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Geoghegan C, Horan M, Crilly E, Kelly A, Lyons R, Geoghegan L, Duke D, Sweeney L, McCartan D, O'Keeffe S. A multicentre review of the direct-access mammography programme in Ireland for women with breast pain. Clin Radiol 2024; 79:e227-e231. [PMID: 38007335 DOI: 10.1016/j.crad.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 11/27/2023]
Abstract
AIM To assess the current use of the direct access mammography pathway for breast pain and the rate of breast cancer detection in this patient cohort. MATERIALS AND METHODS A retrospective review of general practitioner (GP)-referred mammograms performed during a 12-month period from January to December 2022 across four tertiary referral centres. With the use of medical records and GP referrals, patient demographics, presenting symptoms, family history, and clinical outcomes were recorded. RESULTS The present study comprised 2,046 patients of which 21.6% did not report breast pain at the time of referral. Thirty-five per cent had a positive family history with 40% of these patients having no breast pain. Twelve per cent were recalled with 30% of these patients requiring biopsy. An overall cancer detection rate (CDR) of 7 per 1000 was determined for women with mastalgia. A CDR of 0 per 1,000 was determined for women <50 years with mastalgia alone and no additional risk factors for malignancy. Fisher's exact test showed no statistically significant association between breast pain and breast cancer. CONCLUSION There was no statistically significant relationship found between breast pain and breast cancer. This review suggests a low cancer detection rate in women <50 years. In women <50 years with mastalgia without additional symptoms or family history, breast imaging is not required.
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Affiliation(s)
- C Geoghegan
- Radiology Department, St. James's Hospital, Dublin 8, Ireland; University of Galway, Galway, Ireland.
| | - M Horan
- Radiology Department, St. James's Hospital, Dublin 8, Ireland
| | - E Crilly
- Beaumont Breast Centre, Beaumont Hospital, Dublin 9, Ireland
| | - A Kelly
- Radiology Department, University Hospital Waterford, Waterford, Ireland
| | - R Lyons
- Breast Surgery Department, St. Vincent's Hospital, Dublin 4, Ireland
| | - L Geoghegan
- Radiology Department, St. James's Hospital, Dublin 8, Ireland
| | - D Duke
- Beaumont Breast Centre, Beaumont Hospital, Dublin 9, Ireland
| | - L Sweeney
- Radiology Department, University Hospital Waterford, Waterford, Ireland
| | - D McCartan
- Breast Surgery Department, St. Vincent's Hospital, Dublin 4, Ireland
| | - S O'Keeffe
- Radiology Department, St. James's Hospital, Dublin 8, Ireland
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Annual mammography at age 45–49 years and biennial mammography at age 50–69 years: comparing performance measures in an organised screening setting. Eur Radiol 2019; 29:5517-5527. [DOI: 10.1007/s00330-019-06050-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/29/2018] [Accepted: 01/29/2019] [Indexed: 11/26/2022]
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Terry MB, McDonald JA, Wu HC, Eng S, Santella RM. Epigenetic Biomarkers of Breast Cancer Risk: Across the Breast Cancer Prevention Continuum. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 882:33-68. [PMID: 26987530 PMCID: PMC5305320 DOI: 10.1007/978-3-319-22909-6_2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Epigenetic biomarkers, such as DNA methylation, can increase cancer risk through altering gene expression. The Cancer Genome Atlas (TCGA) Network has demonstrated breast cancer-specific DNA methylation signatures. DNA methylation signatures measured at the time of diagnosis may prove important for treatment options and in predicting disease-free and overall survival (tertiary prevention). DNA methylation measurement in cell free DNA may also be useful in improving early detection by measuring tumor DNA released into the blood (secondary prevention). Most evidence evaluating the use of DNA methylation markers in tertiary and secondary prevention efforts for breast cancer comes from studies that are cross-sectional or retrospective with limited corresponding epidemiologic data, raising concerns about temporality. Few prospective studies exist that are large enough to address whether DNA methylation markers add to the prediction of tertiary and secondary outcomes over and beyond standard clinical measures. Determining the role of epigenetic biomarkers in primary prevention can help in identifying modifiable pathways for targeting interventions and reducing disease incidence. The potential is great for DNA methylation markers to improve cancer outcomes across the prevention continuum. Large, prospective epidemiological studies will provide essential evidence of the overall utility of adding these markers to primary prevention efforts, screening, and clinical care.
