Identifying Primary Care Physicians Continuing Education Needs by Examining Clinical Practices,Attitudes, and Barriers to Screening Across Multiple Cancers

Population-based cancer screening for cervical, breast, and colorectal cancers improves patient outcomes, yet screening rates remain low for some cancers. Despite studies investigating physician perceptions and practices for screening, many have focused on individual cancers and lack primary care physicians’ (PCPs) realities around screening for multiple cancers. We surveyed 887 PCPs in British Columbia (BC) to examine practices, beliefs, barriers, and learning needs towards cancer screening across breast, cervical, colorectal, prostate, as well as hereditary predisposition to cancer. Survey results identified differences in PCPs belief in the benefit of screening for recommended and non-recommended routine cancer screening, PCPs adherence to screening guidelines for some cancers and physician comfort and patient testing requests related to physician gender for gender sensitive tests. Further, across cancers, screening barriers included patients with multiple health concerns (41%), limited time to discuss screening (36%), and lack of physician financial compensation to discuss screening (23%). The study highlighted the need for more physician education on screening programs, referral criteria, follow-up processes, and screening guidelines. Conferences (73%), self-directed (46%), small group workshops (42%), hospital rounds (41%), and online CME/CPD (39%) were highly preferred (4+5) for learning about cancer screening. The results suggest a need to improve awareness and adherence to screening guidelines and recommended practices, as well as to provide educational opportunities which address knowledge and practice gaps for physicians.     

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.     

Concepts and Controversies in Cancer Screening

Screening for cancer is a common and expected part of primary care medicine. However, the known effects of lead time, length, and selection bias confound our ability to objectively evaluate screening tests, and often result in an overestimation of the benefits of screening. Because of these biases, the randomized controlled trial remains the only reliable way to measure the true effects of a screening program. Significant controversy remains for many screening tests, because most common screening procedures have come into widespread use without the benefit of definitive trials. These concepts are illustrated by exploring current controversies in screening for cancer of the lung, colon, breast and prostate, which together account for more than 50% of US cancer deaths. In the face of ongoing controversy and uncertainty about the value of screening tests, physicians are advised to engage patients in a process of shared decision making and informed consent.     

Higher long-term cancer survival rates in southeastern Netherlands using up-to-date period analysis.

BACKGROUND: The aim was to compare long-term survival rates for different types of cancer estimated by means of up to date period analysis with those from more traditional cohort analysis. PATIENTS AND METHODS: Data from the Eindhoven Cancer Registry were used. In total 140,137 newly diagnosed patients diagnosed between 1980 and 2002 and followed until 1 January 2005 were included. Five-, 10- and 20-year relative survival rates were calculated. RESULTS: For total cancer in men and women, childhood cancer, rectal cancer, melanoma in women, breast cancer, prostate cancer and all leukaemias, much higher 10-year survival rates were found with period analyses (differences with cohort analyses were 5.1%, 3.6%, 7.4%, 5.6%, 6.5%, 4.0%, 5.1% and 10.5%, respectively). For laryngeal and bladder cancer the 10-year survival rates estimated with period analyses were about 7.5% lower compared with those estimated by means of cohort analyses. CONCLUSIONS: Period analysis, based on the most recent period of diagnosis, enabled us to show higher survival rates for total cancer, childhood cancer, rectal cancer, melanoma, breast cancer, prostate cancer and acute leukaemia, but also lower rates for laryngeal and bladder cancer. Period analysis should be the preferred tool for showing up-to-date survival rates to cancer patients and their physicians.     

乳腺癌合并肾功能不全患者的化疗经验

目的　探讨伴肾功能不全乳腺癌患者的化疗方案。方法　对１例需定期血液透析的肾衰竭乳腺癌患者给予单药吡柔比星１００ｍｇｄ_１,２１天为１个周期;监测血药浓度,观察疗效及安全性。结果　治疗４个周期后疗效评价为稳定,血液透析不影响吡柔比星的治疗,其安全性较高。结论　肾功能不全并非是化疗的绝对禁忌症,在充分评估患者的不良反应及耐受性后,合理安排血液透析与给药的时机,可以做到安全、有效地化疗。     

Pathological Investigation of Vertebral Tumor Metastasis from Unknown Primaries - a Systematic Analysis

