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Schreuders E, van Buuren M, Walsh RJ, Sijtsma H, Hollarek M, Lee NC, Krabbendam L. Learning whom not to trust across early and middle adolescence: A longitudinal neuroimaging study to trusting behavior involving an uncooperative other. Child Dev 2024; 95:368-390. [PMID: 37583272 DOI: 10.1111/cdev.13986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/04/2023] [Accepted: 07/16/2023] [Indexed: 08/17/2023]
Abstract
Longitudinal changes in trusting behavior across adolescence and their neural correlates were examined. Neural regions of interest (ROIs) included the medial prefrontal cortex (mPFC), dorsal anterior cingulate cortex (dACC), left anterior insula (AI), bilateral ventral striatum (VS), and right dorsal striatum (DS). Participants (wave 1 age: M = 12.90) played the investor in a Trust Game with an uncooperative trustee three times (1-year interval). Analyses included 77 primarily Dutch participants (33 females). Participants decreased their investments with wave. Furthermore, activity was heightened in mPFC, dACC, and DS during investment and repayment, and in right VS (investment) and AI (repayment). Finally, DS activity during repayment increased with wave. These findings highlight early-middle adolescence as an important period for developing sensitivity to uncooperative behavior.
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Affiliation(s)
- E Schreuders
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Developmental and Educational Psychology, Leiden University, Leiden, The Netherlands
| | - M van Buuren
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - R J Walsh
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - H Sijtsma
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - M Hollarek
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - N C Lee
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Developmental Psychology, Utrecht University, Utrecht, The Netherlands
| | - L Krabbendam
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
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Sijtsma H, Lee NC, Braams BR, Hollarek M, Walsh RJ, van Buuren M, Krabbendam L. The development of adolescent trust behavior. J Exp Child Psychol 2023; 231:105653. [PMID: 36848696 DOI: 10.1016/j.jecp.2023.105653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 02/27/2023]
Abstract
Interpersonal trust shows developmental changes during adolescence. The current study used a longitudinal design to examine the development of trust behavior, the presence of gender differences in these developmental trajectories, and the association between individual differences in these developmental trajectories and perspective-taking abilities. The participants played a trust game with a hypothetical trustworthy partner and a trust game with a hypothetical untrustworthy partner in 3 consecutive years (Mage = 12.55 years, Mage = 13.54 years, and Mage = 14.54 years). Concerning the development of trust behavior, the results showed an age-related increase in initial trust behavior and indicated increasingly adaptive trust behavior with age during untrustworthy interactions, whereas no evidence was found for age-related changes in the adaptation of trust during trustworthy interactions. Gender differences were found for the development of initial trust behavior (with boys showing a stronger increase with age than girls), whereas no support was found for the presence of gender differences in the developmental trajectories of adaptive trust behavior during trustworthy and untrustworthy interactions. Furthermore, no evidence was found for perspective-taking abilities to explain individual differences in the development of initial trust behavior or in the development of adaptive trust behavior during trustworthy and untrustworthy interactions. The results provide evidence that, during adolescence initial trust behavior increased with age, more for boys than for girls, and that both boys and girls showed a stronger adaptive response to the untrustworthy partner but not to the trustworthy partner.
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Affiliation(s)
- H Sijtsma
- Section of Clinical Developmental Psychology (Faculty of Behavioral and Movement Sciences), Research Institute LEARN!, Institute for Brain and Behavior, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - N C Lee
- Section of Clinical Developmental Psychology (Faculty of Behavioral and Movement Sciences), Research Institute LEARN!, Institute for Brain and Behavior, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - B R Braams
- Section of Clinical Developmental Psychology (Faculty of Behavioral and Movement Sciences), Research Institute LEARN!, Institute for Brain and Behavior, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - M Hollarek
- Section of Clinical Developmental Psychology (Faculty of Behavioral and Movement Sciences), Research Institute LEARN!, Institute for Brain and Behavior, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - R J Walsh
- Section of Clinical Developmental Psychology (Faculty of Behavioral and Movement Sciences), Research Institute LEARN!, Institute for Brain and Behavior, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - M van Buuren
- Section of Clinical Developmental Psychology (Faculty of Behavioral and Movement Sciences), Research Institute LEARN!, Institute for Brain and Behavior, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - L Krabbendam
- Section of Clinical Developmental Psychology (Faculty of Behavioral and Movement Sciences), Research Institute LEARN!, Institute for Brain and Behavior, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
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Sijtsma H, Lee NC, van Kesteren MTR, Braams BR, van Atteveldt NM, Krabbendam L, van Buuren M. The effect of incorrect prior information on trust behavior in adolescents. Neuropsychologia 2023; 179:108423. [PMID: 36574534 DOI: 10.1016/j.neuropsychologia.2022.108423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/05/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022]
Abstract
During adolescence, social cognition and the brain undergo major developments. Social interactions become more important, and adolescents must learn that not everyone can be trusted equally. Prior knowledge about the trustworthiness of an interaction partner may affect adolescents' expectations about the partner. However, the expectations based on prior knowledge can turn out to be incorrect, causing the need to respond adaptively during the interaction. In the current fMRI study, we investigated the effect of incorrect prior knowledge on adolescent trust behavior and on the neural processes of trust. Thirty-three adolescents (Mage = 17.2 years, SDage = 0.5 years) played two trust games with partners whose behavior was preprogrammed using an algorithm that modeled trustworthy behavior. Prior to the start of both games, participants received information suggesting that the partner in one game was untrustworthy (raising incorrect expectations) and the partner in the other game trustworthy (raising correct expectations). Results indicated that participants adapted their trust behavior following incorrect prior expectations. No evidence for a change in trust behavior was shown when prior expectations were correct. fMRI analyses revealed that when receiving the partner's response, activity in the dorsolateral prefrontal cortex and in the superior parietal gyrus were increased when participants had incorrect expectations about the partner compared to when participants had correct expectations. When making trust decisions, no significant differences in neural activity were found when comparing the two games. This study provides insight into how adolescent trust behavior and neural mechanisms are affected by expectations and provides an increased understanding of the factors that influence adolescent social interactions.
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Affiliation(s)
- H Sijtsma
- Department of Clinical, Neuro- & Developmental Psychology, Research Institute LEARN!, Institute for Brain and Behavior, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Netherlands.
| | - N C Lee
- Department of Clinical, Neuro- & Developmental Psychology, Research Institute LEARN!, Institute for Brain and Behavior, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Netherlands; Department of Developmental Psychology, Utrecht University, Netherlands
| | - M T R van Kesteren
- Department of Educational and Family Studies, Institute of Brain and Behavior, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Netherlands
| | - B R Braams
- Department of Clinical, Neuro- & Developmental Psychology, Research Institute LEARN!, Institute for Brain and Behavior, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Netherlands
| | - N M van Atteveldt
- Department of Clinical, Neuro- & Developmental Psychology, Research Institute LEARN!, Institute for Brain and Behavior, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Netherlands
| | - L Krabbendam
- Department of Clinical, Neuro- & Developmental Psychology, Research Institute LEARN!, Institute for Brain and Behavior, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Netherlands
| | - M van Buuren
- Department of Clinical, Neuro- & Developmental Psychology, Research Institute LEARN!, Institute for Brain and Behavior, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Netherlands
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Hwu PWL, Pachelli PE, Chien YH, Lee NC, Tseng SH, Tai CH, Conway AM, Federhen A, Giugliani L, Felix T, Pykett M. SAFETY AND IMPROVED EFFICACY OUTCOMES IN CHILDREN WITH AADC DEFICIENCY TREATED WITH ELADOCAGENE EXUPARVOVEC GENE THERAPY: RESULTS FROM THREE CLINICAL TRIALS. Cytotherapy 2021. [DOI: 10.1016/j.jcyt.2021.02.095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Yan YJ, Tsai YC, Ko ML, Lee NC, Chiou JC, Ou-Yang M. Quantitative examination of early diabetes by light-emitting diodes light-induced pupillary light reflex. Rev Sci Instrum 2021; 92:014101. [PMID: 33514206 DOI: 10.1063/5.0030042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/17/2020] [Indexed: 06/12/2023]
Abstract
This study investigated the abnormal pupillary light reflex in patients with early diabetes mellitus (DM) without retinopathy by using a custom-made noninvasive portable pupilometer. The pupilometer recorded and analyzed the pupillary light reflex. Two light intensities, 0.2 cd and 1.2 cd, and four wavelengths of stimulus light-white (400 nm-800 nm), red (640 ± 5 nm), green (534 ± 5 nm), and blue (470 ± 5 nm)-were used to stimulate the pupil for 10 ms. The pupillary response was recorded for 15 s. A total of 40 healthy people and 40 people with DM without retinopathy participated in the experiment at the National Taiwan University Hospital. The mean and standard deviation of DM duration were 4.5 years and 3.9 years. Of the 16 indices, the duration that pupil restores from its minimum size to half of its resting size (DRP), maximum pupil restoration velocity (MRV), and average restoration velocity (ARV) exhibited the most significant differences between the healthy people and those with DM. Compared with healthy participants, DRP was 16.33% higher, and MRV and ARV were 17.45% and 4.58% lower, respectively, in those with DM. This might be attributable to the sympathetic nervous system (SNS) controlling the dilator muscle during the dark-adapted period and relaxing the pupil; the SNS had few degenerated nerve endings in people with DM. The three aforementioned indices might be used to evaluate the severity of autonomic neuropathy in early DM.
