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Abstract
PURPOSE OF REVIEW To describe the rationale behind the new recommendations for breast cancer screening issued by the U.S. Preventive Services Task Force (USPSTF). RECENT FINDINGS The USPSTF reviewed new summary evidence provided by the Oregon Evidence-based Practice Center and the Cancer Intervention Surveillance and Modeling Network about benefits and harms including radiation exposure and the likelihood of false-positive testing, unnecessary biopsies and treatments that may not impact overall breast cancer mortality. SUMMARY The USPSTF concluded maximal benefit in breast cancer mortality with least harms can be achieved with biennial mammography screening commenced at age 50 and continuing until age 74 years. A small additional benefit could be realized if screening starts at age 40 years. The USPSTF concluded that the decision to start biennial screening before age 50 years should be a personal one and take into account individual patient context, including an individual's values regarding specific benefits and harms. Evidence from large-scale randomized trials led the USPSTF to recommend against the teaching of breast self-examination. The USPSTF found insufficient evidence to recommend for or against performing clinical breast examination.
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152
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Brodersen J, Siersma V, Ryle M. Breast cancer screening: ''reassuring'' the worried well? Scand J Public Health 2011; 39:326-32. [PMID: 21273225 DOI: 10.1177/1403494810396558] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND One of the suggested benefits of cancer screening is the peace of mind and reassurance experienced by those women who are given negative results. The aim of the present study was to investigate whether there was a difference in the expression of psychosocial aspects in a population of women offered screening compared to a population of women not offered screening for breast cancer. METHODS One thousand women, aged 50-69 years, were randomly drawn from the Danish Civil Registration System to receive part I of the questionnaire Consequences of Screening in Breast Cancer (COS-BC1): the sample consisted of 500 women living in a geographical area where screening mammography had been offered for more than 10 years and 500 women living in an area where the public health authorities had never invited women to breast cancer screening. RESULTS A total of 759 women returned the questionnaire. Those living in areas where screening was not offered reported more negative psychosocial aspects compared to women living in areas where screening was offered. CONCLUSIONS The results indicate that women tend to perceive breast cancer screening as a reassuring preventive initiative. Alternatively, the results indicate that the lack of invitation to breast cancer screening may have a negative psychosocial impact.
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Affiliation(s)
- John Brodersen
- Research Unit and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
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153
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Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L. Screening for breast cancer: an update for the U.S. Preventive Services Task Force. Ann Intern Med 2010. [PMID: 19920273 DOI: 10.1059/0003-4819-151-10-200911170-00009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This systematic review is an update of evidence since the 2002 U.S. Preventive Services Task Force recommendation on breast cancer screening. PURPOSE To determine the effectiveness of mammography screening in decreasing breast cancer mortality among average-risk women aged 40 to 49 years and 70 years or older, the effectiveness of clinical breast examination and breast self-examination, and the harms of screening. DATA SOURCES Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the fourth quarter of 2008), MEDLINE (January 2001 to December 2008), reference lists, and Web of Science searches for published studies and Breast Cancer Surveillance Consortium for screening mammography data. STUDY SELECTION Randomized, controlled trials with breast cancer mortality outcomes for screening effectiveness, and studies of various designs and multiple data sources for harms. DATA EXTRACTION Relevant data were abstracted, and study quality was rated by using established criteria. DATA SYNTHESIS Mammography screening reduces breast cancer mortality by 15% for women aged 39 to 49 years (relative risk, 0.85 [95% credible interval, 0.75 to 0.96]; 8 trials). Data are lacking for women aged 70 years or older. Radiation exposure from mammography is low. Patient adverse experiences are common and transient and do not affect screening practices. Estimates of overdiagnosis vary from 1% to 10%. Younger women have more false-positive mammography results and additional imaging but fewer biopsies than older women. Trials of clinical breast examination are ongoing; trials for breast self-examination showed no reductions in mortality but increases in benign biopsy results. LIMITATION Studies of older women, digital mammography, and magnetic resonance imaging are lacking. CONCLUSION Mammography screening reduces breast cancer mortality for women aged 39 to 69 years; data are insufficient for older women. False-positive mammography results and additional imaging are common. No benefit has been shown for clinical breast examination or breast self-examination.
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Affiliation(s)
- Heidi D Nelson
- Oregon Health & Science University, Veterans Affairs Medical Center, Portland, OR 97239-3098, USA.
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154
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Palefsky JM, Reed AC, Reiter PL, Smith JS, Brewer NT. PALEFSKY ET AL. RESPOND. Am J Public Health 2010. [DOI: 10.2105/ajph.2010.204537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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155
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Paris C, Maurel M, Luc A, Stoufflet A, Pairon JC, Letourneux M. CT scan screening is associated with increased distress among subjects of the APExS. BMC Public Health 2010; 10:647. [PMID: 20977751 PMCID: PMC2988732 DOI: 10.1186/1471-2458-10-647] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 10/26/2010] [Indexed: 12/21/2022] Open
Abstract
Background The aim of this study was to assess the psychological consequences of HRCT scan screening in retired asbestos-exposed workers. Methods A HRCT-scan screening program for asbestos-related diseases was carried out in four regions of France. At baseline (T1), subjects filled in self-administered occupational questionnaires. In two of the regions, subjects also received a validated psychological scale, namely the psychological consequences questionnaire (PCQ). The physician was required to provide the subject with the results of the HRCT scan at a final visit. A second assessment of psychological consequences was performed 6 months after the HRCT-scan examination (T2). PCQ scores were compared quantitatively (t-test, general linear model) and qualitatively (chi²-test, logistic regression) to screening results. Multivariate analyses were adjusted for gender, age, smoking, asbestos exposure and counseling. Results Among the 832 subjects included in this psychological impact study, HRCT-scan screening was associated with a significant increase of the psychological score 6 months after the examination relative to baseline values (8.31 to 10.08, p < 0.0001, t-test). This increase concerned patients with an abnormal HRCT-scan result, regardless of the abnormalities, but also patients with normal HRCT-scans after adjustment for age, gender, smoking status, asbestos exposure and counseling visit. The greatest increase was observed for pleural plaques (+3.60; 95%CI [+2.15;+5.06]), which are benign lesions. Detection of isolated pulmonary nodules was also associated with a less marked but nevertheless significant increase of distress (+1.88; 95%CI [+0.34;+3.42]). However, analyses based on logistic regressions only showed a close to significant increase of the proportion of subjects with abnormal PCQ scores at T2 for patients with asbestosis (OR = 1.92; 95%CI [0.97-3.81]) or with two or more diseases (OR = 2.04; 95%CI [0.95-4.37]). Conclusion This study suggests that HRCT-scan screening may be associated with increased distress in asbestos-exposed subjects. If confirmed, these results may have consequences for HRCT-scan screening recommendations.
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156
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Association of diagnostic work-up with subsequent attendance in a breast cancer screening program for false-positive cases. Breast Cancer Res Treat 2010; 127:221-8. [PMID: 20809364 DOI: 10.1007/s10549-010-1118-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 08/06/2010] [Indexed: 10/19/2022]
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157
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Brodersen J, Thorsen H, Kreiner S. Consequences of screening in lung cancer: development and dimensionality of a questionnaire. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2010; 13:601-612. [PMID: 20345552 DOI: 10.1111/j.1524-4733.2010.00697.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The objective of this study was to extend the Consequences of Screening (COS) Questionnaire for use in a lung cancer screening by testing for comprehension, content coverage, dimensionality, and reliability. METHODS In interviews, the suitability, content coverage, and relevance of the COS were tested on participants in a lung cancer screening program. The results were thematically analyzed to identify the key consequences of abnormal and false-positive screening results. Item Response Theory and Classical Test Theory were used to analyze data. Dimensionality, objectivity, and reliability were established by item analysis, examining the fit between item responses and Rasch models. RESULTS Eight themes specifically relevant for participants in lung cancer screening results were identified: "self-blame,""focus on symptoms,""stigmatization,""introvert,""harm of smoking,""impulsivity,""empathy," and "regretful of still smoking." Altogether, 26 new items for part I and 16 new items for part II were generated. These themes were confirmed to fit a partial-credit Rasch model measuring different constructs including several of the new items. CONCLUSION In conclusion, the reliability and the dimensionality of a condition-specific measure with high content validity for persons having abnormal or false-positive lung cancer screening results have been demonstrated. This new questionnaire called Consequences of Screening in Lung Cancer (COS-LC) covers in two parts the psychosocial experience in lung cancer screening. Part I: "anxiety,""behavior,""dejection,""sleep,""self-blame,""focus on airway symptoms,""stigmatization,""introvert," and "harm of smoking." Part II: "calm/relax,""social network,""existential values,""impulsivity,""empathy," and "regretful of still smoking."
