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Shpendi S, Norman P, Gibson-Miller J, Webster RK. Utilising the COM-B model to interpret barriers and facilitators to cervical cancer screening in young women. J Health Psychol 2024:13591053241281405. [PMID: 39340402 DOI: 10.1177/13591053241281405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2024] Open
Abstract
As most women now reaching the age for cervical cancer screening (24.5 years old) in the UK will be HPV vaccinated, their current perspectives on screening can inform effective interventions to increase screening uptake (and thus, early detection). Twenty-four interviews were conducted with women aged 24-30 years old to explore their views on cervical cancer screening (n = 12 attendees and n = 12 non-attendees). Reflexive thematic analysis generated six themes that were then mapped onto the COM-B model. Reflective motivations (e.g. reassurance) were key facilitators to screening attendance for both groups. Social opportunities (e.g. open communication) contrasted between the groups, with attendees more likely to have discussed screening with friends. Automatic motivations (e.g. embarrassment) were key barriers to attending screening in both groups. Notably, HPV vaccination did not factor into the decision to attend screening. Interventions to increase screening uptake may target motivational and social factors.
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Helgestad ADL, Larsen MB, Njor S, Tranberg M, Petersen LK, Andersen B. Increasing coverage in cervical and colorectal cancer screening by leveraging attendance at breast cancer screening: A cluster-randomised, crossover trial. PLoS Med 2024; 21:e1004431. [PMID: 39137185 PMCID: PMC11321549 DOI: 10.1371/journal.pmed.1004431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/20/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Screening participation remains suboptimal in cervical cancer (CC) and colorectal cancer (CRC) screening despite their effectiveness in reducing cancer-related morbidity and mortality. We investigated the effectiveness of an intervention by leveraging the high participation rate in breast cancer (BC) screening as an opportunity to offer self-sampling kits to nonparticipants in CC and CRC screening. METHODS AND FINDINGS A pragmatic, unblinded, cluster-randomised, multiple period, crossover trial was conducted in 5 BC screening units in the Central Denmark Region (CDR) between September 1, 2021 and May 25, 2022. On each of 100 selected weekdays, 1 BC screening unit was randomly allocated as the intervention unit while the remaining units served as controls. Women aged 50 to 69 years attending BC screening at the intervention unit were offered administrative check-up on their CC screening status (ages 50 to 64 years) and CRC screening status (aged 50 to 69), and women with overdue screening were offered self-sampling. Women in the control group received only standard screening offers according to the organised programmes. The primary outcomes were differences between the intervention group and the control group in the total screening coverage for the 2 programmes and in screening participation among women with overdue screening, measured 6 months after the intervention. These were assessed using intention-to-treat analysis, reporting risk differences with 95% confidence intervals (CIs). A total of 27,116 women were included in the trial, with 5,618 (20.7%) in the intervention group and 21,498 (79.3%) in the control group. Six months after the intervention, total coverage was higher in the intervention group as compared with the control group in CC screening (88.3 versus 83.5, difference 4.8 percentage points, 95% CI [3.6, 6.0]; p < 0.001) and in CRC screening (79.8 versus 76.0, difference 3.8 percentage points, 95% CI [2.6, 5.1]; p < 0.001). Among women overdue with CC screening, participation in the intervention group was 32.0% compared with 6.1% in the control group (difference 25.8 percentage points, 95% CI [22.0, 29.6]; p < 0.001). In CRC screening, participation among women overdue with screening in the intervention group was 23.8% compared with 8.9% in the control group (difference 14.9 percentage points, 95% CI [12.3, 17.5]; p < 0.001). Women who did not participate in BC screening were not included in this study. CONCLUSIONS Offering self-sampling to women overdue with CC and CRC screening when they attend BC screening was a feasible intervention, resulting in an increase in participation and total coverage. Other interventions are required to reach women who are not participating in BC screening. TRIAL REGISTRATION ClinicalTrials.gov NCT05022511. The record of processing activities for research projects in the Central Denmark Region (R. No.: 1-16-02-217-21).