Background: This systematic analysis was conducted to investigate pathological diagnosis of vertebral tumormetastasis with unknown primaries. Methods: Clinical studies conducted to pathologically investigate vertebraltumor metastasis were identified using a predefined search strategy. Pooled diagnosis (PD) of each pathologicalconfirmation was calculated. Results: For vertebral tumor metastasis, 5 clinical studies which included 762patients were considered eligible for inclusion. Systematic analysis suggested that, for all patients with vertebraltumor metastasis, dominant PD was pathologically confirmed with lung cancer in 21.7% (165/762), with breastcancer in 26.6% (203/762) and with prostate cancer in 19.2% (146/762) . Other diagnosis that could be confirmedincluded lymphoma, multiple myeloma, renal cancer, for example, in this cohort of patients. Conclusions: Thissystemic analysis suggested that breast, lung and prostate lesions could be the most common pathological typesof cancer for vertebral tumor metastasis formunknown primaries, and other common diagnoses could includelymphoma, multiple myeloma, renal cancer.     

Radiotherapeutic Management of Osseous Metastases: A Survey of Current Patterns of Care

Purpose: Radiotherapy plays a major role in the management of painful osseous metastases. This survey was conducted to study the current approaches to this clinical problem in the radiotherapy community.Methods and Materials: A questionnaire was sent to 2500 members of the American Society for Therapeutic Radiology and Oncology. It consisted of 30 multiple-choice questions regarding four hypothetical clinical scenarios likely to be encountered in daily practice. Questions related to the technique of choice [local field (LF) vs. hemibody radiotherapy (HBI)], the use of systemic radionuclides (SR), fractionation schemes, dose, the integration of modalities, and the follow-up of these patients. The analysis is based on 817 (33%) responses received regarding 3268 cases.Results: Local field is the most common form of therapy. Overall, LF was used, alone or in combination with other forms of therapy, in 54% and 74% of patients, respectively. LF was used more frequently in patients with breast cancer than in patients with prostate cancer (79% vs. 45%; p = 0.0001). Long fractionation schemes were used by 90% of physicians in 96% of cases. Short fractionation schemes were used by 7% of physicians in 4% of cases. This tendency was more pronounced in private practice than in the university or government/multidisciplinary settings (p = 0.008) and in physicians starting their practice before 1982 (p = 0.05). The most common schedule was 30 Gy in 10 fractions, used by 77% of physicians in 64% of cases. HBI was used, alone or in combination with other forms of therapy, in 1% and 2% of patients, respectively. It was used more frequently in patients with prostate cancer than in patients with breast cancer (1.2% vs. 0.1%, respectively; p < 0.0001). SR were used alone or in combination with local-field irradiation in 21% and 40% of cases, respectively. SR were used more frequently in patients with prostate cancer than in those with breast cancer (28% vs. 0.2%, respectively; p < 0.00001). The most common radionuclide in use is Sr-89 (99%) at a dose of 4 mCi (73%) or 10.8 mCi (26%).Conclusions: Although LF remains the mainstay of therapy, our results demonstrate the emergence of a new pattern of practice: LF to the painful site in combination with SR for clinically occult metastases. Despite an ongoing academic debate regarding fractionation schemes, the vast majority of American practitioners advocate long schedules.     

Assessment of prognosis with the total illness burden index for prostate cancer: aiding clinicians in treatment choice

BACKGROUND: Among the most pressing challenges that face physicians who care for men with prostate cancer is evaluating the patient's potential for benefiting from treatment. Because prostate cancer often follows an indolent course, the presence and severity of comorbidities may influence the decision to treat the patient aggressively. The authors adapted the Total Illness Burden Index (TIBI) for use in decision-making among men with prostate cancer at the time of the visit. METHODS: An observational study was performed of 2894 participants in the Cancer of the Prostate Strategic Urologic Research Endeavor, a national disease registry of men with prostate cancer, to examine how well the adapted TIBI for prostate cancer (TIBI-CaP) predicted mortality over the subsequent 3.5 years and health-related quality of life over the subsequent 6 months. RESULTS: The men who had the highest global TIBI-CaP scores were 13 times more likely to die of causes other than prostate cancer over a 3.5-year period than the men who had the lowest scores (hazard ratio, 13.1, 95% confidence interval, 6.3-27.4) after controlling for age, education, income, and race/ethnicity. Patients who had the highest TIBI-CaP scores had 44% mortality compared with 4.9% mortality for patients who had the lowest scores. Demographic variables explained 16% of the variance in future physical function; TIBI-CaP scores explained an additional 19% of the variance. CONCLUSIONS: The TIBI-CaP, a patient-reported measure of comorbidity, identified patients at high risk for nonprostate cancer mortality. It predicted both mortality and future quality of life. The TIBI-CaP may aid physicians and patients in making appropriate treatment decisions.     