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Affiliation(s)
- Y J Yan
- Institute of Electrical and Control Engineering, National Chiao Tung University, Hsinchu City 300, Taiwan
| | - Y C Tsai
- Institute of Electrical and Control Engineering, National Chiao Tung University, Hsinchu City 300, Taiwan
| | - M L Ko
- National Taiwan University Hospital Hsinchu Branch, Hsinchu 300, Taiwan
| | - N C Lee
- National Taiwan University Hospital, Taipei 100, Taiwan
| | - J C Chiou
- Institute of Electrical and Control Engineering, National Chiao Tung University, Hsinchu City 300, Taiwan
| | - M Ou-Yang
- Institute of Electrical and Control Engineering, National Chiao Tung University, Hsinchu City 300, Taiwan
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Abstract
BACKGROUND Studies suggest an increasing occurrence of atypical femoral fractures with the use of bisphosphonates. OBJECTIVE To examine whether the use of bisphosphonates increases the risk for atypical fractures. DESIGN Systematic review and meta-analysis. DATA SOURCES Literature search of MEDLINE, Embase and Cochrane CENTRAL (1948-June 2013). SELECTION CRITERIA (i) randomized controlled trial or an observational study, (ii) evaluated bisphosphonate therapy versus no treatment and (iii) reported an incidence of subtrochanteric or diaphyseal fracture individually, or a composite of both. Two independent investigators completed study selection, data extraction and validity assessment. The Cochrane Risk of Bias Tool was used to assess the quality of included studies. RESULTS Ten (n = 658497) studies were included in the meta-analysis which demonstrated a statistically significant increased risk of subtrochanteric or diaphyseal fracture with bisphosphonate use [adjusted odds ratios (AOR) = 1.99, 95% confidence intervals (CI)= 1.28-3.10] with I (2) = 84.3% (95% CI = 73.5%-89.5%) and Egger P = 0.01. Subtrochanteric fractures showed an AOR = 2.71 (95% CI = 1.86-3.95) with I (2) = 83.6% (95% CI = 64.3%-90.3%) and Egger's P = 2.29. Diaphyseal fractures had an AOR = 2.06 (95% CI = 1.70-2.50), I (2) = 29.7% (95% CI = 0%-73.7%) and Egger's P = 1.22. CONCLUSION Results suggest there is an increased risk for atypical fractures associated with bisphosphonates and raises awareness to the potential complications related with bisphosphonates. These findings warrant the comprehensive evaluation of patients before initiating bisphosphonate therapy and highlights the need for additional medical decision analyses in future studies to compare the benefit over potential harms of bisphosphonate therapy.
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Affiliation(s)
- Soyon Lee
- School of Pharmacy, University of Connecticut, Storrs, CT, Department of Pharmacy, Hartford Hospital, Hartford, CT
| | - Raynold V Yin
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, and
| | - Hemant Hirpara
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, and
| | - Nancy C Lee
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, and
| | - Adrian Lee
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, and
| | - Samantha Llanos
- College of Pharmacy and Health Sciences, Massachusetts University, Worcester, MA, USA
| | - Olivia J Phung
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, and
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Affiliation(s)
- Nancy C. Lee
- Nancy Lee is Deputy Assistant Secretary for Health–Women's Health, at the U.S. Department of Health and Human Services in Washington, DC
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Lee NC, Wong FL, Jamison PM, Jones SF, Galaska L, Brady KT, Wethers B, Stokes-Townsend GA. Implementation of the National Breast and Cervical Cancer Early Detection Program: the beginning. Cancer 2014; 120 Suppl 16:2540-8. [PMID: 25099896 DOI: 10.1002/cncr.28820] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/07/2014] [Accepted: 03/10/2014] [Indexed: 11/10/2022]
Abstract
In 1990, Congress passed the Breast and Cervical Cancer Mortality Prevention Act because of increases in the number of low-income and uninsured women being diagnosed with breast cancer. This act authorized the Centers for Disease Control and Prevention (CDC) to establish the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to provide high-quality and timely breast and cervical cancer screening and diagnostic services to low-income, uninsured women. The program started in 1991, and, in 1993, Congress amended the act to allow the CDC to fund American Indian and Alaska Native tribes and tribal organizations. By 1996, the program was providing cancer screening across the United States. To ensure appropriate delivery and monitoring of services, the program adopted detailed policies on program management, evidence-based guidelines for clinical services, a systematized clinical data system to track service quality, and key partnerships that expand the program's reach. The NBCCEDP currently funds 67 programs, including all 50 states, the District of Columbia, 5 US territories, and 11 tribes or tribal organizations.
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Affiliation(s)
- Nancy C Lee
- Office on Women's Health, Office of the Assistant Secretary for Health, US Department of Health and Human Services, District of Columbia
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Affiliation(s)
- Nancy C. Lee
- U.S. Department of Health and Human Services, Office on Women's Health, Washington, District of Columbia
| | - Caira M. Woods
- U.S. Department of Health and Human Services, Office on Women's Health, Washington, District of Columbia
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Chien YH, Peng SF, Yang CC, Lee NC, Tsai LK, Huang AC, Su SC, Tseng CC, Hwu WL. Long-term efficacy of miglustat in paediatric patients with Niemann-Pick disease type C. J Inherit Metab Dis 2013; 36:129-37. [PMID: 22476655 DOI: 10.1007/s10545-012-9479-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 03/07/2012] [Accepted: 03/12/2012] [Indexed: 10/28/2022]
Abstract
Niemann-Pick disease type C (NP-C) is a rare inherited neurovisceral disease characterized by progressive neurological manifestations. Oral miglustat was first approved for the treatment of children and adults with NP-C in Europe in 2009. There are still relatively few published data on the long-term efficacy and safety of miglustat in patients with NP-C in clinical practice. We report the effects of up to 6 years of treatment with miglustat 100 mg t.i.d. in five children. Overall, 3/5 patients displayed progressive dysphagia before starting miglustat, and 4/5 showed marked cognitive and/or motor impairment. The mean age at treatment start was 11.6 years, and the median (range) duration of therapy so far is 4 (4.1 to 6.1) years. No treatment dose alterations were required, but therapy was interrupted for 1-3 months at least once in all patients due to supply issues. Swallowing function was stabilised during miglustat therapy, with no significant increase in Han dysphagia scale or aspiration-penetration index scores among four evaluable patients (p > 0.05). Scores on the mini-mental state examination indicated an improvement in cognitive function during the first 3-6 months of miglustat therapy, followed by stabilisation up to 5 years. Ambulatory function remained stable for at least the first 2 years of treatment in most patients, but there was a trend towards deterioration thereafter, possibly related to treatment interruptions. The safety/tolerability profile of miglustat was similar to previous clinical studies, although reports of gastrointestinal disturbances were rare. Overall, miglustat appeared to stabilise key parameters of neurological disease progression.
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Affiliation(s)
- Y H Chien
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
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Jamison PM, Noone AM, Ries LA, Lee NC, Edwards BK. Trends in Endometrial Cancer Incidence by Race and Histology with a Correction for the Prevalence of Hysterectomy, SEER 1992 to 2008. Cancer Epidemiol Biomarkers Prev 2012; 22:233-41. [DOI: 10.1158/1055-9965.epi-12-0996] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Chen PW, Hwu WL, Ho MC, Lee NC, Chien YH, Ni YH, Lee PH. Stabilization of blood methylmalonic acid level in methylmalonic acidemia after liver transplantation. Pediatr Transplant 2010; 14:337-41. [PMID: 19686300 DOI: 10.1111/j.1399-3046.2009.01227.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Methylmalonic acidemia with complete mutase deficiency (mut(0) type) is an inborn error of metabolism with high mortality and morbidity. LT has been suggested to be a solution to this disease, but elevation of urinary and blood MMA was still observed after LT. In this study, we measured dry blood spot MMA and its precursor propionyl-carnitine (C3-carnitine) for mut(0) patients. The results revealed that when C3-carnitine rose during metabolic stress, MMA rose exponentially (up to 1000 micromol/L) in patients who did not undergo LT. In patients who underwent LT, MMA rose to 100-200 micromol/L when C3-carnitine reached 10-20 micromol/L. However, when C3-carnitine rose further to 40-50 micromol/L, MMA levels just stayed put. Therefore, LT stabilized blood MMA level, though there might be a threshold for blood MMA clearance by the donor liver. This finding should be critical to understand the long-term outcome for LT in methylmalonic acidemia.
