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Blay Aulina L, Louro Aldamiz-Echevarría J, Ribes Cajas P, Pascual Miguel I, Mitkova Borisova I, Sanchez Haro E, Luna Tomás M, Ríos Gozalvez C, Parrales Mora M, Pares Martínez D, Sala Serra M, Julian Ibañez J. Cáncer de mama en pacientes octogenarias. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2022. [DOI: 10.1016/j.gine.2021.100722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Alves MS, Ferro AGL, Moreira MCL, Santos WS, Neves LP, Perini AP, Belinato W, Souza DN. Estimated risk of radiation-induced cancer following breast screening employing tomosynthesis and digital mammography. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:254-265. [PMID: 33498015 DOI: 10.1088/1361-6498/abdfd8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 01/26/2021] [Indexed: 06/12/2023]
Abstract
The objective of this study was to estimate the risk of radiation-induced injury to the organs due to ionizing radiation following breast screening recommendations employing digital breast tomosynthesis (DBT) and digital mammography (DM). Using the Monte Carlo method, absorbed doses in the tissues and organs were calculated on an adult female phantom, considering two-view craniocaudal (CC) and mediolateral oblique (MLO) projections for each breast. The results showed differences in the total effective risk due to DM (CC + MLO) and DBT (CC + MLO) examinations in Brazil, ranging from 20.73 cases 10-5(DM) to 27.19 cases 10-5(DBT). Significant differences were also observed in the total effective risk of cancer incidence in the lungs due to DM (CC + MLO) and DBT (CC + MLO), ranging from 1.75×10-01cases 10-5(DM) to 1.76×10-01cases 10-5(DBT). The results indicate that the total effective risk of incidence should be considered as an additional parameter for the evaluation of DBT or DBT + DM program performance.
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Affiliation(s)
- Marcos S Alves
- Departamento de Física, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil
| | - Ana G L Ferro
- Departamento de Física, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil
| | - Márcia C L Moreira
- Departamento de Física, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil
| | - William S Santos
- Instituto de Física, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - Lucio P Neves
- Instituto de Física, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
- Programa de Pós-Graduação em Engenharia Biomédica, Faculdade de Engenharia Elétrica, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - Ana P Perini
- Instituto de Física, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
- Programa de Pós-Graduação em Engenharia Biomédica, Faculdade de Engenharia Elétrica, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - Walmir Belinato
- Instituto Federal da Bahia (IFBA), Vitória da Conquista, BA, Brazil
| | - Divanizia N Souza
- Departamento de Física, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil
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Firouzbakht M, Hajian-Tilaki K, Bakhtiari A. Comparison of competitive cognitive models in explanation of women breast cancer screening behaviours using structural equation modelling: Health belief model and theory of reasoned action. Eur J Cancer Care (Engl) 2020; 30:e13328. [PMID: 32909679 DOI: 10.1111/ecc.13328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 01/22/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The efficacy of the theory of reasoned action (TRA), compared with the health belief model (HBM), has not been fully elucidated in screening practices. METHODS This population-based cross-sectional study was conducted with samples of 500 women aged 35-85 years, in the north of Iran. The data of demographic characteristics, awareness, health belief, subjective norms and screening behaviours were collected using standard instruments. Structural equation modelling (SEM) was applied to estimate the pathways of regression coefficients. RESULTS The model that incorporated the health belief and the standardised coefficient of the knowledge scores influenced significantly on the health belief perception (beta = 0.375), and consequently, the health belief directly affected screening behaviours (beta = 0.73). In contrast, In TRA model, while the direct effect of knowledge on intention was negligible it has a greater indirect effect by mediating health belief and subjective norms (indirect beta = 0.35) on behaviour intention. A high coefficient of intention was observed by subjective norms (beta = 0.626), and the intention has a great positive effect on screening behaviour (beta = 0.601). All fitting indexes were quietly improved in the TRA model as compared with HBM. CONCLUSION Thus, the unifying structure of knowledge, health belief, subjective norms and intention improves the predictor power in breast cancer screening behaviours.
