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Bell KJ, Nickel B, Pathirana T, Blennerhassett M, Carter S. Breast cancer screening from age 40 in the US. BMJ 2024; 385:q1353. [PMID: 38914429 DOI: 10.1136/bmj.q1353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Affiliation(s)
- Katy Jl Bell
- Sydney School of Public Health, University of Sydney, NSW, Australia
- Wiser Healthcare Research Collaboration, Australia
| | - Brooke Nickel
- Sydney School of Public Health, University of Sydney, NSW, Australia
- Wiser Healthcare Research Collaboration, Australia
| | - Thanya Pathirana
- Wiser Healthcare Research Collaboration, Australia
- School of Medicine and Dentistry, Griffith University, Sunshine Coast, QLD, Australia
| | | | - Stacy Carter
- Wiser Healthcare Research Collaboration, Australia
- Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, University of Wollongong, NSW, Australia
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2
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Mohan Lal P, Hamza Siddiqui M, Soulat A, Mohan A, Tanush D, Tirath K, Raja S, Khuzzaim Khan M, Raja A, Chaulagain A, Tejwaney U. MicroRNAs as promising biomarkers and potential therapeutic agents in breast cancer management: a comprehensive review. Ann Med Surg (Lond) 2024; 86:3543-3550. [PMID: 38846828 PMCID: PMC11152842 DOI: 10.1097/ms9.0000000000002075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 04/08/2024] [Indexed: 06/09/2024] Open
Abstract
Breast cancer (BC), a complex and varied ailment, poses a significant global health burden. MicroRNAs (miRNAs) have emerged as vital regulators in BC progression, with potential implications for diagnosis and treatment. This review aims to synthesize current insights into miRNA dysregulation in BC. MiRNAs, small RNA molecules, govern gene expression post-transcriptionally and are implicated in BC initiation, metastasis, and therapy resistance. Differential expression of specific miRNAs in BC tissues versus normal breast tissue sheds light on underlying molecular mechanisms. MiRNAs also offer promise as diagnostic biomarkers due to their stable nature, accessibility in bodily fluids, and altered expression patterns in early-stage disease, augmenting conventional diagnostic methods. Beyond diagnosis, miRNAs also hold promise as therapeutic targets in BC. By modulating the expression of specific dysregulated miRNAs, it may be possible to restore normal cellular functions and overcome treatment resistance. However, several challenges need to be addressed before miRNA-based therapies can be translated into clinical practice, including the development of efficient delivery systems and rigorous evaluation through preclinical and clinical trials. MiRNAs represent a promising avenue in BC research, offering potential applications in diagnosis, prognosis, and therapeutic interventions. As our understanding of miRNA biology deepens and technology advances, further research and collaborative efforts are needed to fully exploit the diagnostic and therapeutic potential of miRNAs in BC management. Ultimately, the integration of miRNA-based approaches into clinical practice may lead to more personalized and effective strategies for combating this devastating disease.
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Affiliation(s)
| | | | | | | | | | | | - Sandesh Raja
- Dow Medical College, Dow University of Health Sciences
| | | | - Adarsh Raja
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Aayush Chaulagain
- Shaheed Ziaur Rahman Medical College and Hospital, Bogra, Bangladesh
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3
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Gram EG, Jønsson ABR, Brodersen JB, Damhus CS. Questioning 'Informed Choice' in Medical Screening: The Role of Neoliberal Rhetoric, Culture, and Social Context. Healthcare (Basel) 2023; 11:healthcare11091230. [PMID: 37174772 PMCID: PMC10178002 DOI: 10.3390/healthcare11091230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Participation in medical screening programs is presented as a voluntary decision that should be based on an informed choice. An informed choice is often emphasized to rely on three assumptions: (1) the decision-maker has available information about the benefits and harms, (2) the decision-maker can understand and interpret this information, and (3) the decision-maker can relate this information to personal values and preferences. In this article, we empirically challenge the concept of informed choice in the context of medical screening. We use document analysis to analyze and build upon findings and interpretations from previously published articles on participation in screening. We find that citizens do not receive neutral or balanced information about benefits and harms, yet are exposed to manipulative framing effects. The citizens have high expectations about the benefits of screening, and therefore experience cognitive strains when informed about the harm. We demonstrate that decisions about screening participation are informed by neoliberal arguments of personal responsibility and cultural healthism, and thus cannot be regarded as decisions based on individual values and preferences independently of context. We argue that the concept of informed choice serves as a power technology for people to govern themselves and can be considered an implicit verification of biopower.
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Affiliation(s)
- Emma Grundtvig Gram
- Center of General Practice, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
- Primary Health Care Research Unit, 4100 Region Zealand, Denmark
| | - Alexandra Brandt Ryborg Jønsson
- Center of General Practice, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
- Department of People and Technology, Roskilde University, 4000 Roskilde, Denmark
- The Research Unit for General Practice, Department of Social Medicine, University of Tromsø, 9019 Tromsø, Norway
| | - John Brandt Brodersen
- Center of General Practice, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
- Primary Health Care Research Unit, 4100 Region Zealand, Denmark
- The Research Unit for General Practice, Department of Social Medicine, University of Tromsø, 9019 Tromsø, Norway
| | - Christina Sadolin Damhus
- Center of General Practice, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
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4
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Fattah SA, Selim MS, Abdel Fattah MA, Abo-Elmatty DM, Mesbah NM, Abdel-Hamed AR. Serum Transforming Growth Factor β1 and Its Genetic Variants Are Associated with Increased Macrophage Inflammatory Protein 1β and Susceptibility to Idiopathic Carpal Tunnel Syndrome. J Pers Med 2023; 13:jpm13050715. [PMID: 37240885 DOI: 10.3390/jpm13050715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/15/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is a common entrapment neuropathy in which one of the body's peripheral nerves becomes pinched or crushed. Transforming growth factor beta 1 (TGF-β1) plays an important role in the pathogenesis of CTS. An association between TGF-β1 polymorphisms and the susceptibility or progression of a number of diseases has been reported. In this study, three TGF-β1 single nucleotide polymorphisms (SNPs), serum TGF-β1, and macrophage inflammatory protein 1 beta (MIP-1β) were investigated as potential diagnostic markers for the progression of CTS in Egyptian patients. One hundred CTS patients and 100 healthy controls were recruited for the study. TGF-β1 SNPs +915G/C, -509C/T and -800G/A were determined by TaqMan genotyping assay. Serum TGF-β1 and MIP-1β levels were measured by ELISA. Serum TGF-β1 and MIP-1β levels increased significantly and were strongly correlated with the occurrence of CTS. The C allele of +915G/C, the T allele of -509C/T, and the G allele of -800G/A occurred more frequently in patients from CTS than in controls. The serum levels of TGF-β1 and MIP-1β in the group of carriers of the genotypes +915G/C GC and CC, the genotype -509C/T TT and the genotype -800G/A GA and AA were significantly higher in CTS patients. TGF-β1 and its +915G/C, -509C/T, and -800G/A SNPs and MIP-1β could be useful prognostic markers for the occurrence of CTS.
