Cancer Screening Program For Women Research Articles

Optimizing the Patient Experience for Women With Disabilities in the Breast Imaging Clinic.

While there are varying opinions on what age to begin and at what interval to perform breast cancer screening, screening mammography is recommended for all women irrespective of disability. Unfortunately, women with disabilities are more likely to present with later-stage disease and higher mortality owing to the barriers for more widespread screening in this population. Women with disabilities may experience challenges accessing breast imaging services, and imaging centers may have suboptimal facilities and staff who are inexperienced in caring for this population. Efforts to increase accessibility by employing universal design to increase ease of access and provide training to improve the patient experience will go far to improve outcomes for patients with disabilities. To date, there exists no comprehensive guidance on how to improve breast cancer screening programs for women with disabilities. The purpose of this paper is to review barriers to screening faced by patients with disabilities, describe strategies to overcome these barriers, and provide guidance for radiologists and referring providers in selecting the best exam for the individual patient.

US women screen at low rates for both cervical and colorectal cancers than a single cancer: a cross-sectional population-based observational study.

Using screen counts, women 50-64 years old have lower cancer screening rates for cervical and colorectal cancers (CRC) than all other age ranges. This paper aims to present woman-centric cervical cancer and CRC screenings to determine the predictor of being up-to-date for both. We used the Behavioral Risk Factor Surveillance System (BRFSS), an annual survey to guide health policy in the United States, to explore the up-to-date status of dual cervical cancer and CRC screening for women 50-64 years old. We categorized women into four mutually exclusive categories: up-to-date for dual-screening, each single screen, or neither screen. We used multinomial multivariate regression modeling to evaluate the predictors of each category. Among women ages 50-64 years old, dual-screening was reported for 58.2% (57.1-59.4), cervical cancer screening alone (27.1% (26.0-28.2)), CRC screening alone (5.4% (4.9-5.9)), and neither screen (9.3% (8.7-9.9)). Age, race, education, income, and chronic health conditions were significantly associated with dual-screening compared to neither screen. Hispanic women compared to non-Hispanic White women were more likely to be up-to-date with cervical cancer screening than dual-screening (adjusted odds ratio [aOR] = 1.39 (1.10, 1.77)). Compared to younger women, those 60-64 years are significantly more likely to be up-to-date with CRC screening than dual-screening (aOR = 1.75 (1.30, 2.35)). Screening received by each woman shows a much lower rate of dual-screening than prior single cancer screening rates. Addressing dual-screening strategies rather than single cancer screening programs for women 50-64 years may increase both cancer screening rates. This work was supported by NIH through the Michigan Institute for Clinical and61 Health Research UL1TR002240 and by NCI through The University of Michigan Rogel Cancer62 Center P30CA046592 grants.

A comprehensive cross-sectional survey to identify barriers and facilitators of cervical cancer screening in women with HIV in Guangxi, China

BackgroundCo-infection with HIV is a strong risk factor for cervical cancer development. It is unknown whether women with HIV in Guangxi, China are utilizing currently available cervical cancer screening services, what barriers they face, and if they are aware of their increased risk of developing cervical cancer.MethodsUsing a cross-sectional design, we administered a survey to women with HIV aged 21–65 years from August to October 2019 in Guangxi, China. A 100-item survey was designed in English and translated into Chinese. We assessed knowledge, attitudes, and beliefs about cervical cancer and cervical cancer screening, identified potential barriers and facilitators of cervical cancer screening programs for women with HIV, and assessed potential risk factors for cervical cancer.ResultsA total of 101 participants completed the survey. The median age of participants was 38 years (IQR 34.5–44 years). Forty-seven percent of the women had been screened for cervical cancer at least once. The mean score was 5.6 out of 9 (95% CI 5.3–6.0) on the knowledge about cervical cancer and screening and 6.3 out of 10 (95% CI 5.9–6.6) for cervical cancer risk factors, respectively. Facilitators of participating in cervical cancer screening included trust and openness to healthcare workers having conversations about female health concerns. Barriers identified in our study included knowledge gaps in cervical cancer risk awareness and cervical cancer screening awareness, including the lack of knowledge of available cervical cancer screening services. Women with HIV in Guangxi are under-screened for cervical cancer.ConclusionWhen designing tailored cervical cancer screening programs for women with HIV in Guangxi, educational programs to address existing knowledge gaps will be needed to increase screening uptake in this high-risk population.