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Affiliation(s)
- Anne Dorte Lerche Helgestad
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Bach Larsen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Research Unit, Horsens Regional Hospital, Horsens, Denmark
| | - Sisse Njor
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Data, Innovation and Research, Lillebaelt Hospital, Vejle; University Hospital of Southern Denmark, Odense, Denmark
| | - Mette Tranberg
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Pathology, Randers Regional Hospital, Randers, Denmark
| | - Lone Kjeld Petersen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
- Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Śniadecki M, Jaworek P, Chmielewska Z, Poniewierza P, Stasiak M, Danielkiewicz M, Stencelewski D, Brzeziński M, Boyke ZA, Wycinka E, Sunil M, Nguyen M, Klasa-Mazurkiewicz D, Koziełek K, Rak P, Wolny Y, Liro M, Guzik PW, Dobruch-Sobczak K, Wydra D. Protocol of Breast Cancer Prevention Model with Addition of Breast Ultrasound to Routine Gynecological Visits as a Chance for an Early Diagnosis and Treatment in 25 to 49-Year-Old Polish Females. Diagnostics (Basel) 2023; 13:diagnostics13020227. [PMID: 36673037 PMCID: PMC9857976 DOI: 10.3390/diagnostics13020227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
The low attendance rate for cancer screening tests in Poland is a major healthcare concern that requires specific analysis and the development of implementation recommendations for prevention, and both actions are likely to benefit culturally similar countries. Four female cancers account for approximately 20% of all cancer cases-breast cancer, cervical cancer, endometrial cancer, and ovarian cancer-suggesting that gynecologists have a significant preventative role. Of the four, breast cancer and cervical cancer are among the 10 most common malignant neoplasms globally, regardless of gender, occur only in women and are known to have effective screening measures. Our research aims to create a screening model that combines cervical cancer and breast cancer to maximize health outcomes for women at risk of both cancers. In the study protocol, we have created a model that maximizes benefits for patients with minimal additional costs to the health care system. To achieve the set goal, instead of regular clinical breast exams as recommended by the gynecological societies, we proposed an ultrasound examination, during which palpation may also be performed (in the absence of elastography). We present a scheme for such a protocol that takes into consideration all types of prevention in both cancers, and that emphasizes breast ultrasound as the most frequently missing element. Our study includes a discussion of the strengths and weaknesses of our strategy, and the crucial need for infrastructure and education for the successful implementation of the program. We conclude that our model merits consideration and discussion among health-care decision makers, as the screening changes we propose have significant potential benefits for the female population.
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Affiliation(s)
- Marcin Śniadecki
- Department of Gynecology and Obstetrics, Medical University of Gdańsk, 80-210 Gdańsk, Poland
- Correspondence: ; Tel.: +48-501-337-941
| | - Paulina Jaworek
- Department of Gynecology and Obstetrics, Medical University of Gdańsk, 80-210 Gdańsk, Poland
- The American Health Information Management Association (AHIMA), 60601-5809 Chicago, IL, USA
- Air Chair, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Zuzanna Chmielewska
- Department of Gynecology and Obstetrics, Medical University of Gdańsk, 80-210 Gdańsk, Poland
- Air Chair, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Patryk Poniewierza
- Medicover, Al. Jerozolimskie 96, 00-807 Warszawa, Poland
- Faculty of Medicine, Lazarski University, Swieradowska 43, 02-662 Warsaw, Poland
| | - Maria Stasiak
- Department of Gynecology and Obstetrics, Medical University of Gdańsk, 80-210 Gdańsk, Poland
- Air Chair, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Martyna Danielkiewicz
- Department of Gynecology and Obstetrics, Medical University of Gdańsk, 80-210 Gdańsk, Poland
- Air Chair, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Damian Stencelewski
- Department of Gynecology and Obstetrics, Medical University of Gdańsk, 80-210 Gdańsk, Poland
- Air Chair, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Michał Brzeziński
- Department of Gynecological Oncology, PCK Marine Hospital in Gdynia, 81-519 Gdynia, Poland
- Department of Oncological Propedeutics, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Zuzanna Anna Boyke
- Department of Art History, Faculty of History, University of Gdansk, 80-309 Gdańsk, Poland
| | - Ewa Wycinka
- Department of Statistics, Faculty of Management, University of Gdansk, 81-824 Sopot, Poland
| | - Medha Sunil
- Department of Gynecology and Obstetrics, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Marie Nguyen
- Department of Gynecology and Obstetrics, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | | | - Krzysztof Koziełek
- Mammography Laboratory, HCP Medical Center, Hospital St. John Paul II, 61-001 Poznan, Poland
| | - Piotr Rak
- Wyspa Medycyny Przyjaznej [The Island of Friendly Medicine], 80-747 Gdańsk, Poland