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Affiliation(s)
- Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA.
| | - Jasmine A McDonald
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Hui Chen Wu
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sybil Eng
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Regina M Santella
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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Melnikow J, Tancredi DJ, Yang Z, Ritley D, Jiang Y, Slee C, Popova S, Rylett P, Knutson K, Smalley S. Program-specific cost-effectiveness analysis: breast cancer screening policies for a safety-net program. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:932-941. [PMID: 24041343 DOI: 10.1016/j.jval.2013.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 05/27/2013] [Accepted: 06/03/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Every Woman Counts (EWC), a California breast cancer screening program, faced challenging budget cutbacks and policy choices. METHODS A microsimulation model evaluated costs, outcomes, and cost-effectiveness of EWC program mammography policy options on coverage for digital mammography (which has a higher cost than film mammography but recent legislation allowed reimbursement at the lower film rate); screening eligibility age; and screening frequency. Model inputs were based on analyses of program claims data linked to California Cancer Registry data, Surveillance, Epidemiology, and End Results data, and the Medi-Cal literature. Outcomes included number of procedures, cancers, cancer deaths, costs, and incremental cost per life-year. RESULTS Projected model outcomes matched program data closely. With restrictions on the number of clients screened, strategies starting screening at age 40 years were dominated (not cost-effective). This finding was highly robust in sensitivity analyses. Compared with no screening, biennial film mammography for women aged 50 to 64 years was projected to reduce 15-year breast cancer mortality by nearly 7.8% at $18,999 per additional life-year, annual film mammography was $106,428 per additional life-year, and digital mammography $180,333 per additional life-year. This more effective, more expensive strategy was projected to reduce breast cancer mortality by 8.6%. Under equal mammography reimbursement, biennial digital mammography beginning at age 50 years was projected to decrease 15-year breast cancer mortality by 8.6% at an incremental cost per additional life-year of $17,050. CONCLUSIONS For the EWC program, biennial screening mammography starting at age 50 years was the most cost-effective strategy. The impact of digital mammography on life expectancy was small. Program-specific cost-effectiveness analysis can be completed in a policy-relevant time frame to assist policymakers faced with difficult program choices.
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Affiliation(s)
- Joy Melnikow
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, USA.
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5
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Breast screening policy: are we heading in the right direction? Clin Radiol 2011; 66:915-9. [PMID: 21741631 DOI: 10.1016/j.crad.2011.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 02/25/2011] [Accepted: 03/02/2011] [Indexed: 11/20/2022]
Abstract
There is a large body of evidence supporting 2-yearly screening of women aged 50-69 years. There is good evidence for a mortality reduction from mammographic screening in women aged 40 to 49 years but a 1-year interval is required. The lack of specificity of screening in young women does remain a problem. There is no evidence to suggest that a single screen between the ages of 47 and 50 years within a programme screening at 3-year intervals will reduce mortality; the trials showing a mortality benefit in women in their 40s included multiple screening episodes and shorter screening intervals. There is no randomized, controlled trial evidence to support screening in women aged above 70 years and screening this age group will cause greater harm than in younger women through higher rates of over-diagnosis and consequent over-treatment. The randomized phase of the screening age extension, which at the moment is planned to last only 6 years, should not be immediately followed by general implementation of the policy. Only if and when additional mortality reductions and an acceptable balance between benefit and harms are shown to be achieved by the extra screens should the 2007 Cancer Reform Strategy policy on age extension be implemented. Resources saved by delaying or abandoning the roll-out of the age extension could potentially be redirected towards reducing the current 3 year screening interval to 2 years in women aged 50-69 years. However, reducing the screening interval to 2 years for women aged 50-69 years would require significantly more screening invitations and resources than the proposed age extension.