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Affiliation(s)
- P W Chen
- Department of Medical Genetics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Grünfeld JP, Hwu WL, Van Keimpema L, Alamovitch S, Zivna M, Brown EJ, Chien YH, Lee NC, Chiang SC, Dobrovolny R, Huang AC, Yeh HY, Chao MC, Lin SJ, Kitagawa T, Desnick RJ, Hsu LW, Nevens F, Vanslembrouck R, Van Oijen GH, Hoffmann AL, Dekker HM, De Man RA, Drenth JPH, Plaisier E, Favrole P, Prost C, Chen Z, Van Agrmael T, Marro B, Ronco P, Hulkova H, Matignon M, Hodanova K, Vylet'al P, Kalbacova M, Baresova V, Sikora J, Blazkova H, Zivny J, Ivanek R, Stranecky V, Sovova J, Claes K, Lerut E, Fryns JP, Hart PS, Hart TC, Adams JN, Pawtowski A, Clemessy M, Gasc JM, Gubler MC, Antignac C, Elleder M, Kapp K, Grimbert P, Bleyer AJ, Kmoch S, Schlöndorff JS, Becker DJ, Tsukaguchi H, Uschinski AL, Higgs HN, Henderson JM, Pollak MR. More on Clinical Renal GeneticsNewborn screening for Fabry disease in Taiwan reveals a high incidence of the later-onset mutation c.936+919G>A (IVS4+919G>A). Hum Mutat 30: 1397–1405, 2009Lanreotide reduces the volume of polycystic liver: A randomized, double-blind, placebo-controlled trial. Gastroenterology 137: 1661–1668, 2009Cerebrovascular disease related to COL4A1 mutations in HANAC syndrome. Neurology 73: 1873–1882, 2009Dominant renin gene mutations associated with early-onset hyperuricemia, anemia, and chronic renal failure. Am J Hum Genet 85: 204–213, 2009Mutations in the formin gene INF2 cause focal segmental glomerulosclerosis. Nat Genet 42: 72–76, 2009. Clin J Am Soc Nephrol 2010; 5:563-7. [DOI: 10.2215/cjn.01720210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hwu WL, Chien YH, Lee NC, Chiang SC, Dobrovolny R, Huang AC, Yeh HY, Chao MC, Lin SJ, Kitagawa T, Desnick RJ, Hsu LW. More on Clinical Renal Genetics. Clin J Am Soc Nephrol 2010. [DOI: 10.2215/01.cjn.0000927096.41084.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Baron RC, Rimer BK, Breslow RA, Coates RJ, Kerner J, Melillo S, Habarta N, Kalra GP, Chattopadhyay S, Wilson KM, Lee NC, Mullen PD, Coughlin SS, Briss PA. Client-directed interventions to increase community demand for breast, cervical, and colorectal cancer screening a systematic review. Am J Prev Med 2008; 35:S34-55. [PMID: 18541187 DOI: 10.1016/j.amepre.2008.04.002] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 02/05/2008] [Accepted: 04/10/2008] [Indexed: 11/25/2022]
Abstract
Most major medical organizations recommend routine screening for breast, cervical, and colorectal cancers. Screening can lead to early detection of these cancers, resulting in reduced mortality. Yet not all people who should be screened are screened, either regularly or, in some cases, ever. This report presents the results of systematic reviews of effectiveness, applicability, economic efficiency, barriers to implementation, and other harms or benefits of interventions designed to increase screening for breast, cervical, and colorectal cancers by increasing community demand for these services. Evidence from these reviews indicates that screening for breast cancer (mammography) and cervical cancer (Pap test) has been effectively increased by use of client reminders, small media, and one-on-one education. Screening for colorectal cancer by fecal occult blood test has been increased effectively by use of client reminders and small media. Additional research is needed to determine whether client incentives, group education, and mass media are effective in increasing use of any of the three screening tests; whether one-on-one education increases screening for colorectal cancer; and whether any demand-enhancing interventions are effective in increasing the use of other colorectal cancer screening procedures (i.e., flexible sigmoidoscopy, colonoscopy, double contrast barium enema). Specific areas for further research are also suggested in this report.
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Affiliation(s)
- Roy C Baron
- Community Guide Branch, National Center for Health Marketing, CDC, Atlanta, Georgia, USA
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Breslow RA, Rimer BK, Baron RC, Coates RJ, Kerner J, Wilson KM, Lee NC, Mullen PD, Coughlin SS, Briss PA. Introducing the community guide's reviews of evidence on interventions to increase screening for breast, cervical, and colorectal cancers. Am J Prev Med 2008; 35:S14-20. [PMID: 18541183 DOI: 10.1016/j.amepre.2008.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 02/05/2008] [Accepted: 04/10/2008] [Indexed: 11/30/2022]
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Norman SA, Russell Localio A, Weber AL, Coates RJ, Zhou L, Bernstein L, Malone KE, Marchbanks PA, Weiss LK, Lee NC, Nadel MR. Protection of mammography screening against death from breast cancer in women aged 40-64 years. Cancer Causes Control 2007; 18:909-18. [PMID: 17665313 DOI: 10.1007/s10552-007-9006-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2006] [Accepted: 03/12/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study assessed the efficacy of community-based screening mammography in protecting against breast cancer death, asking whether age differences in efficacy persisted in the 1990s. METHODS In a case-control study with follow-up, odds ratios (OR) were used to estimate the relative mortality rates from invasive breast cancer among women with at least one screening mammogram in the two years prior to a baseline reference date compared to non-screened women, adjusting for potential confounding. The multicenter population-based study included 553 black and white women diagnosed during 1994-1998 who died in the following five years, and 4016 controls without breast cancer. RESULTS Efficacy for reducing the rate of breast cancer death within five years after diagnosis was greater at ages 50-64 years (OR = 0.47, 95% confidence interval (CI) 0.35-0.63) than at ages 40-49 (OR = 0.89, 95% CI 0.65-1.23), and greater among postmenopausal (OR = 0.45, 95% CI 0.33-0.62) than premenopausal women (OR = 0.74, 95% CI 0.53-1.04). Estimates of efficacy were conservative, as shown by sensitivity analyses addressing whether cancer was discovered by a screening mammogram, age at which screening was received, the length of the screening observation window, and years of follow-up after diagnosis. CONCLUSIONS Despite the persistence of age differences in efficacy of mammography screening, with greater observed benefit for women aged 50-64 years, these findings support current screening recommendations for women 40-64 years old.
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Affiliation(s)
- Sandra A Norman
- Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, University of Pennsylvania, 801 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA.
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Norman SA, Localio AR, Zhou L, Weber AL, Coates RJ, Malone KE, Bernstein L, Marchbanks PA, Liff JM, Lee NC, Nadel MR. Benefit of screening mammography in reducing the rate of late-stage breast cancer diagnoses (United States). Cancer Causes Control 2006; 17:921-9. [PMID: 16841259 DOI: 10.1007/s10552-006-0029-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2006] [Accepted: 04/04/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We studied the benefit of modern mammography screening in community settings, evaluating age-related differences in rates of late-stage breast cancer detection. METHODS Our multicenter population-based case-control study included 931 black and white women with incident breast cancer (American Joint Commission on Cancer Stage IIB or higher) diagnosed 1994-1998 and 4,016 randomly sampled controls never diagnosed with breast cancer. Adjusted odds ratios (ORs) estimated the relative rate of late-stage diagnosis in screened and non-screened women. RESULTS Women aged 50-64 at diagnosis with at least one screening mammogram in the previous 2 years were significantly less likely to have late-stage diagnosis (OR = 0.41, 95% CI 0.33-0.52). Results for women aged 40-49 were consistent with a screening benefit, although the confidence interval marginally overlapped the null (OR = 0.81, 95% CI 0.64-1.02). Mammography screening was associated with lower rates of late-stage breast cancer among both premenopausal (OR = 0.64, 95% CI 0.50-0.81) and postmenopausal (OR = 0.44, 95% CI 0.35-0.56) women. CONCLUSIONS With modern mammography in the community, rates of late-stage breast cancer diagnoses are lower in screened compared to non-screened women ages 40 and older, but age-related differences persist.
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Affiliation(s)
- Sandra A Norman
- Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, University of Pennsylvania, 801 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA.
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Eheman CR, Benard VB, Blackman D, Lawson HW, Anderson C, Helsel W, Lee NC. Breast cancer screening among low-income or uninsured women: results from the National Breast and Cervical Cancer Early Detection Program, July 1995 to March 2002 (United States). Cancer Causes Control 2006; 17:29-38. [PMID: 16411050 DOI: 10.1007/s10552-005-4558-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Accepted: 03/24/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the results of breast cancer screening among low-income and uninsured women in the only national organized screening program in the US, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). METHODS We analyzed mammography and diagnostic follow-up data for 789,647 women who received their first mammogram in the NBCCEDP and 454,754 subsequent mammograms among these women. We calculated the rate of mammograms with abnormal findings, diagnostic follow-up, biopsy, and cancers detected per 1000 mammograms by age and racial or ethnic groups. Positive Predictive Values (PPVs) were estimated for abnormal mammograms and biopsy. RESULTS Nearly 64% of the women screened in the program were from 50 to 64 years of age and about 46% were members of racial or ethnic minority groups. Women aged 40 to 49 years had the highest rates of abnormal mammograms and of diagnostic follow-up. However, cancer detection rates were highest in women aged 60 to 64 years. In addition, the PPVs for both abnormal mammograms and biopsy were highest in the oldest age group. CONCLUSIONS Cancer detection rates and PPVs for both abnormal mammograms and biopsy were highest in women aged 50 years or more. These results support the programs focus on screening women aged 50 and older for breast cancer.