| | - Yvonne Wolny
- Amita Health St. Joseph Hospital Chicago, Chicago, IL 60657, USA
| | - Marcin Liro
- Department of Gynecology and Obstetrics, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Paweł Władysław Guzik
- Clinical Department of Gynecology and Obstetrics, City Hospital, 35-241 Rzeszów, Poland
| | - Katarzyna Dobruch-Sobczak
- Ultrasound Department, Institute of Fundamental Technological Research, Polish Academy of Sciences, 02-106 Warsaw, Poland
- Radiology Department II, Maria Sklodowska-Curie National Research Institute of Oncology, 00-001 Warsaw, Poland
| | - Dariusz Wydra
- Department of Gynecology and Obstetrics, Medical University of Gdańsk, 80-210 Gdańsk, Poland
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Kirkegaard P, Larsen MB, Andersen B. “It's cancer screening after all”. Barriers to cervical and colorectal cancer screening and attitudes to promotion of self-sampling kits upon attendance for breast cancer screening. J Med Screen 2022; 30:74-80. [PMID: 36541340 PMCID: PMC10149879 DOI: 10.1177/09691413221137852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives To explore barriers to cervical and colorectal cancer screening and attitudes to promotion of self-sampling kits upon attendance for breast cancer screening. Methods Interview study with women who had not responded to one or more invitations to cervical or colorectal cancer screening. A semi-structured interview guide was used and interviews were audio recorded and transcribed verbatim. Concepts from Temporal Motivation Theory were used to structure and analyse the data. Results Twenty-two women were interviewed. Screening was highly valued but the women perceived screening for cervical cancer and colorectal cancer as more troublesome to participate in, compared with participation in breast cancer screening. The lack of a pre-booked appointment or a suggested deadline attenuated the perceived value of cervical and colorectal cancer screening and this further increased procrastination. Promotion of self-sampling kits for cervical and colorectal cancer screening upon attendance for breast cancer screening was considered a feasible way to increase salience of both types of screening. Conclusion A high number of micro steps and absence of a deadline in cervical and colorectal cancer screening diverted attention away from screening participation in cervical and colorectal cancer screening. The main facilitator could be reduction of micro actions, proposing a suggested deadline, and promotion of self-sampling kits when attending breast cancer screening to increase salience and a renewed attention to all three screening programmes.
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Affiliation(s)
- Pia Kirkegaard
- Department of Public Health Programmes, University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
| | - Mette Bach Larsen
- Department of Public Health Programmes, University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
| | - Berit Andersen
- Department of Public Health Programmes, University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
- Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Azar D, Murphy M, Fishman A, Sewell L, Barnes M, Proposch A. Barriers and facilitators to participation in breast, bowel and cervical cancer screening in rural Victoria: A qualitative study. Health Promot J Austr 2022; 33:272-281. [PMID: 33713368 PMCID: PMC9292328 DOI: 10.1002/hpja.478] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 03/08/2021] [Indexed: 11/18/2022] Open
Abstract
ISSUE ADDRESSED Population cancer screening rates are around 50% for the general population and even lower in rural areas. This study aimed to explore knowledge, attitudes, behaviours, motivators and barriers to breast, bowel and cervical screening participation in under-screened men and women. METHODS We used a qualitative research design. Focus groups were segmented by age, sex and screening participation. Participants were under-screened in at least one of the cancer screening programs, with separate groups for each of the programs. The discussion guides were designed around the Health Belief Model and group discussions were coded using a thematic content analysis approach. RESULTS Fourteen focus groups were held with 80 participants. Key themes were that the concept of cancer screening was not well understood, a low priority for preventive health behaviours, issues relating to local general practitioners (GP) and screening was unpleasant, embarrassing and/or inconvenient. A key determinant of participation in cancer screening was exposure to prompts to action, and it was evident that participants often required multiple prompts before they took action. CONCLUSIONS Opportunities that develop attitudes to health that place disease prevention as a high priority; improve understanding of the benefit of screening in terms of early detection and treatment; improve GP availability and the patient-practitioner relationship; and the development of messages for each of the screening programs should be further explored as factors that may influence rural population screening rates. SO WHAT?: Addressing health attitudes, beliefs, knowledge, health practitioner and test-related barriers and improving messaging may increase cancer screening participation in under-screened rural populations.