慢性肾功能衰竭患者在血液透析期间恶性肿瘤的发病状况及其发病原因

目的 探讨慢性肾功能衰竭患者在血液透析期间恶性肿瘤的发病状况及其发病相关危险因素.方法纳入慢性肾功能衰竭患者69例作为研究对象,其中氮质血症期患者有34例,尿毒症患者35例,回顾性分析入选患者的恶性肿瘤发生率,并分析原发病的情况,采用卡方检验和回归分析的方法对慢性肾功能衰竭血液透析期间恶性肿瘤发生的相关危险因素进行分析.结果慢性肾功能衰竭尿毒症期患者恶性肿瘤的发病率高于氮质血症期患者,差异具有统计学意义(P<0.05).在发生恶性肿瘤的患者中泌尿系肿瘤的发生率最高,其次为消化系统肿瘤.慢性肾功能衰竭尿毒症期患者发生恶性肿瘤患者的平均年龄要高于未发生肿瘤患者,肾小球滤过率低于未发生肿瘤患者,差异具有统计学意义(P<0.05).原发病马兜铃酸肾病患者的肿瘤发病率最高,不同原发病肿瘤发病率之间差异具有统计学差异(P<0.05).高龄、肾小球滤过率降低是慢性肾功能衰竭尿毒症期恶性肿瘤发生的危险因素.结论慢性肾功能衰竭尿毒症期恶性肿瘤的发病率高于氮质血症期患者,高龄、肾小球滤过率下降是导致恶性肿瘤发病的重要因素,其中以泌尿系肿瘤所占比例最高.     

Gefitinib administration in a patient with lung cancer undergoing hemodialysis

Gefitinib is mainly metabolized by the liver and its excretion is mostly in bile excrements. However, the feasibility of gefitinib in patients with chronic renal failure undergoing hemodialysis has not, so far, been reported. A 58-year-old woman with chronic renal failure due to polycystic kidney disease, undergoing hemodialysis, experienced diplopia due to meningitis carcinomatosa by lung adenocarcinoma. Sequencing analysis of her tumor tissue revealed deletion of 15 nucleotides in E746-A750 of exon 19. She started daily administration of 250mg gefitinib with hemodialysis three times a week. Her pharmacokinetic pattern after gefitinib administration was similar to those in patients with normal renal function and 88.7% of gefitinib was kept in the plasma through hemodialysis. Her symptoms and signs of meningitis carcinomatosa on brain magnetic resonance images improved. Thirteen months later, the meningitis got worse again and she stopped gefitinib administration. During gefitinib administration, there were no signs of adverse events. In summary, gefitinib is not eliminated by hemodialysis and was safely administered to a patient with non-small cell lung cancer and chronic renal failure who was undergoing hemodialysis.     

A multicenter,retrospective epidemiologic survey of the clinical features and management of bone metastatic disease in China

Background: Bone metastases are common in patients with advanced cancer. Bisphosphonates (BPs) could prevent or delay the development of skeleton-related events (SREs). The present study aimed to identify the clinical features of and treatment strategies for Chinese patients with bone metastases. Methods: Consecutive cancer patients who had bone metastases and received BP treatment were enrolled. A ques-tionnaire was developed to collect the patients’clinical data, as well as information on the diagnosis and manage-ment of bone metastases. Physicians’awareness of the guidelines and knowledge of the application of BP were also assessed. Results: A total of 3223 patients with lung cancer (36.5%), breast cancer (30.9%), prostate cancer (8.5%), and gas-trointestinal cancer (5.7%) were included in this study. The sites of bone metastases were the thoracic spine (56.0 %), lumbar spine (47.1%), ribs (32.6%), and pelvis (23.2%). The SRE frequency was the highest in patients with multiple myeloma (36.6%), followed by those with lung cancer (25.9%), breast cancer (20.2%), prostate cancer (18.2%), and gas-trointestinal cancer (17.3%). Irradiation to the bone was the most frequent SRE (58% in lung cancer patients, 45% in breast cancer patients, and 48% in prostate cancer patients). Our survey also showed that 45.5% of patients received BP within 3 months after their diagnosis of bone metastases, whereas the remaining 54.5% of patients did not receive BP treatment until at least 3 months after their diagnosis of bone metastases. The SRE frequency in the former group was significantly lower than that in the latter group (4.0% vs. 42.3%, P < 0.05). In patients with more than 6 months of continuous BP treatment, the mean time to the first SRE was significantly longer than that in patients with less than 6 months of continuous BP treatment (7.2 vs. 3.4 months, P < 0.05). In addition, 12.2% of the physicians were not aware of the efcacy of BP in preventing and delaying SRE. Only half (52.3%) of the physicians agreed that the BP treatment should persist for at least 6 months unless it was intolerable. Conclusions: Our study suggested that prompt and persistent BP treatment was associated with a reduced risk of SREs. However, our survey also revealed that the proper application of BP was not as common as expected in China.     

