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Shashar S, Codish S, Ellen M, Davidson E, Novack V. Determinants of Medical Practice Variation Among Primary Care Physicians: Protocol for a Three Phase Study. JMIR Res Protoc 2020; 9:e18673. [PMID: 33079069 PMCID: PMC7609196 DOI: 10.2196/18673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/04/2020] [Accepted: 06/14/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND One of the greatest challenges of modern health systems is the choice and use of resources needed to diagnose and treat patients. Medical practice variation (MPV) is a broad term which entails the differences between health care providers inclusive of both the overuse and underuse. In this paper, we describe a 3-phase research protocol examining MPV in primary care. OBJECTIVE We aim to identify the potential targets for behavioral modification interventions to reduce the variation in practice patterns and thus improve health care, decrease costs, and prevent disparities in care. METHODS The first phase will delineate the variation in primary care practice over a wide range of services and long follow-up period (2003-2017), the second will examine the 3 determinants of variation (ie, patient, physician, and clinic characteristics), and attempt to derive the unexplained variance. In the third phase, we will assess a novel component that might contribute to the previously unexplained variance - the physicians' personal behavioral characteristics (such as risk aversion, fear of malpractice, stress from uncertainty, empathy, and burnout). RESULTS This work was supported by the research grant from Israel National Institute for Health Policy Research (Grant No. 2014/134). Soroka University Medical Center Institutional Ethics Committee has approved the updated version of the study protocol (SOR-14-0063) in February 2019. All relevant data for phases 1 and 2, including patient, physician, and clinic, were collected from the Clalit Health Services data set in 2019 and are currently being analyzed. The evaluation of the individual physician characteristics (eg, risk aversion) by the face-to-face questionnaires was started on 2018 and remains in progress. We intend to publish the results during 2020-2021. CONCLUSIONS Based on the results of our study, we aim to propose a list of potential targets for focused behavioral intervention. Identifying new targets for such an intervention can potentially lead to a decrease in the unwarranted variation in the medical practice. We suggest that such an intervention will result in optimization of the health system, improvement of health outcomes, reduction of disparities in care and savings in cost. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/18673.
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Affiliation(s)
- Sagi Shashar
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shlomi Codish
- Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Moriah Ellen
- Department of Health Services Management, Guilford Glazer Faculty of Business and Management, Ben Gurion University, Beer-Sheva, Israel.,Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,McMaster Health Forum, McMaster University, Hamilton, ON, Canada
| | - Ehud Davidson
- General Management, Clalit Health Services, Tel Aviv, Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Ayanore MA, Adjuik M, Ameko A, Kugbey N, Asampong R, Mensah D, Alhassan RK, Afaya A, Aviisah M, Manu E, Zotor F. Self-reported breast and cervical cancer screening practices among women in Ghana: predictive factors and reproductive health policy implications from the WHO study on global AGEing and adult health. BMC WOMENS HEALTH 2020; 20:158. [PMID: 32723342 PMCID: PMC7388217 DOI: 10.1186/s12905-020-01022-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 07/16/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Breast and cervical cancers constitute the two leading causes of cancer deaths among women in Ghana. This study examined breast and cervical screening practices among adult and older women in Ghana. METHODS Data from a population-based cross-sectional study with a sample of 2749 women were analyzed from the study on global AGEing and adult health conducted in Ghana between 2007 and 2008. Binary and multivariable ordinal logistic regression analyses were performed to assess the association between socio-demographic factors, breast and cervical screening practices. RESULTS We found that 12.0 and 3.4% of adult women had ever had pelvic screening and mammography respectively. Also, 12.0% of adult women had either one of the screenings while only 1.8% had both screening practices. Age, ever schooled, ethnicity, income quantile, father's education, mother's employment and chronic disease status were associated with the uptake of both screening practices. CONCLUSION Nationwide cancer awareness campaigns and education should target women to improve health seeking behaviours regarding cancer screening, diagnosis and treatment. Incorporating cancer screening as a benefit package under the National Health Insurance Scheme can reduce financial barriers for breast and cervical screening.