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Giordano L, Stefanini V, Senore C, Frigerio A, Castagno R, Marra V, Dalmasso M, del Turco MR, Paci E, Segnan N. The impact of different communication and organizational strategies on mammography screening uptake in women aged 40-45 years. Eur J Public Health 2011; 22:413-8. [PMID: 21746751 DOI: 10.1093/eurpub/ckr090] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Several factors can influence access to population breast cancer screening. The aim of the study was to evaluate the impact of different information approaches, women's socio-demographic characteristics and organizational factors on mammography screening uptake. METHODS We selected 5744 women aged 40-45 years who were randomly assigned to be given letters with: (i) a pre-fixed appointment plus standard leaflet (Group 1); (ii) a pre-fixed appointment plus a more comprehensive booklet (Group 2); (iii) point (ii) plus the offer of a counselling session (Group 3); and (iv) an invitation to contact the centre to get information and arrange participation (Group 4). RESULTS Ninety-five women were excluded before the invitation and 5649 were randomized. After excluding undelivered letters (n = 41) and women reporting an exclusion criterion following our invitation (n = 248), the final eligible population was 5360 women. Participation rates following the first contact were 36.5, 39.9, 35.8 and 16.5% for Groups 1-4, respectively. The rates increased to 40.9, 43.6, 40.1 and 35.1% after the reminder letters. Women receiving more complete information had a higher uptake (Group 2), although not statistically significant. Differences among the four groups were maintained by controlling the effect of socio-demographic and attendance determinants. Regardless of intervention, participation was higher among married, higher educated, white-collared women, those born in northern Italy, living closer to the screening unit and with a female-collaborative doctor. CONCLUSION Invitation letters with a fixed appointment correlate with a higher attendance rate. Providing women with more information on procedures, risks and benefits of mammography screening does not modify their participation.
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Affiliation(s)
- Livia Giordano
- Unit of Epidemiology - CPO Piemonte, Center for Cancer Prevention, Turin, Italy.
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Madan J, Rawdin A, Stevenson M, Tappenden P. A rapid-response economic evaluation of the UK NHS Cancer Reform Strategy breast cancer screening program extension via a plausible bounds approach. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2010; 13:215-221. [PMID: 19878494 DOI: 10.1111/j.1524-4733.2009.00667.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES The 2007 National Health Service Cancer Reform Strategy includes a proposed extension of the UK breast screening program to women aged 47 to 49 years. The aim of this study is to undertake a preliminary assessment of this proposal to identify the key factors determining its cost-effectiveness and to determine whether there is sufficient uncertainty that requires more thorough analyses. METHODS An economic model was constructed. For simplicity, the health impact of screening was estimated by calculating the lives saved through shifts in prognostic group. A "plausible bounds" approach was used to derive distributions for model parameters for probabilistic sensitivity analysis. UK data were used to populate the model. RESULTS The cost-effectiveness of the extension is estimated to be pound27,400 per quality-adjusted life-year (QALY) with a 29% probability of cost-effectiveness at a threshold of pound20,000 per QALY. The deterministic estimate of benefit becomes negative if the anxiety due to a false-positive result is set at 0.028 QALYs. Including a small positive benefit from a negative screen has a dramatic impact on the cost-effectiveness of screening. The impact of other factors appears less marked. CONCLUSIONS Because the vast majority of women aged 47 to 49 years will test negative when screened for breast cancer and most of those who test positive will actually be free of the disease, the psychological impacts of screening are likely to drive cost-effectiveness for this age group. Therefore, a research priority should be to better understand and quantify these effects.
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Affiliation(s)
- Jason Madan
- Academic Unit of Primary Health Care, University of Bristol, Cotham House, Bristol, UK.