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Affiliation(s)
- Shaimaa A Fattah
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt
| | - Mohamed S Selim
- Cardiovascular Therapy Department, Novartis Company, Riyadh 12271, Saudi Arabia
| | - Maha A Abdel Fattah
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Dina M Abo-Elmatty
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt
| | - Noha M Mesbah
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt
| | - Asmaa R Abdel-Hamed
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt
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5
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Hild S, Teigné D, Ferrat E, Banaszuk AS, Berquet K, Lebon A, Bataille E, Nanin F, Gaultier A, Rat C. Breast cancer: a randomized controlled trial assessing the effect of a decision aid on mammography screening uptake: study protocol. Front Oncol 2023; 13:1128467. [PMID: 37168386 PMCID: PMC10165111 DOI: 10.3389/fonc.2023.1128467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/06/2023] [Indexed: 05/13/2023] Open
Abstract
Introduction Breast cancer (BC) is the primary cancer among women. The World Health Organization recommends a bilateral screening mammogram every 2 years for women aged 50 to 74 years. However, it has been shown that there is an absence of information about the benefits and risks of screening. Shared medical decision-making is important to ensure patients are involved in the decision process. Decision aids can facilitative this decision-making process. This article presents a protocol to evaluate the effect of a decision aid on participation rates in the French organized BC screening program. Methods and analysis Design and setting. The design is a 2 arm randomized controlled study, performed in the Pays de la Loire region (French West Coast). Randomization will be based on general medicine practices (Primary Care). Participants Women aged between 50 and 74 years, eligible for BC screening. In this region, there are 75000 women, and 2800 general practitioners eligible for recruitment. Intervention In the « Decision aid for organized cancer screening » arm, the intervention will distribute invitation letters to eligible women combined with the provision of decision aid to these women and their general practitioners and an incentive to implement shared medical decision-making. In the « Standard organized cancer screening » arm, only the screening invitation will be sent to eligible women. Primary endpoint BC screening participation rates will be assessed after an 18-month follow-up period. Statistical analysis In this non-inferiority trial, the percentage of women who are up-to-date with their screening at 18 months after the intervention will be compared across arms using a generalized mixed linear model. Discussion The research team expect to demonstrate that providing a better explanation of the benefits and risks of BC screening is not at odds with screening participation. The study results should help policy makers thinking about implementing shared medical decision-making within the framework of organized BC screening programs in the future. Ethics and dissemination On 6 December 2021, the protocol received a favorable opinion from the French Committee for the Protection of Persons (2021-A01583-38). This study is registered with ClinicalTrials.gov, number NCT05607849. (Version 1, November 7, 2022; https://www.clinicaltrials.gov/ct2/show/NCT05607849). The study findings will be used for publication in peer-reviewed scientific journals and presentations in scientific meetings.
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Affiliation(s)
- Sandrine Hild
- General Practice Department, Faculty of Médecine, Nantes, France
- *Correspondence: Sandrine Hild, ; Delphine Teigné, ; Cédric Rat,
| | - Delphine Teigné
- General Practice Department, Faculty of Médecine, Nantes, France
- Research Department, University Hospital of Nantes, Nantes, France
- *Correspondence: Sandrine Hild, ; Delphine Teigné, ; Cédric Rat,
| | - Emilie Ferrat
- Clinical Epidemiology ans Ageing (CEpiA), University Paris-Est Creteil, INSERM, IMRB, Paris, France
| | | | - Karine Berquet
- Regional Organization in Charge of Cancer Screening Programmes, Angers, France
| | - Aline Lebon
- Regional Organization in Charge of Cancer Screening Programmes, Angers, France
| | - Emmanuelle Bataille
- Department of Statistics and Studies, Health Insurance System, Nantes, France
| | - France Nanin
- Department of Statistics and Studies, Health Insurance System, Nantes, France
| | - Aurélie Gaultier
- General Practice Department, Faculty of Médecine, Nantes, France
- Research Department, Methodology and Biostatistics Platform, University Hospital of Nantes, Nantes, France
| | - Cédric Rat
- General Practice Department, Faculty of Médecine, Nantes, France
- National Institute for Health and Medical Research/INSERM U1302 Team 2, CRCINA, Nantes, France
- *Correspondence: Sandrine Hild, ; Delphine Teigné, ; Cédric Rat,
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6
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Ren W, Chen M, Qiao Y, Zhao F. Global guidelines for breast cancer screening: A systematic review. Breast 2022; 64:85-99. [PMID: 35636342 PMCID: PMC9142711 DOI: 10.1016/j.breast.2022.04.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/28/2022] [Accepted: 04/09/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Breast cancer screening guidelines could provide valuable tools for clinical decision making by reviewing the available evidence and providing recommendations. Little information is known about how many countries have issued breast cancer screening guidelines and the differences among existing guidelines. We systematically reviewed current guidelines and summarized corresponding recommendations, to provide references for good clinical practice in different countries. Methods Systematic searches of MEDLINE, EMBASE, Web of Science, and Scopus from inception to March 27th, 2021 were conducted and supplemented by reviewing the guideline development organizations. The quality of screening guidelines was assessed from six domains of the Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ) instrument by two appraisers. The basic information and recommendations of the issued guidelines were extracted and summarized. Results A total of 23 guidelines issued between 2010 and 2021 in 11 countries or regions were identified for further review. The content and quality varied across the guidelines. The average AGREE Ⅱ scores of the guidelines ranged from 33.3% to 87.5%. The highest domain score was "clarity of presentation" while the domain with the lowest score was "applicability". For average-risk women, most of the guidelines recommended mammographic screening for those aged 40–74 years, specifically, those aged 50–69 years were regarded as the optimal age group for screening. Nine of 23 guidelines recommended against an upper age limit for breast cancer screening. Mammography (MAM) was recommended as the primary screening modality for average-risk women by all included guidelines. Most guidelines suggested annual or biennial mammographic screening. Risk factors of breast cancer identified in the guidelines mainly fell within five categories which could be broadly summarized as the personal history of pre-cancerous lesions and/or breast cancer; the family history of breast cancer; the known genetic predisposition of breast cancer; the history of mantle or chest radiation therapy; and dense breasts. For women at higher risk, there was a consensus among most guidelines that annual MAM or annual magnetic resonance imaging (MRI) should be given, and the screening should begin earlier than the average-risk group. Conclusions The majority of 23 included international guidelines were issued by developed countries which contained roughly the same but not identical recommendations on breast cancer screening age, methods, and intervals. Most guidelines recommended annual or biennial mammographic screening between 40 and 74 years for average-risk populations and annual MAM or annual MRI starting from a younger age for high-risk populations. Current guidelines varied in quality and increased efforts are needed to improve the methodological quality of guidance documents. Due to lacking clinical practice guidelines tailored to different economic levels, low- and middle-income countries (LMICs) should apply and implement the evidence-based guidelines with higher AGREE Ⅱ scores considering local adaption. This systematic review comprehensively maps the recommendations of the latest international breast screening guidelines, providing valuable tools for clinical decision making in different settings. Most guidelines recommend annual or biennial mammographic screening between 40 and 74 years for the average-risk populations and annual MAM or annual MRI starting from a younger age for the high-risk populations. However, there are indeed discrepancies in screening age, methods, and intervals among countries. High-quality evidence and rigorous methodology are the keys to guidance development, but current guidelines vary in methodological quality.