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Affiliation(s)
- John Brodersen
- Institute of Public Health, Department and Research Unit of General Practice, University of Copenhagen, Copenhagen, Denmark.
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158
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Jeon BY, Lee HY, Park EC, Choi KS, Jun JK, Kim Y, Han MA, Yoon NH, Kim EJ, Jeon SM. Satisfaction with mammography in the National Cancer Screening Programme participants of age 40s in Korea. Eur J Cancer Care (Engl) 2010; 20:803-9. [PMID: 20649810 DOI: 10.1111/j.1365-2354.2010.01210.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to evaluate satisfaction with the National Cancer Screening Programme of mammography in Korea and to examine the association between subscales of satisfaction and general satisfaction. We conducted a cross-sectional telephone survey for women who had obtained a National Cancer Screening Programme mammographic screening at general hospitals between May and October 2008. The present study included 2005 women in their forties. We performed multivariate linear regression using dependent variable as general satisfaction and independent variables as subscales of satisfaction, such as pre-screening information transfer, staff interpersonal skills, physical surroundings and results reporting. Participants were stratified according to the result of their mammogram as negative or positive. Mean score of satisfaction was above 2.5 of 4 for all subscales. Women who received positive results were less satisfied with all of subscale factors. Staff interpersonal skills were the most important factor that contributed to general satisfaction. Future efforts such as staff training programme of communication/attitude skills, ensuring privacy and explanation of possible discomfort of the screening would be needed.
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Affiliation(s)
- B Y Jeon
- National Cancer Control Research Institute, National Cancer Center, Goyang-si, Gyeonggi-do, Korea
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159
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Silva M, McNeill R, Ashton T. Ladies in waiting: the timeliness of first trimester services in New Zealand. Reprod Health 2010; 7:19. [PMID: 20653931 PMCID: PMC2918568 DOI: 10.1186/1742-4755-7-19] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 07/23/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Termination of pregnancy (TOP) services are a core service in New Zealand. However, compared to other developed countries, TOP services are accessed significantly later in the first trimester, increasing the risk for complications. The aim of this study is to examine the timeliness of access to first trimester TOP services and establish the length of delay between different points in the care pathway for these services. METHODOLOGY Data were collected from all patients attending nine TOP clinics around the country between February and May 2009 (N = 2950). Patient records were audited to determine the timeline between the first point of entry to the health system to the date of termination. In addition, women were invited to fill out a questionnaire to identify personal level factors affecting access to services (N = 1086, response rate = 36.8%). RESULTS Women waited an average of almost 25 days between the date of the first visit with the referring doctor and the date of their termination procedure. There was a delay of 10 days between the first visit with the referring doctor and the date that the appointment for the procedure was booked, and a further 10 days delay between the date the appointment was booked and the first appointment date. Over half of the women in this study had their pregnancy terminated at ten weeks or above. CONCLUSION Women in New Zealand are subject to a lengthy delay while seeking TOP services. Efforts should be made by TOP clinics as well as referring doctors to reduce the waiting times for this service.
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Affiliation(s)
- Martha Silva
- Senior Research Fellow, Health Systems, School of Population Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
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160
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Michel G, Greenfield D, Absolom K, Eiser C. Satisfaction with follow-up consultations among younger adults treated for cancer: the role of quality of life and psychological variables. Psychooncology 2010; 20:813-22. [PMID: 20878873 DOI: 10.1002/pon.1783] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 02/17/2010] [Accepted: 04/20/2010] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Given increased survival rates and treatment-related late effects, follow-up for cancer survivors is increasingly recommended. However, information about adverse events (e.g. possibility of late effects) may be distressing for the cancer survivor and lead to poor clinic attendance. Survivor satisfaction with appointments and the information provided are important. The Monitoring Process Model provides a theoretical framework to understand how survivors cope with threatening information, and consequences for follow-up care. Our aims were to describe satisfaction with routine follow-up and association between monitoring/blunting and satisfaction with care. METHODS Three hundred and forty-nine patients [aged 18-45 years with a history of haematological, germ cell, breast or childhood cancer, >5 years from diagnosis without relapse (>2 years for germ cell survivors) and with a follow-up appointment during the study period] were identified from hospital databases. Participants completed questionnaires before (T1) and after a routine appointment (T2). RESULTS Two hundred and seventy-nine (79.9%) questionnaires were completed at T1 and 198 (56.7%) at T2. Clinic satisfaction was higher with shorter waiting time, longer consultation and more topics discussed, but not associated with monitoring. High monitors reported more psychological problems, more importance of clinic attendance and greater value of support groups and professional counselling. CONCLUSIONS Satisfaction with follow-up is high among young adult cancer survivors. Follow-up was rated more highly by higher monitors, supporting previous findings that monitors seek out health care information. Provision of additional support services might increase satisfaction among survivors with psychological and social problems.
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Affiliation(s)
- Gisela Michel
- Department of Psychology, University of Sheffield, Western Bank, Sheffield, UK.
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161
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Shiloh S. An Experimental Investigation of the Effects of Acknowledging False Negative and False Positive Errors on Clients' Cancer Screening Intentions: The Lesser of Two Evils? Appl Psychol Health Well Being 2010. [DOI: 10.1111/j.1758-0854.2010.01030.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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162
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Hubbard RA, Miglioretti DL, Smith RA. Modelling the cumulative risk of a false-positive screening test. Stat Methods Med Res 2010; 19:429-49. [PMID: 20356857 DOI: 10.1177/0962280209359842] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The goal of a screening test is to reduce morbidity and mortality through the early detection of disease; but the benefits of screening must be weighed against potential harms, such as false-positive (FP) results, which may lead to increased healthcare costs, patient anxiety, and other adverse outcomes associated with diagnostic follow-up procedures. Accurate estimation of the cumulative risk of an FP test after multiple screening rounds is important for program evaluation and goal setting, as well as informing individuals undergoing screening what they should expect from testing over time. Estimation of the cumulative FP risk is complicated by the existence of censoring and possible dependence of the censoring time on the event history. Current statistical methods for estimating the cumulative FP risk from censored data follow two distinct approaches, either conditioning on the number of screening tests observed or marginalizing over this random variable. We review these current methods, identify their limitations and possibly unrealistic assumptions, and propose simple extensions to address some of these limitations. We discuss areas where additional extensions may be useful. We illustrate methods for estimating the cumulative FP recall risk of screening mammography and investigate the appropriateness of modelling assumptions using 13 years of data collected by the Breast Cancer Surveillance Consortium (BCSC). In the BCSC data we found evidence of violations of modelling assumptions of both classes of statistical methods. The estimated risk of an FP recall after 10 screening mammograms varied between 58% and 77% depending on the approach used, with an estimate of 63% based on what we feel are the most reasonable modelling assumptions.
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Affiliation(s)
- Rebecca A Hubbard
- Group Health Research Institute, Biostatistics Unit and Department of Biostatistics, University of Washington, Seattle, WA 98101, USA.
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163
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Petroianu A, Alberti LR, de Lima DCA, Hauter HL, Rodrigues KCDL, Mendes JCDA. [Colonoscopic findings in asymptomatic people]. ARQUIVOS DE GASTROENTEROLOGIA 2010; 46:173-8. [PMID: 19918681 DOI: 10.1590/s0004-28032009000300006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Accepted: 01/07/2009] [Indexed: 01/29/2023]
Abstract
CONTEXT Colorectal cancer is the second leading cause of cancer-related death. Prevention of colorectal cancer should be achievable by screening programs in asymptomatic patients. OBJECTIVE To assess the colonoscopic findings in asymptomatic people submitted to screening. METHODS A prospective study was undertaken on 153 consecutive asymptomatic people submitted to colonoscopy. Sex, age, previous diseases and familial cases of cancer, as well as tobacco and alcohol ingestion were assessed. Patients with rectal macro- or microscopic bleeding and colorectal diseases were excluded. Bowel preparation, polyps, angioectasias, diverticular disease, inflammation and neoplasm were also verified. Polyps were classified according to their size, number and location. RESULTS Mean age was 52.5 +/- 11.7 years. Family history for colorectal cancer occurred in 79.8% of individuals. Colonoscopic alterations were detected in 99 individuals: polyps in 64.3%, diverticular disease in 27.9%, inflammatory mucosal alterations in 9.7%, melanosi coli in 2.6% and angioectasias in 7.8%. There were an increasing incidence of polyps in patients older than 50 year. Multivariate logistic regression showed age and sex as predictive factors for polyps (OR = 1.43; 1.19 <OR <2.67). CONCLUSION There is a significant incidence of colonoscopic alterations in asymptomatic people submitted to colonoscopy for colorectal cancer screening.