OP181 Adapting Evidence To Produce A Health Technology Assessment Of Mammography Screening: An Example From The West Bank

IntroductionHealth technology assessment (HTA) can play a key role in evidence-based decision-making. However, HTA requires resources that might be lacking in low-income settings. To test the feasibility of adapting existing evidence as part of the HTA process, this project evaluated the effectiveness and economic impact of breast cancer screening programs for women over 40 years in the West Bank, where mammography screening is provided for free in governmental clinics.MethodsWe conducted a search for systematic reviews, HTAs and guidelines in electronic databases. We included the most recent global systematic review and meta-analysis that fulfilled our inclusion criteria. The European Network for Health Technology Assessment (EUnetHTA) adaptation toolkit was used to guide adaptation and undertake a budget impact analysis of the economic impact of mammography screening. We build capacity by working as a team of HTA experts and first-time HTA researchers. The results were disseminated to raise awareness for HTA.ResultsThe European Commission Guidelines on Breast Cancer Screening were identified as most recent global systematic review with meta-analyses, out of 2,365 references. The adapted evidence may inform policies on screening in the West Bank. Our experience is that adaption requires extensive skills and resources, including finding, assessing, and adapting relevant evidence. The EUnetHTA toolkit is useful, but also adds to the workload. Furthermore, local stakeholder engagement is important in topic selection, to access information, and to contextualize global evidence to the local setting.ConclusionsThis study is currently ongoing, but preliminary findings show that producing an HTA by adapting existing evidence in resource-limited settings is feasible. There is a need for nuanced guidance on transferability of evidence from other settings. Future studies should investigate innovative methods to optimize the adaption process. Capacity building in adaptation is important to ensure the production of quality HTA products. Inclusion of local team members and stakeholders is important for future development of HTA in the region.

Abstract 54: A Comprehensive Survey to Identify Barriers to and Facilitators of Cervical Cancer Screening in Women With HIV in Guangxi, China

Abstract Purpose: To assess perceived barriers to and facilitators of cervical cancer screening in women with HIV in Guangxi, China. Methods: Using a cross-sectional design, we administered a survey among women with HIV aged 21-65 years from August to October 2019 in Guangxi, China. A 100-item survey was developed in English and translated into Chinese. Age criterion was concordant with the cervical cancer screening recommendations. We assessed knowledge, attitudes, and beliefs about cervical cancer and cervical cancer screening, identified potential barriers to and facilitators of cervical cancer screening programs for women with HIV, and assessed potential risk factors for cervical cancer. We conducted descriptive data analyses with the collected responses. Results: A total of 101 participants, on average 39.5 years old (IQR: 34.5-44 years old), completed the survey. The mean CD4 cell count was 705 cell/µl (IQR: 493-854 cell/µl). 47% of the women had been screened for cervical cancer at least once. The mean score was 5.6 out of 9 (95% CI 5.3-6.0) on the knowledge about cervical cancer and its screening and 6.3 out of 10 (95% CI 5.9-6.6) on cervical cancer risk factors, respectively. 84% of women agreed that cervical cancer is a life-threatening disease, but only 49% agreed that they were at risk for cervical cancer. Facilitators of participating in future cervical cancer screening among women with HIV in Guangxi included family support for related healthcare, trust and openness to conversations with health workers on female health concerns, and convenient transportation. The barriers included knowledge gaps in health awareness, cervical-cancer-related information, and available cervical cancer screening services. Conclusion: Women with HIV in Guangxi are potentially under-screened for cervical cancer. Designing future cervical cancer screening programs targeting women with HIV in Guangxi should address the knowledge gaps to increase screening uptake and improve outcomes in this high-risk population. Citation Format: Ran Zhao, Shujia Liang, Deanna Teoh, Yunqing Fei, Xianwu Pang, Shalini Kulasingam. A Comprehensive Survey to Identify Barriers to and Facilitators of Cervical Cancer Screening in Women With HIV in Guangxi, China [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 54.