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Affiliation(s)
- Mojgan Firouzbakht
- Department of nursing- midwifery, Babol Branch, Islamic Azad University, Babol, Iran
| | - Karimollah Hajian-Tilaki
- Department of Biostatistics and Epidemiology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Afsaneh Bakhtiari
- Department of Midwifery, School of Medicine, Babol University of Medical Sciences, Babol, Iran
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Rundle A, Iles S, Matheson K, Cahill LE, Forbes CC, Saint-Jacques N, Urquhart R, Younis T. Women's views about breast cancer prevention at mammography screening units and well women's clinics. ACTA ACUST UNITED AC 2020; 27:e336-e342. [PMID: 32669942 DOI: 10.3747/co.27.5755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Women attending mammography screening units (msus) and well women's clinics (wwcs) represent a motivated cohort likely to engage in interventions aimed at primary breast cancer (bca) prevention. Methods We used a feasibility questionnaire distributed to women (40-49 or 50-74 years of age) attending msus and wwcs in Halifax, Nova Scotia, to examine■ women's views about bca primary prevention and sources of health care information,■ prevalence of lifestyle-related bca risk factors, and■ predictors of prior mammography encounters within provincial screening guidelines.Variables examined included personal profiling, comorbidities, prior mammography uptake, lifestyle behaviours, socioeconomic status, health information sources, and willingness to discuss or implement lifestyle modifications, or endocrine therapy, or both. A logistic regression analysis examined associations with prior mammography encounters. Results Of the 244 responses obtained during 1.5 months from women aged 40-49 years (n = 75) and 50-74 years (n = 169), 56% and 75% respectively sought or would prefer to receive health information from within, as opposed to outside, health care. Lifestyle-related bca risk factors were prevalent, and most women were willing to discuss or implement lifestyle modifications (93%) or endocrine therapy (67%). Of the two age groups, 49% and 93% respectively had previously undergone mammography within guidelines. Increasing age and marital status (single, separated, or divorced vs. married or partnered) were independent predictors of prior mammography encounters within guidelines for women 40-49 years of age; no independent predictors were observed in the older age group. Conclusions Women attending msus and wwcs seem to largely adhere to mammography guidelines and appear motivated to engage in bca primary prevention strategies, including lifestyle modifications and endocrine therapy. Women's views as observed in this study provide a rationale for the potential incorporation of bca risk assessment within the "mammogram point of care" to engage motivated women in bca primary prevention strategies.
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Affiliation(s)
- A Rundle
- Faculty of Medicine, Dalhousie University, Halifax, NS
| | - S Iles
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS.,Nova Scotia Health Authority (nsha), Halifax, NS
| | - K Matheson
- Research Methods Unit, nsha, Halifax, NS.,Department of Medicine, Dalhousie University, Halifax, NS
| | - L E Cahill
- Nova Scotia Health Authority (nsha), Halifax, NS.,Department of Medicine, Dalhousie University, Halifax, NS.,Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS
| | - C C Forbes
- Nova Scotia Health Authority (nsha), Halifax, NS.,Department of Medicine, Dalhousie University, Halifax, NS
| | - N Saint-Jacques
- Department of Medicine, Dalhousie University, Halifax, NS.,nsha Cancer Care Program, Registry and Analytics, Halifax, NS
| | - R Urquhart
- Nova Scotia Health Authority (nsha), Halifax, NS.,Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS
| | - T Younis
- Nova Scotia Health Authority (nsha), Halifax, NS.,Department of Medicine, Dalhousie University, Halifax, NS
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Karakatsanis A, Markopoulos C. The challenge of avoiding over- and under-treatment in older women with ductal cancer in situ: A scoping review of existing knowledge gaps and a meta-analysis of real-world practice patterns. J Geriatr Oncol 2020; 11:917-925. [PMID: 32146094 DOI: 10.1016/j.jgo.2020.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/25/2020] [Accepted: 02/18/2020] [Indexed: 01/03/2023]
Abstract
Ductal cancer in situ (DCIS) is mainly a screen-detected disease and although the risk for breast cancer is age-dependent, most screening programs do not include women over the age of 75 years. Older women are usually excluded from clinical trials and treatment practices are largely based on observational studies or extrapolation of trial results from younger patients, leading to either over- or under-treatment of this population. We systematically reviewed available electronic databases for DCIS treatment patterns and outcomes in older patients 15 years. Inclusion criteria allowed for randomised controlled trials, cohort studies, case-control and cross-sectional studies, as well as meta-analyses, systematic reviews and position papers. Results showed that, although elderly are not necessarily frail, they are generally treated as such by physicians, aiming to de-escalate therapeutic interventions. After adjusting for frailty, age seems to be a significant factor for less surgery; however, older women with DCIS are more probable to receive surgery than their counterparts with early invasive cancer. DCIS biology and subtypes are independent risk factors for local recurrence or progression to invasive carcinoma, if DCIS is under-treated. The end-benefit of surgery, radio- and endocrine-therapy depend on additional parameters, such as life expectancy, co-morbidities and competing risks of death. Screen-detected DCIS in older women is a challenging clinical problem, mainly due to the lack of high-level data. Therapeutic strategies should be tailored to life expectancy and performance status, DCIS features and patient preference, aiming at combining optimal oncological outcomes with maintenance of quality of life.
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Affiliation(s)
- Andreas Karakatsanis
- Section for Endocrine and Breast Surgery, Department for Surgical Sciences, Uppsala University, Uppsala, Sweden.