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Affiliation(s)
- Andy Petroianu
- Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal de Minas Gerais.
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164
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DeFrank JT, Brewer N. A model of the influence of false-positive mammography screening results on subsequent screening. Health Psychol Rev 2010; 4:112-127. [PMID: 21874132 PMCID: PMC3160720 DOI: 10.1080/17437199.2010.500482] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Decades of empirical research have demonstrated psychological and behavioural consequences of false-positive medical tests. To organise this literature and offer novel predictions, we propose a model of how false-positive mammography results affect return for subsequent mammography screening. We propose that false-positive mammography results alter how women think about themselves (e.g., increasing their perceived likelihood of getting breast cancer) and the screening test (e.g., believing mammography test results are less accurate). We further hypothesise that thoughts elicited by the false-positive experience will, in turn, affect future use of screening mammography. In addition, we discuss methodological considerations for statistical analyses of these mediational pathways and propose two classes of potential moderators. While our model focuses on mammography screening, it may be applicable to psychological and behavioural responses to other screening tests. The model is especially timely as false-positive medical test results are increasingly common, due to efforts to increase uptake of cancer screening, new technologies that improve existing tests' ability to detect disease at the cost of increased false alarms, and growing numbers of new medical tests.
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Affiliation(s)
- Jessica T. DeFrank
- Department of Health Behavior and Health Education, UNC Gillings School of Global Public Health, 325 Rosenau Hall, CB# 7440, Chapel Hill, NC 27599, USA
| | - Noel Brewer
- Department of Health Behavior and Health Education, UNC Gillings School of Global Public Health, 325 Rosenau Hall, CB# 7440, Chapel Hill, NC 27599, USA
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165
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Barbiere JM, Lyratzopoulos G. Cost-effectiveness of endoscopic screening followed by surveillance for Barrett's esophagus: a review. Gastroenterology 2009; 137:1869-76. [PMID: 19840798 DOI: 10.1053/j.gastro.2009.10.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Screening interventions for Barrett's esophagus (BE) are appealing, but there is little supporting evidence. We reviewed health economics studies about BE endoscopic screening followed by, as required, endoscopic surveillance ("screening and surveillance" hereafter) to help inform the design and conduct of future research. Health economics studies about BE screening and surveillance were identified using electronic database searches and personal contact with authors of identified studies. No studies examined general population screening. Five US studies published between 2003 and 2007 examined the cost effectiveness of screening and surveillance (against no intervention) in patients with chronic gastroesophageal reflux disease (GERD). There was no randomized trial evidence to inform model construction. Assumptions about prevalence and transition probabilities between BE histologic subtypes and about surveillance and treatment protocols varied substantially between studies. Parameters such as potential BE diagnosis-related reduction in quality of life or increase in health care use, diagnostic accuracy, and infrastructural costs (for quality assurance) were considered either "optimistically" or not at all. Only 2 studies considered endoscopic treatments. No study considered the recently introduced radiofrequency ablation technique, or the potential for biomarker-based risk stratification of surveillance interval or duration. Current health economics evidence is likely to have provided optimistic cost-effectiveness estimates and is not sufficient to support introduction of endoscopic BE screening programs among GERD patients. The evidence does not adequately incorporate novel (endoscopic) treatments and the potential for (clinical, endoscopic, or biomarker-based) risk stratification of surveillance. Future research should aim to encompass both these factors.
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Affiliation(s)
- Josephine M Barbiere
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
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166
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Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L. Screening for breast cancer: an update for the U.S. Preventive Services Task Force. Ann Intern Med 2009; 151:727-37, W237-42. [PMID: 19920273 PMCID: PMC2972726 DOI: 10.7326/0003-4819-151-10-200911170-00009] [Citation(s) in RCA: 778] [Impact Index Per Article: 51.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND This systematic review is an update of evidence since the 2002 U.S. Preventive Services Task Force recommendation on breast cancer screening. PURPOSE To determine the effectiveness of mammography screening in decreasing breast cancer mortality among average-risk women aged 40 to 49 years and 70 years or older, the effectiveness of clinical breast examination and breast self-examination, and the harms of screening. DATA SOURCES Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the fourth quarter of 2008), MEDLINE (January 2001 to December 2008), reference lists, and Web of Science searches for published studies and Breast Cancer Surveillance Consortium for screening mammography data. STUDY SELECTION Randomized, controlled trials with breast cancer mortality outcomes for screening effectiveness, and studies of various designs and multiple data sources for harms. DATA EXTRACTION Relevant data were abstracted, and study quality was rated by using established criteria. DATA SYNTHESIS Mammography screening reduces breast cancer mortality by 15% for women aged 39 to 49 years (relative risk, 0.85 [95% credible interval, 0.75 to 0.96]; 8 trials). Data are lacking for women aged 70 years or older. Radiation exposure from mammography is low. Patient adverse experiences are common and transient and do not affect screening practices. Estimates of overdiagnosis vary from 1% to 10%. Younger women have more false-positive mammography results and additional imaging but fewer biopsies than older women. Trials of clinical breast examination are ongoing; trials for breast self-examination showed no reductions in mortality but increases in benign biopsy results. LIMITATION Studies of older women, digital mammography, and magnetic resonance imaging are lacking. CONCLUSION Mammography screening reduces breast cancer mortality for women aged 39 to 69 years; data are insufficient for older women. False-positive mammography results and additional imaging are common. No benefit has been shown for clinical breast examination or breast self-examination.
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Affiliation(s)
- Heidi D Nelson
- Oregon Health & Science University, Veterans Affairs Medical Center, Portland, OR 97239-3098, USA.
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167
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Abstract
Mammography remains the mainstay of breast cancer screening. There is little controversy that mammography reduces the risk of dying from breast cancer by about 23% among women between the ages of 50 and 69 years, although the harms associated with false-positive results and overdiagnosis limit the net benefit of mammography. Women in their 70s may have a small benefit from screening mammography, but overdiagnosis increases in this age group as do competing causes of death. While new data support a 16% reduction in breast cancer mortality for 40- to 49-year-old women after 10 years of screening, the net benefit is less compelling in part because of the lower incidence of breast cancer in this age group and because mammography is less sensitive and specific in women younger than 50 years. Digital mammography is more sensitive than film mammography in young women with similar specificity, but no improvements in breast cancer outcomes have been demonstrated. Magnetic resonance imaging may benefit the highest risk women. Randomized trials suggest that self-breast examination does more harm than good. Primary prevention with currently approved medications will have a negligible effect on breast cancer incidence. Public health efforts aimed at increasing mammography screening rates, promoting regular exercise in all women, maintaining a healthy weight, limiting alcohol intake, and limiting postmenopausal hormone therapy may help to continue the recent trend of lower breast cancer incidence and mortality among American women.
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Affiliation(s)
- Jeffrey A Tice
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, 1701 Divisadero Street, Suite 554, San Francisco, CA 94143-1732, USA.