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Clark MA, Rogers ML, Armstrong GF, Rakowski W, Bowen DJ, Hughes T, McGarry KA. Comprehensive cancer screening among unmarried women aged 40-75 years: results from the cancer screening project for women. J Womens Health (Larchmt) 2009; 18:451-9. [PMID: 19361311 PMCID: PMC2857572 DOI: 10.1089/jwh.2008.1046] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES We explored self-reported rates of individual on-schedule breast, cervical, and colorectal cancer screenings, as well as an aggregate measure of comprehensive screenings, among unmarried women aged 40-75 years. We compared women who partner with women (WPW) or with women and men (WPWM) to women who partner exclusively with men (WPM). We also compared barriers to on-schedule cancer screenings between WPW/WPWM and WPM. METHODS Comparable targeted and respondent-driven sampling methods were used to enroll 213 WPW/WPWM and 417 WPM (n = 630). Logistic regression models were computed to determine if partner gender was associated with each measure of on-schedule screening after controlling for demographic characteristics, health behaviors, and cancer-related experiences. RESULTS Overall, 74.3% of women reported on-schedule breast screening, 78.3% reported on-schedule cervical screening, 66.5% reported on-schedule colorectal screening, and 56.7% reported being on-schedule for comprehensive screening. Partner gender was not associated with any of the measures of on-schedule screening in multivariable analyses. However, women who reported ever putting off, avoiding, or changing the place of screenings because of sexual orientation were less likely to be on-schedule for comprehensive screening. Women who reported barriers associated with taking time from work and body image concerns were also less likely to be on-schedule for comprehensive screening. CONCLUSIONS Barriers to cancer screening were comparable across types of examinations as well as between WPW/WPWM and WPM. Developing health promotion programs for unmarried women that address concomitant detection and prevention behaviors may improve the efficiency and effectiveness of healthcare delivery and ultimately assist in reducing multiple disease risks.
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Affiliation(s)
- Melissa A Clark
- Department of Community Health, Brown University Warren Alpert School of Medicine and Program in Public Health, Providence, Rhode Island 02912, USA.
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Keen JD, Keen JE. How does age affect baseline screening mammography performance measures? A decision model. BMC Med Inform Decis Mak 2008; 8:40. [PMID: 18803871 PMCID: PMC2563001 DOI: 10.1186/1472-6947-8-40] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Accepted: 09/21/2008] [Indexed: 11/10/2022] Open
Abstract
Background In order to promote consumer-oriented informed medical decision-making regarding screening mammography, we created a decision model to predict the age dependence of the cancer detection rate, the recall rate and the secondary performance measures (positive predictive values, total intervention rate, and positive biopsy fraction) for a baseline mammogram. Methods We constructed a decision tree to model the possible outcomes of a baseline screening mammogram in women ages 35 to 65. We compared the single baseline screening mammogram decision with the no screening alternative. We used the Surveillance Epidemiology and End Results national cancer database as the primary input to estimate cancer prevalence. For other probabilities, the model used population-based estimates for screening mammography accuracy and diagnostic mammography outcomes specific to baseline exams. We varied radiologist performance for screening accuracy. Results The cancer detection rate increases from 1.9/1000 at age 40 to 7.2/1000 at age 50 to 15.1/1000 at age 60. The recall rate remains relatively stable at 142–157/1000, which varies from 73–236/1000 at age 50 depending on radiologist performance. The positive predictive value of a screening mammogram increases from 1.3% at age 40 to 9.8% at age 60, while the positive predictive value of a diagnostic mammogram varies from 2.9% at age 40 to 19.2% at age 60. The model predicts the total intervention rate = 0.013*AGE2 - 0.67*AGE + 40, or 34/1000 at age 40 to 47/1000 at age 60. Therefore, the positive biopsy (intervention) fraction varies from 6% at age 40 to 32% at age 60. Conclusion Breast cancer prevalence, the cancer detection rate, and all secondary screening mammography performance measures increase substantially with age.
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Affiliation(s)
- John D Keen
- Department of Radiology, John H. Stroger Jr. Hospital of Cook County, 1901 West Harrison Street, Chicago, IL 60612-9985, USA.