Identifying newly diagnosed Hispanic cancer patients who use a physician with a Spanish-language practice, for studies of quality of cancer treatment

BACKGROUND: Language barriers may affect cancer treatment choices among U.S. Hispanic-Latino patients newly diagnosed with cancer. This study examined use of a physician with a Spanish-language practice (SLP) by Hispanic patients diagnosed with a cancer reported to a population-based cancer registry. METHODS: Data on all 1,874 Connecticut Hispanic patients diagnosed with cancer in 1999-2002 were obtained from the Connecticut Tumor Registry, including the follow-up physician (FUP) responsible for the patient's medical care around the time of cancer diagnosis. FUPs were compared to a list of Spanish surnames (SS) to identify potential Hispanic ethnicity. A statewide database from a survey of licensed physicians was used to identify SLPs. For the two most common cancers (breast and prostate), SLP was examined in relation to radiotherapy after breast-conserving surgery (202 patients) and for prostate cancer (207 patients). RESULTS: The 1,874 patients had 829 different FUPs, of whom 783 had information on SLP; only 37 FUPs had a SS but 269 had a SLP. Of the 1,727 Hispanic patients with known FUP, only 3.5% had a SS FUP, while 36.8% had a FUP with a SLP. Having a FUP with a SLP was statistically significantly associated with receipt of radiotherapy for breast cancer but not for prostate cancer. CONCLUSION: This methodology should be explored in states with larger Hispanic populations, and future efforts should include efforts to obtain data on other cancer treatments (e.g., chemotherapy and hormone therapy).     

Weekly irinotecan in a patient with metastatic colorectal cancer on hemodialysis due to chronic renal failure

BACKGROUND: The cytotoxic treatment of patients suffering from advanced or metastatic cancer undergoing hemodialysis due to chronic renal failure still remains a problem, since for those patients pharmacokinetic and pharmacodynamic data on most cytotoxic agents are lacking. CASE REPORT: We report a 45-year-old male who suffered from chronic renal failure and was diagnosed with stage-3 colorectal cancer (CRC) in February 2000. After surgical removal of the tumor an adjuvant chemotherapy of dose-reduced i.v. bolus 5-fluorouracil and folinic acid was begun (Mayo protocol). Due to excessive gastrointestinal toxicity, therapy was discontinued after the first cycle. In April 2000 liver metastases were diagnosed. The patient was then put on a weekly schedule of dose-reduced CPT-11 (50 mg/m(2), 80 mg total). No hematological or non-hematological toxicity grade 3/4 was observed. Due to excellent tolerability and lack of severe side effects the dose was increased up to 80 mg/m(2) (140 mg total) weekly. A dose escalation to 100 mg/m(2) (180 mg total) resulted in severe diarrhea (grade 4). Within 2 months of treatment the patient achieved a lasting partial remission until April 2001 (12 months). A significant progression of hepatic metastases required an alternative treatment regimen beginning in July 2001 (HAI, hepatic artery infusion). CONCLUSION: This case report demonstrates the feasibility and efficacy of a weekly treatment with dose-reduced CPT-11 in a patient with metastatic CRC on hemodialysis due to chronic renal failure.     