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168
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Nothacker M, Duda V, Hahn M, Warm M, Degenhardt F, Madjar H, Weinbrenner S, Albert US. Early detection of breast cancer: benefits and risks of supplemental breast ultrasound in asymptomatic women with mammographically dense breast tissue. A systematic review. BMC Cancer 2009; 9:335. [PMID: 19765317 PMCID: PMC2760575 DOI: 10.1186/1471-2407-9-335] [Citation(s) in RCA: 193] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Accepted: 09/20/2009] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Mammographic screening alone will miss a certain fraction of malignancies, as evidenced by retrospective reviews of mammograms following a subsequent screening. Mammographic breast density is a marker for increased breast cancer risk and is associated with a higher risk of interval breast cancer, i.e. cancer detected between screening tests. The purpose of this review is to estimate risks and benefits of supplemental breast ultrasound in women with negative mammographic screening with dense breast tissue. METHODS A systematic search and review of studies involving mammography and breast ultrasound for screening of breast cancer was conducted. The search was performed for the period 1/2000-8/2008 within the data source of PubMed, DARE, and Cochrane databases. Inclusion and exclusion criteria were determined prospectively, and the Oxford evidence classification system for diagnostic studies was used for evidence level. The parameters biopsy rate, positive predictive value (PPV) for biopsy, cancer yield for breast ultrasound alone, and carcinoma detection rate by breast density were extracted or constructed. RESULTS The systematic search identified no randomized controlled trials or systematic reviews, six cohort studies of intermediate level of evidence (3b) were found. Only two of the studies included adequate follow-up of subjects with negative or benign findings. Supplemental breast ultrasound after negative mammographic screening permitted diagnosis of primarily invasive carcinomas in 0.32% of women in breast density type categories 2-4 of the American College of Radiology (ACR); mean tumor size for those identified was 9.9 mm, 90% with negative lymph node status. Most detected cancers occurred in mammographically dense breast ACR types 3 and 4. Biopsy rates were in the range 2.3%-4.7%, with PPV of 8.4-13.7% for those biopsied due to positive ultrasound, or about one third of the PPV of biopsies due to mammography. LIMITATIONS The study populations included wide age ranges, and the application to women age 50-69 years as proposed for mammographic screening could result in less striking benefit. Further validation studies should employ a uniform assessment system such as BI-RADS and report not only PPV, but also negative predictive value, sensitivity and specificity. CONCLUSION Supplemental breast ultrasound in the population of women with mammographically dense breast tissue (ACR 3 and 4) permits detection of small, otherwise occult, breast cancers. Potential adverse impacts for women in this intermediate risk group are associated with an increased biopsy rate.
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Affiliation(s)
| | - Volker Duda
- Department of Gynecology, Gynecological Endocrinology and Oncology, University of Marburg, Marburg, Germany
| | - Markus Hahn
- Department of Gynecology and Obstetrics, University of Tuebingen, Tübingen, Germany
| | - Mathias Warm
- Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany
| | | | | | | | - Ute-Susann Albert
- Department of Gynecology, Gynecological Endocrinology and Oncology, University of Marburg, Marburg, Germany
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169
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Psychological impact of computed tomography screening for lung cancer and occupational pulmonary disease among asbestos-exposed workers. Eur J Cancer Prev 2009; 18:203-6. [PMID: 19728402 DOI: 10.1097/cej.0b013e328329d800] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to investigate the psychological impact of screening for lung cancer and occupational pulmonary disease among asbestos-exposed workers. Altogether, 633 workers were screened with chest computed tomography (627 men, 6 women, mean age 64.5 years). Participants' views on the necessity of screening,awareness of asbestos-exposure risks, their perceived lung cancer risk, trial adherence intention, health anxiety,and worry about lung cancer were assessed. Health anxiety was reduced significantly after screening (P < 0.001). After 1 year, no significant long-term psychological differences were found between those who immediately received clear results and those who were submitted to additional examinations because of positive findings. In conclusion,computed tomography screening of pulmonary disease was well accepted and did not produce excessive long-term anxiety or other negative psychological effects,which could prevent the participation in the future screening programs.
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170
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Hafslund B, Nortvedt MW. Mammography screening from the perspective of quality of life: a review of the literature. Scand J Caring Sci 2009; 23:539-48. [DOI: 10.1111/j.1471-6712.2008.00634.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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171
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Bangsbøll Andersen S, Vejborg I, von Euler-Chelpin M. Participation behaviour following a false positive test in the Copenhagen mammography screening programme. Acta Oncol 2009; 47:550-5. [PMID: 18465321 DOI: 10.1080/02841860801935483] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION There is an ongoing debate concerning possible disadvantages of mammography screening, one being the consequence of receiving a false positive test-result. It is argued that receiving a false positive answer may have short- and/or long-term adverse psychological effects on women, but results from different studies are conflicting. We tested if there was a difference in continued participation behaviour between the group of women who have been subject to a false positive result and those who have not. MATERIAL AND METHODS The study used the registers from the first six invitation rounds of the mammography screening programme in Copenhagen (1991-2003). We estimated the relative risk of not participating in the subsequent screening round for women with a false positive test using women with a negative test as baseline. As outcome measure odds ratios (OR) with 95% confidence intervals (CI) were used. RESULTS There was no significant difference in participation in the subsequent round between women with a false positive test and women with a negative test. The proportion of screens resulting in false positive answers, both after assessment and after surgery, decreased from 5.54% in Round 1 to 1.79% in Round 5. Participation in the subsequent screening round was well above 80% in all five screening rounds. DISCUSSION Our results showed that women experiencing a false positive test at mammography screening participated in the subsequent screening round to the same extent as did women experiencing a negative screening test, regardless of whether the false positive statement was given following assessment or following surgery. The benign to malignant biopsy ratio, comparing the type B false positives to the true positives, was by the fifth round well below the desirable level of </=1:4, recommended by the European guidelines. Other possible adverse effects should be further investigated.
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172
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Giel KE, Enck P, Zipfel S, Schrauth M, Bury A, Graf M, Kümmerle S, Guthoff M, Stefan N, Häring HU, Fritsche A. Psychological effects of prevention: do participants of a type 2 diabetes prevention program experience increased mental distress? Diabetes Metab Res Rev 2009; 25:83-8. [PMID: 19145589 DOI: 10.1002/dmrr.917] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the mental health outcome of a lifestyle intervention for the prevention of type 2 diabetes and to exclude possible harmful psychological effects. BACKGROUND There is little empirical data on potential harmful effects of prevention programs. However, information, education, diagnostic procedures, phenotyping and risk assessment may cause or intensify psychological distress such as anxiety, depression or somatization in vulnerable individuals. METHODS The Tuebingen Lifestyle Intervention Program (TULIP) for the prevention of type 2 diabetes has assessed mental health outcome in the participants after 9 months of program participation using the Symptom Checklist-90-R (SCL-90-R). The 24-months lifestyle intervention TULIP comprises regular exercise and changes in nutrition and assesses both, a broad range of somatic parameters as well as psychometric variables. For an interim analysis of psychological outcome, complete data sets of the SCL-90-R assessed at baseline and after 9 months of intervention were available for 195 participants (125 females, 70 males; age: 46.1 +/- 10.6 years). Data on somatization, anxiety, depression and overall psychological distress were compared to baseline levels. RESULTS SCL-90-R scores of the TULIP-participants did not significantly differ from the German healthy reference population. Compared to baseline, a significant decrease in SCL-90-R scores was found for anxiety, depression and overall psychological distress at re-assessment after 9 months. CONCLUSION The interim analysis on mental health outcome of a type 2 diabetes prevention program comprising extensive phenotyping and risk assessment rules out adverse psychological effects, suggesting rather beneficial changes concerning symptoms of anxiety, depression and overall psychological distress.
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Affiliation(s)
- Katrin E Giel
- Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Germany.