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Marmarà D, Marmarà V, Hubbard G. Predicting reattendance to the second round of the Maltese national breast screening programme: an analytical descriptive study. BMC Public Health 2019; 19:189. [PMID: 30760275 PMCID: PMC6374893 DOI: 10.1186/s12889-019-6507-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 02/01/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND A range of barriers influence women's uptake to a first breast screening invitation. Few studies however, have examined factors associated with second screening uptake. This study follows Maltese women to explore predictors and behaviours to re-attendance, and to determine if uptake of first invitation to the Maltese Breast Screening Programme (MBSP) is a significant predictor of second screening uptake. METHODS A prospective study was conducted to determine factors associated with re-attendance for 100 women invited to the second MBSP round. Records of women's second attendance to the MBSP were extracted in January 2016 from the MBSP database. Data were analyzed using chi-square tests, Independent Samples t-test, Mann Whitney test, Shapiro Wilk test and logistic regression. RESULTS There were no significant associations for sociodemographic or health status variables with second screening uptake (p > 0.05), except breast condition (Fisher's exact test, p = 0.046). Non-attendees at second screening were most unsure of screening frequency recommendations (χ2 = 9.580, p = 0.048). Attendees were more likely to perceive their susceptibility to breast cancer (p = 0.041), believed breast cancer to be life changing (p = 0.011) and considered cues to action to aid attendance (p = 0.028). Non-attendees were in stronger agreement on mammography pain (p = 0.008) and were less likely to consider cues to action (15.4% non-attendees vs 1.4% attendees) (p = 0.017 respectively). 'Perceived barriers', 'breast cancer identity', 'causes' and 'consequences' were found to be significant predictors of second screening uptake, with 'perceived barriers' being the strongest. The inclusion of illness perception items improved the regression model's accuracy in predicting non-attendance to the second screening round (84.6% vs 30.8%). First screening uptake was found to be a significant predictor of subsequent uptake (OR = 0.102; 95% CI = 0.037, 0.283; p = 0.000). CONCLUSIONS Interventions to increase uptake should target first invitees since attending for the first time is a strong predictor of uptake to the second cycle. Further research is required given the small sample. Particular attention should be paid to women who did not respond to their first invite or are unsure or reluctant participants initially.
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Affiliation(s)
- Danika Marmarà
- Faculty of Health Sciences, University of Stirling, School of Health Sciences, Room E9, Pathfoot, Stirling, FK9 4LA Scotland
- Cancer Care Pathways Directorate, Sir Anthony Mamo Oncology Centre, Level -1, Dun Karm Street, Msida, MSD 2090 Malta
| | | | - Gill Hubbard
- Highland Campus, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH UK
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Marmarà D, Marmarà V, Hubbard G. A national cross-sectional study of adherence to timely mammography use in Malta. BMC Cancer 2018; 18:346. [PMID: 29587678 PMCID: PMC5870824 DOI: 10.1186/s12885-018-4278-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 03/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Routine mammography improves survival. To achieve health benefits, women must attend breast screening regularly at recommended time intervals. Maltese women are routinely invited to undergo mammography at three-year intervals at an organized breast screening programme (MBSP) or can opt to attend a private clinic. Previous research shows that health beliefs, particularly perceived barriers, were the most significant predictors of uptake to the first MBSP invitation. Whether these beliefs and other factors are predictive of adherence with recommended time intervals for mammography at organized or private screening in Malta is unknown. For the first time, this paper explores the predictors for Maltese women screened within or exceeding the recommended three-year frequency in organized or private screening in Malta. METHODS Information was obtained from a cross-sectional survey of 404 women, aged 50 to 60 years at the time of their first MBSP invitation, where women's characteristics, knowledge, health beliefs and illness perceptions were compared. The main variable of interest was women's mammography attendance within a three-year interval (ADHERENT) or exceeding three years (NON-ADHERENT). Data were analysed using descriptive statistics, chi-square test, Mann Whitney test, Independent Samples t-test and Shapiro Wilk test. RESULTS At the time of the survey, 80.2% (n = 324) had been screened within three years (ADHERENT), 5.9% (n = 24) had exceeded the three-year frequency (NON-ADHERENT) while 13.9% (n = 56) never had a mammogram. No significant associations were found between ADHERENT or NON-ADHERENT women in relation to sociodemographic or health status variables (p > 0.05). Knowledge of screening frequency was significantly associated with women's mammography adherence (χ2 = 5.5, p = 0.020). Health beliefs were the strongest significant predictors to describe the variance between ADHERENT and NON-ADHERENT screeners. When Mann Whitney test and Independent Samples t-test were applied on mammography adherence, perceived barriers and cues to action were found to be the most important predictors (p = 0.000, p = 0.039 respectively). CONCLUSIONS To increase routine and timely mammography practices, women who are non-adherent to recommended time frequency guidelines should be targeted, together with their health beliefs, predominantly perceived barriers and cues to action.
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Affiliation(s)
- Danika Marmarà
- Faculty of Health Sciences, University of Stirling, Room E9, Pathfoot, Stirling, FK9 4LA, Scotland. .,Ministry for Health, Cancer Care Pathways Directorate, Sir Anthony Mamo Oncology Centre, Level -1, Dun Karm Psaila Street, Msida, MSD, 2090, Malta.
