Fecal occult blood test screening for colorectal cancer

In summary, high-quality scientific studies indicate that the use of the FOBT for colorectal cancer screening has a number of important advantages. The test is capable of detecting most early colorectal cancers and many advanced adenomas. It has been shown in randomized, controlled trials to reduce substantially colorectal cancer mortality and incidence. The FOBT is feasible, widely available, and acceptable to most individuals. It has a low up-front cost and is highly cost-effective. Combining annual FOBT with periodic flexible sigmoidoscopy seems to be an especially effective screening option. Limitations of FOBT screening include its low sensitivity for polyps, especially smaller ones. Some of the trials report a relatively low sensitivity for detecting cancers located in the distal colon. The test has a relatively low specificity, so there are many false-positive screens; and for it to be most effective, repetitive screening is necessary. Balancing these advantages and disadvantages, the evidence-based screening guidelines have concluded that FOBT screening has a major role to play in colorectal cancer control and a program of annual FOBT plus flexible sigmoidoscopy every 5 years is a preferred option for screening the asymptomatic, average-risk population for colorectal cancer. Short of doing direct colonoscopy screening for the entire at-risk population, the FOBT currently is the best available method of identifying asymptomatic, average-risk people most likely to benefit from colonoscopy.     

Multi-level Intervention to increase participation in mammography screening: ¡Fortaleza Latina! study design

BackgroundBreast cancer is the most common cancer and the leading cause of death among Latinas in the United States. The Multi-level Intervention to Increase Participation in Mammography Screening study (¡Fortaleza Latina!) is a partnership among research institutions, a Latino-serving community-based primary care clinic organization, and a cancer treatment center. The study will assess the efficacy of a clinic- and patient-level program to increase breast cancer screening among Latinas in Western Washington.Methods/designThe intervention is a multi-level breast cancer screening program in four participating primary care clinics. The study is a parallel randomized controlled trial of 600 Latino women aged 42–74 who are non-compliant with breast cancer screening guidelines. Participants will be randomized within clinic using block randomization to: (1) a control arm (usual care); and (2) a theory-based counseling program consisting of a ‘promotora’ or community health worker-led home-based intervention to encourage breast cancer screening. At the clinic-level, two clinics will offer additional mammography services provided by a mobile mammography unit operated by the Seattle Cancer Care Alliance. The primary endpoint is the rate of mammography uptake over the 1-year follow-up period.DiscussionThis multi-level intervention aims to raise rates of participation in breast cancer screening among Latino women. If effective, the program may improve rates of early detection of breast cancer in Latino women.Clinicaltrials.gov Registration Number: NCT02010008.     

The rationale for, and design of, a lung cancer screening program

We are entering a new era in which lung cancer screening may be considered the standard of care. The National Lung Screening Trial (NLST) has shown that the number of deaths due to lung cancer can be reduced through screening with low-dose computed tomography (CT) in a high-risk population (N Engl J Med 2011; 365:395-409). Key issues--such as how to manage lung nodules, how to improve cost-effectiveness, and how to minimize radiation exposure--need to be addressed when designing a lung cancer screening program. Time and further technical advances will help to optimize the programs that are developed.     

基于精细化管理ORTCC模型构建结直肠癌患者口服营养补充方案

目的 基于循证及精细化管理ORTCC模型构建结直肠癌患者围术期口服营养补充使用及随访方案。方法 检索结直肠癌患者围术期口服营养补充相关文献, 进行证据提取和筛选, 参考ORTCC模型拟定方案初稿, 使用德尔菲法及小组讨论法确定方案内容。结果 2轮专家函询有效回复率均>95%, 专家权威系数分别为0.903、0.912, 各级条目肯德尔和谐系数为0.108~0.254,均具有统计学意义（P<0.05）。方案内容包含一级条目8项, 二级条目29项, 涵盖目标、规则、训练、检查考核及文化5个模型维度的内容。结论 基于ORTCC模型的结直肠癌患者围术期口服营养补充使用及随访方案具有科学性和实用性, 能为临床医护人员开展结直肠癌围术期口服营养补充实践提供参考。     

Technical assessment of direct colonoscopy screening: procedural success, safety, and feasibility

Colonoscopy, when performed by adequately trained physicians, is a safe and effective procedure for colorectal cancer screening. To realize the benefits of colonoscopic screening of the general population for colorectal cancer, it is imperative that physicians performing this procedure receive appropriate training to maintain the highest standards of patient care.     