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Affiliation(s)
- Christie R Eheman
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, NCCDPHP, CDC, Atlanta, GA 30341, USA.
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Coates RJ, Given LS, Lee NC, Colditz G. A Collaborative, Comprehensive Approach to Fulfilling the Promise of Cancer Prevention and Control. Cancer Causes Control 2005; 16 Suppl 1:1. [PMID: 16208569 DOI: 10.1007/s10552-005-0489-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Ralph J Coates
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE (K-52), Atlanta, GA 30341, USA
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Saraiya M, Glanz K, Briss PA, Nichols P, White C, Das D, Smith SJ, Tannor B, Hutchinson AB, Wilson KM, Gandhi N, Lee NC, Rimer B, Coates RC, Kerner JF, Hiatt RA, Buffler P, Rochester P. Interventions to prevent skin cancer by reducing exposure to ultraviolet radiation: a systematic review. Am J Prev Med 2004; 27:422-66. [PMID: 15556744 DOI: 10.1016/j.amepre.2004.08.009] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The relationship between skin cancer and ultraviolet radiation is well established. Behaviors such as seeking shade, avoiding sun exposure during peak hours of radiation, wearing protective clothing, or some combination of these behaviors can provide protection. Sunscreen use alone is not considered an adequate protection against ultraviolet radiation. This report presents the results of systematic reviews of effectiveness, applicability, other harms or benefits, economic evaluations, and barriers to use of selected interventions to prevent skin cancer by reducing exposure to ultraviolet radiation. The Task Force on Community Preventive Services found that education and policy approaches to increasing sun-protective behaviors were effective when implemented in primary schools and in recreational or tourism settings, but found insufficient evidence to determine effectiveness when implemented in other settings, such as child care centers, secondary schools and colleges, and occupational settings. They also found insufficient evidence to determine the effectiveness of interventions oriented to healthcare settings and providers, media campaigns alone, interventions oriented to parents or caregivers of children, and community-wide multicomponent interventions. The report also provides suggestions for areas for future research.
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Affiliation(s)
- Mona Saraiya
- National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Niu DM, Hwang B, Tiu CM, Tsai LP, Yen JL, Lee NC, Lin CY. Contributions of bone maturation measurements to the differential diagnosis of neonatal transient hypothyroidism versus dyshormonogenetic congenital hypothyroidism. Acta Paediatr 2004; 93:1301-6. [PMID: 15499948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
AIM To a) evaluate the contribution of bone maturation in the diagnosis of neonatal transient hypothyroidism versus dyshormonogenetic congenital hypothyroidism in full-term newborns, and b) use bone maturation to test the hypothesis that neonatal transient hypothyroidism is perinatal in onset. MATERIALS AND METHODS The study included 20 patients with dyshormonogenetic and 43 with transient hypothyroidism. Thyroid function and measurements of the distal femoral epiphysis area, obtained at the time of first confirmatory diagnosis, were compared between the two groups. The epiphysis area in two control groups with normal thyroid function was also measured and compared with that in patients with transient hypothyroidism, at age 1-3 d (control A), or at the age when normal thyroid function was confirmed (control B). RESULTS Mean epiphysis area was 0.04 cm2 in patients with dyshormonogenetic versus 0.22 cm2 in patients with transient hypothyroidism (p < 0.0001). An area <0.05 cm2 was limited to patients with dyshormonogenetic hypothyroidism. Conversely, a normal area (>0.2 cm2) was only observed in patients with transient hypothyroidism. Mean epiphysis areas in control A (0.20 cm2) and in patients with transient hypothyroidism were similar (p = 0.37), consistent with perinatal onset of transient hypothyroidism. Mean epiphysis area in control B (0.31 cm2) was significantly greater than in patients with transient hypothyroidism (p < 0.01). CONCLUSIONS A short duration of hypothyroidism can significantly delay bone maturation. Examination of bone maturation at initial confirmatory evaluation yields important information pertaining to congenital hypothyroidism, not only to predict intellectual development, but also to evaluate the risk of dyshormonogenetic hypothyroidism.
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Affiliation(s)
- D M Niu
- Department of Paediatrics, Veterans General Hospital-Taipei, Taipei, Taiwan
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Escobedo LG, Lee NC, Peterson HB, Wingo PA. Infertility-associated endometrial cancer risk may be limited to specific subgroups of infertile women. Int J Gynaecol Obstet 2004. [DOI: 10.1016/0020-7292(91)90508-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Benard VB, Eheman CR, Lawson HW, Blackman DK, Anderson C, Helsel W, Thames SF, Lee NC. Cervical screening in the National Breast and Cervical Cancer Early Detection Program, 1995-2001. Obstet Gynecol 2004; 103:564-71. [PMID: 14990422 DOI: 10.1097/01.aog.0000115510.81613.f0] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe results of cervical cytology screening among low-income and uninsured women in the National Breast and Cervical Cancer Early Detection Program. METHODS We analyzed data from 750,591 women who received their first Papanicolaou (Pap) test in the program between July 1995 and March 2001. RESULTS Nearly 85% of the women were aged 40 years or older. Almost half were members of racial or ethnic minority groups. Overall, the percentage of abnormal Pap test results decreased with increasing age. The rates of cervical intraepithelial neoplasia (CIN) were highest in the younger age groups but the rate of invasive cancer increased with age. White women had the highest age-adjusted percentage of abnormal Pap test results and the highest rate of biopsy-confirmed CIN 2 or worse. CONCLUSIONS In this nationwide screening program, only 7% of all biopsy-confirmed high-grade cervical lesions (CIN 2 or worse) were invasive cancer. This underscores the success of Pap screening in identifying preinvasive disease and preventing cancer. LEVEL OF EVIDENCE II-3
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Affiliation(s)
- Vicki B Benard
- Epidemiology and Health Services Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention/NCCDPHP, 4770 Buford Highway NE, Atlanta, GA 30341, USA.
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Hall IJ, Burke W, Coughlin S, Lee NC. Population-based estimates of the prevalence of family history of cancer among women. Public Health Genomics 2004; 4:134-42. [PMID: 14960905 DOI: 10.1159/000051173] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Family history of cancer is recognized as one of the most important risk factors in predicting personal cancer risk. Nevertheless, there are few published population-based estimates of family history prevalence by age categories. METHODS We used responses of female controls (n = 4,754) from the population-based Cancer and Steroid Hormone study (1980-1982) to estimate the frequency of family history of various cancers among female relatives. We determined the age- and race-specific prevalence of family history of breast, ovarian, endometrial, and other cancers in first-degree female relatives of women aged 20-54 years. To evaluate changes in reporting family history over time, we also analyzed responses of control women (n = 1,544) from the Women's Interview Study on Health (WISH) (1990-1992) to estimate the prevalence of family history of breast cancer. RESULTS The prevalence of a first-degree family history of breast, ovarian, endometrial, and cervical cancers was 6.4% (95% CI 5.7-7.1%), 1.1% (0.8-1.4%), 3.5% (3.0-4.0%), and 2.1% (1.7-2.5%), respectively. Among first-degree female relatives, the prevalence of family history of colon, lung, and thyroid cancers was 2.4% (2.1-2.9%), 1.5% (1.2-1.8%), and 0.5% (0.3-0.7%), respectively. The prevalence of family history of breast and colon cancers increased significantly with respondent's age. Similar results for family history of breast cancer were obtained from an analysis of responses from the WISH. CONCLUSIONS In addition to providing a point of reference for research and health policy, these results may be of interest to providers who care for female patients because of the usefulness of information about family history of cancer for assessing lifetime risk of cancer.
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Affiliation(s)
- I J Hall
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA 30341-3724, USA.
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Briss P, Rimer B, Reilley B, Coates RC, Lee NC, Mullen P, Corso P, Hutchinson AB, Hiatt R, Kerner J, George P, White C, Gandhi N, Saraiya M, Breslow R, Isham G, Teutsch SM, Hinman AR, Lawrence R. Promoting informed decisions about cancer screening in communities and healthcare systems. Am J Prev Med 2004; 26:67-80. [PMID: 14700715 DOI: 10.1016/j.amepre.2003.09.012] [Citation(s) in RCA: 233] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Individuals are increasingly involved in decisions about their health care. Shared decision making (SDM), an intervention in the clinical setting in which patients and providers collaborate in decision making, is an important approach for informing patients and involving them in their health care. However, SDM cannot bear the entire burden for informing and involving individuals. Population-oriented interventions to promote informed decision making (IDM) should also be explored. This review provides a conceptual background for population-oriented interventions to promote informed decisions (IDM interventions), followed by a systematic review of studies of IDM interventions to promote cancer screening. This review specifically asked whether IDM interventions (1) promote understanding of cancer screening, (2) facilitate participation in decision making about cancer screening at a level that is comfortable for individuals; or (3) encourage individuals to make cancer-screening decisions that are consistent with their preferences and values.Fifteen intervention arms met the intervention definition. They used small media, counseling, small-group education, provider-oriented strategies, or combinations of these to promote IDM. The interventions were generally consistent in improving individuals' knowledge about the disease, accuracy of risk perceptions, or knowledge and beliefs about the pros and cons of screening and treatment options. However, few studies evaluated whether these interventions resulted in individuals participating in decision making at a desirable level, or whether they led to decisions that were consistent with individuals' values and preferences. More research is needed on how best to promote and facilitate individuals' participation in health care. Work is especially needed on how to facilitate participation at a level desired by individuals, how to promote decisions by patients that are consistent with their preferences and values, how to perform effective and cost-effective IDM interventions for healthcare systems and providers and in community settings (outside of clinical settings), and how to implement these interventions in diverse populations (such as populations that are older, nonwhite, or disadvantaged). Finally, work is needed on the presence and magnitude of barriers to and harms of IDM interventions and how they might be avoided.