| | - Vincent Marmarà
- Faculty of Economics, Management and Accountancy, University of Malta, Room 408, Msida, MSD 2080, Malta
| | - Gill Hubbard
- Faculty of Health Sciences, University of Stirling, Room E9, Pathfoot, Stirling, FK9 4LA, Scotland
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Marmarà D, Marmarà V, Hubbard G. Lifetime utilization of mammography among Maltese women: a cross-sectional survey. BMC Public Health 2018; 18:182. [PMID: 29370835 PMCID: PMC5785821 DOI: 10.1186/s12889-018-5093-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The knowledge of Maltese women not attending the Maltese Breast Screening Programme (MBSP) for mammography screening is scarce. Previous research has identified two distinct groups of non-attendees: those who do not attend because a mammogram was taken elsewhere and those who never attended for mammography anywhere. It is however unknown which determinants are predictive of lifetime attendance 'anywhere' and 'real' non-attendance. The present study examines the relationship between ever-using (Lifetime attendees) or never using mammography (Lifetime non-attendees) and psychosocial - as well as sociodemographic factors, with the aim to identify predictors that can inform practice. METHODS Women's characteristics, knowledge, health beliefs and illness perceptions were compared, based on prior data of 404 women, aged 50-60 years at the time of their first MBSP invitation. The main variable of interest described women's attendance to mammography (LIFETIME ATTENDEES) and no mammography (LIFETIME NON-ATTENDEES). Data were analyzed using descriptive statistics, chi-square tests, Mann Whitney test, Independent Samples t-test, Shapiro Wilk test and logistic regression. RESULTS During their lifetime, 86.1% of Maltese women (n = 348) were attendees, while 13.9% (n = 56) were non-attendees. Non-attendees were more likely to be women with a lower family income (χ2 = 13.1, p = 0.011), widowers (χ2 = 9.0, p = 0.030), non-drivers (χ2 = 7.7, p = 0.006), without a breast condition (χ2 = 14.2, p < 0.001), who had no relatives or close friends with cancer (χ2 = 8.3, p = 0.016), and who were less encouraged by a physician (χ2 = 4.9, p = 0.027), unsure of the screening frequency (χ2 = 28.5, p < 0.001), more anxious (p = 0.040) and fearful (p = 0.039). Perceived benefits, barriers, cues to action, self-efficacy and emotional representations were the most significant variables to describe the differences between lifetime attendees and non-attendees. Perceived barriers and cues to action were the strongest predictors for lifetime non-attendance (p < 0.05 respectively). CONCLUSIONS The health beliefs of women who have never attended for mammography during their lifetime should be targeted, particularly perceived barriers and cues to action. Further research should focus on understanding knowledge gaps, attitudinal barriers and emotional factors among 'real' non-attendees who require a more targeted approach.
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Affiliation(s)
- Danika Marmarà
- Faculty of Health Sciences, University of Stirling, Room E9, Pathfoot, Stirling, FK9 4LA, Scotland.
- Ministry for Health, Cancer Care Pathways Directorate, Sir Anthony Mamo Oncology Centre, Level -1, Dun Karm Psaila Street, Msida, MSD 2090, Malta.
| | | | - Gill Hubbard
- Faculty of Health Sciences, University of Stirling, Room E9, Pathfoot, Stirling, FK9 4LA, Scotland
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Maltese Translation and Adaptation of Champion's Health Belief Model Scale and the Revised Illness Perception Questionnaire for Breast Screening Among Maltese Women. J Nurs Meas 2017; 25:486-503. [PMID: 29268831 DOI: 10.1891/1061-3749.25.3.486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Translating, adapting, and piloting Champion's Health Belief Model Scale for Mammography Screening (CHBMS-MS) and Revised Illness Perception Questionnaire (IPQ-R) among Maltese women. METHODS The Maltese questionnaire (Maltese Breast Screening Questionnaire [MBSQ]) was developed through 9 steps. Bilingual women (n = 15) completed MBSQ at 2 time points. RESULTS During forward-backward translations (Steps 1-4), 4 English controversial terms were raised. Twelve experts agreed on terminologies during adaptation process (Step 5). Following face validity (n = 6; Step 6), 3 items were deleted. Following reconciliation (Step 7) and proofreading (Step 8), MBSQ consisted of 121 items. Pilot testing (Step 9) showed positive correlation (CHBMS-MS = .87, IPQ-R = .85; p < .001); high Cronbach's alpha (CHBMS-MS = .93, IPQ-R = .92); overall acceptable internal consistency (CHBMS-MS = .69-.83, IPQ-R = .75-.93); and acceptable test-retest reliability correlations: CHBMS-MS (Maltese = .62-.76; English = .61-.84), IPQ-R (Maltese=.63-.82; English = .61-.91; p < .001). CONCLUSIONS Maltese and English scale items demonstrated high reliability and validity preliminary values.