Screening for the early detection of disease, the need for evidence

BACKGROUND: Screening for the early detection of disease has had a spotted history. Structured approaches to the process of gathering and evaluating evidence, with the emphasis on well-controlled randomized studies, have greatly improved the beneficial potential of appropriate and effective screening. Good quality evidence will contribute to quality health care. ISSUES: The volunteer participants in screening programs must give fully informed consent. This means that they must be presented with clear and accurate statements of the advantages and disadvantages of the screening program. Among the screening programs that have been conducted include hyperhomocysteinemia and coronary artery disease, Down's syndrome, Neonatal Group B streptococcal disease, Type 2 diabetes mellitus and endometrial cancer. The evidence in these studies has strengths and weaknesses as to how they support or oppose a particular intervention. The laboratory has a major role to play in establishing and validating standards of accuracy for diagnostic tests. Agreement on standards and their application does not mean the end of different interpretation and controversy. CONCLUSIONS: Laboratory physicians and scientists will be very effective consultants if they have the best available, high quality evidence for the appropriate use of laboratory tests.     

Prostate Cancer Education in African American Churches

Abstract The use of churches as recruitment sites of African Americans into health promotion activities is a popular theme in the 1990s literature. This research measured the impact of previous exposure to cancer on participation in an educational program and a free prostate cancer screening. Cues to action from the Health Belief Model provided the conceptual framework. Over 500 men attended a prostate cancer educational program at their church. Men who participated in the educational program and completed the questionnaire were given a voucher that they could take to their doctor of choice for a free prostate cancer examination. Having a member of the congregation who was previously diagnosed with cancer was a significant cue to attendance at the educational program ( P = 0.03). Recommendations for future cancer screening in churches are given.     

Barriers to prostate cancer screening

The revised prostate cancer screening guidelines of the American Cancer Society recommend that men be informed of the risks associated with prostate cancer screening. However, there are no published studies on men's fear of impotence and its impact on prostate cancer screening. In addition, little is known about barriers to prostate cancer screening when the two main barriers of cost and lack of knowledge are eliminated. This study reports the association between barriers and free prostate cancer screening after a prostate cancer education program. All men were called 1 month after a prostate cancer education program and asked: "What would (or did) make it hard for you to get your prostate checkup done?" A total postbarrier score was created to measure how many barriers each man indicated. The following barriers were significant in predicting participation in prostate cancer screening: "put it off," "doctor hours not convenient," "didn't know kind of doctor," "didn't know where to go," and "refuse to go." Fear of impotence was not a significant barrier. Suggestions for reducing barriers to prostate cancer screening are given.     

Promoting community awareness of the need for colorectal cancer screening: a pilot study

The purpose of this pilot study was to determine if a community education program based on the Health Belief Model effectively promotes awareness of the need for colorectal cancer (CRC) prevention and screening. An education program was given to 20 employees of an accounting firm in a midwestern city. A survey evaluated the participants' beliefs about CRC, before and after the presentation. The results support a significant increase in the belief that CRC is preventable, and in 5 of 6 screening factors from the Health Belief Model. Participants were encouraged to share what they learned and reported that they anticipate sharing with at least 31 others. A screening questionnaire was distributed as a "cue to action" to discuss CRC screening with their physicians. Participants' intention to discuss CRC with their physicians also increased. The actual effectiveness will be evaluated with 11 participants who volunteered for a 1-year follow-up study. This community education concept had several advantages, including simultaneous access to many participants who share personal testimonials and who invite peers to become screened. The program was effective in increasing awareness of the need for CRC prevention and screening, even beyond those in attendance. The results of the 1-year follow-up study may provide more insight to what education factors promote screening most effectively.     

Oncology patients' and their significant others' responses to a proposed cancer prevention/detection program.

We used a needs assessment questionnaire to survey a primarily adult oncology population and their significant others, to gauge their interest in a cancer screening program. The purpose of the study was to determine the feasibility of developing a cancer prevention and detection program for this group of individuals. Although there was overwhelming interest in participating in the program, the subjects held varied opinions about the program's benefits. Differences correlated with personal and familial history of cancer and, in some categories, were quite significant. Additional questionnaire information related to patients' preference in the design of a cancer screening program. The majority preferred the screening examination to be performed by both nurses and physicians. In selecting what should be included in examinations, those surveyed chose testicular cancer and prostate cancer the least number of times. Results of this questionnaire can be used to demonstrate the need for nurses to take an active role in the screening process, especially in patient education.     

Trying to improve the compliance to colorectal cancer screening: a complex study design for a complex planning question

The efficacy of faecal occult blood test as primary screening for colorectal cancer has been demonstrated. Screening programs, to be effective, should guarantee high compliance in the target population. The aim of this paper is to describe the design of three connected studies aimed at obtaining precise indications for planning a colorectal cancer screening program with high compliance. We designed a survey, with a randomised controlled trial nested within it, and a case-control study nested within that and defined by the results of the trial. The complex interconnection of studies reflects the aim to produce indications for an evidence-based planning of a public health program, which is itself, a complex phenomenon. The trial was designed to evaluate two different types of tests, Immunochemical and Guaiac, and two different providers, general practitioner and hospital, with a 2 x 2 factorial design. The randomization was performed at two different levels to minimize the loss of power: at the practice level for test type (cluster randomisation) and individual level for provider type.     