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Affiliation(s)
- Peter Briss
- Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Smith-Bindman R, Chu PW, Miglioretti DL, Sickles EA, Blanks R, Ballard-Barbash R, Bobo JK, Lee NC, Wallis MG, Patnick J, Kerlikowske K. Comparison of screening mammography in the United States and the United kingdom. JAMA 2003; 290:2129-37. [PMID: 14570948 DOI: 10.1001/jama.290.16.2129] [Citation(s) in RCA: 252] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
CONTEXT Screening mammography differs between the United States and the United Kingdom; a direct comparison may suggest methods to improve the practice. OBJECTIVE To compare screening mammography performance between the United States and the United Kingdom among similar-aged women. DESIGN, SETTING, AND PARTICIPANTS Women aged 50 years or older were identified who underwent 5.5 million mammograms from January 1, 1996, to December 31, 1999, within 3 large-scale mammography registries or screening programs: the Breast Cancer Surveillance Consortium (BCSC, n = 978 591) and National Breast and Cervical Cancer Early Detection Program (NBCCEDP, n = 613 388) in the United States; and the National Health Service Breast Screening Program (NHSBSP, n = 3.94 million) in the United Kingdom. A total of 27 612 women were diagnosed with breast cancer (invasive or ductal carcinoma in situ) within 12 months of screening among the 3 groups. MAIN OUTCOME MEASURES Recall rates (recommendation for further evaluation including diagnostic imaging, ultrasound, clinical examination, or biopsy) and cancer detection rates were calculated for first and subsequent mammograms, and within 5-year age groups. RESULTS Recall rates were approximately twice as high in the United States than in the United Kingdom for all age groups; however, cancer rates were similar. Among women aged 50 to 54 years who underwent a first screening mammogram, 14.4% in the BCSC and 12.5% in the NBCCEDP were recalled for further evaluation vs only 7.6% in the NHSBSP. Cancer detection rates per 1000 mammogram screens were 5.8, 5.9, and 6.3, in the BCSC, NBCCEDP, and NHSBSP, respectively. Recall rates were lower for subsequent examinations in all 3 settings but remained twice as high in the United States. A similar percentage of women underwent biopsy in each setting, but rates of percutaneous biopsy were lower and open surgical biopsy higher in the United States. Open surgical biopsies not resulting in a diagnosis of cancer (negative biopsies) were twice as high in the United States than in the United Kingdom. Based on a 10-year period of screening 1000 women aged 50 to 59 years, 477, 433, and 175 women in the BCSC, NBCCEDP, and NHSBSP, respectively, would be recalled; and for women aged 60 to 69 years, 396, 334, and 133 women, respectively. The estimated cancer detection rates per 1000 women aged 50 to 59 years were 24.5, 23.8, and 19.4, respectively, and for women aged 60 to 69 years, 31.5, 26.6, and 27.9, respectively. CONCLUSIONS Recall and negative open surgical biopsy rates are twice as high in US settings than in the United Kingdom but cancer detection rates are similar. Efforts to improve US mammographic screening should target lowering the recall rate without reducing the cancer detection rate.
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Sawaya GF, McConnell KJ, Kulasingam SL, Lawson HW, Kerlikowske K, Melnikow J, Lee NC, Gildengorin G, Myers ER, Washington AE. Risk of cervical cancer associated with extending the interval between cervical-cancer screenings. N Engl J Med 2003; 349:1501-9. [PMID: 14561792 DOI: 10.1056/nejmoa035419] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although contemporary guidelines suggest that the intervals between Papanicolaou tests can be extended to three years among low-risk women with previous negative tests, the excess risk of cervical cancer associated with less frequent than annual screening is uncertain. METHODS We determined the prevalence of biopsy-proven cervical neoplasia among 938,576 women younger than 65 years of age, stratified according to the number of previous consecutive negative Papanicolaou tests. Using a Markov model that estimates the rate at which dysplasia will progress to cancer, we estimated the risk of cancer within three years after one or more negative Papanicolaou tests, as well as the number of additional Papanicolaou tests and colposcopic examinations that would be required to avert one case of cancer given a particular interval between screenings. RESULTS Among 31,728 women 30 to 64 years of age who had had three or more consecutive negative tests, the prevalence of biopsy-proven cervical intraepithelial neoplasia of grade 2 was 0.028 percent and the prevalence of grade 3 neoplasia was 0.019 percent; none of the women had invasive cervical cancer. According to our model, the estimated risk of cancer with annual Papanicolaou tests for three years was 2 in 100,000 among women 30 to 44 years of age, 1 in 100,000 among women 45 to 59 years of age, and 1 in 100,000 among women 60 to 64 years of age; these risks would be 5 in 100,000, 2 in 100,000, and 1 in 100,000, respectively, if screening were performed once three years after the last negative test. To avert one additional case of cancer by screening 100,000 women annually for three years rather than once three years after the last negative test, an average of 69,665 additional Papanicolaou tests and 3861 colposcopic examinations would be needed in women 30 to 44 years of age and an average of 209,324 additional Papanicolaou tests and 11,502 colposcopic examinations in women 45 to 59 years of age. CONCLUSIONS As compared with annual screening for three years, screening performed once three years after the last negative test in women 30 to 64 years of age who have had three or more consecutive negative Papanicolaou tests is associated with an average excess risk of cervical cancer of approximately 3 in 100,000.
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Affiliation(s)
- George F Sawaya
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Department of Veterans Affairs and University of California, San Francisco, San Francisco, USA
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Norman SA, Localio AR, Zhou L, Bernstein L, Coates RJ, Flagg EW, Marchbanks PA, Malone KE, Weiss LK, Lee NC, Nadel MR. Validation of self-reported screening mammography histories among women with and without breast cancer. Am J Epidemiol 2003; 158:264-71. [PMID: 12882949 DOI: 10.1093/aje/kwg136] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
As part of a case-control study of the efficacy of screening mammography, the authors validated the mammography histories of 2,495 women aged 40-64 years with incident breast cancer diagnosed in 1994-1998 and a 25% random sample of 615 controls never diagnosed with breast cancer, all reporting a mammogram in the past 5 years. Subjects from five metropolitan areas of the United States were cross-classified by facility records ("gold standard") and self-report according to history of a recent screening mammogram (within 1 year or within 2 years). Sensitivity and specificity of self-reported screening at 1 year were 0.93 and 0.82, respectively, for cases and 0.92 and 0.80 for controls. At 2 years, sensitivity and specificity were 0.97 and 0.78 for both cases and controls. Confidence intervals for the differences in sensitivity and specificity were narrow and included zero. Scant evidence was found of telescoping (recollection of events as more recent than actual). Findings suggest that, in an interview-based case-control study of the efficacy of screening mammography, 1) estimated true prevalences of recent screening mammography adjusted for sensitivity and specificity will be slightly lower than self-reported prevalences, and 2) differential misclassification of exposure status is slight. Therefore, odds ratios will likely be biased toward the null, underestimating screening efficacy.
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Affiliation(s)
- Sandra A Norman
- Center for Clinical Epidemiology and Biostatistics and Department of Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia 19104-6021, USA.
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Abstract
BACKGROUND Although clinical breast examinations (CBEs) provide important opportunities to detect breast cancer, little is known about factors that affect cancer detection during CBEs performed in community settings. To evaluate several potential factors, we analyzed data from 1,056,153 cancer screening records reported to the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). METHODS Using case-series methods, we compared 2159 cancers missed during CBEs with 3161 cancers detected during CBEs. Cancers missed during CBE were found by mammography and confirmed by biopsy or fine needle aspiration. RESULTS After controling for cancer stage, tumor size, and breast symptoms at time of CBE, we found that patient age and CBE history were significantly associated with the likelihood of cancer detection. Compared to women 50-59, women 40-49 were more likely to have their cancer detected during CBE (odds ratio (OR) = 1.84, 95% confidence interval (95% CI) 1.47-2.29), while women 70 and older were less likely to have it detected (OR = 0.74, 95% CI: 0.55-1.00). Among women receiving their first NBCCEDP-funded CBE, 67.5% had their cancer detected by CBE. Among women receiving their second or third CBE, the values were 59.3 and 48.8%, respectively. In an adjusted logistic model, a significant inverse relationship was observed between number of prior CBEs and percent of cancers detected in the index CBE (OR = 0.79, 95% CI: 0.72-0.88). CONCLUSIONS Among women diagnosed with breast cancer, older women and those who have had multiple CBEs were more likely to have their cancer missed during CBE.