Evaluation Knowledge,Attitude, and Behaviour for Breast Cancer among Young Women Living in Two Different Habitats of Turkey

Background: Breast cancer is the most frequently diagnosed cancer among women in Turkey and worldwide,and is ranked as the second-leading cause of death in women after lung cancer. Early diagnosis of breast cancer ispossible, and breast cancer is included in cancer-screening programs in Turkey. The aim of this study was to evaluatethe knowledge, attitude, and behaviour of young women (older than 20 years of age) on breast self-examination andbreast cancer screening methods, and to determine the effect of sociodemographic characteristics. Methods: A totalof 489 patients were included in the study. The mean age of participants was 36.53 ± 11.22 years. 346 (70.8%) of theparticipants were married. The study was a cross-sectional, non-randomized study in public health. The participants inthis study were women over 20 years old, who presented to Arnavutkoy State Hospital General surgery policlinic andSisli Hamidiye Etfal Family Medicine policlinic. Results: The rate and duration of breastfeeding were higher amongparticipants living in rural areas than those living in urban areas (p<0.001) The awareness of breast cancer increased asthe level of education increased (p<0.001). Having a family history of a high incidence of breast cancer significantlyincreased the rate of breast self examination practice by 1.93 fold (p=0.016). Conclusion: Breast Cancer is a diseasethat can be treated 100 % with early diagnosis. Primary care physicians especially works in lower socioeconomicconditions have to tell the importance of early diagnosis of breast cancer, and properly explain breast self examinationand other screening tools.     

Chronic renal failure: a significant risk factor in the development of acquired renal cysts and renal cell carcinoma. Case reports and review of the literature

Three male patients with end-stage renal disease on chronic hemodialysis presented with gross hematuria and were subsequently found to have acquired renal cyst disease and progressive bilateral renal cell carcinoma. There are now more than 84 similar cases in the literature, but the precise roles that renal failure and hemodialysis play in the development of renal cysts and renal neoplasms remain unclear. The high incidence of acquired renal cyst disease (45%) and the development of renal tumors (9%, with a 5% to 7% metastatic rate) in patients with end-stage renal failure clearly underscores the need for more intense radiologic monitoring.     

Responses by breast and prostate cancer patients to out-of-pocket costs in Newfoundland and Labrador

Purpose

Cancer patients face substantial care-related out-of-pocket (oop) costs that may influence treatment decisions, attitudes, and use of drug- or appointment-related cost-saving strategies. We examined the relationship between oop costs and care-related responses by patients.

Methods

We surveyed 170 prostate and 131 breast cancer patients presenting at clinics or support groups, or listed on the cancer registry in Newfoundland and Labrador.

Results

In the 3-month period before the survey, 18.8% of prostate and 25.2% of breast cancer patients had oop costs greater than $500. Those oop costs consumed more than 7.5% of quarterly household income for 15.9% of prostate and 19.1% of breast cancer patients. Few patients (8.8% prostate, 15.3% breast) ever adopted any drug- or appointment-related cost-saving strategy. Few patients (7.2% prostate, 9.6% breast) said oop costs influenced treatment decisions, told their physicians about their oop costs (27.0% prostate, 21.1% breast), or were aware of available financial assistance programs (27.3% prostate, 36.9% breast). Compared with patients having low or moderate oop costs (22.9% prostate, 16.7% breast, and 25.7% prostate, 58.3% breast respectively), a larger proportion of prostate (56.0%) and breast (58.3%) cancer patients with high oop costs said that those costs created stress. Among prostate cancer patients, a larger proportion of those having high oop costs (compared with low or moderate costs) used drug-related (22.2% vs. 3.3% and 9.6% respectively) and appointment-related (11.1% vs. 1.1% and 3.8% respectively) cost-saving strategies, said oop costs created an unusual amount of stress (48.0% vs. 18.4% and 10.4%), and had difficulty paying those costs (29.2% vs. 6.2% and 10.4%).

Conclusions

For a small group of breast and prostate cancer patients, oop costs are high, but rarely lead to the use of care-related cost-saving strategies or influence care decisions.     