Cost-effectiveness analysis of screening for gastric cancer in Japan.

Cost-effectiveness analysis of gastric cancer screening in Japan was performed, and the cost-effectiveness ratio was compared with that of colorectal cancer screening. The analytical model was the same as that adopted in our previous study on colorectal cancer screening (Tsuji et al. 1991). The results indicated that the cost per case-fatality prevented by colorectal cancer screening was 5.5 and 2.7 times more expensive for males and females, respectively, than that by gastric cancer screening. The age of the population influenced the cost-effectiveness of screening programs. The cost-effectiveness ratio in gastric cancer screening became negative among males older than the age of 65 years, suggesting that the total cost for prevention and control of deaths by gastric cancer in these age populations is saved by the screening program.     

Screening for colorectal cancer.

A voluntary colorectal screening program was carried out in North Carolina to evaluate the public's willingness to perform a do-it-yourself bowel test, to educate the public on the importance of routine colorectal screening, and to assess the efficacy of a small-scale screening program in detecting colorectal cancer. A screening kit was requested by 1,204 individuals after hearing or reading about the program; 770 kits were returned. Of 29 (3.7%) positive test results, six were negative after retesting. Adequate follow-up was available for 18 of the remaining 23 positive results. Thirteen were due to anal bleeding, diverticulosis, or heavy ingestion of aspirin; five were considered false-positive results, since no evidence of disease could be found. No cases of polypoid tumors or carcinoma were detected. The main value of such a program in an area with a small population base is to increase the awareness of the public of the importance of routine screening for colorectal cancer.     

Response to breast health screening program at a not‐for‐profit clinic for working poor,uninsured, ethnically diverse women

Aims and objectives. Examine the effect of an ongoing breast health screening program, at a not‐for‐profit, non‐government assisted, volunteer clinic, specifically examining mammography usage and to discover variables to improve the rate of mammography. Background. Detection of breast cancer in women of low socio‐economic status, lacking health insurance, can be improved by increasing annual mammography rates, yet little is known about their screening behaviour. Design. Quantitative, retrospective subject‐controlled study. Methods. Subject‐controlled, longitudinal study of English and Spanish‐speaking women 40 years old and over, working poor, and uninsured, who participated in a comprehensive screening program that included a 7‐minute breast health educational DVD (n = 223). Results. Radiology records, breast health behaviours and beliefs indicated 76% of women invited for a second test completed it over a year after viewing the educational DVD. Chi‐square and t‐test indicated two significant findings for completing annual mammography in the 12th month: receiving a reminder postcard and scoring lower on perceptions of breast cancer susceptibility. Two significant findings for completing annual mammography even if late are knowledgeable about screening recommendations and ethnically identifying as Hispanic. Conclusions. This study shows statistically significant actions that can be undertaken to strengthen programs: reminder postcards, assessing susceptibility score and screening recommendation education. Relevance to clinical practice. Simple, inexpensive interventions encourage working, uninsured, Hispanic women to complete mammography.     

A Nurse Practitioner-led Centralized Lung Cancer Screening Program

Lung cancer is the leading cause of cancer-related deaths. Screening eligible high-risk individuals for lung cancer with a low-dose computed tomography scan is evidence based. A nurse practitioner centralized screening process was initiated to evaluate the impact on patient volume, follow-up compliance, and the length of time from diagnosis to treatment intervention. The implementation of a centralized lung cancer screening program standardization of practice resulted in a statistically significant improvement with follow-up recommendations and patient compliance compared with the established lung cancer screening process.     

健康教育对中老年男性健康体检人群前列腺癌筛查率的影响简

目的：探讨健康教育对中老年男性健康体检人群前列腺癌筛查率的影响。方法将474例50岁以上中老年男性健康体检人群,随机分为健康教育组和对照组,各237例。健康教育组在体检时接受健康教育。对照组参加体检时进行常规健康宣教。观察并比较两组相关知识知晓率及前列腺癌筛查率。结果健康教育组在健康教育后对前列腺癌筛查项目的知晓率和接受前列腺癌筛查率高于对照组,有显著性差异（P＜0．01）。结论对中老年健康体检男性实施健康教育具有良好的效果,能明显提高受检者对前列腺癌筛查项目知晓率,提高前列腺癌筛查率。