Cost-Effectiveness Analysis of a Mobile Mammography Unit for Breast Cancer Screening to Reduce Geographic and Social Health Inequalities

Assessment of barriers to cancer screening and interventions implemented to overcome these barriers in 27 Latin American and Caribbean countries

There is a gap in the understanding of the barriers to cancer screening participation and complying with downstream management in the Community of Latin American and Caribbean states (CELAC). Our study aimed to assess barriers across the cancer screening pathway from the health system perspective, and interventions in place to improve screening in CELAC. A standardized tool was used to collect information on the barriers across the screening pathway through engagement with the health authorities of 27 member states of CELAC. Barriers were organized in a framework adapted from the Tanahashi conceptual model and consisted of the following dimensions: availability of services, access (covering accessibility and affordability), acceptability, user-provider interaction, and effectiveness of services (which includes governance, protocols and guidelines, information system, and quality assurance). The tool also collected information of interventions in place, categorized in user-directed interventions to increase demand, user-directed interventions to increase access, provider-directed interventions, and policy and system-level interventions. All countries prioritized barriers related to the information systems, such as the population register not being accurate or complete (N = 19; 70.4%). All countries implemented some kind of intervention to improve cancer screening, group education being the most reported (N = 23; 85.2%). Training on screening delivery was the most referred provider-directed intervention (N = 19; 70.4%). The study has identified several barriers to the implementation of cancer screening in the region and interventions in place to overcome some of the barriers. Further analysis is required to evaluate the effectiveness of these interventions in achieving their objectives.

Low-Field, Low-Cost, Point-of-Care Magnetic Resonance Imaging

Low-field magnetic resonance imaging (MRI) has recently experienced a renaissance that is largely attributable to the numerous technological advancements made in MRI, including optimized pulse sequences, parallel receive and compressed sensing, improved calibrations and reconstruction algorithms, and the adoption of machine learning for image postprocessing. This new attention on low-field MRI originates from a lack of accessibility to traditional MRI and the need for affordable imaging. Low-field MRI provides a viable option due to its lack of reliance on radio-frequency shielding rooms, expensive liquid helium, and cryogen quench pipes. Moreover, its relatively small size and weight allow for easy and affordable installation in most settings. Rather than replacing conventional MRI, low-field MRI will provide new opportunities for imaging both in developing and developed countries. This article discusses the history of low-field MRI, low-field MRI hardware and software, current devices on the market, advantages and disadvantages, and low-field MRI's global potential.

Overcoming barriers: Modelling the effect of potential future changes of organized breast cancer screening in Italy

OBJECTIVES

Organized breast cancer screening may not achieve its full potential due to organizational and cultural barriers. In Italy, two identified barriers were low attendance in Southern Italy and, in Italy as a whole, underscreening and overscreening in parts of the eligible population. The objective of this study was to identify potential changes to overcome these barriers and to quantify their costs and effects.

METHODS

To assess the impact of potential measures to improve breast cancer screening in Italy, we performed an evaluation of costs and effects for increasing adherence for Southern Italy and harmonizing screening intervals (biennial screening) for the whole of Italy, using an online tool (EU-TOPIA evaluation tool) based on the MIcrosimulation SCreening ANalysis (MISCAN) model.

RESULTS

Increasing adherence in Southern Italy through investing in mobile screening units has an acceptable cost-effectiveness ratio of €9531 per quality-adjusted life year gained. Harmonizing the screening interval by investing in measures to reduce opportunistic screening and simultaneously investing in mobile screening units to reduce underscreening is predicted to gain 1% fewer life-years, while saving 19% of total screening costs compared to the current situation.

CONCLUSIONS

Increasing adherence in Southern Italy and harmonizing the screening interval could result in substantial improvements at acceptable costs, or in the same benefits at lower costs. This example illustrates a systematic approach that can be easily applied to other European countries, as the online tools can be used by stakeholders to quantify effects and costs of a broad range of specific barriers, and ways to overcome them.

Impact of the COVID-19 Pandemic on Cancer Screening Delays

PURPOSE

To examine delays in cancer screenings during the COVID-19 pandemic.