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Affiliation(s)
- Denise Azar
- Gippsland Primary Health NetworkTraralgonVICAustralia
| | | | | | - Lauren Sewell
- Gippsland Primary Health NetworkTraralgonVICAustralia
| | - Megan Barnes
- Gippsland Primary Health NetworkTraralgonVICAustralia
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Malone C, Buist DSM, Tiro J, Barlow W, Gao H, Lin J, Winer RL. Out of reach? Correlates of cervical cancer underscreening in women with varying levels of healthcare interactions in a United States integrated delivery system. Prev Med 2021; 145:106410. [PMID: 33388329 PMCID: PMC7956225 DOI: 10.1016/j.ypmed.2020.106410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/22/2020] [Accepted: 12/28/2020] [Indexed: 01/14/2023]
Abstract
One in five U.S. women with health insurance are underscreened for cervical cancer. We sought to identify whether underscreening correlates differed among women with different levels of health care interaction. Among women age 30-64 years who were members of an integrated U.S. health system, we used 2014-2015 electronic health record data to identify underscreened cases (≥3.4 years since last Papanicolaou (Pap) test, n=3352) and screening-adherent controls (<3.4 years since last Pap test, n=45,359) and extracted data on potential underscreening correlates (demographics, health history, and healthcare utilization). We calculated the odds of underscreening in the total population and by subgroups defined by healthcare visits and online health portal usage in the prior 12 months. Underscreening was associated with older age (50-64 vs. 30-39; odds ratio (OR)=1.6; 95%CI=1.4-1.8), current tobacco use (vs. never use; OR=2.1; 95%CI=1.8-2.2), higher BMI (≥35 kg/m2 vs <25 kg/m2, OR=2.0; 95%CI=1.8-2.3), screening non-adherence for colorectal cancer (OR=5.1; 95%CI=4.6-5.7) and breast cancer (OR=8.1, 95%CI=7.2-9.0), and having no recent visit with their primary care provider (PCP) nor recent health portal use (vs. recent PCP visit and portal use; OR=8.4, 95%CI=7.6-9.4). Underscreening correlates were similar between the total study population and within all healthcare interaction groups. Interaction with the healthcare system is associated with lower odds of underscreening, but sociodemographic and health status correlates are similar regardless of primary care visits or online portal use. These data support the need for additional interventions to reach insured women who remain underscreened for cervical cancer.
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Affiliation(s)
- Colin Malone
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Jasmin Tiro
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - William Barlow
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Hongyuan Gao
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - John Lin
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
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Witte MK, Mahle WT, Pasquali SK, Nicolson SC, Shekerdemian LS, Wolf MJ, Zhang W, Donohue JE, Gaies M. Spillover of Early Extubation Practices From the Pediatric Heart Network Collaborative Learning Study. Pediatr Crit Care Med 2021; 22:204-212. [PMID: 33273409 PMCID: PMC7855235 DOI: 10.1097/pcc.0000000000002620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The Pediatric Heart Network Collaborative Learning Study used collaborative learning strategies to implement a clinical practice guideline that increased rates of early extubation after infant repair of tetralogy of Fallot and coarctation of the aorta. We assessed early extubation rates for infants undergoing cardiac surgeries not targeted by the clinical practice guideline to determine whether changes in extubation practices spilled over to care of other infants. DESIGN Observational analyses of site's local Society of Thoracic Surgeons Congenital Heart Surgery Database and Pediatric Cardiac Critical Care Consortium Registry. SETTING Four Pediatric Heart Network Collaborative Learning Study active-site hospitals. PATIENTS Infants undergoing ventricular septal defect repair, atrioventricular septal defect repair, or superior cavopulmonary anastomosis (lower complexity), and arterial switch operation or isolated aortopulmonary shunt (higher complexity). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Aggregate outcomes were compared between the 12 month pre-clinical practice guideline and 12 months after study completion (Follow Up). In infants undergoing lower complexity surgeries, early extubation increased during Follow Up compared with Pre-Clinical Practice Guideline (30.2% vs 18.8%, p = 0.006), and hours to initial postoperative extubation decreased. We observed variation in these outcomes by surgery type, with only ventricular septal defect repair associated with a significant increase in early extubation during Follow Up compared with Pre-Clinical Practice Guideline (47% vs 26%, p = 0.006). Variation by study site was also seen, with only one hospital showing an increase in early extubation. In patients undergoing higher complexity surgeries, there was no difference in early extubation or hours to initial extubation between the study eras. CONCLUSIONS We observed spillover of extubation practices promoted by the Collaborative Learning Study clinical practice guideline to lower complexity operations not included in the original study that was sustainable 1 year after study completion, though this effect differed across sites and operation subtypes. No changes in postoperative extubation outcomes following higher complexity surgeries were seen. The significant variation in outcomes by site suggests that center-specific factors may have influenced spillover of clinical practice guideline practices.