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Affiliation(s)
- Wenhui Ren
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Mingyang Chen
- Center for Global Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Youlin Qiao
- Center for Global Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Fanghui Zhao
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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7
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Baines CJ. To Comply or Not to Comply With the US Preventive Services Task Force-That Is the Question. JAMA Netw Open 2022; 5:e229709. [PMID: 35499832 DOI: 10.1001/jamanetworkopen.2022.9709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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8
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Mühlberger N, Sroczynski G, Gogollari A, Jahn B, Pashayan N, Steyerberg E, Widschwendter M, Siebert U. Cost effectiveness of breast cancer screening and prevention: a systematic review with a focus on risk-adapted strategies. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:1311-1344. [PMID: 34342797 DOI: 10.1007/s10198-021-01338-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/10/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Benefit and cost effectiveness of breast cancer screening are still matters of controversy. Risk-adapted strategies are proposed to improve its benefit-harm and cost-benefit relations. Our objective was to perform a systematic review on economic breast cancer models evaluating primary and secondary prevention strategies in the European health care setting, with specific focus on model results, model characteristics, and risk-adapted strategies. METHODS Literature databases were systematically searched for economic breast cancer models evaluating the cost effectiveness of breast cancer screening and prevention strategies in the European health care context. Characteristics, methodological details and results of the identified studies are reported in evidence tables. Economic model outputs are standardized to achieve comparable cost-effectiveness ratios. RESULTS Thirty-two economic evaluations of breast cancer screening and seven evaluations of primary breast cancer prevention were included. Five screening studies and none of the prevention studies considered risk-adapted strategies. Studies differed in methodologic features. Only about half of the screening studies modeled overdiagnosis-related harms, most often indirectly and without reporting their magnitude. All models predict gains in life expectancy and/or quality-adjusted life expectancy at acceptable costs. However, risk-adapted screening was shown to be more effective and efficient than conventional screening. CONCLUSIONS Economic models suggest that breast cancer screening and prevention are cost effective in the European setting. All screening models predict gains in life expectancy, which has not yet been confirmed by trials. European models evaluating risk-adapted screening strategies are rare, but suggest that risk-adapted screening is more effective and efficient than conventional screening.
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Affiliation(s)
- Nikolai Mühlberger
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria
| | - Gaby Sroczynski
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria
| | - Artemisa Gogollari
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria
| | - Beate Jahn
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria
| | - Nora Pashayan
- Institute of Epidemiology and Healthcare, Department of Applied Health Research, UCL-University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Ewout Steyerberg
- Department of Public Health, Erasmus MC, PO Box 9600, 3000 CA, Rotterdam, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin Widschwendter
- Department of Women's Cancer, EGA Institute for Women's Health, UCL - University College London, 74 Huntley St, Rm 340, London, WC1E 6AU, UK
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria.
- Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria.
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA.
- Harvard Medical School, Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
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9
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Bähler C, Brüngger B, Ulyte A, Schwenkglenks M, von Wyl V, Dressel H, Gruebner O, Wei W, Blozik E. Temporal trends and regional disparities in cancer screening utilization: an observational Swiss claims-based study. BMC Public Health 2021; 21:23. [PMID: 33402140 PMCID: PMC7786957 DOI: 10.1186/s12889-020-10079-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022] Open
Abstract
Background We examined colorectal, breast, and prostate cancer screening utilization in eligible populations within three data cross-sections, and identified factors potentially modifying cancer screening utilization in Swiss adults. Methods The study is based on health insurance claims data of the Helsana Group. The Helsana Group is one of the largest health insurers in Switzerland, insuring approximately 15% of the entire Swiss population across all regions and age groups. We assessed proportions of the eligible populations receiving colonoscopy/fecal occult blood testing (FOBT), mammography, or prostate-specific antigen (PSA) testing in the years 2014, 2016, and 2018, and calculated average marginal effects of individual, temporal, regional, insurance-, supply-, and system-related variables on testing utilization using logistic regression. Results Overall, 8.3% of the eligible population received colonoscopy/FOBT in 2014, 8.9% in 2016, and 9.2% in 2018. In these years, 20.9, 21.2, and 20.4% of the eligible female population received mammography, and 30.5, 31.1, and 31.8% of the eligible male population had PSA testing. Adjusted testing utilization varied little between 2014 and 2018; there was an increasing trend of 0.8% (0.6–1.0%) for colonoscopy/FOBT and of 0.5% (0.2–0.8%) for PSA testing, while mammography use decreased by 1.5% (1.2–1.7%). Generally, testing utilization was higher in French-speaking and Italian-speaking compared to German-speaking region for all screening types. Cantonal programs for breast cancer screening were associated with an increase of 7.1% in mammography utilization. In contrast, a high density of relevant specialist physicians showed null or even negative associations with screening utilization. Conclusions Variation in cancer screening utilization was modest over time, but considerable between regions. Regional variation was highest for mammography use where recommendations are debated most controversially, and the implementation of programs differed the most. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10079-8.
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Affiliation(s)
- Caroline Bähler
- Department of Health Sciences, Helsana Group, Zürichstrasse 130, 8600, Dübendorf, Switzerland. .,Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland.
| | - Beat Brüngger
- Department of Health Sciences, Helsana Group, Zürichstrasse 130, 8600, Dübendorf, Switzerland.,Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Agne Ulyte
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Matthias Schwenkglenks
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Viktor von Wyl
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Holger Dressel
- Division of Occupational and Environmental Medicine, Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich and University Hospital Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Oliver Gruebner
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland.,Department of Geography, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland
| | - Wenjia Wei
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Eva Blozik
- Department of Health Sciences, Helsana Group, Zürichstrasse 130, 8600, Dübendorf, Switzerland.,Institute of Primary Care, University of Zurich and University Hospital Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
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10
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Abstract
In recommending and offering screening, health services make a health claim ('it's good for you'). This article considers ethical aspects of establishing the case for cancer screening, building a service programme, monitoring its operation, improving its quality and integrating it with medical progress. The value of (first) screening is derived as a function of key parameters: prevalence of the target lesion in the detectable pre-clinical phase, the validity of the test and the respective net utilities or values attributed to four health states-true positives, false positives, false negatives and true negatives. Decision makers as diverse as public regulatory agencies, medical associations, health insurance funds or individual screenees can legitimately come up with different values even when presented with the same evidence base. The main intended benefit of screening is the reduction of cause-specific mortality. All-cause mortality is not measurably affected. Overdiagnosis and false-positive tests with their sequelae are the main harms. Harms and benefits accrue to distinct individuals. Hence the health claim is an invitation to a lottery with benefits for few and harms to many, a violation of the non-maleficence principle. While a public decision maker may still propose a justified screening programme, respect for individual rights and values requires preference-sensitive, autonomy-enhancing educational materials-even at the expense of programme effectiveness. Opt-in recommendations and more 'consumer-oriented' qualitative research are needed.