Knowledge and Attitude towards HPV, PAP Testing and HPV Vaccination among Women with HIV

Background: Although cancer prevention strategies have resulted in a dramatic reduction in the overall cervical cancer burden in developed countries, among women with HIV the problem remains unabated. Several studies have identified limited knowledge as a major contributory factor for cervical cancer especially in vulnerable populations like women with HIV. Objective: To determine the knowledge and attitudes of HPV, Pap smear testing and HPV vaccination among women with HIV utilizing the health belief model as a guiding framework for the study. Methods: 50 HIV positive women in the 21-64 age groups were purposively sampled from the HIV clinic in San Fernando General Hospital, South Trinidad. Data were collected using an administered questionnaire with a 100% response rate after receiving ethical approval. Results: Respondents were generally knowledgeable about Pap Smear testing but had limited knowledge about HPV and HPV vaccination. Most respondents were unaware that HPV infection was a risk factor for cervical cancer. Many respondents knew that the purpose of pap testing and the recommended Pap testing guidelines for women with HIV. Although most respondents 43 (86%) considered Pap Smear testing to be important it was not a regular practice. The main reasons for not having regular Pap test include the procedure is embarrassing and painful, fear of a cervical cancer diagnosis, reluctance to be examined by male doctor and not being asked to do Pap test by healthcare professionals. Respondents also had a negative attitude when asked if they would recommend the vaccine to friends and relatives. Conclusion: While women with HIV may be knowledgeable of the risk associated with cervical cancer, this does not necessarily translate into effective screening behaviours. The findings of this study demonstrate the need for an organized and integrated cervical cancer screening program for women with HIV as an integral component of management.

Urban-rural disparity of breast cancer and socioeconomic risk factors in China.

Breast cancer is one of the most commonly diagnosed cancers worldwide. The primary aim of this work is the study of breast cancer disparity among Chinese women in urban vs. rural regions and its associations with socioeconomic factors. Data on breast cancer incidence were obtained from the Chinese cancer registry annual report (2005–2009). The ten socioeconomic factors considered in this study were obtained from the national population 2000 census and the Chinese city/county statistical yearbooks. Student’s T test was used to assess disparities of female breast cancer and socioeconomic factors in urban vs. rural regions. Pearson correlation and ordinary least squares (OLS) models were employed to analyze the relationships between socioeconomic factors and cancer incidence. It was found that the breast cancer incidence was significantly higher in urban than in rural regions. Moreover, in urban regions, breast cancer incidence remained relatively stable, whereas in rural regions it displayed an annual percentage change (APC) of 8.55. Among the various socioeconomic factors considered, breast cancer incidence exhibited higher positive correlations with population density, percentage of non-agriculture population, and second industry output. On the other hand, the incidence was negatively correlated with the percentage of population employed in primary industry. Overall, it was observed that higher socioeconomic status would lead to a higher breast cancer incidence in China. When studying breast cancer etiology, special attention should be paid to environmental pollutants, especially endocrine disruptors produced during industrial activities. Lastly, the present work’s findings strongly recommend giving high priority to the development of a systematic nationwide breast cancer screening program for women in China; with sufficient participation, mammography screening can considerably reduce mortality among women.

Cost-effectiveness analysis on the once-in-a-lifetime cervical cancer screening program for women living in rural and urban areas of China

To estimate the cost-effectiveness of once-in-a-lifetime cervical cancer screening program and to predict the optimal modality for its operation on women living in rural and urban areas of China, based on Markov modeling and simulation. Three modalities including visual inspection with acetic acid plus Lugol's iodine (VIA/VILI), conventional Pap Smear (Pap Smear), and simple HPV DNA testing (careHPV) were hypothesized for the rural cohort, whereas other five modalities including Pap Smear, liquid-based cytology (LBC), simple HPV DNA testing (careHPV), Hybrid Capture 2 HPV DNA testing (HC2), and LBC plus HC2 (LBC + HC2) were tested for the urban cohort. A Markov model was constructed based on the factors as natural history, screening, diagnosis and treatment on cervical cancer using data related to the epidemics and the costs from rural and urban areas of the country. Long-term effectiveness and cost-effectiveness were predicted through simulation of the model. Compared to the non-screening scenario, the amount of life years saved were 277.97 - 2727.53 and 134.02 - 1446.84 years per 100 000 women, respectively, for different cohorts in rural and urban areas. The cost-effectiveness ratios were 1520.99 - 2453.74 and 3847.35 - 44 570.35 RMB per life year saved, respectively, for different cohorts in rural and urban areas. The incremental cost-effective ratio for careHPV starting from 40 years old (careHPV@40) and careHPV from 30 years old (careHPV@30) dominated other strategies for the rural cohort, while careHPV@40, careHPV@30, HC2 from 30 years old (HC2@30), and LBC + HC2 from 30 years old (LBC + HC2@30) were dominant for the urban cohort. All eight once-in-a-lifetime cervical cancer screening modalities were cost-effective based on our model. In particular, careHPV screening starting from 40 years old seemed to be the most cost-effective one for women living in both rural and urban areas.