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Affiliation(s)
- Janet Kay Bobo
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Swan J, Breen N, Coates RJ, Rimer BK, Lee NC. Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey. Cancer 2003; 97:1528-40. [PMID: 12627518 DOI: 10.1002/cncr.11208] [Citation(s) in RCA: 598] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Understanding differences in cancer screening among population groups in 2000 and successes or failures in reducing disparities over time among groups is important for planning a public health strategy to reduce or eliminate health disparities, a major goal of Healthy People 2010 national cancer screening objectives. In 2000, the new cancer control module added to the National Health Interview Survey (NHIS) collected more detailed information on cancer screening compared with previous surveys. METHODS Data from the 2000 NHIS and earlier surveys were analyzed to discern patterns and trends in cancer screening practices, including Pap tests, mammography, prostate specific antigen (PSA) screening, and colorectal screening. The data are reported for population subgroups that were defined by a number of demographic and socioeconomic characteristics. RESULTS Women who were least likely to have had a mammogram within the last 2 years were those with no usual source of health care (61%), women with no health insurance (67%), and women who immigrated to the United States within the last 10 years (61%). Results for Pap tests within the last 3 years were similar. Among both men and women, those least likely to have had a fecal occult blood test or endoscopy within the recommended screening interval had no usual source of care (14% for men and 18% for women), no health insurance (20% for men and 18% for women), or were recent immigrants (20% for men and 18% for women). An analysis of changes in test use since the 1987 survey indicates that the disparities are widening among groups with no usual source of care. CONCLUSIONS No striking improvements have been observed for the groups with greatest need. Although screening use for most groups has increased since 1987, major disparities remain. Some groups, notably individuals with no usual source of care and the uninsured are falling further behind; and, according to the 2000 data, recent immigrants also experience a significant gap in screening utilization. More attention is needed to overcome screening barriers for these groups if the population benefits of cancer screening are to be achieved.
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Affiliation(s)
- Judith Swan
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland 20892, USA.
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Wingo PA, Jamison PM, Hiatt RA, Weir HK, Gargiullo PM, Hutton M, Lee NC, Hall HI. Building the infrastructure for nationwide cancer surveillance and control--a comparison between the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology, and End Results (SEER) Program (United States). Cancer Causes Control 2003; 14:175-93. [PMID: 12749723 DOI: 10.1023/a:1023002322935] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE In preparation for jointly publishing official government cancer statistics, the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI) compared incidence rates from NCI's Surveillance Epidemiology and End Results (SEER) Program and CDC's National Program of Cancer Registries (NPCR). METHODS Data for 1999 covering 78% of the US population were obtained from SEER and selected NPCR registries that met high quality data criteria. Incidence rates (per 100,000 population) were age-adjusted to the 2000 US standard population, and 95% gamma confidence intervals were estimated. RESULTS NPCR rates for all sites combined were higher than SEER rates (males: NPCR 553.6, SEER 538.7; females: NPCR 420.8, SEER 412.5), but rates for specific cancer sites varied by registry program. Rates for colon cancer (males: NPCR 47.0, SEER 42.7; females: NPCR 36.5, SEER 33.8) and tobacco-related cancers were higher in NPCR than SEER. In contrast, NPCR rates were lower than SEER rates for cancers of the female breast (NPCR 134.0, SEER 135.9), prostate (NPCR 162.0, SEER 170.2), and melanoma as well as for cancers more common among Asians and Pacific Islanders (e.g., stomach cancer). CONCLUSIONS Rate differences may arise from population differences in socio-demographic characteristics, screening use, health behaviors, exposure to cancer causing agents or registry operations factors.
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Affiliation(s)
- Phyllis A Wingo
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Affiliation(s)
- Steven S Coughlin
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Antman K, Abraido-Lanza AF, Blum D, Brownfield E, Cicatelli B, Debor MD, Emmons K, Fitzgibbon M, Gapstur SM, Gradishar W, Hiatt RA, Hubbell FA, Joe AK, Klassen AC, Lee NC, Linden HM, McMullin J, Mishra SI, Neuhaus C, Olopade FI, Walas K. Reducing disparities in breast cancer survival: a Columbia University and Avon Breast Cancer Research and Care Network Symposium. Breast Cancer Res Treat 2002; 75:269-80. [PMID: 12353816 DOI: 10.1023/a:1019947110236] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
On November 8th, 2001, faculty from Universities, government and non-profit community organizations met to determine how, separately and together, they could address disparities in survival of women with breast cancer in the diverse patient populations served by their institutions. Studies and initiatives directed at increasing access had to date met modest success. The day was divided into three sections, defining the issues, model programs, government initiatives and finally potential collaborations. By publishing these proceedings, interested readers will be aware of the ongoing programs and studies and can contact the investigators for more information. The Avon Foundation funded this symposium to bring together interested investigators to share programmatic experiences, data and innovative approaches to the problem.
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Burke W, Coughlin SS, Lee NC, Weed DL, Khoury MJ. Application of population screening principles to genetic screening for adult-onset conditions. Genet Test 2002; 5:201-11. [PMID: 11788085 DOI: 10.1089/10906570152742245] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Recent advances in molecular genetics have highlighted the potential use of genetic testing to screen for adult-onset chronic diseases. Several issues must be addressed, however, before such tests can be recommended for population-based prevention programs. These issues include the adequacy of the scientific evidence, the balance of risks and benefits, the need for counseling and informed consent, and the costs and resources required. Ongoing assessment of the screening program and quality assurance of laboratory testing are also needed. This paper considers the application of general principles for mass screening to genetic testing for susceptibility to adult-onset chronic diseases. Evaluation of proposals for genetic screening in context of these principles reveals that needed evidence is often absent, particularly with respect to the predictive value of tests, efficacy of interventions, and social consequences of testing. The principles of population screening are developed into a framework for public health policy on genetic screening that has three stages: assessment of the screening test and interventions for those who test positive, including assessment of risks and costs, policy development, and program evaluation. Essential elements are identified, including evaluation of evidence and processes for consensus development and program evaluation. The proposed framework for public health policymaking outlined in this commentary, when combined with future efforts that involve an authoritative consensus process, may be useful for the evaluation and planning of genetic screening programs aimed at reducing morbidity and mortality from adult-onset chronic diseases.
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Affiliation(s)
- W Burke
- Department of Medical History and Ethics, University of Washington, 1959 NE Pacific, Room A204, Seattle, WA 98195.
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Saraiya M, Lee NC, Blackman D, Smith MJ, Morrow B, McKenna MT. Observations from the CDC. An assessment of Pap smears and hysterectomies among women in the United States. J Womens Health Gend Based Med 2002; 11:103-9. [PMID: 11975858 DOI: 10.1089/152460902753645245] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Mona Saraiya
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, and The Klemm Analysis Group, Atlanta, Georgia 30341, USA
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Le HN, Lee NC, Tsung K, Norton JA. Pre-existing tumor-sensitized T cells are essential for eradication of established tumors by IL-12 and cyclophosphamide plus IL-12. J Immunol 2001; 167:6765-72. [PMID: 11739491 DOI: 10.4049/jimmunol.167.12.6765] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The antitumor immune response activated by IL-12, especially by a combination of cyclophosphamide and IL-12 (Cy+IL-12), is clinically significant in certain experimental tumor models, in that a number of well-established (10-20 mm in diameter) s.c. tumors are completely eradicated. Furthermore, Cy+IL-12 treatment is also able to eradicate well-established grossly detectable experimental lung metastases and advanced ascites tumors. Despite the dramatic antitumor effects seen in some tumor models, Cy+IL-12 fails to induce regression of other established tumors. Characterization of tumor immunogenicity shows that all tumors responding to IL-12 and Cy+IL-12 treatments are immunogenic tumors, in that an antitumor immune response is detectable in tumor-bearing hosts upon tumor establishment. In contrast, none of the nonimmunogenic tumor responds to IL-12 and Cy+IL-12 treatments. Analysis of cellular requirements for successful tumor rejection through an adoptive cell transfer approach reveals that the presence of tumor-sensitized, but not naive, T cells is essential for tumor rejection by IL-12 and Cy+IL-12. Transfer of these tumor-sensitized T cells must be conducted before, but not after, IL-12 treatment in order for tumor rejection to occur. The requirement of sensitized T cells is also tumor specific. In mice bearing immunogenic tumors, the presence of pre-existing tumor-sensitized T cells is demonstrated by adoptive cell transfer experiments using purified spleen T cells from these mice. Results from our study show that Cy+IL-12-based immunotherapy of cancer may be highly effective and that pre-existing tumor-sensitized T cells are essential for the success of the therapy.
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Affiliation(s)
- H N Le
- Department of Surgery, University of California and San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA
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Abstract
BACKGROUND Relatively little is known about factors that predict ongoing participation in mammography screening at regular intervals. Members of managed care plans have access to this preventive service; yet, many still do not receive it routinely. METHODS Using administrative data from HIP Health Plan of New York, a group model HMO, 24,215 women ages 50-80 years identified as having a screening mammogram during the baseline period were followed for 2 years to determine demographic and utilization factors that might be related to having a subsequent mammogram within the recommended time interval. RESULTS Of the 24,215 women with an index mammogram, 71.8;pc had a subsequent screening mammogram within 2 years. Women ages 65-74 years and those with Medicare coverage had the highest mammogram rates among the age and coverage categories. Number of primary care and gynecology physician visits was strongly related to having a subsequent mammogram. The average (mean) time between index and subsequent mammogram was 14.4 months. CONCLUSION The significance of health plan visits in subsequent mammography underscores the importance of physician-patient communication in a managed care plan and the integration of health plan members into the HMO delivery system. Even in this environment with equal access for all types of coverage, Medicaid members were less likely to receive this preventive service.