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Affiliation(s)
- Bernt-Peter Robra
- Institute for Social Medicine and Health Services Research, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, D-39140, Magdeburg, Germany.
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11
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Comins JD, Brodersen J, Siersma V, Jensen J, Hansen CF, Krogsgaard MR. How to develop a condition-specific PROM. Scand J Med Sci Sports 2020; 31:1216-1224. [PMID: 33145839 DOI: 10.1111/sms.13868] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/20/2020] [Accepted: 10/29/2020] [Indexed: 01/09/2023]
Abstract
Developing new patient-reported outcome measures (PROMs) for application in clinical studies can be necessary if an adequate PROM does not exist. For adequate measurement, it is essential that the PROM has face validity (ie, is perceived to be relevant by clinicians and researchers) and has high content validity (ie, content relevance and content coverage for the targeted patient group). The steps needed to create PROMs that possess face and content validity for a specific condition are described in this paper. Face validity is achieved by item identification and generation through literature review. Content validity is confirmed through repetitive cognitive interviews of patients from the targeted patient group in order to generate a consensus-based pilot-version of the new PROM. This qualitative process ensures that items are appropriately worded, understandable, and minimizes doubts about how items should be answered. A practical example of this process is presented, which shows the development of the Knee Numeric-Entity Evaluation Score (KNEES-ACL), a condition-specific PROM for patients with deficiency of the anterior cruciate ligament (ACL).
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Affiliation(s)
- Jonathan D Comins
- Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Brodersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Primary Health Care Research Unit, Region Zealand, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Jensen
- Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Christian Fugl Hansen
- Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Michael R Krogsgaard
- Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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12
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Ulyte A, Wei W, Dressel H, Gruebner O, von Wyl V, Bähler C, Blozik E, Brüngger B, Schwenkglenks M. Variation of colorectal, breast and prostate cancer screening activity in Switzerland: Influence of insurance, policy and guidelines. PLoS One 2020; 15:e0231409. [PMID: 32298325 PMCID: PMC7162274 DOI: 10.1371/journal.pone.0231409] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/23/2020] [Indexed: 11/21/2022] Open
Abstract
Variation in utilization of healthcare services is influenced by patient, provider and healthcare system characteristics. It could also be related to the evidence supporting their use, as reflected in the availability and strength of recommendations in clinical guidelines. In this study, we analyzed the geographic variation of colorectal, breast and prostate cancer screening utilization in Switzerland and the influence of available guidelines and different modifiers of access. Colonoscopy, mammography and prostate specific antigen (PSA) testing use in eligible population in 2014 was assessed with administrative claims data. We ran a multilevel multivariable logistic regression model and calculated Moran's I and regional level median odds ratio (MOR) statistics to explore residual geographic variation. In total, an estimated 8.1% of eligible persons received colonoscopy, 22.3% mammography and 31.3% PSA testing. Low deductibles, supplementary health insurance and enrollment in a managed care plan were associated with higher screening utilization. Cantonal breast cancer screening programs were also associated with higher utilization. Spatial clustering was observed in the raw regional utilization of all services, but only for prostate cancer screening in regional residuals of the multilevel model. MOR was highest for prostate cancer screening (1.24) and lowest for colorectal cancer screening (1.16). The reasons for the variation of the prostate cancer screening utilization, not recommended routinely without explicit shared decision-making, could be further investigated by adding provider characteristics and patient preference information. This first cross-comparison of different cancer screening patterns indicates that the strength of recommendations, mediated by specific health policies facilitating screening, may indeed contribute to variation.
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Affiliation(s)
- Agne Ulyte
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Wenjia Wei
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Holger Dressel
- Division of Occupational and Environmental Medicine, Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Oliver Gruebner
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Geography, University of Zurich, Zurich, Switzerland
| | - Viktor von Wyl
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Caroline Bähler
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Health Sciences, Helsana Group, Dubendorf, Switzerland
| | - Eva Blozik
- Department of Health Sciences, Helsana Group, Dubendorf, Switzerland
- Division of General Practice, University Medical Centre Freiburg, Freiburg, Germany
| | - Beat Brüngger
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Health Sciences, Helsana Group, Dubendorf, Switzerland
| | - Matthias Schwenkglenks
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
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13
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Hadj-Ahmed M, Ghali RM, Bouaziz H, Habel A, Stayoussef M, Ayedi M, Hachiche M, Rahal K, Yacoubi-Loueslati B, Almawi WY. Transforming growth factor beta 1 polymorphisms and haplotypes associated with breast cancer susceptibility: A case-control study in Tunisian women. Tumour Biol 2019; 41:1010428319869096. [PMID: 31405342 DOI: 10.1177/1010428319869096] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Variable association of transforming growth factor beta 1 (TGFβ1) in breast cancer (BC) pathogenesis was documented, and the contribution of specific TGFB1 polymorphisms to the progression of BC and associated features remains poorly understood. We investigated the contribution of TGFB1 rs1800469, rs1800470, rs1800471, and rs1800472 variants and 4-locus TGFB1 haplotypes on BC susceptibility, and pathological presentation of BC subtypes. Study subjects comprised 430 female BC cases, and 498 cancer-free control women. BC-associated pathological parameters were also evaluated for correlation with TGFB1 variants. Results obtained showed that the minor allele frequency (MAF) of rs1800471 (+74G>C) was higher seen in BC cases than in control subjects, and was associated with increased risk of BC. Significant differences in rs1800471 and rs1800469 (-509C>T) genotype distribution were noted between BC cases and controls, which persisted after controlling for key covariates. TGFB1 rs1800472 was positively, while rs1800470 was negatively associated with triple negativity, while rs1800470 positively correlated with menarche, but negatively with tumor size and molecular type, and rs1800469 correlated positively with menstrual irregularity, distant metastasis, nodal status, and hormonotherapy. Heterogeneity in LD pattern was noted between the tested TGFB1 variants. Four-locus (rs1800472-rs1800471-rs1800470-rs1800469) Haploview analysis identified haplotype TGCT to be negatively associated, and haplotypes CGTT and CCCC to be positively associated with BC. This association of CGTT and CCCC, but not TGCT, with BC remained significant after controlling for key covariates. In conclusion, TGFB1 alleles and specific genotypes, and 4-locus TGFB1 haplotypes influence BC susceptibility, suggesting dual association imparted by specific SNP, consistent with dual role for TGFB1 in BC pathogenesis.