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173
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Brain K, Henderson BJ, Tyndel S, Bankhead C, Watson E, Clements A, Austoker J. Predictors of breast cancer-related distress following mammography screening in younger women on a family history breast screening programme. Psychooncology 2008; 17:1180-8. [DOI: 10.1002/pon.1355] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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174
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Wong G, Howard K, Chapman JR, Craig JC. Cost-Effectiveness of Breast Cancer Screening in Women on Dialysis. Am J Kidney Dis 2008; 52:916-29. [DOI: 10.1053/j.ajkd.2008.06.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 06/04/2008] [Indexed: 11/11/2022]
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175
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Psychological impact of recall in high-risk breast MRI screening. Breast Cancer Res Treat 2008; 115:365-71. [DOI: 10.1007/s10549-008-0140-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Accepted: 07/15/2008] [Indexed: 10/21/2022]
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176
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Albert US, Altland H, Duda V, Engel J, Geraedts M, Heywang-Köbrunner S, Hölzel D, Kalbheim E, Koller M, König K, Kreienberg R, Kühn T, Lebeau A, Nass-Griegoleit I, Schlake W, Schmutzler R, Schreer I, Schulte H, Schulz-Wendtland R, Wagner U, Kopp I. 2008 update of the guideline: early detection of breast cancer in Germany. J Cancer Res Clin Oncol 2008; 135:339-54. [DOI: 10.1007/s00432-008-0450-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Accepted: 06/24/2008] [Indexed: 01/09/2023]
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177
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Bonomi AE, Boudreau DM, Fishman PA, Ludman E, Mohelnitzky A, Cannon EA, Seger D. Quality of life valuations of mammography screening. Qual Life Res 2008; 17:801-14. [PMID: 18491217 DOI: 10.1007/s11136-008-9353-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Accepted: 04/21/2008] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To obtain quality-of-life (QOL) valuations associated with mammography screening and breast cancer treatment that are suitable for use in cost-effectiveness analyses. METHODS Subjects comprised 131 women (age range 50-79 years) randomly sampled from a breast cancer screening program. In an in-person or telephone interview, women rated the QOL impact of 14 clinical scenarios (ranging from mammography to end-of-life care for breast cancer) using a visual analogue scale anchored by death (0) and perfect health/quality of life (100). RESULTS Women rated the scenarios describing true negative results, false positive results, and routine screening mammography at 80 or above on a scale of 0-100, suggesting that they perceive these states as being close to perfect health. They rated adjuvant chemotherapy (39.7; range 10-90), palliation/end-of-life care (35.8; range 0-100), and recurrence at 1 year (33.0; range 0-95) the lowest, suggesting that these health states are perceived as compromised. Women rated receiving news of a breast cancer diagnosis (true positive) (45.7; range 5-100) and receiving delayed news of a breast cancer diagnosis (false negative) (48.5; range 5-100) as being comparable to undergoing mastectomy (48.3; range 10-100) and radiation therapy (46.2; range 5-100) for breast cancer. CONCLUSIONS These data can be used to update cost analyses of mammography screening that wish to take into account the QOL impact of screening.
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Affiliation(s)
- Amy E Bonomi
- Human Development and Family Science, The Ohio State University, 135 Campbell Hall, 1787 Neil Avenue, Columbus, OH 43210, USA.
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Tyndel S, Austoker J, Henderson BJ, Brain K, Bankhead C, Clements A, Watson E. What is the psychological impact of mammographic screening on younger women with a family history of breast cancer? Findings from a prospective cohort study (PIMMS). Breast Cancer Res 2008. [PMCID: PMC3300794 DOI: 10.1186/bcr1975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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179
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Thompson A, Brennan K, Cox A, Gee J, Harcourt D, Harris A, Harvie M, Holen I, Howell A, Nicholson R, Steel M, Streuli C. Evaluation of the current knowledge limitations in breast cancer research: a gap analysis. Breast Cancer Res 2008; 10:R26. [PMID: 18371194 PMCID: PMC2397525 DOI: 10.1186/bcr1983] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Revised: 03/13/2008] [Accepted: 03/27/2008] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND A gap analysis was conducted to determine which areas of breast cancer research, if targeted by researchers and funding bodies, could produce the greatest impact on patients. METHODS Fifty-six Breast Cancer Campaign grant holders and prominent UK breast cancer researchers participated in a gap analysis of current breast cancer research. Before, during and following the meeting, groups in seven key research areas participated in cycles of presentation, literature review and discussion. Summary papers were prepared by each group and collated into this position paper highlighting the research gaps, with recommendations for action. RESULTS Gaps were identified in all seven themes. General barriers to progress were lack of financial and practical resources, and poor collaboration between disciplines. Critical gaps in each theme included: (1) genetics (knowledge of genetic changes, their effects and interactions); (2) initiation of breast cancer (how developmental signalling pathways cause ductal elongation and branching at the cellular level and influence stem cell dynamics, and how their disruption initiates tumour formation); (3) progression of breast cancer (deciphering the intracellular and extracellular regulators of early progression, tumour growth, angiogenesis and metastasis); (4) therapies and targets (understanding who develops advanced disease); (5) disease markers (incorporating intelligent trial design into all studies to ensure new treatments are tested in patient groups stratified using biomarkers); (6) prevention (strategies to prevent oestrogen-receptor negative tumours and the long-term effects of chemoprevention for oestrogen-receptor positive tumours); (7) psychosocial aspects of cancer (the use of appropriate psychosocial interventions, and the personal impact of all stages of the disease among patients from a range of ethnic and demographic backgrounds). CONCLUSION Through recommendations to address these gaps with future research, the long-term benefits to patients will include: better estimation of risk in families with breast cancer and strategies to reduce risk; better prediction of drug response and patient prognosis; improved tailoring of treatments to patient subgroups and development of new therapeutic approaches; earlier initiation of treatment; more effective use of resources for screening populations; and an enhanced experience for people with or at risk of breast cancer and their families. The challenge to funding bodies and researchers in all disciplines is to focus on these gaps and to drive advances in knowledge into improvements in patient care.
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MESH Headings
- Angiogenesis Inhibitors/therapeutic use
- Animals
- Antineoplastic Agents/therapeutic use
- Biomarkers, Tumor/analysis
- Biomedical Research
- Breast Neoplasms/blood supply
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Breast Neoplasms/physiopathology
- Breast Neoplasms/prevention & control
- Breast Neoplasms/therapy
- Carcinoma, Intraductal, Noninfiltrating
- Cell Transformation, Neoplastic/metabolism
- Cell Transformation, Neoplastic/pathology
- Clinical Trials as Topic
- Disease Models, Animal
- Disease Progression
- Evidence-Based Medicine
- Exercise
- Feeding Behavior
- Female
- Gene Expression Regulation, Neoplastic
- Genes, BRCA1
- Genes, BRCA2
- Genetic Predisposition to Disease
- Humans
- Mammography
- Mass Screening
- Neovascularization, Pathologic/drug therapy
- Neovascularization, Pathologic/metabolism
- Quality of Life
- Signal Transduction
- United Kingdom
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Affiliation(s)
- Alastair Thompson
- Department of Surgery and Molecular Oncology, University of Dundee, Ninewells Avenue, Dundee DD1 9SY, UK
| | - Keith Brennan
- Wellcome Trust Centre for Cell Matrix Research, Faculty of Life Sciences, University of Manchester, Oxford Road, Manchester M13 9PT, UK
| | - Angela Cox
- Institute for Cancer Studies, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX, UK
| | - Julia Gee
- Tenovus Centre for Cancer Research, Welsh School of Pharmacy, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff CF10 3NB, UK
| | - Diana Harcourt
- The Centre for Appearance Research, School of Psychology University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK
| | - Adrian Harris
- Cancer Research UK Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, Headington, Oxford OX3 9DS, UK
| | - Michelle Harvie
- Family History Clinic, Nightingale & Genesis Prevention Centre, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK
| | - Ingunn Holen
- Academic Unit of Clinical Oncology, School of Medicine and Biomedical Sciences, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK
| | - Anthony Howell
- Breast Cancer Prevention Centre, South Manchester University Hospitals NHS Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Robert Nicholson
- Tenovus Centre for Cancer Research, Welsh School of Pharmacy, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff CF10 3NB, UK
| | - Michael Steel
- University of St Andrews, Bute Medical School, University of St Andrews, Fife KT16 9TS, UK
| | - Charles Streuli
- Wellcome Trust Centre for Cell Matrix Research, Faculty of Life Sciences, University of Manchester, Oxford Road, Manchester M13 9PT, UK
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Brodersen J, Thorsen H. Consequences of Screening in Breast Cancer (COS-BC): development of a questionnaire. Scand J Prim Health Care 2008; 26:251-6. [PMID: 19034808 PMCID: PMC3406644 DOI: 10.1080/02813430802542508] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE The aims of the study were to translate and adapt both the negative and positive items of the Psychological Consequences Questionnaire (PCQ) into Danish and to test the translated version for comprehension, suitability, and content coverage by developing new items in a setting of false-positive screening mammography. DESIGN The translation was carried out following an internationally accepted method involving two panels: bilingual and lay. SUBJECTS The suitability and the content coverage of the PCQ were tested in six group interviews. Participants in the interviews were women who had had a false-positive screening mammography. They were grouped according to additional examinations they experienced following abnormal screening mammography. The audio-recordings from the group interviews were thematically analysed to identify the key consequences of abnormal and false-positive screening mammography. RESULTS Fifteen new items were generated to cover the negative psychosocial consequences of abnormal and false-positive screening mammography comprehensively. Five new items were produced that concerned the consequences of screening mammography during the period after being declared "free from" suspicion of cancer. Three items from the PCQ were deleted because they were judged by interviewees to be irrelevant. Response options for the positive items were changed to allow responses in both positive and negative directions. CONCLUSION Because of the major changes to both parts of the PCQ the measure derived from this study should be regarded as a new questionnaire with two parts: Consequences Of Screening in Breast Cancer (COS-BC). Part II focuses on the long-term consequences of a false-positive screening mammography.
