use to encourage receipt of colorectal cancer screening (CRCS). This study conducted focus groups with physicians. Twenty-seven physicians participated in four focus groups. Physicians described four categories of approaches: (1) why screening is important, (2) providing test information, (3) motivational strategies, and (4) tailoring strategies. Participants reported tailoring based on their relationship with a patient, as well as to patient gender, education, and language. Tailoring to cultural background or ethnicity was not prominent. Most physicians reported a typical approach to CRCS and reported some tailoring based on gender, education, and language, but not on ethnicity.     

Breast Cancer Knowledge, Attitudes and Screening Behaviors in Two Groups of Iranian Women: Physicians and Non-health Care Personnel

Breast cancer is one of the most frequent malignancies worldwide which is characterized by early onset and diagnosis at advanced stages in Iranian women. Increasing women’s awareness and implementing breast cancer screening programs detect cancer earlier and reduce mortality. Physicians play a pivotal role in this regard. Further, there is limited literature about knowledge, attitude, and screening behaviors in Iranian women. Using a questionnaire, we assessed and compared breast cancer knowledge, attitude, and screening behaviors in 102 female physicians and 94 female non-health care personnel, who were mostly from the hospital’s cleaning and housekeeping sections. Of the physicians and of non-health care personnel, respectively, 93.1 and 24.7 % felt confident about their knowledge and 37.6 and 26.1 % performed monthly breast self-examination. Of physicians aged 40 and over, 31.25 and 18.75 % had clinical breast examination and mammogram, respectively, within 12 months prior to date of data collection. In non-health care personnel aged 40 and over, the results were 27.59 % for clinical breast examination and 17.24 % for mammogram at the same period of time. Despite the higher knowledge and socioeconomic class of physicians, there were no significant difference in screening behaviors between physicians and non-health care personnel (P?>?0.05).     

Cost-Effectiveness Analysis of Breast Cancer Screening in Rural Iran

Background: Although breast cancer is the most common cancer in women, economic evaluation of breast cancer screening is not fully addressed in developing countries. The main objective of the present study was to analyze the cost-effectiveness of breast cancer screening using mammography in 35-69 year old women in an Iranian setting. Materials and Methods: This was an economic evaluation study assessing the cost-effectiveness of a population-based screening program in 35-69 year old women residing in rural areas of South east Iran. The study was conducted from the perspective of policy-makers of insurance. The study population consisted of 35- to 69-year old women in rural areas of Kerman with a population of about 19,651 in 2013. The decision tree modeling and economic evaluation software were used for cost-effectiveness and sensitivity analyses of the interventions. Results: The total cost of the screening program was 7,067.69 US$ and the total effectiveness for screening and no-screening interventions was 0.06171 and 0.00864 disability adjusted life years averted, respectively. The average cost-effectiveness ratio DALY averted US$ for screening intervention was 7,7082.5 US$ per DALY averted and 589,027 US $ for no-screening intervention. The incremental cost-effectiveness ratio DALY averted was 6,264 US$ per DALY averted for screening intervention compared with no-screening intervention. Conclusions: Although the screening intervention is more cost effective than the alternative (noscreening) strategy, it seems that including breast cancer screening program in health insurance package may not be recommended as long as the target group has a low participation rate.     

Immunotherapy Approaches to Breast Cancer

Purpose of Review

Activating the immune system to eradicate breast cancer has emerged as a promising treatment strategy, and immune checkpoint inhibition has demonstrated activity in both advanced and early stage disease. Here we review recent clinical trial results of immunotherapy approaches to treat breast cancer.

Recent Findings

A number of trials of immune checkpoint inhibitors, both as monotherapy and in combination with other therapies, have been reported. While response rates with monotherapy in the advanced stage setting are relatively low, the durability of responses observed is remarkable. While PD-L1 positivity enriches for responders, it is not a consistent predictor of response. Response appears to correlate more strongly with tumor-infiltrating lymphocyte (TIL) density.

Summary

Immune checkpoint inhibition alone and in combination with chemotherapy appears well tolerated with manageable side effects. Treatment clearly benefits a subset of patients, and more precise biomarkers of response are needed.

     

Contrasts in Practices and Perceived Barriers to Colorectal Cancer Screening by Nurses and Physicians Working in Primary Care Settings in Oman

Colorectal cancer (CRC) is the fourth most common type of cancer worldwide and it is responsible for 610,000 deaths annually, despite availability of screening tests that ensure early detection. Predictions specific to the Middle East show that this region will experience a significant increase in cancer mortality over the next 15 years. This study explored the practices and perceived barriers to CRC screening from the perspective of health care providers (HCPs) working in primary care settings in Muscat, Oman. A cross-sectional design and self-administered questionnaires were used to collect data from 142 HCPs. The HCPs were nurses (57.7 %) and physicians (42.3 %) with average age and clinical experience of 32.5 and 9.5 years, respectively. The majority of the HCPs (64.8 %) rarely ordered, referred, health educated, or recommended CRC screening to eligible patients. The only major patient-related barrier to CRC screening reported by HCPs was lack of awareness about CRC tests (63.7 %). There were significant differences between nurses’ and physicians’ rating of patient-related barriers such as fear of cancer diagnosis (p?=?0.037), belief that screening is not effective (p?=?0.036), embarrassment or anxiety about screening tests (p?=?0.022), and culture (p?=?0.001). The major system barriers to CRC screening were lack of hospital policy or protocols, lack of trained HCPs, lack of CRC screening services, and timely appointments to get CRC screening. The findings indicate a need for interventions to enhance patient awareness, HCPs CRC screening practices, and strategies to ameliorate patient and system barriers to CRC screening.     