Access to Breast Cancer Screening Programs for Women with Disabilities

The goal of this study was to identify measures to facilitate access to the Quebec Breast Cancer Screening Program for women with activity limitations, considering the barriers to screening uptake in that population. The study was carried out in three stages. First, 124 semi-structured interviews were conducted in five regions of Quebec with five groups of key informants. The content analysis lead to the identification of 64 proposals, which were submitted to 31 experts through a two-round Delphi survey process. Finally, consultations were held with 11 resource people to determine which decision-making levels (local, regional, provincial) could play a key role in implementing the proposals. A strong consensus (≥80%) was achieved for 25 proposals seen as highly relevant and feasible. The implementation of such proposals could substantially improve access to screening, given the prevalence of activity limitations in the age group targeted by the program.

The significance of HPV16, 18, 31, 33 subtype detection in cervical cancer screening.

Objective To discuss the significance of HPV16, 18,31,33 subtype infection in cervical cancer screening for women whose age is beyond 30. Methods The patients who choose the combination use of TCT and HPV-DNA genotyping for screening during Jan. 2008-Mar. 2009 in our Gyn.Out-patient department, for that HPV16,18,31,33 positive ones, colposcopy and biopsy were used for further examination to get the histopathology result. Results There were 275 patients in total who suffers HPV16,18,31,33 infection, their age ranges from 30-72, the average age is 41.76 ± 8.88; HPV 16 infection accouts for 64.0%, one single subtype infection accouts for 64.7%; Among 210 ones who have an abnormal cytology test result, 127(60.5%)were confirmed to be CIN Ⅱ + by histopathology. In patients whose cytology test result were ASC-US,ASC-H,LSIL, HSIL,SCC and AGC, there were 32.6% ,67.8% ,42. 3%,81.8% , 100. 0%, 50.0% P = 0.000) of them who were confirmed to be CIN Ⅱ + by histopathology separately;There were 65 ones whose cytology result is negative, 10 patients were certified of CIN Ⅱ , Ⅲ by histopathology(15.4%) ,it accounts for 7.3% of all patients whose histopathology result is advanced of CIN Ⅱ,Ⅲ, 9 were found in HPV 16's group. Conclusion HPV16, 18,31,33 subtype infection have a significance in cervical cancer screening program for women whose age is beyond 30. We can detect another extra 7.3% CIN Ⅱ , Ⅲ ,especially in HPV16's group. Key words: Papillomavirus, human; Genes; Cervical intraepithelial neoplasia; Cervix neoplasms

Intensivierte Vorsorge bei familiärer Disposition für Brustkrebs – Eigene Ergebnisse und derzeitiger Stand