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Affiliation(s)
- John Brodersen
- Department and Research Unit of General Practice, Centre for Health and Society, University of Copenhagen, Denmark.
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181
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Moyle P, Warren R. Screening women at moderate risk of breast cancer. Br J Hosp Med (Lond) 2007; 68:584-8. [PMID: 18087844 DOI: 10.12968/hmed.2007.68.11.27679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Penny Moyle
- University Department of Radiology, Addenbrooke's Hospital, Cambridge
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182
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Tyndel S, Austoker J, Henderson BJ, Brain K, Bankhead C, Clements A, Watson EK. What Is the Psychological Impact of Mammographic Screening on Younger Women With a Family History of Breast Cancer? Findings From a Prospective Cohort Study by the PIMMS Management Group. J Clin Oncol 2007; 25:3823-30. [PMID: 17761970 DOI: 10.1200/jco.2007.11.0437] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Studies are underway to establish the clinical effectiveness of annual mammographic screening in women younger than 50 years with a family history of breast cancer. This study investigated both the positive and negative psychological effects of screening on these women. Patients and Methods Women who received an immediate all-clear result after mammography (n = 1,174) and women who were recalled for additional tests before receiving an all-clear result (false positive; n = 112) completed questionnaires: 1 month before mammography, and 1 and 6 months after receiving final results. The questionnaires included measures of cancer worry, psychological consequences, and perceived benefits of breast screening. Results Women who received an immediate all-clear result experienced a decrease in cancer worry and negative psychological consequences immediately after the result, whereas women who were recalled for additional tests did not. By 6 months this cancer-specific distress had reduced significantly in both groups. Changes in levels of distress were significantly different between the two groups, but in absolute terms the differences were not large. Recalled women reported significantly greater positive psychological consequences of screening immediately after the result, and were also more positive about the benefits of screening compared with women who received an immediate all-clear result. Conclusion For women receiving an immediate all-clear result, participating in annual mammographic screening is psychologically beneficial. Furthermore, women who are recalled for additional tests do not appear to be harmed by screening: these women's positive views about mammography suggest that they view any distress caused by recall as an acceptable part of screening.
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Affiliation(s)
- Sally Tyndel
- Cancer Research UK, Primary Care Education Research Group, Division of Public Health, Primary Health Care, University of Oxford, Oxford, United Kingdom
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183
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Abstract
PURPOSE/OBJECTIVES To describe anxiety experienced by participants in a breast cancer screening program who have received an abnormal screening mammography result and are waiting for further testing and diagnosis and to identify the social support needed during this period. DESIGN Exploratory, descriptive. SETTING Quebec Breast Cancer Screening Program (QBCSP) participants in Montreal, Canada. SAMPLE Nonprobability sample of 631 asymptomatic women, aged 50-69, who had abnormal screening mammogram results in the two months prior to the survey and who spoke or read French or English. METHODS Mailed self-report questionnaire. MAIN RESEARCH VARIABLES Anxiety, social support, and breast cancer screening. FINDINGS Fifty-one percent of the participants were quite or very anxious at every stage of the prediagnostic phase. Seventy-five percent expressed their feelings to family and friends whose support was comforting but did not diminish participants' anxiety. Satisfaction from social support offered by healthcare professionals reduced their anxiety. CONCLUSIONS To decrease anxiety in the prediagnostic phase, women need support from healthcare professionals during the early stage of the screening process to prevent exacerbation of their concerns. Support has to be integrated into a continuity-of-care process. IMPLICATIONS FOR NURSING Nurses can play a significant role in breast cancer screening programs. They can evaluate, at an early stage, participant anxiety and offer the appropriate social support. They also can ensure the follow-up and personalized support required while a patient awaits a diagnosis.
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Carlsson S, Aus G, Wessman C, Hugosson J. Anxiety associated with prostate cancer screening with special reference to men with a positive screening test (elevated PSA) - Results from a prospective, population-based, randomised study. Eur J Cancer 2007; 43:2109-16. [PMID: 17643983 DOI: 10.1016/j.ejca.2007.06.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 06/05/2007] [Accepted: 06/06/2007] [Indexed: 10/23/2022]
Abstract
Levels of anxiety were assessed through questionnaires completed by 1781 screen-positive (PSA > or = 3 ng/mL) men attending the European Randomised Study of Screening for Prostate Cancer in Gothenburg, Sweden. During the first visit (clinical examination, including biopsies), no anxiety whilst awaiting the PSA test results was reported by 66% and 2% reported high levels of anxiety. A multinomial logistics model for repeated measurements, adjusted for age, PSA level, heredity, biopsy finding and urinary symptoms, revealed that anxiety awaiting the PSA was only influenced (increased) by the existence of previously elevated PSA tests (p<.0001). No anxiety associated with biopsy was reported by 45%, while 6% experienced high levels of anxiety. Levels of anxiety decreased significantly with subsequent rounds of examinations (p<0.0001) and with increasing age (p=0.0016). Anxiety associated with prostate cancer screening in general is low to moderate, even in men with elevated PSA, and severe anxiety affects a smaller group of susceptible men.
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Affiliation(s)
- Sigrid Carlsson
- Department of Urology, Sahlgrenska University Hospital, Bruna Stråket 11 B, SE-413 45 Göteborg, Sweden.
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185
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Schell MJ, Yankaskas BC, Ballard-Barbash R, Qaqish BF, Barlow WE, Rosenberg RD, Smith-Bindman R. Evidence-based target recall rates for screening mammography. Radiology 2007; 243:681-9. [PMID: 17517927 DOI: 10.1148/radiol.2433060372] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively identify target recall rates for screening mammography on the basis of how sensitivity shifts with recall rate. MATERIALS AND METHODS The study group included 1 872 687 subsequent and 171 104 first screening mammograms from 1996 to 2001 from 172 and 139 facilities, respectively, in six sites of the Breast Cancer Surveillance Consortium. Institutional review board (IRB) approval was obtained from each site. Informed consent requirements of the IRBs were followed. The study was HIPAA compliant. Recall rate was defined as the percentage of screening studies for which further work-up was recommended by the radiologist. Sensitivity was defined as the proportion of cancers that were detected at screening mammography. Piecewise linear regression was used to model sensitivity as a function of recall rate. This model allows detection of critical recall rates in which significant changes (shifts) occurred in the rates that sensitivity increased with increasing recall rate. Rates were interpreted as number of additional work-ups per additional cancer detected (AW/ACD) or, in other words, the estimated number of additional women needed to be recalled at a given rate to detect one additional cancer. RESULTS For first mammograms, a single shift in the estimated AW/ACD rate occurred at a recall rate of 10.0%, with the rate jumping dramatically from 35 to 172. For subsequent mammograms, four shifts were identified. At a recall rate of 6.7%, the estimated AW/ACD increased from 80 to 132, which rendered it the highest desirable target recall rate. At a recall rate of 12.3%, the estimated AW/ACD was 304, which suggests little benefit for any higher recall rate. CONCLUSION Recall rates of 10.0% for first and 6.7% for subsequent mammograms are recommended targets on the basis of their AW/ACD rates (less than 100).
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Affiliation(s)
- Michael J Schell
- Biostatistics Division, Department of Interdisciplinary Oncology, Moffitt Research Center, 12902 Magnolia Dr, Tampa, FL 33612-9497, USA.