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Affiliation(s)
- Martin Amogre Ayanore
- School of Public Health, University of Health and Allied Sciences, University of Health and Allied Sciences, Ho, Ghana.
| | - Martin Adjuik
- School of Public Health, University of Health and Allied Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Asiwome Ameko
- School of Public Health, University of Health and Allied Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Nuworza Kugbey
- School of Public Health, University of Health and Allied Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Robert Asampong
- School of Public Health, University of Health and Allied Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Derrick Mensah
- School of Public Health, University of Health and Allied Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Robert Kaba Alhassan
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Agani Afaya
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Mark Aviisah
- School of Public Health, University of Health and Allied Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Emmanuel Manu
- School of Public Health, University of Health and Allied Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Francis Zotor
- School of Public Health, University of Health and Allied Sciences, University of Health and Allied Sciences, Ho, Ghana
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Natal C, Fernández-Somoano A, Torá-Rocamora I, Tardón A, Castells X. [Variations in the diagnostic confirmation process between breast cancer mass screening units]. GACETA SANITARIA 2016; 30:265-71. [PMID: 27137776 DOI: 10.1016/j.gaceta.2016.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/11/2016] [Accepted: 03/15/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To analyse variations in the diagnostic confirmation process between screening units, variations in the outcome of each episode and the relationship between the use of the different diagnostic confirmation tests and the lesion detection rate. METHOD Observational study of variability of the standardised use of diagnostic and lesion detection tests in 34 breast cancer mass screening units participating in early-detection programmes in three Spanish regions from 2002-2011. RESULTS The diagnostic test variation ratio in percentiles 25-75 ranged from 1.68 (further appointments) to 3.39 (fine-needle aspiration). The variation ratio in detection rates of benign lesions, ductal carcinoma in situ and invasive cancer were 2.79, 1.99 and 1.36, respectively. A positive relationship between rates of testing and detection rates was found with fine-needle aspiration-benign lesions (R(2): 0.53), fine-needle aspiration-invasive carcinoma (R(2): 0 28), core biopsy-benign lesions (R(2): 0.64), core biopsy-ductal carcinoma in situ (R(2): 0.61) and core biopsy-invasive carcinoma (R(2): 0.48). CONCLUSIONS Variation in the use of invasive tests between the breast cancer screening units participating in early-detection programmes was found to be significantly higher than variations in lesion detection. Units which conducted more fine-needle aspiration tests had higher benign lesion detection rates, while units that conducted more core biopsies detected more benign lesions and cancer.
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Affiliation(s)
- Carmen Natal
- Servicio de Salud del Principado de Asturias, Oviedo (Asturias), España.
| | - Ana Fernández-Somoano
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, España; Universidad de Oviedo, Oviedo (Asturias), España; IUOPA-Área de Medicina Preventiva y Salud Pública, Departamento de Medicina, Universidad de Oviedo, Asturias, España
| | - Isabel Torá-Rocamora
- IUOPA-Área de Medicina Preventiva y Salud Pública, Departamento de Medicina, Universidad de Oviedo, Asturias, España; Departamento de Epidemiología y Evaluación, IMIM (Hospital del Mar Instituto de Investigación Médica) y Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, España
| | - Adonina Tardón
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, España; Universidad de Oviedo, Oviedo (Asturias), España
| | - Xavier Castells
- IUOPA-Área de Medicina Preventiva y Salud Pública, Departamento de Medicina, Universidad de Oviedo, Asturias, España; Departamento de Epidemiología y Evaluación, IMIM (Hospital del Mar Instituto de Investigación Médica) y Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, España
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Luctkar-Flude M. Are primary care providers implementing evidence-based care for breast cancer survivors? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2015; 61:978-984. [PMID: 26889509 PMCID: PMC4642911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To describe the implementation of key best practice guideline recommendations for posttreatment breast cancer survivorship care by primary care providers (PCPs). DESIGN Descriptive cross-sectional survey. SETTING Southeastern Ontario. PARTICIPANTS Eighty-two PCPs: 62 family physicians (FPs) and 20 primary health care nurse practitioners (PHCNPs). MAIN OUTCOME MEASURES Twenty-one “need-to-know” breast cancer survivorship care guideline recommendations rated by participants as “implemented routinely,” “aware of guideline recommendation but not implemented routinely,” or “not aware of guideline recommendation.” RESULTS Overall, FPs and PHCNPs in our sample reported similar practice patterns in terms of implementation of breast cancer survivorship guideline recommendations. The PCPs reported routinely implementing approximately half (46.4%, 9.7 of 21) of the key guideline recommendations with breast cancer survivors in their practices. Implementation rates were higher for recommendations related to prevention and surveillance aspects of survivorship care, such as mammography and weight management. Knowledge and practice gaps were highest for recommendations related to screening for and management of long-term effects such as fatigue and distress. There were only a few minor differences reported between FPs and PHCNPs. CONCLUSION There are knowledge and practice gaps related to implementation of the key guideline recommendations for breast cancer survivorship care in the primary care setting that could be targeted for improvement through educational or other interventions.