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Marmarà D, Marmarà V, Hubbard G. Health beliefs, illness perceptions and determinants of breast screening uptake in Malta: a cross-sectional survey. BMC Public Health 2017; 17:416. [PMID: 28482828 PMCID: PMC5422914 DOI: 10.1186/s12889-017-4324-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 04/27/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Women's beliefs and representations of breast cancer (BC) and breast screening (BS) are salient predictors for BS practices. This study utilized the health belief model (HBM) and common-sense model (CSM) of illness self-regulation to explore factors associated with BS uptake in Malta and subsequently, to identify the most important predictors to first screening uptake. METHODS This cross-sectional survey enrolled Maltese women (n = 404) ages 50 to 60 at the time of their first screening invitation, invited to the National Breast Screening Programme by stratified random sampling, with no personal history of BC. Participants responded to a 121-item questionnaire by telephone between June-September 2015. Data were analyzed using descriptive statistics, chi-square tests and logistic regression. RESULTS There is high awareness of BC signs and symptoms among Maltese women (>80% agreement for 7 out of 8 signs), but wide variation about causation (e.g., germ or virus: 38.6% 'agree', 30.7% 'disagree'). 'Fear' was the key reason for non-attendance to first invitation (41%, n = 66) and was statistically significant across all subscale items (p < 0.05). Most items within HBM constructs (perceived barriers; cues to action; self-efficacy) were significantly associated with first invitation to the National Breast Screening Programme, such as fear of result (χ2 = 12.0, p = 0.017) and life problems were considered greater than getting mammography (χ2 = 38.8, p = 0.000). Items within CSM constructs of Illness Representation (BC causes; cyclical cancer timeline; consequences) were also significantly associated, such as BC was considered to be life-changing (χ2 = 18.0, p = 0.000) with serious financial consequences (χ2 = 13.3, p = 0.004). There were no significant associations for socio-demographic or health status variables with uptake, except for family income (χ2 = 9.7, p = 0.047). Logistic regression analyses showed that HBM constructs, in particular perceived barriers, were the strongest predictors of non-attendance to first invitation throughout the analyses (p < 0.05). However, the inclusion of illness representation dimensions improved the model accuracy to predict non-attendance when compared to HBM alone (65% vs 38.8%). CONCLUSIONS Interventions should be based on theory including HBM and CSM constructs, and should target first BS uptake and specific barriers to reduce disparities and increase BS uptake in Malta.
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Affiliation(s)
- Danika Marmarà
- Faculty of Health Sciences, University of Stirling, Room E9, Pathfoot, Stirling, FK9 4LA, Scotland, UK.
- Cancer Care Pathways Directorate, Sir Anthony Mamo Oncology Centre, Level -1, Dun Karm Street, Msida, MSD, 2090, Malta.
| | - Vincent Marmarà
- Department of Mathematics, University of Stirling, Stirling, FK94LA, Scotland, UK
- Department of Management, University of Malta, Msida, Malta
| | - Gill Hubbard
- Faculty of Health Sciences, University of Stirling, Room E9, Pathfoot, Stirling, FK9 4LA, Scotland, UK
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Primary Care Providers' Barriers and Adherence to the U.S. Preventive Services Task Force Mammography Screening Guidelines. J Dr Nurs Pract 2017; 10:38-44. [PMID: 32751040 DOI: 10.1891/2380-9418.10.1.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Earlier detection through mammography screening, increased awareness, and improved treatment modalities has resulted in a decline in breast cancer incidence. Despite the availability of the clinical guidelines by the U.S. Preventive Services Task Force (USPSTF), adherence to these methods is only 42% (Meissener, Klabunde, Breen, & Zapka, 2011). The purpose of this scholarly project was to identify and improve provider's adherence to the USPSTF mammography screening clinical guidelines in three primary care clinics located in Southeastern North Carolina. The project included development of an educational program to increase awareness of the guidelines followed by measures to increase screening. A posteducation intervention chart review was completed to determine if there was an increase in adherence and use to the guidelines. Sample size included 90 retrospective chart reviews of the patients meeting the criteria for mammography screening. Based on the results, further recommendations were provided to the providers to improve adherence. Data analysis was conducted using descriptive statistics. The findings of this project identified barriers to the adherence to the USPSTF mammography screening guidelines among primary care providers in the three clinics selected. The educational intervention increased the adherence to the USPSTF mammography screening guideline from 15% to 16%.
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Zehtab N, Jafari M, Barooni M, Nakhaee N, Goudarzi R, Zadeh MHL. Cost-Effectiveness Analysis of Breast Cancer Screening in Rural Iran. Asian Pac J Cancer Prev 2016; 17:609-14. [DOI: 10.7314/apjcp.2016.17.2.609] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ambroggio S, Peris C, Picardo E, Mitidieri M, Minniti E, Benedetto C, Gregori G, Baù MG. β-thalassemia patients and gynecological approach: review and clinical experience. Gynecol Endocrinol 2016; 32:171-6. [PMID: 26492849 DOI: 10.3109/09513590.2015.1109617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Significant improvements in therapy and life expectancy of β-thalassemia patients in last decades result in the need of commitment for gynecologists and obstetricians as the complexity of organ impairment needs a specific multidisciplinary approach. After a review of clinical manifestations of β-thalassemia from a gynecologic point of view, we present the experience of a gynecologic center in treating β-thalassemia patients from more than 20 years.