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186
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Brodersen J, Thorsen H, Kreiner S. Validation of a condition-specific measure for women having an abnormal screening mammography. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2007; 10:294-304. [PMID: 17645684 DOI: 10.1111/j.1524-4733.2007.00184.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVES The aim of this study is to assess the validity of a new condition-specific instrument measuring psychosocial consequences of abnormal screening mammography (PCQ-DK33). METHODS The draft version of the PCQ-DK33 was completed on two occasions by 184 women who had received an abnormal screening mammography and on one occasion by 240 women who had received a normal screening result. Item Response Theories and Classical Test Theories were used to analyze data. Construct validity, concurrent validity, known group validity, objectivity and reliability were established by item analysis examining the fit between item responses and Rasch models. RESULTS Six dimensions covering anxiety, behavioral impact, sense of dejection, impact on sleep, breast examination, and sexuality were identified. One item belonging to the dejection dimension had uniform differential item functioning. Two items not fitting the Rasch models were retained because of high face validity. A sick leave item added useful information when measuring side effects and socioeconomic consequences of breast cancer screening. Five "poor items" were identified and should be deleted from the final instrument. CONCLUSIONS Preliminary evidence for a valid and reliable condition-specific measure for women having an abnormal screening mammography was established. The measure includes 27 "good" items measuring different attributes of the same overall latent structure-the psychosocial consequences of abnormal screening mammography.
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Affiliation(s)
- John Brodersen
- Department of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
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187
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Absolom K, Greenfield D, Ross R, Davies H, Hancock B, Eiser C. Reassurance following breast screening recall for female survivors of Hodgkin's lymphoma. Breast 2007; 16:590-6. [PMID: 17582768 DOI: 10.1016/j.breast.2007.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Revised: 03/09/2007] [Accepted: 05/02/2007] [Indexed: 11/18/2022] Open
Abstract
Female survivors of Hodgkin's lymphoma (HL) treated with mantle radiotherapy experience increased breast cancer risk related to radiation dose and age at diagnosis. In 2003, the Department of Health (DoH) in the UK recalled patients to explain this risk and offer screening. The aims of this paper are to describe women's emotional responses and knowledge of their personal risk following the recall. Women were interviewed before risk counselling and breast screening (Time 1, n=56) and again following screening and results (Time 2, n=50). Questionnaire measures of quality of life, anxiety, depression and cancer worries were completed at Time 2. No cases of breast cancer were identified. After the recall, 64% had learned more about late effects and 76% were reassured about their health. All but one woman intended to attend future screening. Women are keen to take advantage of screening and experience relatively little distress.
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Affiliation(s)
- Kate Absolom
- University of Sheffield, Department of Psychology, Western Bank, Sheffield, S10 2TP, UK.
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188
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Mueller-Holzner E, Frede T, Daniaux M, Ban M, Taucher S, Schneitter A, Zeimet AG, Marth C. Ultrasound-guided core needle biopsy of the breast: does frozen section give an accurate diagnosis? Breast Cancer Res Treat 2007; 106:399-406. [PMID: 17318378 DOI: 10.1007/s10549-007-9508-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Accepted: 01/01/2007] [Indexed: 11/30/2022]
Abstract
Reducing the period of uncertainty between the discovery of a breast tumor and histological diagnosis alleviates the psychological impact of breast cancer to an important degree. We aimed to verify whether histological results obtained with frozen sections of core needle biopsies (CNBs) offer an accurate and reliable tool for minimising this period. In 2619 cases we compared histological diagnosis on frozen sections with those on paraffin sections of CNB and finally with the results of open biopsies. Of the cases 49% were proved malignant and 51% benign. In 99.3% of the malignant lesions preceding CNB was correctly classified as B5 (n = 1185, 92.9%) or at least B4 (n = 82, 6.4%) in frozen and in paraffin sections. There were seven false-negative cases in frozen (false-negative rate = 0.5%) and five false-negative cases (false-negative rate = 0.4%) in paraffin sections of CNB. On frozen sections complete sensitivity was 99.5% and the positive predictive value of B5 was 99.9%. There was one false-positive case in frozen sections and one in paraffin sections. False-positive rate = 0.08%, negative predictive value for B2 = 99.4% for frozen and 99.6% for paraffin sections; full specificity was 85.9 for frozen and 85.8 for paraffin sections of CNBs. Immediate investigation of CNB in frozen sections is an accurate diagnostic method and an important step in reducing psychological strain on patients with breast tumors and may be offered by specialised Breast Assessment Units.
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189
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Joffe MM, Small D, Hsu CY. Defining and Estimating Intervention Effects for Groups that will Develop an Auxiliary Outcome. Stat Sci 2007. [DOI: 10.1214/088342306000000655] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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190
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Brodersen J, McKenna SP, Doward LC, Thorsen H. Measuring the psychosocial consequences of screening. Health Qual Life Outcomes 2007; 5:3. [PMID: 17210071 PMCID: PMC1770907 DOI: 10.1186/1477-7525-5-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Accepted: 01/08/2007] [Indexed: 11/13/2022] Open
Abstract
The last three decades have seen a dramatic rise in the implementation of screening programmes for cancer in industrialised countries. However, in contrast to screening for infectious diseases, most cancer screening programmes only have the potential to reduce mortality; they cannot lower the incidence of cancer in a population. In fact, most cancer screening programmes have been shown to increase the incidence of the disease as a consequence of over-diagnosis. A further dilemma of cancer screening programmes is that they do not distinguish between healthy people and those with disease. Rather, they identify a continuum of disease severity. Consequently, many healthy people who have abnormal screening tests are wrongly diagnosed. Indeed, studies have demonstrated that for each screening-prevented death from cancer, at least 200 false-positive results are given. Therefore, screening has the potential to be harmful as well as beneficial. The psychosocial consequences of false-positive screening results cannot be determined by diagnostic tests or by other technical means. Instead, patient reported outcome measures must be employed. To measure the outcomes of screening accurately and comprehensively patient reported outcome measures have to capture; the nature and extent of the psychosocial consequences and how these change over time. The outcome measures used must have high content validity and their psychometric properties should be determined prior to their use in the specific population. In particular it is important to establish unidimensionality, additivity and item ordering through the application of Item Response Theory.
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Affiliation(s)
- John Brodersen
- Department and Research Unit of General Practice, University of Copenhagen, Oester Farimagsgade 5, 24Q, Postbox 2099, DK-1014 Copenhagen, Denmark
| | - Stephen P McKenna
- Galen Research, Enterprise House, Manchester Science Park, Lloyd Street North, Manchester M15 6SE, UK
| | - Lynda C Doward
- Galen Research, Enterprise House, Manchester Science Park, Lloyd Street North, Manchester M15 6SE, UK
| | - Hanne Thorsen
- Department and Research Unit of General Practice, University of Copenhagen, Oester Farimagsgade 5, 24Q, Postbox 2099, DK-1014 Copenhagen, Denmark
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191
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Brindle LA, Oliver SE, Dedman D, Donovan JL, Neal DE, Hamdy FC, Lane JA, Peters TJ. Measuring the psychosocial impact of population-based prostate-specific antigen testing for prostate cancer in the UK. BJU Int 2006; 98:777-82. [PMID: 16978272 DOI: 10.1111/j.1464-410x.2006.06401.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the psychosocial impact of participation in a population-based prostate-specific antigen (PSA) testing programme, akin to screening, and to explore the relationship between urinary symptoms reported before PSA testing and the response to the subsequent PSA result. PATIENTS AND METHODS This prospective questionnaire study was nested within the case-finding component of the ProtecT (prostate testing for cancer and treatment) feasibility study (ISRCTN20141297). Men aged 50-69 years from 18 general practices in three cities in the UK completed the Hospital Anxiety and Depression Scale (HADS), the Short Form-12 (SF-12) Health Survey, and the International Continence Society 'male' (ICSmale) questionnaires before giving consent for a PSA test in a community clinic (baseline). Men with an 'abnormal' PSA result returned for further investigation (including biopsy) and repeated these questionnaires before biopsy. RESULTS At baseline, study participants had similar levels of anxiety and depression to the general male population. There was no increase in the HADS scores, or reduction in the SF-12 mental health component summary score, on attendance at the biopsy clinic after receiving an 'abnormal' PSA result. Urinary symptoms were associated with levels of anxiety and depression before receiving a PSA result (baseline), but were not associated with anxiety and depression at biopsy independently of baseline scores. Therefore changes in anxiety or depression at biopsy did not appear to differ between those with and without urinary symptoms. CONCLUSIONS This study confirms the findings of other studies that the deleterious effects of receiving an abnormal PSA result during population screening are not identified by generic health-status questionnaires. Comparisons with outcomes of studies measuring cancer-specific distress and using qualitative research methods raise the question of whether a prostate cancer screening-specific instrument is required. However, a standardized measure of anxiety identified differences at baseline between those who did and did not report urinary symptoms. These findings suggest that it might be advisable to better inform men undergoing PSA testing about the uncertain relationship between urinary symptoms and prostate cancer, to minimize baseline levels of psychological distress.