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Affiliation(s)
- Madolin K Witte
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | | | - Sara K Pasquali
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
| | - Susan C Nicolson
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | | | - Wenying Zhang
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
| | - Janet E Donohue
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
| | - Michael Gaies
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
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Usher-Smith J, Simmons RK, Rossi SH, Stewart GD. Current evidence on screening for renal cancer. Nat Rev Urol 2020; 17:637-642. [PMID: 32860009 PMCID: PMC7610655 DOI: 10.1038/s41585-020-0363-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2020] [Indexed: 02/07/2023]
Abstract
Renal cell carcinoma (RCC) incidence is increasing worldwide. A high proportion of individuals are asymptomatic at diagnosis, but RCC has a high mortality rate. These facts suggest that RCC meets some of the criteria for screening, and a new analysis shows that screening for RCC could potentially be cost-effective. Targeted screening of high-risk individuals is likely to be the most cost-effective strategy to maximize the benefits and reduce the harms of screening. However, the size of the benefit of earlier initiation of treatment and the overall cost-effectiveness of screening remains uncertain. The optimal screening modality and target population is also unclear, and uncertainties exist regarding the specification and implementation of a screening programme. Before moving to a fully powered trial of screening, future work should focus on the following: developing and validating accurate risk prediction models; developing non-invasive methods of early RCC detection; establishing the feasibility, public acceptability and potential uptake of screening; establishing the prevalence of RCC and stage distribution of RCC detected by screening; and evaluating the potential harms of screening, including the impact on quality of life, overdiagnosis and over-treatment.
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Affiliation(s)
- Juliet Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Rebecca K Simmons
- Department of Public Health, Bartolins Allé 2, University of Aarhus, Aarhus C, Denmark
| | - Sabrina H Rossi
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK.
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Harvey-Kelly LLW, Harrison H, Rossi SH, Griffin SJ, Stewart GD, Usher-Smith JA. Public attitudes towards screening for kidney cancer: an online survey. BMC Urol 2020; 20:170. [PMID: 33115457 PMCID: PMC7592501 DOI: 10.1186/s12894-020-00724-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/17/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Kidney cancer is often asymptomatic, leading to proposals for a screening programme. The views of the public towards introducing a new screening programme for kidney cancer are unknown. The aim of this study was to explore attitudes towards kidney cancer screening and factors influencing intention to attend a future screening programme. METHODS We conducted an online population-based survey of 1021 adults aged 45-77 years. The main outcome measure was intention to attend four possible screening tests (urine, blood, ultrasound scan, low-dose CT) as well as extended low-dose CT scans within lung cancer screening programmes. We used multivariable regression to examine the association between intention and each screening test. RESULTS Most participants stated that they would be 'very likely' or 'likely' to undergo each of the screening tests [urine test: n = 961 (94.1%); blood test: n = 922 (90.3%); ultrasound: n = 914 (89.5%); low-dose CT: n = 804 (78.8%); lung CT: n = 962 (95.2%)]. Greater intention to attend was associated with higher general cancer worry and less perceived burden/inconvenience about the screening tests. Less worry about the screening test was also associated with higher intention to attend, but only in those with low general cancer worry (cancer worry scale ≤ 5). Compared with intention to take up screening with a urine test, participants were half as likely to report that they intended to undergo blood [OR 0.56 (0.43-0.73)] or ultrasound [OR 0.50 (0.38-0.67)] testing, and half as likely again to report that they intended to take part in a screening programme featuring a low dose CT scan for kidney cancer screening alone [OR 0.19 (0.14-0.27)]. CONCLUSION Participants in this study expressed high levels of intention to accept an invitation to screening for kidney cancer, both within a kidney cancer specific screening programme and in conjunction with lung cancer screening. The choice of screening test is likely to influence uptake. Together these findings support on-going research into kidney cancer screening tests and the potential for combining kidney cancer screening with existing or new screening programmes.