Fragestellung: Evaluation eines intensivierten Vorsorgeprogramms zur Brustkrebsfrüherkennung bei Frauen mit familiärer Disposition für Brustkrebs. Material und Methodik: In der vorliegenden prospektiven Studie wurden 157 Frauen untersucht. Einschlusskriterium war eine molekulargenetisch nachgewiesene BRCA-1-Mutation (n = 33), BRCA-2-Mutation (n = 14) oder ein Heterozygotenrisiko ≥ 20 % bzw. ein Lebenszeiterkrankungsrisiko ≥ 30 % (n = 110). Die Ergebnisse wurden getrennt nach gesunden Ratsuchenden (n = 75) und bereits an Brust- bzw. Eierstockkrebs erkrankten Teilnehmerinnen (n = 82) evaluiert. Das Studienprotokoll beinhaltet halbjährlich eine ärztliche klinische Untersuchung und Sonografie sowie jährlich eine Mammografie und MR-Mammografie. Ergebnisse: Bei 12 Frauen wurde im Überwachungszeitraum (1. 11. 1999 – 31. 10. 2007) histologisch ein Mammakarzinom nachgewiesen, wobei 75 % der Karzinome in einem pT1-Stadium bzw. 89 % im pN0-Stadium diagnostiziert wurden. Folgende diagnostische Kennzahlen wurden ermittelt. Sensitivität: klinische Untersuchung 25 %, Mammografie 27 %, Sonografie 58 %, MR-Mammografie 100 %; positiver Vorhersagewert: klinische Untersuchung 75 %, Mammografie 38 %, Sonografie 50 %, MR-Mammografie 60 %; Spezifität: klinische Untersuchung 99,8 %, Mammografie 99,6 %, Sonografie 99,0 %, MR-Mammografie 97,6 %. Insgesamt korrelieren diese Daten gut mit den Ergebnissen nationaler und internationaler Studien. Die Karzinomdetektionsrate und der positive Vorhersagewert waren bei den BRCA-1-Mutationsträgerinnen am höchsten. Schussfolgerung: Basierend auf den vorliegenden Daten der Forschungsliteratur erlauben intensivierte Vorsorgeprogramme bei Frauen mit familiärer Disposition für Brustkrebs eine Karzinomdetektion in einem frühen Tumorstadium. Die MR-Mammografie ist bei den eingesetzten Verfahren die Methode mit der höchsten Sensitivität bei einem gleichzeitig akzeptablen positiven Vorhersagewert. Derzeit nicht endgültig geklärt sind die günstigsten Untersuchungsintervalle und inwieweit der Einsatz aller Verfahren erforderlich ist.

Abstract B14: Howard University Cancer Center's Mammoday yields results in the fight against breast cancer

Abstract B14 Background Washington D.C. has one of the highest breast cancer mortality rates in the country(30.3 per 100,000)*. In June 2003, Howard University Cancer Center started Mammoday, a free breast cancer screening program for women in the Washington, D.C. area to help remedy this egregious public health disparity. Mammograms, in conjunction with clinical breast exams, are provided to low income, underinsured or uninsured women who are at least 40 years of age. Methods All participants complete a survey that takes into account all of the major breast cancer risk factors before being examined by a physician. The women then receive a clinical breast examination and mammogram. If the results warrant further investigation, an ultrasound and biopsy is offered at no cost to the patient. If the findings are positive, the patient will receive assistance from a patient navigator to obtain the health coverage needed for treatment. The survey data, the clinical breast examination, and radiologic results are all recorded for analysis. Results Using a pure frequency analysis, with a sample size of 243 patients, 17.0% resulted in an abnormal clinical breast exam and 12.9% resulted in an abnormal mammogram. Over the four years that the program has been in existence, 304 women have received breast cancer screening and 10 women have been diagnosed with breast cancer. Conclusion The results prove the necessity for a screening program such as Mammoday, by discovering breast cancers that otherwise would have gone unnoticed . The importance of this program registers with the patients and leads to a follow-up rate of 19.4%.Due to its success, the program plans to expand by increasing the number of screenings per year in order to further impact the glaring statistics of breast cancer mortality in the District of Columbia. *American Cancer Society, Surveillance Research , 2007 Citation Information: Cancer Prev Res 2008;1(7 Suppl):B14.

Three-year Follow-up Study of Women Who Participated in a Cervical Cancer Screening Intervention While in Prison

This study describes rescreening following a prison cervical cancer screening intervention: the numbers of women who received rescreening during the three-year follow-up period; their timing of rescreening in relationship to intervention follow-up recommendations; and socio-demographic factors associated with rescreening. Socio-demographic information was collected from Corrections Branch records. Clinical and risk factor information was obtained by a self-administered questionnaire. Pap screening histories were collected from Cervical Cancer Screening Program (CCSP) client records using the client ID number for Pap smears taken during the intervention period, during the three-year follow-up period, and during the 30-month period preceding the intervention period. Results were entered in Excel and responses summarized with frequency tables; bivariate analysis of categoric variables was done using chi-square tests of independence. During the three-year follow-up period, only 28 (21%) of 138 women who participated in a prison cervical cancer screening intervention were rescreened within 6 months of the recommendation received at intervention Pap test. Women with fewer than 5 multiple names (aliases) were more likely to be rescreened (p=0.02). Educational level approached statistical significance (p=0.05), with women with least education receiving highest rescreening. There was no relationship between rescreening and ethnicity, injection drug use, having borne children and current methadone treatment. Only 50% of women who participated in a specifically designed prison screening intervention were rescreened during the subsequent three years. Further work is needed to design, implement and evaluate follow-up initiatives of community cervical cancer screening programs for women who are at higher risk of developing cervical dysplasia.