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Affiliation(s)
- J K Barr
- Qualidigm (Connecticut Peer Review Organization), Middletown, Connecticut 06457, USA.
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Barr JK, Franks AL, Lee NC, Antonucci DM, Rifkind S, Schachter M. A randomized intervention to improve ongoing participation in mammography. Am J Manag Care 2001; 7:887-94. [PMID: 11570022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
OBJECTIVE To test the effectiveness of interventions intended to increase rates of regular breast cancer screening, according to recommended guidelines. STUDY DESIGN A randomized controlled trial of 2 outreach interventions (a mail reminder and a telephone reminder plus appointment scheduling) compared with a routine publicity campaign to encourage continued participation in mammography screening. PARTICIPANTS AND METHODS Participants were 1908 women aged 50 to 75 years continuously enrolled in a large group-model HMO during the study who underwent a bilateral mammogram during the first quarter of 1994 and no subsequent mammogram during the next 18 to 21 months. Data were obtained from health plan administrative data files supplemented by medical chart review. Women were randomly assigned to receive (1) a mail reminder, (2) a telephone reminder, or (3) routine publicity on mammography for all women. The outcome measure was a mammogram received after the intervention period and within 2 years of the initial mammogram date. RESULTS Bivariate and multivariate statistical analyses showed that participation was significantly higher for women contacted by telephone than through routine publicity. Mail reminders were no more effective than a routine publicity campaign. Primary care physician and gynecologist visits increased the likelihood of a subsequent mammogram for women in all intervention groups. CONCLUSIONS Telephone contact by regular health plan staff was more successful than publicity in encouraging continued participation in mammography screening in women enrolled in a group-model managed health care plan. Because mailings did not influence participation in mammography screening, health plans should be cautious about investing in member mailings without first evaluating their effectiveness in the context of existing outreach efforts.
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Affiliation(s)
- J K Barr
- Medical Quality Improvement, Qualidigm, 100 Roscommon Drive, Middletown, CT 06457, USA.
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Richardson LC, Schulman J, Sever LE, Lee NC, Coate RJ. Early-stage breast cancer treatment among medically underserved women diagnosed in a national screening program, 1992-1995. Breast Cancer Res Treat 2001; 69:133-42. [PMID: 11759819 DOI: 10.1023/a:1012252607421] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Little research has been conducted on the breast cancer treatment of low income, underserved women. This study was designed to describe initial treatment of breast cancer among low-income women diagnosed through federally funded screening programs in Detroit, Michigan, and the states of New Mexico and California; and to compare the treatment received by program women with early-stage breast cancer with that of all women diagnosed in those regions. METHODS Data from the three screening programs were linked with cancer registry data from the corresponding geographic areas. All women diagnosed between 1992 and 1995 through the state-based screening programs and all women contemporaneously diagnosed with breast cancer in the three regions were studied. Descriptive analyses were done of the proportion of women with breast cancer receiving treatment; the proportion of early-stage breast cancer (stage I or II) cases treated with breast-conserving surgery, and the proportion treated with mastectomy; and among women with breast-conserving surgery, the proportion receiving radiation therapy. Logistic regression models controlled for age and stage at diagnosis, race or ethnicity and geographic region. RESULTS Less than 2% of program women diagnosed with breast cancer received no treatment. More than two of five women with early-stage breast cancer underwent breast-conserving surgery, with 72% of these women receiving radiation therapy. Multivariate regression analysis revealed that women with stage IIA or IIB breast cancer had lower odds of undergoing breast-conserving surgery than women with stage I (0.51 [95% CI = 0.30-0.87] and 0.36 [95% CI = 0.19-0.70], respectively). Women over age 65 and those with incompletely staged cancer had the lowest odds for receiving radiation therapy after breast-conserving surgery (0.29 [95% CI = 0.09-0.99] and 0.14 [95% CI = 0.03-0.72], respectively). Women diagnosed through the screening programs had odds of undergoing breast-conserving surgery similar to those of all women in the regions (1.11 [95% CI= 0.89-1.39]). CONCLUSIONS Treatment patterns for women diagnosed with early-stage breast cancer through three state-based screening programs appear to have been similar to those reported in the literature. In addition, their treatment appears to have been similar to that of other women during the same time period.
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Affiliation(s)
- L C Richardson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Lee NC, Bouvet M, Nardin S, Jiang P, Baranov E, Rashidi B, Yang M, Wang X, Moossa AR, Hoffma RM. Antimetastatic efficacy of adjuvant gemcitabine in a pancreatic cancer orthotopic model. Clin Exp Metastasis 2001; 18:379-84. [PMID: 11467769 DOI: 10.1023/a:1010831823004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Gemcitabine is a promising new agent that has been recently studied for palliation of advanced (stage IV) unresectable pancreatic cancer. We hypothesized that adjuvant gemcitabine would reduce recurrence and metastases following surgical resection of pancreatic cancer. To test this hypothesis, we evaluated gemcitabine on a green fluorescent protein (GFP) transductant of the human pancreatic cancer cell line BxPC-3 (BxPC-3-GFP) using surgical orthotopic implantation (SOI) in nude mice. GFP enabled high resolution fluorescent visualization of primary and metastatic growth. Five weeks after SOI, the mice were randomized into three groups: Group I received exploratory laparotomy only. Group II underwent surgical resection of the pancreatic tumor without further treatment. Group III underwent tumor resection followed by adjuvant treatment with gemcitabine, 100 mg/kg every three days for a total of four doses, starting two days after resection. The mice were sacrificed at thirteen weeks following implantation and the presence and location of recurrent tumor was recorded. Gemcitabine reduced the recurrence rate to 28.6% compared to 70.6% with resection only (P = 0.02) and reduced metastatic events 58% in the adjuvant group compared to resection only. This study, demonstrating that gemcitabine is effective as adjuvant chemotherapy post-pancreatectomy, suggests this new indication of the drug clinically.
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Affiliation(s)
- N C Lee
- AntiCancer Inc., San Diego, California 92111, USA
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Abstract
OBJECTIVE To evaluate the potential overuse of Papanicolaou smears among women who have had a hysterectomy. METHODS We analyzed two surveys of US women aged 18 years or older, the Behavioral Risk Factor Surveillance System (1992-1997) and the National Health Interview Survey (1993-1994), and one survey of US hospitals (National Hospital Discharge Survey, 1980-1997). We examined the number of women who have had a hysterectomy who had a recent (within 3 years) Papanicolaou smear. We also examined trends in the proportions and rates of hysterectomies by diagnoses and type of procedure that potentially could require a Papanicolaou smear. RESULTS From the Behavioral Risk Factor Surveillance System, an estimated 21.2% of US women have had a hysterectomy. Among women who have had a hysterectomy, 78.3% had a recent Papanicolaou smear. Among those reporting no hysterectomy, 82.1% had a recent Papanicolaou smear. Estimates from the National Health Interview Survey were similar. From the National Hospital Discharge Survey, an estimated 6.7% to 15.4% of women with a history of hysterectomy would require a subsequent Papanicolaou smear because they had a diagnosis related to cervical neoplasia or because they had undergone a supracervical hysterectomy. For an estimated 10.6-11.6 million of the 12.5 million women who had a hysterectomy and a recent Papanicolaou smear, that test could be considered unnecessary. CONCLUSION Continued Papanicolaou screening of women without an intact uteri may result in excessive use of resources in time and money with minimal impact on decreasing cervical cancer.
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Affiliation(s)
- M Saraiya
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Affiliation(s)
- N C Lee
- Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA
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Benard VB, Lee NC, Piper M, Richardson L. Race-specific results of Papanicolaou testing and the rate of cervical neoplasia in the National Breast and Cervical Cancer Early Detection Program, 1991-1998 (United States). Cancer Causes Control 2001; 12:61-8. [PMID: 11227926 DOI: 10.1023/a:1008959019019] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To describe differences in cervical screening and biopsy results by race or ethnicity from women in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). METHODS We examined the percentage of abnormalities detected by Papanicolaou (Pap) tests and the rate of biopsy-diagnosed high-grade precancerous or cancerous lesions by racial or ethnic group. RESULTS Almost half the 628,085 women screened were members of racial or ethnic minority groups. American Indian or Alaska Native women were more likely than others to report never having had a prior Pap test. American Indian or Alaska Native women had the highest proportion of abnormal Pap tests for first program screens (4.4%), followed by blacks (3.2%), whites (3.0%), Hispanics (2.7%), and Asians or Pacific Islanders (1.9%). Whites had the highest biopsy detection rate of high-grade lesions for first program screens (9.9 per 1000 Pap tests), followed by Hispanics (7.6), blacks (7.1), American Indians or Alaska Natives (6.7), and Asians or Pacific Islanders (5.4). CONCLUSIONS This program provides important data on the prevalence of cervical neoplasia among diverse populations. Our findings that black women with a high-grade Pap test were less likely to get a work-up are disconcerting and merit further study and ultimate correction.