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Corbelli J, Borrero S, Bonnema R, McNamara M, Kraemer K, Rubio D, Karpov I, McNeil M. Use of the Gail model and breast cancer preventive therapy among three primary care specialties. J Womens Health (Larchmt) 2014; 23:746-52. [PMID: 25115368 DOI: 10.1089/jwh.2014.4742] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Breast cancer is an issue of serious concern among women of all ages. The extent to which providers across primary care specialties assess breast cancer risk and discuss chemoprevention is unknown. METHODS Cross-sectional web-based survey completed by 316 physicians in internal medicine (IM), family medicine (FM), and gynecology (GYN) from February to April of 2012. Survey items assessed respondents' frequency of use of the Gail model and chemoprevention, and their attitudes behind practice patterns. Descriptive statistics were used to generate response distributions, and chi-squared tests were used to compare responses among specialties. RESULTS The response rate was 55.0 % (316/575). Only 40% of providers report having used the Gail model (37% IM, 33% FM, 60% GYN) and 13% report having recommended or prescribed chemoprevention (9% IM, 8% FM, 30% GYN). Among providers who use the Gail model, a minority use it regularly in patients who may be at increased breast cancer risk. Among providers who have prescribed chemoprevention, most have done so five times or fewer. Lack of both time and familiarity were commonly cited barriers to use of the Gail score and chemoprevention. CONCLUSIONS An overall minority of providers, most notably in FM and IM, use the Gail model to assess, and chemoprevention to decrease, breast cancer risk. Until providers are more consistent in their use of the Gail model (or other breast cancer risk calculator) and chemoprevention, opportunities to intervene in women at increased risk will likely continue to be missed.
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Affiliation(s)
- Jennifer Corbelli
- 1 Division of General Internal Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
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Corbelli J, Borrero S, Bonnema R, McNamara M, Kraemer K, Rubio D, Karpov I, McNeil M. Physician adherence to U.S. Preventive Services Task Force mammography guidelines. Womens Health Issues 2014; 24:e313-9. [PMID: 24794545 DOI: 10.1016/j.whi.2014.03.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 03/06/2014] [Accepted: 03/07/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND In 2009, the U.S. Preventive Services Task Force (USPSTF) guidelines for screening mammography changed significantly, and are now in direct conflict with screening guidelines of other major national organizations. The extent to which physicians in different primary care specialties adhere to current USPSTF guidelines is unknown. METHODS We conducted a cross-sectional web-based survey completed by 316 physicians in internal medicine, family medicine (FM), and gynecology (GYN) from February to April 2012. Survey items assessed respondents' breast cancer screening recommendations in women of different ages at average risk for breast cancer. We used descriptive statistics to generate response distribution for survey items, and logistic regression models to compare responses among specialties. FINDINGS The response rate was 55.0% (316/575). A majority of providers in internal medicine (65%), FM (64%), and GYN (92%) recommended breast cancer screening starting at age 40 versus 50. A majority of providers in internal medicine (77%), FM (74%), and GYN (98%) recommended annual versus biennial screening. Gynecologists were significantly more likely than both internists and family physicians to recommend initial mammography at age 40 (p ≤ .0001) and yearly mammography (p = .0003). There were no other differences by respondent demographic. CONCLUSIONS Primary care providers, especially gynecologists, have not implemented USPSTF guidelines. The extent to which these findings may be driven by patient versus provider preferences should be explored. These findings suggest that patients are likely to receive conflicting breast cancer screening recommendations from different providers.