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Affiliation(s)
- Laragh L. W. Harvey-Kelly
- University of Cambridge School of Clinical Medicine, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0SP UK
| | - Hannah Harrison
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR UK
| | - Sabrina H. Rossi
- Department of Oncology, University of Cambridge, Addenbrooke’s Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
| | - Simon J. Griffin
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR UK
| | - Grant D. Stewart
- Department of Surgery, University of Cambridge, Addenbrooke’s Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
| | - Juliet A. Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR UK
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Franck JE, Ringa V, Rigal L, Sassenou J, Cœuret-Pellicer M, Chauvin P, Menvielle G. Patterns of gynaecological check-up and their association with body mass index within the CONSTANCES cohort. J Med Screen 2020; 28:10-17. [PMID: 32279590 DOI: 10.1177/0969141320914323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To investigate the relationship between patterns of gynaecological check-up and body mass index while accounting for various determinants of health care use. METHODS Sequence analysis and clustering were used to highlight patterns of gynaecological check-up, which included the regularity of breast and cervical cancer screening and visits to the gynaecologist over four years, among 6182 women aged 54-65 included in the CONSTANCES cohort between 2013 and 2015 in France. Multinomial logistic regressions were used to study the association between these patterns and women's body mass index. RESULTS We identified four patterns of gynaecological check-up, from (A) no or inappropriate check-up (20%) to (D) almost one visit to the gynaecologist every year, overscreening for cervical cancer and frequent use of opportunistic breast cancer screening (12%). From patterns A to D, the proportion of obese women decreased and that of women with normal body mass index increased. Obese and overweight women underwent more breast than cervical cancer screening and were less often overscreened than normal weight women. These differences were only partly explained by the lower socioeconomic situation of overweight and obese women. Beyond the financial barrier, the screening modality and the type of exam may play a role. Among women who were screened for cervical cancer, obese and overweight women were less often screened by a gynaecologist. CONCLUSION Further efforts should be made to enhance the take-up of screening among obese women who are deterred by the healthcare system.
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Affiliation(s)
- Jeanna-Eve Franck
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Virginie Ringa
- CESP Centre for Research in Epidemiology and Population Health, Gender, Sexuality and Health team, University of Paris-Saclay, University of Paris-Sud, UVSQ, Villejuif, France. Ined, Paris, France
| | - Laurent Rigal
- CESP Centre for Research in Epidemiology and Population Health, Gender, Sexuality and Health team, University of Paris-Saclay, University of Paris-Sud, UVSQ, Villejuif, France. Ined, Paris, France
| | - Jeanne Sassenou
- CESP Centre for Research in Epidemiology and Population Health, Gender, Sexuality and Health team, University of Paris-Saclay, University of Paris-Sud, UVSQ, Villejuif, France. Ined, Paris, France
| | - Mireille Cœuret-Pellicer
- Inserm-Versailles Saint Quentin en Yvelines University, "Epidemiological Population-Based Cohorts Unit", Villejuif, France
| | - Pierre Chauvin
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Gwenn Menvielle
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
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11
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Larsen SH, Virgilsen LF, Kristiansen BK, Andersen B, Vedsted P. Strong association between cervical and breast cancer screening behaviour among Danish women; A register-based cohort study. Prev Med Rep 2018; 12:349-354. [PMID: 30450274 PMCID: PMC6234495 DOI: 10.1016/j.pmedr.2018.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/30/2018] [Accepted: 10/21/2018] [Indexed: 12/13/2022] Open
Abstract
High coverage is essential for the effectiveness of national screening programmes. Identifying non-screeners across different screening programmes may help inform strategies to improve uptake. This study aims to analyse the association between previous cervical cancer screening (CCS) coverage and participation in breast cancer screening (BCS). This historical register-based cohort study included 91,787 Danish women aged 50-64 years who were invited to participate in the first organised round of BCS in the Central Denmark Region (CDR) in 2008-09. CCS coverage was defined as having a smear registered in the 5 1/2 years preceding the BCS, and BCS participants were divided into participants and non-participants and further categorised as active non-participants (ANP) if they cancelled and passive non-participants (PNP) if they abstained from the appointment. Of all 91,787 women included in the study, 62,391 (68%) were covered both by CCS and participated in BCS. Women not covered by CCS were more likely to be non-participants in BCS than women covered by CCS (PRRadjusted = 2.80, 95% CI: 2.68-2.93). Both PNP (PRRadjusted = 3.99, 95% CI: 3.80-4.19) and ANP (PRRadjusted = 2.50, 95% CI: 2.34-2.68) were more likely not to be covered by the CCS. In conclusion, non-coverage by CCS was strongly associated with nonparticipation in BCS. Specific groups of women only participated in one screening programme. To increase uptake, future interventions may specifically target these groups.