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Affiliation(s)
- V B Benard
- Council of State and Territorial Epidemiologists, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Atlanta, GA 30341, USA.
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Abstract
Multiple endocrine neoplasia (MEN) type 2B is a heritable endocrine disorder characterized by medullary thyroid carcinoma (MTC), pheochromocytoma, multiple mucosal neuromas, and a marfanoid habitus. Intestinal ganglioneuromatosis, corneal nerve thickening and skeletal abnormalities are also often present. The disease is inherited in an autosomal dominant fashion and is caused by a single mutation in the RET proto-oncogene, with a methionine to threonine substitution at codon 918. The MTC in MEN 2B presents at an earlier age and tends to be more aggressive than the MTC in MEN 2A. It is multicentric and bilateral and occurs as young as age 3, with early lymph node metastases. Pheochromocytoma is also often bilateral but is rarely malignant. If pheochromocytoma is detected, adrenalectomy should precede thyroidectomy to avoid intraoperative catecholamine crisis. Patients at risk for MEN 2B should undergo genetic screening in infancy. Total thyroidectomy should be performed on all patients positive for RET mutations even prior to the onset of clinical symptoms.
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Affiliation(s)
- N C Lee
- Department of Surgery, University of California, 94143, San Francisco, CA, USA
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Abstract
OBJECTIVE Although recent screening guidelines recommend annual fecal occult blood testing (FOBT) for adults aged > or = 50, a number of studies report that these tests are underused. Systematic efforts to increase awareness of colorectal cancer (CRC) and to promote screening participation are needed to meet national objectives for CRC control. METHODS This study examined CRC-screening practices and evaluated factors related to recent participation in screening by FOBT in a sample of women aged 50 to 80 who were surveyed about their use of clinical preventive services at Group Health Cooperative, a managed care organization in western Washington State. RESULTS Of the 931 women eligible for analysis, 75% reported ever having been screened by FOBT and 48% reported having been screened within 2 years before the survey. Participation in screening did not vary by demographic characteristics or by perceived or actual risk of CRC. Women with a positive attitudes toward CRC screening had sevenfold greater odds of recent screening by FOBT (odds ratio=7.1; 95% confidence interval, 4.4 to 11.6). Only 58% of study women reported that their physicians encouraged CRC screening, but this factor was strongly related to participation (odds ratio=12.7; 95% confidence interval, 6.6 to 24.4). CONCLUSIONS We identified several areas in which understanding of CRC risk may be low. As a whole, these findings suggest that effective strategies to control CRC may include efforts to improve knowledge of risk and prevention, but must also appeal directly to primary care physicians to identify and address their barriers to screening recommendations.
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Affiliation(s)
- M T Mandelson
- Center For Health Studies, Group Health Cooperative, Seattle, Washington, USA.
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May DS, Lee NC, Richardson LC, Giustozzi AG, Bobo JK. Mammography and breast cancer detection by race and Hispanic ethnicity: results from a national program (United States). Cancer Causes Control 2000; 11:697-705. [PMID: 11065006 DOI: 10.1023/a:1008900220924] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Some of the racial and ethnic variation in breast cancer incidence rates may reflect differential use of mammography. We report breast cancer rates using mammography and diagnostic data from five race/ethnicity groups. METHODS Mammography data were analyzed for 573,751 women who received breast cancer screening between July 1991 and March 1998 from the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Abnormal mammography rates, breast cancer detection rates, and cancer stage distribution data are presented by race/ethnicity and screening round (first or subsequent). RESULTS For the first screening round, percentages of abnormal mammographies ranged from 7.3% among black women to 9.3% among Asian/Pacific Islander women. Cancer detection rates ranged from 4.9 cancers per 1000 mammograms for Hispanic and American Indian/Alaska Native (AI/AN) women to 7.7 per 1000 for white women. Subsequent round rates were lower but varied similarly. AI/AN women had the highest percentage (68%) of first-round cancers detected in the early stage (range for the other groups: 52-63%). CONCLUSIONS Breast cancer detection rates for racial and ethnic groups in this program varied less than published population-based incidence rates. Differential use of mammography among these groups may account for some of the variation reported for breast cancer incidence.
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Affiliation(s)
- D S May
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA
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Abstract
OBJECTIVE To compare cervical screening outcomes associated with age and three screening intervals, 1, 2, and 3 years. METHODS We did a prospective cohort study comprising 128,805 women at community-based clinics throughout the United States who were screened for cervical cancer within 3 years of normal smears through the National Breast and Cervical Cancer Early Detection Program. We determined the incidence of cytologic abnormalities defined as atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (SIL), high-grade SIL, and suggestive of squamous cell cancer. RESULTS Over the 3 years after normal smear results, the incidence of new smears interpreted as high-grade SIL or suggestive of squamous cell cancer (high-grade SIL or worse) was 66 of 10,000 for women under 30 years old, 22 of 10, 000 for those 30-49 years, 15 of 10,000 for those 50-64 years, and 10 of 10,000 for those over 65 years. Age-adjusted incidence rates of high-grade SIL or worse were similar for women screened at 9-12 months (25 of 10,000), 13-24 months (29 of 10,000), and 25-36 months (33 of 10,000) after normal smears (P =.46). Age-adjusted incidence rates of ASCUS, the most common cytologic abnormality, did not change (P =.36). Incidence of smears interpreted as low-grade SIL increased as time from the normal smear increased (P =.01). CONCLUSIONS Within 3 years after normal cytology results, cervical smears interpreted as high-grade SIL or worse are uncommon, and the incidence rate is unrelated to the time since last normal smear. Optimal screening strategies for women with recent normal cytology results should be based on comprehensive modeling studies that incorporate the true risks and benefits of repetitive screening.
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Affiliation(s)
- G F Sawaya
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California 94143-0856, USA.
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Bobo JK, Lee NC, Thames SF. Findings from 752,081 clinical breast examinations reported to a national screening program from 1995 through 1998. J Natl Cancer Inst 2000; 92:971-6. [PMID: 10861308 DOI: 10.1093/jnci/92.12.971] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND METHODS Mammography programs have received extensive study, but little is known about the outcome of clinical breast examinations (CBEs) performed in community settings. Consequently, we analyzed data from the National Breast and Cervical Cancer Early Detection Program on CBEs provided to low-income women from 1995 through 1998 and determined the percentage of CBEs considered to be abnormal, suspicious for cancer; the rates of cancer detection; and the sensitivity, specificity, and positive predictive value of CBEs. RESULTS We analyzed data from 752081 CBEs and found that 6.9% of all CBEs were coded abnormal, suspicious for cancer, and that 5.0 cancers were detected per 1000 examinations (95% confidence interval [CI] = 4.9-5.2). The values observed for sensitivity (58.8%) and specificity (93.4%) were comparable to those reported for the CBE component of clinical trials. The observed positive predictive value was 4.3%. About 74% of all records also reported mammography results. The cancer-detection rate among records reporting an abnormal CBE and normal mammography was 7.4 cancers per 1000 records (95% CI = 6. 3-8.4). When the CBE was normal but the mammography was abnormal, the rate was 42.0 cancers per 1000 records (95% CI = 39.9-44.1). When both CBE and mammography results were abnormal, the rate was 170.3 cancers per 1000 records (95% CI = 162.7-177.9). Cancer detection could not be attributed entirely to CBE or mammography on 38% of the records in the latter subset because the tests were performed on the same day. CONCLUSION CBEs performed in community-based screening programs can detect breast cancers as effectively as CBEs performed in clinical trials and may modestly improve early-detection campaigns.
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Affiliation(s)
- J K Bobo
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Abstract
Estrogen replacement therapy (ERT) has not been associated with epithelial ovarian cancer in most reported epidemiologic studies that have looked for an association. Some studies may have found weak statistically nonsignificant associations because the number of cases or number of women who reported estrogen use was small. We performed a meta-analysis of data from 15 case-control studies that provided data on ERT and risk of epithelial ovarian cancer. The 15 combined studies were statistically heterogeneous (chi(2) (14) = 26. 3, P < 0.05) in terms of the effect they found. When we combined these studies using a random effects model, we did not find a significant association of ERT with ovarian cancer (odds ratio = 1.1, 95% confidence interval = 0.9-1.3). There was no clear evidence of a dose-response relation with increasing duration of estrogen use in a subset of five studies that reported estrogen use by duration (overall slope = 0.0012, 95% confidence interval = -0.0055 to 0. 0080). The influences of statistical outliers, study design (hospital or clinic controls vs. community controls), and location (U.S. and Canada vs. Europe and Australia) were examined. The odds ratio was 1.3 (95% confidence interval = 1.0-1.6) in the relatively homogeneous subset of four U.S. case-control studies with community controls, but we cannot rule out the possibility of uncontrolled confounding. The odds ratios for estrogen use for other subgroups defined by geographic location and type of control group were not significantly different from one.
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Affiliation(s)
- S S Coughlin
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE (K-55), Atlanta, GA 30341, USA.
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