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Affiliation(s)
- Simona Ambroggio
- a CIDIMU, Centro Italiano di Diagnostica Medica Ultrasonica , Torino , Italia
| | - Clementina Peris
- b Gin&Co, Ginecologia Mini Invasiva e Senologia , Torino , Italia
| | | | | | | | | | - Gianluca Gregori
- e Ginecologia e Ostetricia 3, A.O.U. Città della Salute e della Scienza di Torino, Sant'Anna Hospital , Torino , Italy
| | - Maria G Baù
- e Ginecologia e Ostetricia 3, A.O.U. Città della Salute e della Scienza di Torino, Sant'Anna Hospital , Torino , Italy
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Guessous I, Cornuz J. Why and how would we implement a lung cancer screening program? Public Health Rev 2015; 36:10. [PMID: 29450038 PMCID: PMC5804495 DOI: 10.1186/s40985-015-0010-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 10/02/2015] [Indexed: 12/18/2022] Open
Abstract
For decades, lung cancer has been the most common cancer in terms of both incidence and mortality. There has been very little improvement in the prognosis of lung cancer. Early treatment following early diagnosis is considered to have potential for development. The National Lung Screening Trial (NLST), a large, well-designed randomized controlled trial, evaluated low-dose computed tomography (LDCT) as a screening tool for lung cancer. Compared with chest X-ray, annual LDCT screening reduced death from lung cancer and overall mortality by 20 and 6.7 %, respectively, in high-risk people aged 55–74 years. Several smaller trials of LDCT screening are under way, but none are sufficiently powered to detect a 20 % reduction in lung cancer death. Thus, it is very unlikely that the NLST results will be replicated. In addition, the NLST raises several issues related to screening, such as the high false-positive rate, overdiagnosis and cost. Healthcare providers and systems are now left with the question of whether the available findings should be translated into practice. We present the main reasons for implementing lung cancer screening in high-risk adults and discuss the main issues related to lung cancer screening. We stress the importance of eligibility criteria, smoking cessation programs, primary care physicians, and informed-decision making should lung cancer screening be implemented. Seven years ago, we were waiting for the results of trials. Such evidence is now available. Similar to almost all other cancer screens, uncertainties exist and persist even after recent scientific efforts and data. We believe that by staying within the characteristics of the original trial and appropriately sharing the evidence as well as the uncertainties, it is reasonable to implement a LDCT lung cancer screening program for smokers and former smokers.
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Affiliation(s)
- Idris Guessous
- 1Unit of Population Epidemiology, Division of primary care medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,2Division of Chronic Diseases, Institute of Social and Preventive Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.,3Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Jacques Cornuz
- 4Department of Ambulatory Care and Community Medicine University of Lausanne, Lausanne, Switzerland
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Jafari M, Nakhaee N, Goudarzi R, Zehtab N, Barouni M. Participation of the Women Covered by Family Physicians in Breast Cancer Screening Program in Kerman, Iran. Asian Pac J Cancer Prev 2015; 16:4555-61. [PMID: 26107203 DOI: 10.7314/apjcp.2015.16.11.4555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mammography screening is a method for reducing breast cancer mortality in women over 40 years old . A participation rate of at least 70% is a prerequisite for screening programs. This study aimed at determining the participation rate of women in breast cancer screening in Iran. MATERIALS AND METHODS The study population in this prospective research consisted of 35 to 69 years old women in the villages and towns Kerman District, in 2013. The data were collected by a well-validated risk assessment questionnaire. The questionnaires were completed with the help of health workers and technicians in the health centers, who were trained on breast cancer screening program. RESULTS As a whole, 19,651 women were invited to complete the questionnaire, of whom 15,794 women (80.37%) completed it. In the urban region, of 3150 eligible women 2728 women (86.60%) participated in the study. The acceptance rates for mammography in rural and urban regions were 34.95% and 8.75%, respectively. CONCLUSIONS Finally, 3.8% and 16.34% of 35 to 69 years old women in the urban regions were mammographed, respectively. CONCLUSION The low participation of eligible women in breast cancer screening program alerts us against including the program in the health insurance package.
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Picardo E, Mitidieri M, Minniti E, Ambroggio S, D'Addato F, Benedetto C, Gregori G, Baù MG. The first case of breast cancer in thalassemic patient: case report and review of literature. Gynecol Endocrinol 2015; 31:345-8. [PMID: 25578420 DOI: 10.3109/09513590.2014.998646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Thalassemias are genetic disorders characterized by decreased synthesis of one of the globin chains. Beta-thalassemia is caused by impairment in the production of beta-globin chains leaving the excess alpha chains unstable. With better treatment approaches and improvement in chelation therapy, thalassemic patients are living longer. As a consequence, new complications and associations with other conditions including malignancy have emerged. The occurrence of malignancies in thalassemia has rarely been reported, and our review of the literature revealed only few cases. We report the first case of a thalassemic patient developing breast cancer and discuss the possibility of a link between the two disease entities. This case is intended to alert physicians of the possibility of a malignancy in thalassemia patients.