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Affiliation(s)
- S H Larsen
- Research Unit for General Practice, The Research Centre for Cancer Diagnosis in Primary Care (CaP), Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - L F Virgilsen
- Research Unit for General Practice, The Research Centre for Cancer Diagnosis in Primary Care (CaP), Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - B K Kristiansen
- Department for Public Health Programs, Randers Regional Hospital, Skovlyvej 1, 8930 Randers, Denmark
| | - B Andersen
- Department for Public Health Programs, Randers Regional Hospital, Skovlyvej 1, 8930 Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
| | - P Vedsted
- Research Unit for General Practice, The Research Centre for Cancer Diagnosis in Primary Care (CaP), Bartholins Allé 2, 8000 Aarhus C, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
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12
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Tavasoli SM, Kane E, Chiarelli AM, Kupets R. Women's Behaviors Toward Mammogram and Pap Test: Opportunities to Increase Cervical Cancer Screening Participation Rates among Older Women. Womens Health Issues 2018; 28:42-50. [DOI: 10.1016/j.whi.2017.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/13/2017] [Accepted: 10/19/2017] [Indexed: 12/18/2022]
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13
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Bobridge A, Price K, Gill TK, Taylor AW. Influencing Cancer Screening Participation Rates-Providing a Combined Cancer Screening Program (a 'One Stop' Shop) Could Be a Potential Answer. Front Oncol 2017; 7:308. [PMID: 29322029 PMCID: PMC5733549 DOI: 10.3389/fonc.2017.00308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/28/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Participation in established cancer screening programs remains variable. Therefore, a renewed focus on how to increase screening uptake, including addressing structural barriers such as time, travel, and cost is needed. One approach could be the provision of combined cancer screening, where multiple screening tests are provided at the same time and location (essentially a ‘One Stop’ screening shop). This cohort study explored both cancer screening behavior and the acceptability of a combined screening approach. Methods Participants of the North Western Adelaide Health Study (NWAHS), South Australia were invited to participate in a questionnaire about cancer screening behaviors and the acceptability of a proposed ‘One Stop’ cancer screening shop. Data were collected from 10th August 2015 to 18th January 2016, weighted for selection probability, age, and sex and analyzed using descriptive and multivariable logistic regression analysis. Results 1,562 people, 52% female (mean age 54.1 years ± 15.2) participated. Reported screening participation was low, the highest being for Pap Smear (34.4%). Common reasons for screening participation were preventing sickness (56.1%, CI 53.2–59.0%), maintaining health (51%, CI 48–53.9%), and free program provision (30.9%, CI 28.2–33.6%). Females were less likely to state that screening is not beneficial [OR 0.37 (CI 0.21–0.66), p < 0.001] and to cite sickness prevention [OR 2.10 (CI 1.46–3.00), p < 0.001] and free program [OR 1.75 (CI 1.22–2.51), p < 0.003] as reasons for screening participation. Of those who did not participate, 34.6% (CI 30.3–39.1%) stated that there was nothing that discouraged them from participation, with 55- to 64-year olds [OR 0.24 (CI 0.07–0.74), p < 0.04] being less likely to cite this reason. 21% (CI 17.2–24.8%) thought they did not need screening, while a smaller proportion stated not having time (6.9%, CI 4.9–9.7%) and the costs associated with screening (5.2%, CI 3.5–7.7%). The majority of participants (85.3%, CI 81.9–88.2%) supported multiple screening being offered at the same time and location. Conclusion Identified screening behaviors in this study are similar to those reported in the literature. The high support for the concept of combined cancer screening demonstrates that this type of approach is acceptable to potential end users and warrants further investigation.
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Affiliation(s)
| | - Kay Price
- University of South Australia, Adelaide, SA, Australia
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14
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Labeit A, Kedir A, Peinemann F. Blood pressure and cholesterol level checks as dynamic interrelated screening examinations. Sci Rep 2017; 7:13235. [PMID: 29038602 PMCID: PMC5643389 DOI: 10.1038/s41598-017-12904-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 09/11/2017] [Indexed: 12/28/2022] Open
Abstract
This study analysed the determinants of screening uptake for blood pressure and cholesterol level checks. Furthermore, it investigated the presence of possible spillover effects from one type of cardiovascular screening to another type of cardiovascular screening. A dynamic random effects bivariate panel probit model with initial conditions (Wooldridge-type estimator) was adopted for the estimation. The outcome variables were the participation in blood pressure and cholesterol level checks by individuals in a given year. The balanced panel sample of 21,138 observations was constructed from 1,626 individuals from the British Household Panel Survey (BHPS) between 1996 and 2008. The analysis showed the significance of past screening behaviour for both cardiovascular screening examinations. For both cardiovascular screening examinations state dependence exist. The study also shows a significant spillover effect of the cholesterol level check on the blood pressure check and vice versa. Also a poorer health status led to a higher uptake for both types of screening examinations. Changes in recommendations have to consider the fact that taking part in one type of cardiovascular screening examination can influence the decision to take part in the other type of cardiovascular screening examination.
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Affiliation(s)
- Alexander Labeit
- School of Health and Related Sciences, University of Sheffield, Sheffield, UK.
- Centre for Applied Health Economics, School of Medicine, Griffith University, Nathan Campus, Australia.