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Affiliation(s)
- Mariem Hadj-Ahmed
- 1 Laboratory of Mycology, Pathologies and Biomarkers, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Rabeb M Ghali
- 2 Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia
| | - Hanen Bouaziz
- 3 Department of Carcinological Surgery, Salah Azaïz Institute, Tunis, Tunisia
| | - Azza Habel
- 1 Laboratory of Mycology, Pathologies and Biomarkers, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mouna Stayoussef
- 1 Laboratory of Mycology, Pathologies and Biomarkers, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mouna Ayedi
- 4 Department of Medical Oncology, Salah Azaïz Institute, Tunis, Tunisia
| | - Monia Hachiche
- 2 Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia
| | - Khaled Rahal
- 2 Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia
| | - Besma Yacoubi-Loueslati
- 1 Laboratory of Mycology, Pathologies and Biomarkers, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Wassim Y Almawi
- 1 Laboratory of Mycology, Pathologies and Biomarkers, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia.,5 Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana, Kazakhstan
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14
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Lousdal ML, Møller MH, Kristiansen IS, Kalager M, Wisløff T, Støvring H. The Screening Illustrator: separating the effects of lead-time and overdiagnosis in mammography screening. Eur J Public Health 2019; 28:1138-1142. [PMID: 29796623 DOI: 10.1093/eurpub/cky085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Mammography screening increases incidence because cancers are detected earlier in time and because of overdiagnosis. We developed an Excel-based model to visualize the expected increase from lead-time amplified by increasing background incidence. Subsequently, we added overdiagnosis to the model. Methods We constructed two hypothetical populations of women aged 50-79 in 5-year age and calendar groups: one with screening for women aged 50-69 and one without. The user enters information on population at risk, number of breast cancers, trends in background incidence, average length of lead-time and, optionally, overdiagnosis. The model computes incidence rate ratios (IRRs) comparing incidence changes with screening to changes without in open and closed cohorts. Results We entered information from Norway from 1990 to 1994, the period preceding the gradual introduction of a national mammography screening programme. As expected, the Screening Illustrator showed prevalence peaks and compensatory drops. Only the closed cohort approach remained unaffected by increasing background incidence. The model showed a 20% sustained increase in incidence (IRR: 1.20) from lead-time and increasing background incidence in the open cohort approach for women aged 50-69. However, real life Norwegian data show a corresponding 38% increase. For the model to achieve the observed incidence, 10-14% overdiagnosis had to be added. Conclusion The observed breast cancer incidence increase in Norway after screening implementation could not be obtained from an average lead-time of 2.5 years and empirical background incidence trends, but had to incorporate overdiagnosis.
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Affiliation(s)
- Mette L Lousdal
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Mette H Møller
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ivar S Kristiansen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Mette Kalager
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.,Oslo University Hospital, Oslo, Norway
| | - Torbjørn Wisløff
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
| | - Henrik Støvring
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Lippey J, Keogh LA, Mann GB, Campbell IG, Forrest LE. "A Natural Progression": Australian Women's Attitudes About an Individualized Breast Screening Model. Cancer Prev Res (Phila) 2019; 12:383-390. [PMID: 31003994 DOI: 10.1158/1940-6207.capr-18-0443] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/01/2019] [Accepted: 04/09/2019] [Indexed: 11/16/2022]
Abstract
Individualized screening is our logical next step to improve population breast cancer screening in Australia. To explore breast screening participants' views of the current program in Victoria, Australia, examine their openness to change, and attitudes toward an individualized screening model, this qualitative work was performed from a population-based breast screening cohort. This work was designed to inform the development of a decision aid to facilitate women's decisions about participating in individualized screening, and to elicit Australian consumer perspectives on the international movement toward individualized breast screening. A total of 52 women participated in one of four focus groups, and were experienced with screening with 90% of participants having had more than three mammograms. Focus group discussion was facilitated following three main themes: (i) experience of breast screening; (ii) breast cancer risk perception, and (iii) views on individualized screening. Participants had strong, positive, emotional ties to breast screening in its current structure but were supportive, with some reservations, of the idea of individualized screening. There was good understanding about the factors contributing to personalized risk and a wide range of opinions about the inclusion of genetic testing with genetic testing being considered a foreign and evolving domain. Individualized breast screening that takes account of risk factors such as mammographic density, lifestyle, and genetic factors would be acceptable to a population of women who are invested in the current system. The communication and implementation of a new program would be critical to its acceptance and potential success. Reservations may be had in regards to uptake of genetic testing, motivations behind the change, and management of the women allocated to a lower risk category.
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Affiliation(s)
- Jocelyn Lippey
- Department of Surgery, University of Melbourne, Melbourne, Australia. .,St. Vincent's Hospital, Victoria, Australia
| | - Louise A Keogh
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - G Bruce Mann
- Department of Surgery, University of Melbourne, Melbourne, Australia.,Royal Melbourne Hospital, Victoria, Australia
| | - Ian G Campbell
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia.,Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Laura E Forrest
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia.,Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Australia
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16
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17
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Mathioudakis AG, Salakari M, Pylkkanen L, Saz-Parkinson Z, Bramesfeld A, Deandrea S, Lerda D, Neamtiu L, Pardo-Hernandez H, Solà I, Alonso-Coello P. Systematic review on women's values and preferences concerning breast cancer screening and diagnostic services. Psychooncology 2019; 28:939-947. [PMID: 30812068 PMCID: PMC6594004 DOI: 10.1002/pon.5041] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/21/2019] [Accepted: 02/25/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is still lack of consensus on the benefit-harm balance of breast cancer screening. In this scenario, women's values and preferences are crucial for developing health-related recommendations. In the context of the European Commission Initiative on Breast Cancer, we conducted a systematic review to inform the European Breast Guidelines. METHODS We searched Medline and included primary studies assessing women's values and preferences regarding breast cancer screening and diagnosis decision making. We used a thematic approach to synthesise relevant data. The quality of evidence was determined with GRADE, including GRADE CERQual for qualitative research. RESULTS We included 22 individual studies. Women were willing to accept the psychological and physical burden of breast cancer screening and a significant risk of overdiagnosis and false-positive mammography findings, in return for the benefit of earlier diagnosis. The anxiety engendered by the delay in getting results of diagnostic tests was highlighted as a significant burden, emphasising the need for rapid and efficient screening services, and clear and efficient communication. The confidence in the findings was low to moderate for screening and moderate for diagnosis, predominantly because of methodological limitations, lack of adequate understanding of the outcomes by participants, and indirectness. CONCLUSIONS Women value more the possibility of an earlier diagnosis over the risks of a false-positive result or overdiagnosis. Concerns remain that women may not understand the concept of overdiagnosis. Women highly value time efficient screening processes and rapid result delivery and will accept some discomfort for the peace of mind screening may provide.