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Affiliation(s)
- Lucy A Brindle
- School of Nursing and Midwifery, University of Southampton, Southampton, UK.
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192
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Taupin D, Chambers SL, Corbett M, Shadbolt B. Colonoscopic screening for colorectal cancer improves quality of life measures: a population-based screening study. Health Qual Life Outcomes 2006; 4:82. [PMID: 17044941 PMCID: PMC1626073 DOI: 10.1186/1477-7525-4-82] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Accepted: 10/18/2006] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Screening asymptomatic individuals for neoplasia can have adverse consequences on quality of life. Colon cancer screening is widespread but the quality of life (QOL) consequences are unknown. This study determined the impact of screening colonoscopy on QOL measures in asymptomatic average-risk participants. METHODS Asymptomatic male and female participants aged 55-74 years were randomly selected from the Australian Electoral Roll or six primary care physicians' databases. Participants completed the Short-Form (SF-36) Quality of Life Assessment at baseline and at a mean of 39 days after colonoscopy. Outcome measures were (i) significant changes in raw scores in any of the eight SF-36 domains assessed following colonoscopic screening and (ii) improvements or declines in previously validated categories, representing clinically significant changes, within any of the eight SF-36 domains. RESULTS Baseline QOL measures were similar to those of a matched general population sample. Role Limitations due to Emotions, Mental Health and Vitality raw scores significantly improved following colonoscopy (P < 0.05, 2-tailed t-test). Health ratings according to Category were similar (same clinical status) in the majority of participants. However, 30% participants recorded clinically significant improvement in the Mental Health and Vitality domains (P < 0.05, Wilcoxon Signed-Ranks test). This improvement was not offset by declines in other domains or in other participants. Improvement in QOL was not related to colonoscopy results. CONCLUSION Average-risk persons benefit significantly from colon cancer screening with colonoscopy, improving in Mental Health and Vitality domains of Quality of Life. This improvement is not offset by declines in other domains.
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Affiliation(s)
- Doug Taupin
- Gastroenterology and Hepatology Unit and Centre for Advances in Epidemiology and Information Technology, The Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory, Australia
| | - Sharon L Chambers
- Gastroenterology and Hepatology Unit and Centre for Advances in Epidemiology and Information Technology, The Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory, Australia
| | - Mike Corbett
- Gastroenterology and Hepatology Unit and Centre for Advances in Epidemiology and Information Technology, The Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory, Australia
| | - Bruce Shadbolt
- Gastroenterology and Hepatology Unit and Centre for Advances in Epidemiology and Information Technology, The Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory, Australia
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Gui GPH, Kadayaprath G, Darhouse N, Self J, Ward A, A'Hern R, Eeles R. Clinical outcome and service implications of screening women at increased breast cancer risk from a family history. Eur J Surg Oncol 2006; 32:719-24. [PMID: 16784834 DOI: 10.1016/j.ejso.2006.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Accepted: 05/03/2006] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The value of special screening for women at moderate breast cancer risk with a family history of breast cancer remains controversial. Little is known about recall rates, false negative outcomes and the impact on clinical service. Despite this, surveillance programmes within breast units have been established in the United Kingdom. PATIENTS AND METHODS In our institution, screening of women at moderate (lifetime risk, 17-30%) and high risk (>30%) consisted of annual clinical examination and mammography from the age of 35 years. The active study period ran for four months and each patient was followed through a further screening cycle (whole study period), providing information on interval cancers and detection at the subsequent screen. RESULTS One thousand one hundred and thirty-two women attended for their incident screen: 137 at high risk, 803 at moderate risk and 192 at standard risk. The median age at cancer diagnosis in the moderate risk group was 54 (range, 45-68) years and the high-risk group 51 (46-52) years, compared to 63 (45-69) years in the standard risk group. Seven cancers were diagnosed during the four-month active study period. Two patients were diagnosed with interval cancers and eight at the next screen, giving a cancer incidence in the whole study period of 17/1132 (1.5%). Thirteen patients had invasive cancer and four had ductal carcinoma in situ (DCIS) The median invasive tumour size was 15 had (range, 7-28)mm and the median DCIS size was 4 (2-30)mm. 10/13 (76.9%) invasive cancers were < or =20mm and 2/13 patients (15.4%) with invasive cancer were lymph node positive. The sensitivity and specificity of mammography were 85.7% and 98.8%, respectively. The mammogram recall rate was 27.6 per 1000. The benign to malignant surgery ratio was 8:17. CONCLUSION Screening women at increased breast cancer risk is effective. Early detection and recall rates are comparable to that of older women attending the British National Breast Screening Programme.
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Affiliation(s)
- G P H Gui
- Department of Academic Surgery and the Breast Diagnostic Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, United Kingdom.
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194
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Jatoi I, Zhu K, Shah M, Lawrence W. Psychological Distress in U.S. Women Who Have Experienced False-Positive Mammograms. Breast Cancer Res Treat 2006; 100:191-200. [PMID: 16773439 DOI: 10.1007/s10549-006-9236-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2006] [Accepted: 03/21/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the United States, approximately 10.7% of all screening mammograms lead to a false-positive result, but the overall impact of false-positives on psychological well-being is poorly understood. MATERIALS AND METHODS Data were analyzed from the 2000 U.S. National Health Interview Survey (NHIS), the most recent national survey that included a cancer control module. Study subjects were 9,755 women who ever had a mammogram, of which 1,450 had experienced a false-positive result. Psychological distress was assessed using the validated K6 questionnaire and logistic regression was used to discern any association with previous false-positive mammograms. RESULTS In a multivariate analysis, women who had indicated a previous false-positive mammogram were more likely to report feeling sad (OR = 1.18, 95% CI, 1.03-1.35), restless (OR = 1.23, 95% CI, 1.08-1.40), worthless (OR = 1.27, 95% CI, 1.04-1.54), and finding that everything was an effort (OR = 1.27, 95% CI, 1.10-1.47). These women were also more likely to have seen a mental health professional in the 12 months preceding the survey (OR = 1.28, 95% CI, 1.03-1.58) and had a higher composite score on all items of the K6 scale (P < 0.0001), a reflection of increased psychological distress. Analyses by age and race revealed that, among women who had experienced false-positives, younger women were more likely to feel that everything was an effort, and blacks were more likely to feel restless. CONCLUSION In a random sampling of the U.S. population, women who had previously experienced false-positive mammograms were more likely to report symptoms of anxiety and depression.
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Affiliation(s)
- Ismail Jatoi
- Department of Surgery, National Naval Medical Center and Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
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195
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Twine C, Barthelmes L, Gateley CA. Kylie Minogue's breast cancer: effects on referrals to a rapid access breast clinic in the UK. Breast 2006; 15:667-9. [PMID: 16730988 DOI: 10.1016/j.breast.2006.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2005] [Revised: 02/16/2006] [Accepted: 03/08/2006] [Indexed: 12/13/2022] Open
Abstract
We examine the effect of the announcement of Kylie's breast cancer on referrals to a rapid access breast clinic in the United Kingdom. General practitioner referrals were examined, concentrating on June 2005; the month following Kylie's diagnosis. Time series analysis with autoregressive integrated moving average modeling was used to forecast data. There was a significant increase in referrals and radiographic investigations, with no increase in the number of malignant diagnoses. It is encouraging that media campaigns appear to make women more 'breast aware;' however there may also be a detrimental effect with increased radiation exposure, anxiety and cancer phobia.
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Affiliation(s)
- C Twine
- Breast Unit, Department of General Surgery, Royal Gwent Hospital, Cardiff road, Newport, South Wales NP20 2UB, UK.
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