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Delaloye JF. La mammographie de dépistage avant 50 ans. IMAGERIE DE LA FEMME 2008. [DOI: 10.1016/s1776-9817(08)77194-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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CLEMENTS A, HENDERSON B, TYNDEL S, EVANS G, BRAIN K, AUSTOKER J, WATSON E. Diagnosed with breast cancer while on a family history screening programme: an exploratory qualitative study. Eur J Cancer Care (Engl) 2008; 17:245-52. [DOI: 10.1111/j.1365-2354.2007.00837.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Making policy decisions about population screening for breast cancer: the role of citizens' deliberation. Health Policy 2007; 85:314-20. [PMID: 17931738 DOI: 10.1016/j.healthpol.2007.08.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Revised: 08/13/2007] [Accepted: 08/31/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To test a method of assessing whether a community of interest - when well informed - would be prepared to support or reject a public policy decision about cancer screening. In particular, whether the New Zealand government should offer free mammography screening to all women aged 40-49 years. METHODS Eleven women aged from 40 to 49 years, randomly selected from the electoral roll, agreed to participate in trial of a citizens' jury: a deliberative method of gathering the views of the public. Only selected aspects of the jury method were trialled. Participants met over a day and a half to hear evidence from expert witnesses with differing views and to deliberate the verdict. RESULTS All but one woman changed their minds during the jury process, and voted against government provision of mammography screening in this age group. The main reasons reported were the inaccuracy of the test and the potential for harm, and the lack of firm evidence of saving lives in this age group. CONCLUSIONS A deliberative 'citizens' jury' approach is a feasible way of eliciting a well informed, considered community view about screening or other population health initiatives. Pro-screening views of affected populations may change when individuals are given accurate information and enabled to deliberate about benefits and harms. This method could be used to determine how complex benefits and harms are weighed by affected populations, particularly where experts and advocacy groups disagree.
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Luengo-Matos S, Polo-Santos M, Saz-Parkinson Z. Mammography use and factors associated with its use after the introduction of breast cancer screening programmes in Spain. Eur J Cancer Prev 2006; 15:242-8. [PMID: 16679867 DOI: 10.1097/01.cej.0000199503.30818.e6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to measure the use of mammography and the factors associated with testing among Spanish women, after the introduction of screening programmes in Spain. We conducted a cross-sectional population survey of a representative sample of women aged 40-70 (2409 women). Data collection took place in October 2000, using a questionnaire addressing the dependent variable (mammography use) and the independent variables (socio-demographic and socio-health factors, and women's knowledge and attitudes). Mammography use was defined as having received at least one screening test in the previous 2 years. Data analysis consisted of univariate and multivariate analyses. 48.1% (95% confidence interval (CI) 46.0-50.2) of women had received screening mammography. The main factors associated with testing were: mammography invitation from the screening programme (odds ratio (OR) 4.81; 95% CI 3.85-6.01); gynaecologist visit (OR 4.32; 95% CI 3.45-5.41); and intention to have a mammogram (OR 2.94; 95% CI 2.00-4.32). Other test-related factors were: not rejecting test for discomfort or fear of cancer; mammography perceived as necessary; age 56-65; upper/upper-middle socio-economic status. In conclusion, after the introduction of screening programmes, almost half of Spanish women aged 40-70 had received mammography. Invitation to screening, gynaecologist visit and women's attitudes are the main reasons for undergoing testing. Women over 65 years of age and/or those in a lower socio-economic level warrant special attention.
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Affiliation(s)
- Setefilla Luengo-Matos
- Agencia de Evaluación de Tecnologías Sanitarias (Health Technology Assessment Agency). Instituto de Salud Carlos III (Institute of Health Carlos III), Madrid, Spain.
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Gabe R, Duffy SW. Evaluation of service screening mammography in practice: the impact on breast cancer mortality. Ann Oncol 2005; 16 Suppl 2:ii153-62. [PMID: 15958448 DOI: 10.1093/annonc/mdi718] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R Gabe
- Wolfson Institute of Preventive Medicine, Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, London, UK
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