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Affiliation(s)
- Alexander G Mathioudakis
- Biomedical Research Institute (IIB Sant Pau), Iberoamerican Cochrane Centre, Barcelona, Spain.,Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Minna Salakari
- Department of Public Health, Faculty of Medicine, University of Turku, Turku, Finland
| | - Liisa Pylkkanen
- Joint Research Centre, European Commission, Ispra, Italy.,Clinico-Pharmacological Unit, Finnish Medicines Agency Fimea, Turku, Finland
| | | | - Anke Bramesfeld
- Joint Research Centre, European Commission, Ispra, Italy.,Institute for Epidemiology Social Medicine and Health System Research, Hanover Medical School, Hannover, Germany
| | - Silvia Deandrea
- Joint Research Centre, European Commission, Ispra, Italy.,Health Protection Agency, Metropolitan city of Milan, Italy
| | - Donata Lerda
- Joint Research Centre, European Commission, Ispra, Italy
| | | | - Hector Pardo-Hernandez
- Biomedical Research Institute (IIB Sant Pau), Iberoamerican Cochrane Centre, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Ivan Solà
- Biomedical Research Institute (IIB Sant Pau), Iberoamerican Cochrane Centre, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Pablo Alonso-Coello
- Biomedical Research Institute (IIB Sant Pau), Iberoamerican Cochrane Centre, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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18
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Rogers WA. Analysing the ethics of breast cancer overdiagnosis: a pathogenic vulnerability. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2019; 22:129-140. [PMID: 30030748 DOI: 10.1007/s11019-018-9852-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Breast cancer screening aims to help women by early identification and treatment of cancers that might otherwise be life-threatening. However, breast cancer screening also leads to the detection of some cancers that, if left undetected and untreated, would not have damaged the health of the women concerned. At the time of diagnosis, harmless cancers cannot be identified as non-threatening, therefore women are offered invasive breast cancer treatment. This phenomenon of identifying (and treating) non-harmful cancers is called overdiagnosis. Overdiagnosis is morally problematic as it leads to overall patient harm rather than benefit. Further, breast cancer screening is offered in a context that exaggerates cancer risk and screening benefit, minimises risk of harm and impedes informed choice. These factors combine to create pathogenic vulnerability. That is, breast cancer screening exacerbates rather than reduces women's vulnerability and undermines women's agency. This paper provides an original way of conceptualising agency-supporting responses to the harms of breast cancer overdiagnosis through application of the concept of pathogenic vulnerability.
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Affiliation(s)
- Wendy A Rogers
- Department of Philosophy and Department of Clinical Medicine, Macquarie University, North Ryde, NSW, 2107, Australia.
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19
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Trends in mammography, hormone replacement therapy, and breast cancer incidence and mortality in Canadian women. Cancer Causes Control 2019; 30:137-147. [DOI: 10.1007/s10552-019-1127-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/03/2019] [Indexed: 10/27/2022]
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20
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Buribekova R, Shukurbekova I, Ilnazarova S, Jamshevov N, Sadonshoeva G, Sayani S, Aminmuhammad A, Amersi F, Asaria S, Saleh M, Talib Z. Promoting Clinical Breast Evaluations in a Lower Middle-Income Country Setting: An Approach Toward Achieving a Sustainable Breast Health Program. J Glob Oncol 2018; 4:1-8. [PMID: 30241226 PMCID: PMC6223421 DOI: 10.1200/jgo.17.00103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To promote a systems-based approach for the early detection and downstaging of breast cancer at presentation in the remote mountainous region of Gorno Badakhshan Autonomous Oblast (GBAO), Tajikistan, by introducing breast cancer awareness into the community and training health care professionals in clinical breast evaluation (CBE). METHODS Through a public-private partnership between the Ministry of Health, the Aga Khan Health Services, Tajikistan, and the Aga Khan Health Board, we organized breast cancer screening in the community and trained family medicine doctors (FMDs) and family medicine nurses (FMNs) in CBE. We identified and trained CBE master trainers, who, in turn, systematically trained FMNs to conduct CBEs in each of the remote regional clinics. RESULTS Between 2014 and 2017, 47 FMDs (85% of all FMDs in GBAO), 166 FMNs (55% of all FMNs in GBAO), and six master trainers were trained. Of 3,556 women who were screened, abnormal CBEs were noted in 696 of them (20%). Of the last 1,101 CBEs that were performed by trainee FMNs, with secondary CBEs by master trainers, the rate of abnormal CBEs plateaued at 9%. A total of 18 women were diagnosed with breast cancer-2.6% of abnormal CBEs and 0.5% of all screened women. CONCLUSION A dual-pronged approach of community awareness and CBE training of health care professionals, supported by CBE master trainers, offers a sustainable approach for the early detection of breast pathology. We observed anecdotal evidence of clinical early-stage detection over time with improved CBE proficiency and community acceptance. Sustaining this program will require advocacy by health care providers and a responsive public policy to support the early detection and treatment of breast cancer across the region.
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Affiliation(s)
- Roziya Buribekova
- Roziya Buribekova, Irina Shukurbekova, Surayo Ilnazarova, Nekruz Jamshevov, and Guldarbogh Sadonshoeva, Aga Khan Health Services, Dushanbe, Tajikistan; Saleem Sayani and Aliya Aminmuhammad, Aga Khan University; Farin Amersi, Sheemain Asaria, Mansoor Saleh, and Zohray Talib, Aga Khan Health Board, Karachi, Pakistan; Zohray Talib, George Washington University School of Medicine, Washington, DC; and Mansoor Saleh, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Irina Shukurbekova
- Roziya Buribekova, Irina Shukurbekova, Surayo Ilnazarova, Nekruz Jamshevov, and Guldarbogh Sadonshoeva, Aga Khan Health Services, Dushanbe, Tajikistan; Saleem Sayani and Aliya Aminmuhammad, Aga Khan University; Farin Amersi, Sheemain Asaria, Mansoor Saleh, and Zohray Talib, Aga Khan Health Board, Karachi, Pakistan; Zohray Talib, George Washington University School of Medicine, Washington, DC; and Mansoor Saleh, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Surayo Ilnazarova
- Roziya Buribekova, Irina Shukurbekova, Surayo Ilnazarova, Nekruz Jamshevov, and Guldarbogh Sadonshoeva, Aga Khan Health Services, Dushanbe, Tajikistan; Saleem Sayani and Aliya Aminmuhammad, Aga Khan University; Farin Amersi, Sheemain Asaria, Mansoor Saleh, and Zohray Talib, Aga Khan Health Board, Karachi, Pakistan; Zohray Talib, George Washington University School of Medicine, Washington, DC; and Mansoor Saleh, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Nekruz Jamshevov
- Roziya Buribekova, Irina Shukurbekova, Surayo Ilnazarova, Nekruz Jamshevov, and Guldarbogh Sadonshoeva, Aga Khan Health Services, Dushanbe, Tajikistan; Saleem Sayani and Aliya Aminmuhammad, Aga Khan University; Farin Amersi, Sheemain Asaria, Mansoor Saleh, and Zohray Talib, Aga Khan Health Board, Karachi, Pakistan; Zohray Talib, George Washington University School of Medicine, Washington, DC; and Mansoor Saleh, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Guldarbogh Sadonshoeva
- Roziya Buribekova, Irina Shukurbekova, Surayo Ilnazarova, Nekruz Jamshevov, and Guldarbogh Sadonshoeva, Aga Khan Health Services, Dushanbe, Tajikistan; Saleem Sayani and Aliya Aminmuhammad, Aga Khan University; Farin Amersi, Sheemain Asaria, Mansoor Saleh, and Zohray Talib, Aga Khan Health Board, Karachi, Pakistan; Zohray Talib, George Washington University School of Medicine, Washington, DC; and Mansoor Saleh, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Saleem Sayani