- Menzies Health Institute Queensland, Griffith University, Nathan Campus, Australia.
| | - Abbi Kedir
- Management School, University of Sheffield, Sheffield, UK
| | - Frank Peinemann
- FOM University of Applied Science for Economics & Management, Essen, Germany
- Children's Hospital, University Hospital of Cologne, Cologne, Germany
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15
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Kim JM, Rivera M, Persing N, Bundy DG, Psoter KJ, Ghazarian SR, Miller MR, Solomon BS. Electronic Immunization Alerts and Spillover Effects on Other Preventive Care. Clin Pediatr (Phila) 2017; 56:811-820. [PMID: 28720032 DOI: 10.1177/0009922817715935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The impact of electronic health record (EHR) immunization clinical alert systems on the delivery of other preventive services remains unknown. We assessed for spillover effects of an EHR immunization alert on delivery of 6 other preventive services, in children 18 to 30 months of age needing immunizations. We conducted a secondary data analysis, with additional primary data collection, of a randomized, historically controlled trial to improve immunization rates with EHR alerts, in an urban, primary care clinic. No significant differences were found in screening for anemia, lead, development, nutrition, and injury prevention counseling in children prompting EHR immunization alerts (n = 129), compared with controls (n = 135). Significant increases in oral health screening in patients prompting EHR alerts (odds ratio = 4.8, 95% CI = 1.8-13.0) were likely due to practice changes over time. An EHR clinical alert system targeting immunizations did not have a spillover effect on the delivery of other preventive services.
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Affiliation(s)
- Julia M Kim
- 1 Johns Hopkins University, Baltimore, MD, USA
| | | | | | - David G Bundy
- 1 Johns Hopkins University, Baltimore, MD, USA.,2 Medical University of South Carolina, Charleston, SC, USA
| | | | - Sharon R Ghazarian
- 1 Johns Hopkins University, Baltimore, MD, USA.,3 Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
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Farzaneh E, Heydari H, Shekarchi AA, Kamran A. Breast and cervical cancer-screening uptake among females in Ardabil, northwest Iran: a community-based study. Onco Targets Ther 2017; 10:985-992. [PMID: 28255244 PMCID: PMC5322848 DOI: 10.2147/ott.s125344] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Breast and cervical cancers are the most commonly diagnosed type of cancer and cause of cancer-related deaths in Iranian females. In contrast to previous studies, this study was carried out with a large sample size for assessment of breast self-examination (BSE)-, clinical breast examination (CBE)-, mammography-, and Pap smear-uptake rates and determination of associations among these screening behaviors with sociodemographic and cognitive variables in Azeri females. MATERIALS AND METHODS This was a cross-sectional, community-based study that was carried out among 1,134 females 20-60 years old during March-June 2016. Data-collection variables included sociodemographic questions, screening behaviors for breast and cervical cancer, self-efficacy, beliefs, and barriers to breast and cervical cancer screening. Collected data were analyzed by SPSS version 13 using χ2, Mann-Whitney U, and logistic regression tests. RESULTS Among the 1,134 participants, 53.9%, 9.8%, and 28.1% had done BSE, CBE, and Pap smear tests, respectively, and among the 625 females aged >40 years, 187 (29.9%) had done the mammography test. Moreover, 416 (36.7%), 103 (16.5%), and 64 (5.6%) females had done BSE, mammography, and CBE regularly, respectively. Beliefs, barriers, income, health insurance, number of children, and age were all important factors for BSE and regular BSE and mammography. Females who had high belief scores were more likely to undertake mammography (odds ratio [OR]: 1.2, 95% confidence interval [CI]: 1.03-1.5), regular mammography (OR: 4.2, 95% CI: 1.9-9.3), regular CBE (OR: 1.25, 95% CI: 1.2-1.3), and Pap smears (OR: 1.2, 95% CI: 1.1-1.4). Also, females who had high self-efficacy scores were more likely to perform regular BSE (OR: 1.8, 95% CI: 1.4-2.5) and mammography (OR: 2.5, 95% CI: 1.4-4.6) than females with lower self-efficacy scores. CONCLUSION The frequency of breast and cervical cancer screening was low in our study. The findings of this study indicated that beliefs, self-efficacy, and barriers were important predictive factors of cancer-screening behavior among the females studied.
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Affiliation(s)
- Esmaeil Farzaneh
- Department of Forensic Medicine and Toxicology, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Heshmatolah Heydari
- Department of Nursing, Lorestan University of Medical Sciences, Khorramabad, Iran
| | | | - Aziz Kamran
- Department of Public Health, Ardabil University of Medical Sciences, Ardabil, Iran
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