Awareness and Misconceptions of Breast Cancer Risk Factors Among Laypersons and Physicians

Background

Primary prevention of cancer relies on awareness of and consequent identification of risk factors. We investigated knowledge of breast cancer risk factors not only among laywomen but also among female physicians.

Methods

The EDIFICE 4 nationwide observational survey was conducted by phone interviews of a representative female population (737 laywomen and 105 female physicians) aged 40–75 years, using the quota method. This analysis focuses on spontaneous replies to the question “In your opinion, what are the five main risk factors that increase the risk of breast cancer?”.

Results

Heredity/Family history of breast cancer was the most widely recognized risk factor in both study populations (98.1% physicians vs. 54.2% laywomen; P?≤?0.01). Smoking (19.0 and 17.5%) and alcohol consumption (3.8 and 5.5%) were among the lifestyle risk factors that were cited by similar proportions of physicians and laywomen, respectively. Other established risk factors were however very rarely cited by either physicians or laywomen, e.g., Exposure to medical radiation (4.8 vs. 0.4%, respectively; P?≤?0.05) or not cited at all, i.e., Benign mastopathy and Personal history of breast cancer.

Conclusion

This survey highlights a number of misconceptions relating to behavioral risk factors for breast cancer, including the relative impact of alcohol and tobacco consumption and the importance of menopausal status. The limited awareness of the risk related to Exposure to medical radiation, Benign mastopathy, or Personal history raises concern regarding compliance with national screening recommendations.

     

Combined Screening of Cervical Cancer,Breast Cancer and Reproductive Tract Infections in Rural China

Objectives: To investigate the current prevalence and knowledge of cervical cancer, breast cancer andreproductive tract infections (RTIs) in rural Chinese women, and to explore the acceptance and feasibility ofimplementing a combined screening program in rural China. Methods: A population-based, cross-sectionalstudy was conducted among women aged 30 to 59 years old in Xiangyuan County, Shanxi Province from 2009 to2010. Socio-demographic characteristics, knowledge of cervical cancer, breast cancer and RTIs, and the attitudetoward single or combined screening were collected by an interview questionnaire. Each participant receiveda clinical examination of the cervix, breast and reproductive tract. Examinations included visual inspection,mammography, laboratory tests and pathological diagnosis. Results: A total of 1,530 women were enrolled inthis study. The prevalence of cervical precancerous lesions, suspicious breast cancer, suspicious benign breastdisease and RTIs was 1.4%, 0.2%, 14.0% and 54.3%, respectively. Cervicitis, trichomonas vaginitis, and bacterialvaginitis were the three most common RTIs among our participants. Television, radio broadcast, and publiceducation during screening were the major source of healthcare knowledge in rural China. Moreover 99.7%of women expressed great interest in participating in a combined screening project. The affordable limit forcombined screening project was only 50 RMB for more than half of the rural women. Conclusion: A combinedscreening program would be more effective and popular than single disease screening projects, while appropriateaccompanied education and a co-pay model for its successful implementation need to be explored, especially inlow-resource settings.     

山西省农村妇女宫颈癌筛查结果分析

[目的]评价2014年山西省农村妇女宫颈癌检查结果,探讨宫颈癌流行趋势与特点,为进一步推进宫颈癌筛查工作提供科学依据.[方法]回顾性分析2014年宫颈癌筛查项目35～64岁农村已婚妇女的筛查数据资料.[结果]2014年共计完成408 618例农村妇女的免费宫颈癌筛查,检出宫颈癌前病变721人,检出率为176.44/10万;检出宫颈癌215人,检出率为52.62/10万.[结论]进行育龄妇女人群的健康教育,加强高危人群管理,重点培训参加宫颈癌筛查的基层医师,是提高宫颈癌早诊早治的关键.     

Nutritional Related Knowledge of Cancer Prevention among Primary Health Care Physicians

Objectives: To explore the cancer prevention-related nutrition knowledge of primary health care physicians towards nutrition and its relation to the development of cancer. Materials and methods: a cross-sectional study was conducted among family physicians in Riyadh, between November 2019 and April 2020. The participants in the current study were surveyed using a self-administered questionnaire. The questionnaire included socio-economic data and data related to the association between nutrition and cancer. Results: The mean correct knowledge score for physicians is good but less than expected (26.5+5.8) 73.6%. Multiple regression revealed that age, position, and nationality to be significantly associated with knowledge of cancer prevention (P<0.05) among physicians. Conclusions:  Primary care physicians have good knowledge about the relation between nutrition and cancer but not sufficient, they should have continuous nutrition educational training programs to ensure safe and sound nutritional advice to patients and for the public about the relation of nutrition and cancer.     

浙江省农村试点地区妇女宫颈癌筛查结果及成本效果分析

摘 要：［目的］ 分析浙江省农村妇女宫颈癌筛查试点项目的筛查结果和成本效果情况。［方法］ 收集2009至2011年浙江省农村4个开展宫颈癌筛查试点地区（嵊州市、武义县、台州市黄岩区、丽水市莲都区）的工作数据以及直接成本,分析筛查结果和成本效果。［结果］ 试点地区完成筛查231 702人,共确诊癌前病变1342例（检出率为579.19/10万）,宫颈癌69例（检出率为29.78/10万）,合计1411例（检出率为608.97/10万）;不同地区合计检出率差异具有统计学意义。此外,还发现56 817例（24.52%）生殖道感染、11 205例（4.84%）子宫肌瘤和11 148例（4.81%）其他良性病变。浙江省农村试点地区宫颈癌筛查成本效果比为18 996.00元/例,早期发现成本系数为0.477。［结论］ 浙江省开展宫颈癌筛查具有较好成本效果,宫颈癌疫苗接种暂不影响现行宫颈癌筛查的必要性。