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Huang ML, Rose S, Yang WT. Breast cancer screening: meeting the challenges of today and exploring the technologies of tomorrow. Semin Roentgenol 2015; 50:88-100. [PMID: 25770339 DOI: 10.1053/j.ro.2014.10.004] [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)
- Monica L Huang
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Stephen Rose
- Solis Women's Health, Houston, TX; Rose Imaging Specialists, Houston, TX; TOPS Comprehensive Breast Center, Houston, TX
| | - Wei T Yang
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Abdel-Rahman O, ElHalawani H. Adjuvant systemic treatment for elderly breast cancer patients; addressing safety concerns. Expert Opin Drug Saf 2014; 13:1443-67. [PMID: 25244502 DOI: 10.1517/14740338.2014.955848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The issue of systemic treatment for early breast cancer in the elderly has always been challenging and in spite of the clear evidence of the potential benefits of adjuvant treatment in older women, they are usually undertreated with the potential consequence of worse outcomes. AREAS COVERED This article will review the evidence surrounding the various systemic options in the treatment armamentarium of early-stage breast cancer in elderly patients. The risks and benefits, with particular attention to a number of newly introduced targeted agents, along with the potential role of incorporating a combined geriatric/oncologic assessment as a routine part of the management of elderly patients with breast cancer are considered. EXPERT OPINION Administration of available options for (neo)adjuvant endocrine, chemo, as well as targeted therapeutics in fit elderly patients is feasible and tolerable; however, a routine input from geriatric medicine and psycho-oncology experts as well as the training of specialized oncology staff with special interest in geriatric oncology are believed to improve the outcome of elderly patients.
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Affiliation(s)
- Omar Abdel-Rahman
- Ain Shams University, Clinical Oncology Department, Faculty of Medicine , Lotfy Elsayed street, Cairo, Postal code: 11665 , Egypt +20 33028656 ;
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Mamdouh HM, El-Mansy H, Kharboush IF, Ismail HM, Tawfik MM, El-Baky MA, El Sharkawy OG. Barriers to breast cancer screening among a sample of Egyptian females. J Family Community Med 2014; 21:119-24. [PMID: 24987281 PMCID: PMC4073560 DOI: 10.4103/2230-8229.134771] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Breast cancer (BC) is usually diagnosed in late stages in countries with limited resources. Early detection of BC is likely to improve the outcome of the disease for women in these areas. OBJECTIVE The aim of this study was to understand the possible personal, economic, and systems barriers to BC screening in a sample of Egyptian women. MATERIALS AND METHODS A cross-sectional study was conducted in family health centers representing the seven districts of Alexandria governorate, Egypt. A total of 612 women were randomly selected from the chosen centers. RESULTS IN THIS SAMPLE OF EGYPTIAN WOMEN, THE MOST FREQUENTLY IDENTIFIED POTENTIAL BARRIERS TO BC SCREENING WERE THE FOLLOWING: 81.8% would not seek care until they were ill, 77% were unwilling to have a mammogram until it was recommended by the doctor, 71.4% blamed the, lack of privacy, 69.2% thought that medical checkups were not worthwhile, and 64.6% blamed the cost of services. The study further revealed that women of lower education, women in the lower income category, women who did not do paid work, those who had poor knowledge of the risks of BC, and women with no family history of BC were more likely to perceive different screening barriers compared with their counterparts. CONCLUSION Many potential personal, economic, and health system barriers were identified. Addressing these barriers by increasing the awareness of BC and dealing with the misconceptions that the women have can help the policy makers to design more culturally relevant strategies to motivate women to utilize screening services.
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Affiliation(s)
- Heba M. Mamdouh
- Department of Family Health, High Institute of Public Health, University of Alexandria, Alexandria, Egypt
- Department of Research, Alexandria Regional Center for Women's Health and Development, Alexandria, Egypt
| | - Hazzem El-Mansy
- Medical Research Institute, High Institute of Public Health, University of Alexandria, Alexandria, Egypt
| | - Ibrahim F. Kharboush
- Department of Family Health, High Institute of Public Health, University of Alexandria, Alexandria, Egypt
- Department of Research, Alexandria Regional Center for Women's Health and Development, Alexandria, Egypt
| | - Hanaa M. Ismail
- Department of Family Health, High Institute of Public Health, University of Alexandria, Alexandria, Egypt
- Department of Nutrition, High Institute of Public Health, University of Alexandria, Alexandria, Egypt
| | - May M. Tawfik
- Department of Research, Alexandria Regional Center for Women's Health and Development, Alexandria, Egypt
| | - Mohamed Abdel El-Baky
- Department of Research, Alexandria Regional Center for Women's Health and Development, Alexandria, Egypt
| | - Omnia G. El Sharkawy
- Department of Research, Alexandria Regional Center for Women's Health and Development, Alexandria, Egypt
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González C. Deepening on breast cancer metastasis: the ERα-mediated modulation of KISS/KISS1R system. Endocrinology 2013; 154:1959-61. [PMID: 23687110 DOI: 10.1210/en.2013-1285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Celestino González
- Department of Functional Biology, Physiology Area, University of Oviedo, Calle Julián Clavería Sin Número, 33006 Oviedo, Spain.