- Roziya Buribekova, Irina Shukurbekova, Surayo Ilnazarova, Nekruz Jamshevov, and Guldarbogh Sadonshoeva, Aga Khan Health Services, Dushanbe, Tajikistan; Saleem Sayani and Aliya Aminmuhammad, Aga Khan University; Farin Amersi, Sheemain Asaria, Mansoor Saleh, and Zohray Talib, Aga Khan Health Board, Karachi, Pakistan; Zohray Talib, George Washington University School of Medicine, Washington, DC; and Mansoor Saleh, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Aliya Aminmuhammad
- Roziya Buribekova, Irina Shukurbekova, Surayo Ilnazarova, Nekruz Jamshevov, and Guldarbogh Sadonshoeva, Aga Khan Health Services, Dushanbe, Tajikistan; Saleem Sayani and Aliya Aminmuhammad, Aga Khan University; Farin Amersi, Sheemain Asaria, Mansoor Saleh, and Zohray Talib, Aga Khan Health Board, Karachi, Pakistan; Zohray Talib, George Washington University School of Medicine, Washington, DC; and Mansoor Saleh, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Farin Amersi
- Roziya Buribekova, Irina Shukurbekova, Surayo Ilnazarova, Nekruz Jamshevov, and Guldarbogh Sadonshoeva, Aga Khan Health Services, Dushanbe, Tajikistan; Saleem Sayani and Aliya Aminmuhammad, Aga Khan University; Farin Amersi, Sheemain Asaria, Mansoor Saleh, and Zohray Talib, Aga Khan Health Board, Karachi, Pakistan; Zohray Talib, George Washington University School of Medicine, Washington, DC; and Mansoor Saleh, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Sheemain Asaria
- Roziya Buribekova, Irina Shukurbekova, Surayo Ilnazarova, Nekruz Jamshevov, and Guldarbogh Sadonshoeva, Aga Khan Health Services, Dushanbe, Tajikistan; Saleem Sayani and Aliya Aminmuhammad, Aga Khan University; Farin Amersi, Sheemain Asaria, Mansoor Saleh, and Zohray Talib, Aga Khan Health Board, Karachi, Pakistan; Zohray Talib, George Washington University School of Medicine, Washington, DC; and Mansoor Saleh, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Mansoor Saleh
- Roziya Buribekova, Irina Shukurbekova, Surayo Ilnazarova, Nekruz Jamshevov, and Guldarbogh Sadonshoeva, Aga Khan Health Services, Dushanbe, Tajikistan; Saleem Sayani and Aliya Aminmuhammad, Aga Khan University; Farin Amersi, Sheemain Asaria, Mansoor Saleh, and Zohray Talib, Aga Khan Health Board, Karachi, Pakistan; Zohray Talib, George Washington University School of Medicine, Washington, DC; and Mansoor Saleh, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Zohray Talib
- Roziya Buribekova, Irina Shukurbekova, Surayo Ilnazarova, Nekruz Jamshevov, and Guldarbogh Sadonshoeva, Aga Khan Health Services, Dushanbe, Tajikistan; Saleem Sayani and Aliya Aminmuhammad, Aga Khan University; Farin Amersi, Sheemain Asaria, Mansoor Saleh, and Zohray Talib, Aga Khan Health Board, Karachi, Pakistan; Zohray Talib, George Washington University School of Medicine, Washington, DC; and Mansoor Saleh, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
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Czwikla J, Giersiepen K, Langner I, Enders D, Heinze F, Rothgang H, Haug U, Zeeb H, Hense HW. A cohort study of mammography screening finds that comorbidity measures are insufficient for controlling selection bias. J Clin Epidemiol 2018; 104:1-7. [PMID: 30075187 DOI: 10.1016/j.jclinepi.2018.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/09/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To examine the potential of claims-based comorbidity measures for controlling selection bias in observational studies of mammography screening. STUDY DESIGN AND SETTING Based on claims data of a large German Statutory Health Insurance fund, the single comorbidities considered by the Charlson, Elixhauser, Multipurpose Australian Comorbidity Scoring System, and M3 comorbidity measures were identified for mammography screening participants and nonparticipants. Total death rates within 4 years after screening invitation were compared. Cox proportional hazards regressions were performed unadjusted and adjusted for age, federal state of residence, and comorbidity. RESULTS Among 1,247,919 insured women aged 50-68 years (56.2% participants), 10,311 participants (death rate 375.8/100,000 person-years) and 18,113 nonparticipants (death rate 854.8/100,000 person-years) died from any cause during the follow-up. The unadjusted hazard ratio (HR) for death from any cause for participants vs. nonparticipants was 0.44 (99.9% confidence interval 0.42-0.46). Adjustments attenuated the HR to a maximum of 0.52 (0.50-0.54). CONCLUSION The lower short-term all-cause mortality among participants cannot be explained by mammography screening effects and should be interpreted as selection bias. Adjusting for comorbidities only slightly attenuated this bias. Future studies should examine whether claims data include further information that is beneficial to adequately control selection bias in observational studies of mammography screening.
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Affiliation(s)
- Jonas Czwikla
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany; High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany.
| | - Klaus Giersiepen
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany; High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Ingo Langner
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Dirk Enders
- Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Franziska Heinze
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany; High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Heinz Rothgang
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany; High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Ulrike Haug
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany; Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Hajo Zeeb
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany; Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Hans-Werner Hense
- Institute of Epidemiology and Social Medicine, Medical Faculty, University of Münster, Albert-Schweitzer-Campus 1 D3, 48149 Münster, Germany
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22
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Perrenoud C, Stiefel F, Bourquin C. From facts to arguments: A study of the 2014 Swiss controversy over systematic mammography screening. PATIENT EDUCATION AND COUNSELING 2018; 101:1110-1115. [PMID: 29305062 DOI: 10.1016/j.pec.2017.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/07/2017] [Accepted: 12/18/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The Swiss Medical Board (SMB) has recently revived the controversy over mammography screening by recommending to stop the introduction of new systematic mammography screening programs. This study aimed to examine the Swiss media coverage of the release of the SMB report. METHODS The dataset consisted of 25 newspaper and "medical magazine" articles, and TV/radio interviews. The analytic approach was based on argumentation theory. RESULTS Authority and community arguments were the most frequent types of arguments. With respect to authority arguments, stakeholders for instance challenged or supported the expertise of the SMB by referring to the competence of external figures of authority. Community arguments were based on common values such as life (saved thanks to systematic mammography screening) and money (costs associated with unnecessary care induced by systematic mammography screening). CONCLUSION The efficiency of mammography screening which was the key issue of the debate appeared to be largely eluded, and the question of what women should do endures. PRACTICE IMPLICATIONS While interpersonal and interprofessional communication has become a major topic of interest in the medical community, it appears that media communication on mammography screening is still rather ineffective. We call in particular for a more fact-based discussion.