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Affiliation(s)
- Jennifer Corbelli
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Sonya Borrero
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Research Health Equity and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Center for Research on Health Care, University of Pittsburgh Center for Research on Health Care, Pittsburgh, Pennsylvania
| | - Rachel Bonnema
- Division of General Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Megan McNamara
- Division of General Internal Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio; Louis Stokes VA Healthcare System, Cleveland, Ohio
| | - Kevin Kraemer
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Research on Health Care, University of Pittsburgh Center for Research on Health Care, Pittsburgh, Pennsylvania
| | - Doris Rubio
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Research on Health Care, University of Pittsburgh Center for Research on Health Care, Pittsburgh, Pennsylvania
| | - Irina Karpov
- Center for Research on Health Care, University of Pittsburgh Center for Research on Health Care, Pittsburgh, Pennsylvania
| | - Melissa McNeil
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Corbelli J, Borrero S, Bonnema R, McNamara M, Kraemer K, Rubio D, Karpov I, McNeil M. Differences Among Primary Care Physicians' Adherence to 2009 ACOG Guidelines for Cervical Cancer Screening. J Womens Health (Larchmt) 2014; 23:397-403. [DOI: 10.1089/jwh.2013.4475] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jennifer Corbelli
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sonya Borrero
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for Research Health Equity and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Center for Research on Health Care, University of Pittsburgh Center for Research on Health Care, Pittsburgh, Pennsylvania
| | - Rachel Bonnema
- University of Nebraska Medical Center Division of General Internal Medicine, Omaha, Nebraska
| | - Megan McNamara
- Case Western Reserve University School of Medicine Division of General Internal Medicine, Cleveland, Ohio
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Kevin Kraemer
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for Research on Health Care, University of Pittsburgh Center for Research on Health Care, Pittsburgh, Pennsylvania
| | - Doris Rubio
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for Research on Health Care, University of Pittsburgh Center for Research on Health Care, Pittsburgh, Pennsylvania
| | - Irina Karpov
- Center for Research on Health Care, University of Pittsburgh Center for Research on Health Care, Pittsburgh, Pennsylvania
| | - Melissa McNeil
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Trigoni M, Mahoney MC, Moschandreas J, Tsiftsis D, Koumantakis E, Lionis C. Approaches to breast cancer screening among primary care physicians in rural areas of crete, Greece. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2011; 26:490-496. [PMID: 21221884 DOI: 10.1007/s13187-010-0186-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The aim of this study was to assess levels of knowledge regarding breast cancer screening among primary care physicians in rural areas of Crete. A cross-sectional survey of 106 general practitioners and internists and 83 trainee general practitioners (GPs) employed as of October 2004 and practicing at 14 primary health centers in Crete was performed. It was a self-administered survey with 27 items exploring knowledge, attitudes, and behaviors concerning delivery of general preventive and cancer screening services. The main outcome measures were responses to four items on approaches to breast cancer screening practices. Overall response rate was 55% (primary care physicians (PCPs) = 53%; trainee GPs = 60%). Respondents demonstrated a limited awareness of international recommendations for breast cancer screening and exhibited marked variation in their responses to survey items. Agreement with current international guidelines ranged from 31% to 58% for the individual survey items. This survey revealed limited knowledge among PCPs to well-publicized breast cancer screening guidelines and variations in approaches to breast cancer early detection.
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Affiliation(s)
- Maria Trigoni
- Head of Department of Social Work, University Hospital of Heraklion, Heraklion, Crete, Greece.
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Geographic Variation in the Utilization of Noninvasive Diagnostic Imaging: National Medicare Data, 1998–2007. AJR Am J Roentgenol 2010; 194:1034-9. [DOI: 10.2214/ajr.09.3528] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Trigoni M, Mahoney MC, Moschandreas J, Markaki A, Lionis C. "Cancer Control Practices": translation and cultural adaptation of an instrument in Crete, Greece. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2009; 24:105-106. [PMID: 19431025 DOI: 10.1080/08858190902854434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Although early detection and systematic prevention of cancer improves outcomes and reduces mortality, General Practitioners' (GP) effectiveness remains an issue that merits further investigation. METHODS To explore cancer control practices of Greek GPs, a version of the Cancer Control Practices questionnaire, originally developed in Western New York in 2001, was translated and culturally adapted. RESULTS Its reliability was found satisfactory in most the items. CONCLUSIONS The instrument can be useful in determining Greek GPs' knowledge and application of internationally established cancer-related guidelines, barriers they face in daily practice, and educational or training needs.
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Affiliation(s)
- Maria Trigoni
- Department of Social Work, University Hospital of Heraklion, Crete, Greece.