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21
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Montagnon E, Hadj-Henni A, Schmitt C, Cloutier G. Viscoelastic characterization of elliptical mechanical heterogeneities using a semi-analytical shear-wave scattering model for elastometry measures. Phys Med Biol 2013; 58:2325-48. [DOI: 10.1088/0031-9155/58/7/2325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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22
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Cardoso F, Loibl S, Pagani O, Graziottin A, Panizza P, Martincich L, Gentilini O, Peccatori F, Fourquet A, Delaloge S, Marotti L, Penault-Llorca F, Kotti-Kitromilidou AM, Rodger A, Harbeck N. The European Society of Breast Cancer Specialists recommendations for the management of young women with breast cancer. Eur J Cancer 2012; 48:3355-77. [PMID: 23116682 DOI: 10.1016/j.ejca.2012.10.004] [Citation(s) in RCA: 196] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 10/02/2012] [Accepted: 10/02/2012] [Indexed: 12/22/2022]
Abstract
EUSOMA (The European Society of Breast Cancer Specialists) is committed to writing recommendations on different topics of breast cancer care which can be easily adopted and used by health professionals dedicated to the care of patients with breast cancer in their daily practice. In 2011, EUSOMA identified the management of young women with breast cancer as one of the hot topics for which a consensus among European experts was needed. Therefore, the society recently organised a workshop to define such recommendations. Thirteen experts from the different disciplines met for two days to discuss the topic. This international and multidisciplinary panel thoroughly reviewed the literature in order to prepare evidence-based recommendations. During the meeting, two working groups were set up to discuss in detail diagnosis and loco-regional and systemic treatments, including both group aspects of psychology and sexuality. The conclusions reached by the working groups were then discussed in a plenary session to reach panel consensus. Whenever possible, a measure of the level of evidence (LoE) from 1 (the highest) to 4 (the lowest) degree, based on the methodology proposed by the US Agency for Healthcare Research and Quality (AHRQ), was assigned to each recommendation. The present manuscript presents the recommendations of this consensus group for the management of young women with breast cancer in daily clinical practice.
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Affiliation(s)
- Fatima Cardoso
- Breast Unit, Champalimaud Cancer Center, Lisbon, Portugal.
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Ayvaci MUS, Alagoz O, Burnside ES. The Effect of Budgetary Restrictions on Breast Cancer Diagnostic Decisions. MANUFACTURING & SERVICE OPERATIONS MANAGEMENT : M & SOM 2012; 14:600-617. [PMID: 24027436 PMCID: PMC3767197 DOI: 10.1287/msom.1110.0371] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We develop a finite-horizon discrete-time constrained Markov decision process (MDP) to model diagnostic decisions after mammography where we maximize the total expected quality-adjusted life years (QALYs) of a patient under resource constraints. We use clinical data to estimate the parameters of the MDP model and solve it as a mixed-integer program. By repeating optimization for a sequence of budget levels, we calculate incremental cost-effectiveness ratios attributable to consecutive levels of funding and compare actual clinical practice with optimal decisions. We prove that the optimal value function is concave in the allocated budget. Comparing to actual clinical practice, using optimal thresholds for decision making may result in approximately 22% cost savings without sacrificing QALYs. Our analysis indicates short-term follow-ups are the immediate target for elimination when budget becomes a concern. Policy change is more drastic in the older age group with the increasing budget, yet the gains in total expected QALYs related to larger budgets are predominantly seen in younger women along with modest gains for older women.
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Affiliation(s)
- Mehmet U. S. Ayvaci
- Department of Industrial and Systems Engineering, University of Wisconsin–Madison, Madison, Wisconsin 53706
| | - Oguzhan Alagoz
- Department of Industrial and Systems Engineering, University of Wisconsin–Madison, Madison, Wisconsin 53706
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24
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Martin-Moreno JM, Anttila A, von Karsa L, Alfonso-Sanchez JL, Gorgojo L. Cancer screening and health system resilience: keys to protecting and bolstering preventive services during a financial crisis. Eur J Cancer 2012; 48:2212-8. [PMID: 22424881 DOI: 10.1016/j.ejca.2012.02.060] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 02/20/2012] [Indexed: 01/20/2023]
Abstract
The aim of this paper is to elucidate the rationale for sustaining and expanding cost-effective, population-based screening services for breast, cervical and colorectal cancers in the context of the current financial crisis. Our objective is not only to promote optimal delivery of high-quality secondary cancer prevention services, but also to underline the importance of strengthening comprehensive cancer control, and with it, health system response to the complex care challenges posed by all chronic diseases. We focus primarily on issues surrounding planning, organisation, implementation and resources, arguing that given the growing cancer burden, policymakers have ample justification for establishing and expanding population-based programmes that are well-organised, well-resourced and well-executed. In a broader economic context of rescue packages, deficits and cutbacks to government entitlements, health professionals must intensify their advocacy for the protection of vital preventive health services by fighting for quality services with clear benefits for population health outcomes.
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Affiliation(s)
- Jose M Martin-Moreno
- University of Valencia, Department of Preventive Medicine and Public Health, Av. Blasco Ibañez 15, 46010 Valencia, Spain.
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25
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Cardoso F, Harbeck N. Breast Cancer in Young Women a Clinical Challenge to Be Addressed in a Multidisciplinary Setting. Breast Care (Basel) 2012. [DOI: 10.1159/000341098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Hennedige AA, Kong TY, Gandhi A. Oncological screening for Bilateral Breast Reduction: A survey of practice variations in UK Breast and Plastics surgeons 2009. J Plast Reconstr Aesthet Surg 2011; 64:878-83. [DOI: 10.1016/j.bjps.2010.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Revised: 09/21/2010] [Accepted: 12/07/2010] [Indexed: 10/18/2022]
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