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Affiliation(s)
| | - Friedrich Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital, Les Allières, Av. de Beaumont 23, 1011 Lausanne-CHUV, Switzerland
| | - Céline Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital, Les Allières, Av. de Beaumont 23, 1011 Lausanne-CHUV, Switzerland.
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23
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Section Editor's Notebook: Breast Cancer Screening—What Now, and What Next? AJR Am J Roentgenol 2018; 210:239-240. [DOI: 10.2214/ajr.17.18800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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24
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Walter EJ, Lilge L. Optical assessment of mammographic breast density by a 12-wavelength vs a continuous-spectrum optical spectroscopy device. JOURNAL OF BIOPHOTONICS 2018; 11:e201700071. [PMID: 28700125 DOI: 10.1002/jbio.201700071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/21/2017] [Accepted: 06/21/2017] [Indexed: 06/07/2023]
Abstract
A 12-laser-wavelength, fixed source-detector position, cup-based optical breast spectroscopy (OBS) device was developed for use in large-scale, multicenter trials as a mammographic breast density (MBD) quantification and breast cancer (BC) risk prescreening tool. In this study, the device was evaluated in comparison with a spectrometer-based device used in previous studies. The devices were compared on their ability to predict mammographic percent density (MPD) and to identify women with high MBD from optical spectra. OBS measurements were made on 60 women, (age 29-73), using both devices. Recent mammograms were collected for all women and MPD quantified from the mammograms. Principal components (PCs) analysis was performed on both sets of OBS spectra, and multivariate logistic regression analysis of the resulting PC scores was used to identify women with high MBD. Both devices are able to identify high MBD with very high sensitivity and specificity. Partial least-squares regression of the spectra was used to predict MPD. Both devices show a strong correlation between OBS-predicted MPD and MPD read from mammograms, however, the correlation is stronger for the continuous-spectrum device (r = 0.74, P = .001) than for the 12-wavelength device (r = 0.62, P = .004). Improvements to the cup-based device to reduce detector saturation should improve the prediction of MPD from the spectra.
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Affiliation(s)
- E J Walter
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Lothar Lilge
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
- Division of Molecular Imaging, Princess Margaret Cancer Centre, Toronto, Canada
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25
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26
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Hamam R, Hamam D, Alsaleh KA, Kassem M, Zaher W, Alfayez M, Aldahmash A, Alajez NM. Circulating microRNAs in breast cancer: novel diagnostic and prognostic biomarkers. Cell Death Dis 2017; 8:e3045. [PMID: 28880270 PMCID: PMC5636984 DOI: 10.1038/cddis.2017.440] [Citation(s) in RCA: 252] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 06/13/2017] [Accepted: 06/20/2017] [Indexed: 12/13/2022]
Abstract
Effective management of breast cancer depends on early diagnosis and proper monitoring of patients' response to therapy. However, these goals are difficult to achieve because of the lack of sensitive and specific biomarkers for early detection and for disease monitoring. Accumulating evidence in the past several years has highlighted the potential use of peripheral blood circulating nucleic acids such as DNA, mRNA and micro (mi)RNA in breast cancer diagnosis, prognosis and for monitoring response to anticancer therapy. Among these, circulating miRNA is increasingly recognized as a promising biomarker, given the ease with which miRNAs can be isolated and their structural stability under different conditions of sample processing and isolation. In this review, we provide current state-of-the-art of miRNA biogenesis, function and discuss the advantages, limitations, as well as pitfalls of using circulating miRNAs as diagnostic, prognostic or predictive biomarkers in breast cancer management.
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Affiliation(s)
- Rimi Hamam
- Stem Cell Unit, Department of Anatomy, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Dana Hamam
- Stem Cell Unit, Department of Anatomy, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.,McGill University Health Centre and RI-MUHC, Montreal, Canada
| | - Khalid A Alsaleh
- Medical Oncology Unit, Department of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Moustapha Kassem
- Stem Cell Unit, Department of Anatomy, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.,KMEB, Department of Endocrinology, University of Southern Denmark, Odense, Denmark.,Institute of Cellular and Molecular Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Waleed Zaher
- Department of Anatomy, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.,College of Medicine Research Center, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Musaad Alfayez
- Stem Cell Unit, Department of Anatomy, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah Aldahmash
- Stem Cell Unit, Department of Anatomy, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.,Prince Naif Health Research Center, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Nehad M Alajez
- Stem Cell Unit, Department of Anatomy, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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27
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Jacklyn G, Howard K, Irwig L, Houssami N, Hersch J, Barratt A. Impact of extending screening mammography to older women: Information to support informed choices. Int J Cancer 2017; 141:1540-1550. [PMID: 28662267 DOI: 10.1002/ijc.30858] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/24/2017] [Accepted: 06/22/2017] [Indexed: 01/19/2023]
Abstract
From 2013 through 2017, the Australian national breast cancer screening programme is gradually inviting women aged 70-74 years to attend screening, following a policy decision to extend invitations to older women. We estimate the benefits and harms of the new package of biennial screening from age 50-74 compared with the previous programme of screening from age 50-69. Using a Markov model, we applied estimates of the relative risk reduction for breast cancer mortality and the risk of overdiagnosis from the Independent UK Panel on Breast Cancer Screening review to Australian breast cancer incidence and mortality data. We estimated screening specific outcomes (recalls for further imaging, biopsies, false positives, and interval cancer rates) from data published by BreastScreen Australia. When compared with stopping at age 69, screening 1,000 women to age 74 is likely to avert one more breast cancer death, with an additional 78 women receiving a false positive result and another 28 women diagnosed with breast cancer, of whom eight will be overdiagnosed and overtreated. The extra 5 years of screening results in approximately 7 more overdiagnosed cancers to avert one more breast cancer death. Thus extending screening mammography in Australia to older women results in a less favourable harm to benefit ratio than stopping at age 69. Supporting informed decision making for this age group should be a public health priority.
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Affiliation(s)
- Gemma Jacklyn
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia
| | - Kirsten Howard
- Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia
| | - Les Irwig
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia
| | - Nehmat Houssami
- Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia
| | - Jolyn Hersch
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia
| | - Alexandra Barratt
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia
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28
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Knottnerus BJ. Cancer screening is not only about numbers. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28488741 DOI: 10.1111/ecc.12700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2017] [Indexed: 11/29/2022]
Abstract
In the cancer screening debate, arguments for and against screening are often based on statistics, whereas for individuals personal, non-statistical factors are at least as important when deciding whether to participate in screening. Health care professionals have a responsibility in helping individuals navigate in this complex field by identifying and clarifying the individuals' beliefs, fears and preferences while being aware of their own. Moreover, researchers should explore beliefs and motives that matter for individuals and not only report numbers that can be interpreted in different ways.
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Affiliation(s)
- B J Knottnerus
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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