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Trigoni M, Griffiths F, Tsiftsis D, Koumantakis E, Green E, Lionis C. Mammography screening: views from women and primary care physicians in Crete. BMC WOMENS HEALTH 2008; 8:20. [PMID: 18990253 PMCID: PMC2588567 DOI: 10.1186/1472-6874-8-20] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Accepted: 11/07/2008] [Indexed: 11/25/2022]
Abstract
Background Breast cancer is the most commonly diagnosed cancer among women and a leading cause of death from cancer in women in Europe. Although breast cancer incidence is on the rise worldwide, breast cancer mortality over the past 25 years has been stable or decreasing in some countries and a fall in breast cancer mortality rates in most European countries in the 1990s was reported by several studies, in contrast, in Greece have not reported these favourable trends. In Greece, the age-standardised incidence and mortality rate for breast cancer per 100.000 in 2006 was 81,8 and 21,7 and although it is lower than most other countries in Europe, the fall in breast cancer mortality that observed has not been as great as in other European countries. There is no national strategy for screening in this country. This study reports on the use of mammography among middle-aged women in rural Crete and investigates barriers to mammography screening encountered by women and their primary care physicians. Methods Design: Semi-structured individual interviews. Setting and participants: Thirty women between 45–65 years of age, with a mean age of 54,6 years, and standard deviation 6,8 from rural areas of Crete and 28 qualified primary care physicians, with a mean age of 44,7 years and standard deviation 7,0 serving this rural population. Main outcome measure: Qualitative thematic analysis. Results Most women identified several reasons for not using mammography. These included poor knowledge of the benefits and indications for mammography screening, fear of pain during the procedure, fear of a serious diagnosis, embarrassment, stress while anticipating the results, cost and lack of physician recommendation. Physicians identified difficulties in scheduling an appointment as one reason women did not use mammography and both women and physicians identified distance from the screening site, transportation problems and the absence of symptoms as reasons for non-use. Conclusion Women are inhibited from participating in mammography screening in rural Crete. The provision of more accessible screening services may improve this. However physician recommendation is important in overcoming women's inhibitions. Primary care physicians serving rural areas need to be aware of barriers preventing women from attending mammography screening and provide women with information and advice in a sensitive way so women can make informed decisions regarding breast caner screening.
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Affiliation(s)
- Maria Trigoni
- University of Crete, Head of Department of Social Work, University Hospital of Heraklion, Crete, Greece.
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Sabatino SA, McCarthy EP, Phillips RS, Burns RB. Breast cancer risk assessment and management in primary care: Provider attitudes, practices, and barriers. ACTA ACUST UNITED AC 2007; 31:375-83. [DOI: 10.1016/j.cdp.2007.08.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2007] [Indexed: 10/22/2022]
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Blair SL, Sadler GR, Bristol R, Summers C, Tahar Z, Saltzstein SL. Early cancer detection among rural and urban Californians. BMC Public Health 2006; 6:194. [PMID: 16869975 PMCID: PMC1544333 DOI: 10.1186/1471-2458-6-194] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Accepted: 07/26/2006] [Indexed: 11/18/2022] Open
Abstract
Background Since the stage of cancer detection generally predicts future mortality rates, a key cancer control strategy is to increase the proportion of cancers found in the early stage. This study compared stage of detection for members of rural and urban communities to determine whether disparities were present. Methods The California Cancer Registry (CCR), a total population based cancer registry, was used to examine the proportion of early stage presentation for patients with breast, melanoma, and colon cancer from 1988 to 2003. Cancer stage at time of detection for these cancers was compared for rural and urban areas. Results In patients with breast cancer, there were significantly more patients presenting at early stage in 2003 compared to 1988, but no difference in the percentage of patients presenting with early stage disease between rural and urban dwellers. There were no differences in incidence in early stage cancer incidence between these groups for melanoma patients, as well. In colorectal cancer in 1988, significantly more patients presented with early stage disease in the urban areas (42% vs 34%, p < 0.02). However, over time the rural patients were diagnosed with early stage disease with the same frequency in 2003 as 1988. Conclusion This analysis demonstrates that people in rural and urban areas have their breast, melanoma or colorectal cancers diagnosed at similar stages. Health care administrators may take this information into account in future strategic planning.