IMPLEMENTATION OF A CERVICAL CANCER SCREENING PROGRAM FOR HIV-INFECTED WOMEN IN NAIROBI, KENYA.

Purpose/Background Women in developing countries face some of the highest rates of cervical cancer in the world. Similarly, human immunodeficiency virus (HIV)-positive women are at much greater risk of cervical cancer than their HIV-negative counterparts. A cervical cancer screening program for HIV-positive African women was designed to address the intersection of these two public health concerns. Objective To implement a cervical cancer screening program for women receiving HIV care in a Nairobi clinic, as per guidelines outlined in previously conducted needs assessment. Methods Develop infrastructure clinic-wide to support a sustainable program, including training staff, acquiring necessary medical supplies and patient education materials, creating clinic forms and data tracking systems, and establishing a protocol for ongoing management of abnormal results. Results/Conclusions A cervical cancer screening program was established to screen HIV-positive women with an initial target patient population defined as women aged 30 to 39 who were currently on ARV therapy (approximately 550 women). Clinicians counseled and referred patients to a Pap smear procedure clinic conducted by nurses. Slides were read by an on-site pathologist with an estimated turnaround time of 1 week. Clinicians informed patients of results at follow-up appointments and made referrals to the national hospital for additional diagnostics and treatment as indicated. A special fund was established at the national hospital to subsidize care for patients referred from the program. Program monitoring and evaluation are ongoing.

Differences between first and subsequent rounds of the MRISC breast cancer screening program for women with a familial or genetic predisposition

Within the Dutch MRI Screening (MRISC) study, a Dutch multicenter screening study for hereditary breast cancer, the authors investigated whether previously reported increased diagnostic accuracy of magnetic resonance imaging (MRI) compared with mammography would be maintained during subsequent screening rounds. From November 1999 to October 2003, 1909 eligible women were included in the study. Screening parameters and tumor characteristics of different rounds were calculated and compared. The authors defined 3 different types of imaging screening rounds: first round in women never screened by imaging before, first round in women screened by imaging (mainly mammography) before, and subsequent rounds. The difference in sensitivity for invasive cancers between mammography and MRI was largest in the first round of women previously screened with mammography (20.0 vs. 93.3%; P=.003), but also in subsequent rounds, there was a significant difference in favor of MRI (29.4 vs. 76.5%; P=.02). The difference in false-positive rate between mammography and MRI was also largest in the first round of women previously screened with mammography (5.5 vs. 14.0%; P<.001), and it remained significant in subsequent rounds (4.6 vs. 8.2%; P<.001). Screen-detected tumors were smaller and more often lymph node negative than symptomatic tumors in age-matched control patients, but no major differences in tumor stage were found between tumors detected at subsequent rounds compared with those in the first round. In subsequent rounds, a significantly higher sensitivity and better discriminating capacity of MRI compared with mammography was maintained, and a favorable tumor stage compared with age-matched symptomatic controls. As results of these subsequent screening rounds were most predictive for long-term effects, the authors expect that this screening program will contribute to a decrease of breast cancer mortality in these high-risk women.

Cost effectiveness of human papillomavirus testing to augment cervical cancer screening in women infected with the human immunodeficiency virus