METHODS

Participants from previous studies (N = 32,989) with permissions to be recontacted were invited to complete a survey between June and November 2020. Participants (n = 7,115) who met the age range for cancer screenings were included. Participants were asked if they planned to have and then if they postponed a scheduled mammogram, Pap test, stool blood test, colonoscopy, or human papillomavirus (HPV) test. Logistic regression was used to determine the factors associated with cancer screening delays for each planned test.

RESULTS

The average age was 57.3 years, 75% were female, 89% were non-Hispanic White, 14% had public insurance, and 34% lived in rural counties. Those who planned cancer screenings (n = 4,266, 60%) were younger, more likely to be female, with higher education, had private insurance, and lived in rural counties. Specifically, 24% delayed a mammogram (n = 732/2,986), 27% delayed a Pap test (n = 448/1,651), 27% delayed an HPV test (n = 59/220), 11% delayed a stool blood test (n = 44/388), and 36% delayed a colonoscopy (n = 304/840). Age, race/ethnicity, education, and health insurance were associated with delays in cancer screenings (all P < .05). Compared with non-Hispanic White women, non-Hispanic Black women had lower odds of delaying a mammogram (odds ratio [OR], 0.60; 95% CI, 0.39 to 0.94), Hispanic women had higher odds of delaying Pap test (OR, 2.46; 95% CI, 1.34 to 4.55), and women with other race/ethnicity had higher odds of delaying both Pap test (OR, 2.38; 95% CI, 1.41 to 4.02) and HPV test (OR, 5.37; 95% CI, 1.44 to 19.97).

CONCLUSION

Our findings highlighted the urgency for health care providers to address the significant delays in cancer screenings in those most likely to delay. Strategies and resources are needed to help those with barriers to receiving guideline-appropriate cancer screening.

Barriers and Facilitators to Participation in Health Screening: an Umbrella Review Across Conditions

Screening is an essential prevention practice for a number of health conditions. However, screening coverage remains generally low. Studies that investigate determinants of screening participation are becoming more common, but oftentimes investigate screening for health conditions in an individualized rather than integrated fashion. In routine clinical practice, however, healthcare professionals are often confronted with situations in which several screening procedures are recommended for the same patient. The consideration of their common determinants may support a more integrated screening approach. The objectives of this umbrella review were therefore to examine: 1) the determinants (barriers and facilitators) that have been identified in relation to recommended health screening procedures; and 2) the modifiable determinants (in primary care) common across health conditions or specific to individual procedures. Results were presented through a narrative synthesis. PubMed, PsycInfo and Cochrane were searched up to January 2022. Systematic reviews reporting determinants of participation in health screening procedures with grade A or B recommendation according to the US Preventive Services Task Force were included. A total of 85 systematic reviews were included, most which contained both qualitative and quantitative studies on determinants that describe individual factors (961 occurrences), social factors (113 occurrences, healthcare professional factors (149 occurrences), health system factors (105 occurrences) and screening procedure factors (99 occurrences). The most studied screening procedures concerned cervical cancer/human papillomavirus (n = 33), breast cancer (n = 28), colorectal cancer (n = 25) and the human immunodeficiency virus (n = 12). Other conditions have been under-studied (e.g. cardiovascular problems, lung cancer, syphilis). The individual domain, including determinants such as knowledge, beliefs and emotions, was the most covered across health conditions. Healthcare professional's recommendations and the quality of patient-provider communication were identified to have a strong influence on screening participation in most conditions. The other three domains included determinants which were more specific to a condition or a population. Various determinants modifiable in primary care were found in the individual domain and in the health system, healthcare professional and screening procedure domains. Quality was assessed as low for most systematic reviews included. The identification of various modifiable determinants common across conditions highlights the potential of an integrated screening participation approach. Interventions may address common determinants in a broader person-centred framework within which tailoring to specific procedures or populations can be considered. This approach needs to be explored in intervention studies. The systematic review registration is PROSPERO CRD42019126709.