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Affiliation(s)
- Sarah L Blair
- Department of Surgery, University of California at San Diego, San Diego, California, USA
| | - Georgia R Sadler
- Department of Surgery, University of California at San Diego, San Diego, California, USA
| | - Rebecca Bristol
- University of California at San Diego Undergraduate Education, San Diego California, USA
| | - Courtney Summers
- University of California at San Diego Medical School, San Diego California, USA
| | - Zanera Tahar
- University of California at San Diego Medical School, San Diego California, USA
| | - Sidney L Saltzstein
- Department of Pathology University of California at San Diego, San Diego, California, USA
- Department of Preventive Medicine University of California at San Diego, San Diego, California, USA
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Engelman KK, Perpich DL, Peterson SL, Hall MA, Ellerbeck EF, Stanton AL. Cancer information needs in rural areas. JOURNAL OF HEALTH COMMUNICATION 2005; 10:199-208. [PMID: 16036728 DOI: 10.1080/10810730590934217] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Although cancer presents obstacles for all who experience it, persons in rural communities must negotiate additional challenges. This study determined the cancer information (CI) needs and the CI-seeking behavior and preferences among rural-dwelling persons. Patients (N = 801) = 50 years of age seen in 36 rural Kansas primary care practices completed a Cancer Care Information Needs Survey (CCINS); physicians completed a cancer resource knowledge and preference survey. Of the 801 patients, 184 (23%) reported a CI need. Of these 184 patients, 45% reported either not discussing cancer or having insufficient discussion time with their physicians; 44% needed more information after consulting their physician. Patients more likely to report a CI need were young, female, Internet users, persons with a prior cancer diagnosis, and persons seeing male physicians or physicians in group/multispecialty practices. Patients and physicians were unfamiliar with services provided by national cancer organizations. Physicians are a primary CI source; however, patients who need CI report insufficient cancer discussion time with their physician and need more CI after consulting their physician. Promoting access to national CI sources could bridge the CI needs gap that exists in rural areas currently.
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Affiliation(s)
- Kimberly K Engelman
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
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Behjati F, Atri M, Najmabadi H, Nouri K, Zamani M, Mehdipour P. Prognostic value of chromosome 1 and 8 copy number in invasive ductal breast carcinoma among Iranian women: an interphase FISH analysis. Pathol Oncol Res 2005; 11:157-63. [PMID: 16195769 DOI: 10.1007/bf02893392] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Accepted: 08/31/2005] [Indexed: 02/05/2023]
Abstract
Breast cancer is amongst the leading causes of death in women worldwide and the most common cancer amongst Iranian women. Unfortunately, the current clinical and histological criteria can only help 60 percent of women with breast cancer in diagnosis and long-term treatment. Therefore, genetic markers both at single gene and chromosomal level can play an important role in improving the diagnosis and prognosis of breast cancer patients. The aim of this retrospective study was to investigate the role of chromosome 1 and 8 copy number assessed by interphase fluorescence in situ hybridization (FISH), as prognostic parameters in 50 Iranian women, aged 35 to 64 years, with sporadic invasive ductal breast carcinoma. Chromosome 1 and 8 copy numbers were evaluated in relation to established clinicopathological parameters, the immunohistochemical markers ER, PR, P53 and cathepsin D, DNA index by flow cytometry, age and survival status of the patients. FISH using centromeric probes for chromosomes 1 and 8 was applied to interphase cell suspensions prepared from archived, Carnoyfixed tumor cells and selected paraffin-embedded tumor sections. Aneusomy for chromosomes 1 and 8 was present in all 50 patients to different levels. The total abnormality rate for chromosome 1 was 33.92 percent (4.24 percent monosomy and 29.68 percent polysomy), whereas for chromosome 8 this rate was 28.30 percent (6.48 percent monosomy and 21.82 percent polysomy). Statistically significant association (p<0.05) was demonstrated between monosomy 1 and patients' age below 50 years, and between monosomy 1 and poor survival, respectively. Disomy 8 was significantly associated with P53 expression. A borderline significant correlation was demonstrated between polysomy 8 and diploid DNA content, as well as between disomy 1 and disease-free status of the patients. Chromosome 1 and 8 copy numbers may be considered as useful prognostic markers in invasive ductal carcinoma of the breast.
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Affiliation(s)
- Farkhondeh Behjati
- Department of Medical Genetics, Cancer Institute, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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