Comparison of observed and expected numbers of detected cancers in the research center for cancer prevention and screening program

BACKGROUND: The Research Center for Cancer Prevention and Screening program is a one-arm prospective study designed to evaluate the effect of multiple modalities for cancer screening. Basic programs consist of screening tests for cancer of the lung, esophagus, stomach, colon, rectum, liver, gall bladder, pancreas and kidneys, in addition to prostate cancer screening for males and breast, cervical, endometrial and ovarian cancer screenings for females. OBJECTIVE: To investigate the possibility of overdiagnosis, we compared the observed numbers with expected numbers based on the model. METHODS: We calculated the expected number of cancers on the basis of negative or positive history of screening tests within the previous year, based on assumed sensitivity and sojourn time. Observed numbers of screen-detected cases for stomach, colorectal, lung, prostate and breast cancer were compared with expected numbers. RESULTS: From February 2004 to January 2005, 3786 participants were enrolled in our study. The overall cancer detection rate was 5.8% (119/2061) for males and 4.1% (71/1725) for females. No statistically significant difference was found between observed and expected cases for colorectal cancer screening, gastric cancer screening for females and lung cancer screening for males. Observed numbers of breast, prostate and lung cancer for females exceeded those expected (P < 0.05). CONCLUSIONS: Although cancer screening programs in the present study increased the detection of potentially curable cancers, these modalities, particularly lung, breast and prostate screening, might detect cancers which would not necessarily be clinically significant. We should therefore weigh up benefit and harm for such cancer screening programs.     

Do We Need to Maximise the Breast Cancer Screening Awareness?: Experience with an Endogamous Society with High Fertility

Background: In the State of Qatar, breast cancer has become the most common form of cancer amongwomen. The aim of this study was to explore knowledge, attitude and practice about breast cancer and toidentify potential barriers to screening procedures among women. Methods: This multistage sampling crosssectional survey in primary health care centers and the outpatient department of the Women’s Hospital in theState of Qatar targeted a representative sample of 1,200 Qatari women aged between 30 to 55 years of ageduring the period from December 2008 to April 2009. A total 1,002 subjects (83.5%) consented to participation.Face to face interviews were conducted with a designed questionnaire covering knowledge about breast cancer,attitudes and practices of breast cancer screening. Socio-demographic variables were included. Results: Themajority of Qatari women demonstrated an adequate knowledge about breast cancer, with a significant relationto education status. Almost three quarters were aware that breast cancer is the most common cancer in women.A good proportion knew that nipple retraction (81.2%) and discharge of blood (74.6%) are warning signs. Ofthe studied Qatari women, 24.9% identified breast self examination, 23.3% clinical breast examination (CBE)and 22.5% mammography as methods for detection of breast cancer. The frequently reported barriers amongthe Qatari women were asking any doctor/nurse how to perform breast self examination (57.3%), embarrassmentabout CBE (53.3%) and fear of mammography results (54.9%). Univariate and multivariate logistic regressionanalysis showed that family history, level of education, living in an urban area and having medical check-upswhen healthy were significant predictors for CBE and mammography. Conclusion: The study findings revealedthat although Qatari women had adequate general knowledge about breast cancer, the screening rates for BSE,CBE and mammography were low, these being performed most frequently by young Qatari women with ahigher level of education.     

How American oncologists treat breast cancer: an assessment of the influence of clinical trials

The present study was designed to assess the preferred methods of treatment of breast cancer by American oncologists, and the impact of clinical trials on their practice. We mailed 465 questionnaires to surgical, radiation, or medical oncologists. The questionnaire described five hypothetic patients with breast cancer, and respondents were asked to select their preferred treatment for each patient. For primary breast cancer, most physicians would offer the choice of local excision followed by radiation therapy or modified radical mastectomy. About 80% of physicians would prescribe adjuvant chemotherapy for a premenopausal woman with estrogen receptor-negative, axillary node negative breast cancer, and for a postmenopausal woman with estrogen receptor-negative, node-positive disease. This policy was favored by male and female physicians of each specialty. Almost all respondents would treat a young woman with inflammatory breast cancer with initial chemotherapy followed by radiation and/or surgery, and about 60% would recommend chemotherapy to a postmenopausal patient with estrogen receptor-negative disease and minimally symptomatic bone metastases. Clinical trials have compared treatment strategies that could be applied to patients described in our questionnaire. Preferred treatments for primary breast cancer, and for inflammatory breast cancer are supported by the results of clinical trials. Recommendation of adjuvant chemotherapy for node-negative breast cancer is not based on a consistent demonstration of improvement in survival, although randomized trials with short follow-up have shown delay to recurrence. Recommendation of adjuvant chemotherapy for a postmenopausal woman with node-positive breast cancer is contrary to the results of large randomized controlled trials (and to a meta-analysis), which have shown that this policy does not lead to improved survival. Our report suggests that even large randomized clinical trials may have a minimal impact on practice if their results run counter to belief in the value of the treatment.