Effect of accessibility improvement in a national population-based breast cancer screening policy on mammography utilization among women with comorbid conditions in Taiwan

In Taiwan, a Cancer Screening Quality Improvement Program (CAQIP), implemented in 2010, provides financial support to qualified hospitals to improve accessibility. This study aimed to examine the effect of CAQIP on mammography participation among women aged 50-69 years at various health statuses. A natural experimental study design before and after CAQIP implementation in 2010 was conducted. Phase 1 included 437,875 screened and 1,490,453 non-screened women, and 830,348 and 1,03,454 in Phase 2. Compared with women with no comorbidity, women with severe chronic conditions were less likely to participate in mammography screening. CAQIP was positively associated with the likelihood of mammography participation (OR 3.899, 95% CI 3.878-3.920); the magnitude of the effect was smaller for women with comorbid conditions. The findings provide evidences and economic theorical perspectives of potential benefits of health policy interventions to improve accessibility and mammography participation among women aged 50-69 years with comorbid conditions.

Adherence to Screening Among American Indian Women Accessing a Mobile Mammography Unit

RATIONALE AND OBJECTIVES

Although screening mammography is essential to reducing breast cancer morbidity and mortality, barriers exist especially among underrepresented minority groups. There are few studies of mammogram screening among American Indian women, many of whom reside in rural areas where screening access is challenging. A mobile mammography unit served 24 Indian Health Service clinics during 2013-17. Screening mammography adherence was evaluated.

MATERIALS AND METHODS

Among mobile unit women, 'adherence to screening' was determined by the date of the most recent prior mammogram. Those having a prior mammogram 9-27 months ago were classified as 'adherent to screening'. Comparison screening data were obtained from the American College of Radiology National Mammography Database, consisting of screening cases occurring in year 2015. Additionally, among mobile unit women 'continued adherence to screening' was determined, defined as at least one repeat screening at the mobile unit within the subsequent 9-27 months after a screening there.

RESULTS

Among 1,615 mobile unit women, 624 (38.6%) were adherent to screening. Among 2,509,826 National Mammography Database women, 1,481,021 (59.0%) were adherent to screening. (p<0.0001) The prevalence of a >27-month interval between mammograms was 3.13 (95% CI 2.91-3.36) times greater among mobile unit women than National Mammography Database women. 'Continued adherence to screening' of mobile unit women was 428/1194 (35.9%).

CONCLUSION

Adherence to screening and continued adherence to screening were low among mobile unit women and time interval between screenings was longer than National Mammography Database women. Factors to improve screening adherence among these underserved women should be determined.

Evaluating Preoperative Anxiety Levels in Patients Undergoing Breast Cancer Surgery

OBJECTIVE

Patients' anxiety and stress levels are increased after the surgery. High levels of anxiety and stress could increase postoperative complications, as well as to prolong postoperative hospitalization and postoperative morbidity. This prospective, cross-sectional study was to evaluate the preoperative stress levels in patients undergoing breast cancer surgery.

METHODS

In the study participated 165 female patients who underwent breast cancer surgery, in a major oncological hospital in Greece. Demographic and clinical data were collected, and anxiety and stress levels assessed using the State-Trait Anxiety Inventory (STAI) Scale, which was a self-report questionnaire consisting of 40, 4 Likert Scale questions. The first 20 questions, STAI-X-1, were concerned to how the patient felt while answering the questionnaire (anxiety as a condition) and the remaining 20 questions, STAI-X-2, based on how the patient felt overall (stress as a personality trait). Descriptive statistics and nonparametric tests were performed at a significance level alpha = 0.05.

RESULTS

In the present study, 165 females were enrolled who underwent breast cancer surgery. The mean age of the participants was 55.86 years, whereas the mean body mass index was 26.85. The 60.6% of patients underwent a lumpectomy and 28.5% had mastectomy. The 35.8% experienced moderate levels of anxiety, and the 17.6% experienced high levels. The two scales were positively correlated (rho = 0.643, P < 0.001), at the significance level P = 0.01. Furthermore, the Stai-X-2 Scale was negatively correlated with body height (rho = -0.1188, P = 0.016).

CONCLUSIONS

The present study showed that patients' personality influenced their anxiety levels. Thus, the role of the nurse is a cornerstone in their psychological support preoperatively, to reduce the anxiety and stress levels.