Purpose To determine the cost effectiveness of incorporating molecular testing for high-risk types of human papillomavirus into a cervical cancer screening program for women infected with the human immunodeficiency virus (HIV). Subjects and methods We developed a Markov model to simulate the natural history of cervical cancer precursor lesions in HIV-infected women. Probabilities of progression and regression of cervical lesions were conditional on transient or persistent infection with human papillomavirus, as well as stage of HIV and effectiveness of antiretroviral therapy. Incorporating data from prospective cohort studies, national databases, and published literature, the model was used to calculate quality-adjusted life expectancy, life expectancy, lifetime costs, and incremental cost-effectiveness ratios for two main strategies: targeted screening—human papillomavirus testing is added to the initial two cervical cytology smears obtained after an HIV diagnosis and subsequent screening intervals are modified based on the test results; and universal screening—no testing for human papillomavirus is performed, and a single cytology screening interval is applied to all women. Results In HIV-infected women on anti-retroviral therapy, a targeted screening strategy in which cervical cytology screening was conducted every 6 months for women with detected human papillomavirus DNA, and annually for all others, cost $10,000 to $14,000 per quality-adjusted life year gained compared with no screening. A universal screening strategy consisting of annual cervical cytology for all women was 15% less effective and had a less attractive cost-effectiveness ratio. Targeted screening remained economically attractive in multiple sensitivity analyses, although when the overall incidence of cervical cancer precursor lesions was lowered by 75%, the screening interval for women with detected human papillomavirus DNA could be widened to 1 year. Conclusions Adding human papillomavirus testing to the two cervical cytology smears obtained in the year after an HIV diagnosis, and modifying subsequent cytology screening intervals based on the results, appears to be an effective and cost-effective modification to current recommendations for annual cytology screening in HIV-infected women.

Relationship between Method of Detection of Breast Cancer and Stage of Disease, Method of Treatment, and Survival in Women Aged 40 to 49 Years

The optimal breast cancer screening program for women 40 to 49 years of age remains controversial. To help assess the value of screening mammography for this age group, we studied the relationship between the method of breast cancer detection and stage, therapy, and survival. Cases of breast cancer diagnosed at Sinai Hospital (Detroit, MI) between January 1985 and December 1994 were reviewed. A total of 181 cases involving 40- to 49-year-old women were available for analysis. The distribution of stage of disease significantly differed among the three methods of detection (P<0.0001). Breast-conserving surgery was more commonly performed in cases detected by screening mammography and clinical breast examination than in cases detected by breast self-examination (P = 0.001). Variation in the stage of disease resulted in improved survival for cases detected by screening mammography and clinical breast examination when compared with those detected by breast self-examination (P = 0.019). Women diagnosed with breast cancer between the ages of 40 and 49 years had earlier stage disease, were more likely to be treated with breast-conserving therapy, and had better survival if their disease was first recognized by screening mammography. Screening mammography has an important role for women of this age.

Participation in breast cancer screening: randomised controlled trials of doctors' letters and of telephone reminders

The study used a randomised controlled trial to find out whether supporting letters from general practitioners accompanying the invitations from a screening centre affected participation in a population-based breast cancer screening program for women aged 50 to 64. A further randomised controlled trial compared the effect of postal reminders with telephone reminders for women who did not respond to an initial invitation to participate in the program. There were 482 women in the first trial and 641 in the second. Excluding women who were ineligible or could not be contacted, participation in screening was 71 per cent in the group which received letters from their general practitioners compared with 62 per cent in the group which did not receive letters (P = 0.059). In the group that received letters, 56 per cent were screened without a reminder compared with 43 per cent of the group that did not receive letters (P = 0.01). Fewer women who received letters from their general practitioners declined the invitation to be screened (P = 0.048). In the second trial, there was no difference in participation between the group receiving telephone reminders and the group receiving postal reminders. As in breast cancer screening programs in other countries, general practitioner endorsement of invitations increased participation in breast cancer screening. Postal reminders were as effective as telephone reminders in encouraging women who did not respond to an initial invitation to participate in screening.

A breast cancer screening program in a community hospital

Breast cancer screening continues to be underutilized in the United States. The National Cancer Institute has set a goal of increasing screening by the year 2000. The American Cancer Society wants to identify programs that target asymptomatic women and economically disadvantaged women. The purpose of this study was to develop, implement and evaluate a comprehensive breast cancer screening program for women in a community setting. One case of infiltrating ductal carcinoma was detected from the 144 women who participated in the study. Following the educational component, the post test demonstrated a significant increase (p less than 0.01) in the women's awareness of breast cancer. Additionally, 100% of the women were able to demonstrate breast self examination to an oncology nurse after the educational component of the study. The majority of the women who participated were not economically disadvantaged which sheds new light on the scope of the problem of taking care of the unmet cancer needs of the disadvantaged through outreach programs. However 27% of the women had a household income less than $10,000 with 19% of the women having no insurance and 7% having Medicare/Medicaid. The results of this study could help future programs in bringing breast cancer screening to women in the community setting.