Organized Screening Program Research Articles

Task sharing in the eye care workforce: Screening, detection, and management of diabetic retinopathy in Pakistan. A case study.

Diabetic retinopathy (DR) is a preventable cause of vision loss. Reducing vision loss due to DR and providing access to eye care services for people with diabetes have been severely constrained by a shortage in the number of ophthalmologists. This study aimed to explore the potential for task sharing in the eye care workforce for screening, detection, and management of DR. Using purposive sampling, 24 participants were recruited from four selected hospitals in 2 provinces in Pakistan. Face-to-face interviews were conducted to explore the potential for task sharing in DR management. Amongst 24 participants recruited, 22 (91.7%) including administrators (n=3), ophthalmologists (n=10), optometrists (n=3), mid-level eye care workers (n=4), and endocrinologist (2) participated in the study. All participants indicated the need for an organised screening program for DR detection through task sharing. Participants suggested that people with diabetes can be sent directly to an optometrist for initial eye exams, rather than making them wait to be examined by an ophthalmologist. Factors favouring task sharing included the name task sharing rather than task shifting and a high demand for eye care services. Major barriers to implementation of task sharing included the lack of a trained eye care workforce in the healthcare system and the lack of coordination amongst health professionals and policy makers. Participants were accepting task sharing approach and believed that task sharing could improve access to eye care services for people with diabetes and better utilise the services of eye and healthcare providers.

Results of the national organised colorectal cancer screening program with FIT in Paris

In France, colorectal cancer (CRC) benefits from a nationwide screening program. The faecal immunochemical test (FIT) is being used since April 2015. The test is recommended in asymptomatic patients followed by a colonoscopy if positive for identification and treatment of colorectal lesions. We investigate the CRC national organised screening program using FIT in Paris. We performed a retrospective observational study, collecting data from the screening program in Paris using the ADECA75 database. Rates of participation, numbers of positive FIT, detection rates and positive predictive values (PPV) for advanced adenomas (AA) and/or CRC were determined. Between 01/01/2016 and 30/06/2017, 620.227 Parisians were eligible and 409.340 were invited to participate to the program. A total of 88.796 participants (23%) performed the test with 3.839 positive tests (4.3%). In the positive test population, 2.706 out of 3.839 individuals (70.5%) performed the required colonoscopy with available reports. Histology reports were only available for 2.401 participants (88,7%). Regarding lesions, 733 (30,5%) and 205 patients (8.5%) had AA and CRC, respectively. Over 18 months of screening with FIT in Paris, the PPV is in line with expected results while the participation rate is below European recommendations.

Patterns and predictors of repeat fecal immunochemical and occult blood test screening in four large health care systems in the United States

Effectiveness of fecal occult blood test (FOBT) for colorectal cancer (CRC) screening depends on annual testing, but little is known about patterns of repeat stool-based screening within different settings. Our study's objective was to characterize screening patterns and identify factors associated with repeat screening among patients who completed an index guaiac FOBT (gFOBT) or fecal immunochemical test (FIT). We performed a multi-center retrospective cohort study among people who completed a FOBT between January 2010 and December 2011 to characterize repeat screening patterns over the subsequent 3 years. We studied at 4 large health care delivery systems in the United States. Logistic regression analyses were used to identify factors associated with repeat screening patterns. We included individuals aged 50-71 years who completed an index FOBT and had at least 3 years of follow-up. We excluded people with a history of CRC, colonoscopy within 10 years or flexible sigmoidoscopy within 5 years before the index test, or positive index stool test. Consistent screening was defined as repeat FOBT within every 15 months and inconsistent screening as repeat testing at least once during follow-up but less than consistent screening. Among 959,857 eligible patients who completed an index FIT or gFOBT, 344,103 had three years of follow-up and met inclusion criteria. Of these, 46.6% had consistent screening, 43.4% inconsistent screening, and 10% had no repeat screening during follow-up. Screening patterns varied substantially across healthcare systems, with consistent screening proportions ranging from 1 to 54.3% and no repeat screening proportions ranging from 6.9 to 42.8%. Higher consistent screening proportions were observed in health systems with screening outreach and in-reach programs, whereas the safety-net health system, which uses opportunistic clinic-based screening, had the lowest consistent screening. Consistent screening increased with older age but was less common among racial/ethnic minorities and patients with more comorbidities. Adherence with annual FOBT screening is highly variable across healthcare delivery systems. Settings with more organized screening programs performed better than those with opportunistic screening, but evidence-based interventions are needed to improve CRC screening adherence in all settings.

Seroprevalences of Antibodies to 11 Human Papillomavirus (HPV) Types Mark Cumulative HPV Exposure

The antibody responses against human papillomavirus type 16 (HPV-16) and HPV-18 are well known, but many genital HPV types are oncogenic. We assessed the correlation between detection of type-specific HPV DNA and antibodies for 11 HPV types. A total of 2024 women attending the organized national cervical cancer screening program in Slovenia were tested for cervical high-risk HPV DNA (HPV-16, -18, -31, -33, -35, -39, -45, -52, -56, -58, -59, and -68) and serum anti-HPV antibodies. Of these, 1848 women were tested with the same methods 3 years earlier. Type-specific antibodies against 10 of 11 HPV types (HPV-16, -18, -31, -33, -35, -39, -45, -52, -56, and -58) were associated with concomitant presence of type-specific DNA (median odds ratio [OR], 7.5; 95% confidence interval [CI], 2.2-26.1). When the concomitant presence of type-specific HPV DNA at the 3-year visit was combined with the presence of the same HPV DNA type 3 years earlier, the statistical precision was greatly improved, and antibodies against all 11 types (HPV-16, -18, -31, -33, -35, -39, -45, -52, -56, -58, and -59) were associated with the presence of DNA of the same HPV type (median OR, 7.4; 95% CI, 4.2-12.8). Sensitivity had a slight tendency to increase (from 47% to 52%) when DNA positivity at the earlier time point was included, whereas specificity was the same (88%). Seroconversion was associated with previous HPV DNA positivity. Seropositivity mostly remained stable during the observation period. For 11 HPV types, type-specific seropositivity was associated with the presence of DNA of the same HPV type (either concomitantly or previously). Antibodies to these HPV types mark cumulative HPV exposure.

Appropriateness and yield of surveillance colonoscopy in first-degree relatives of colorectal cancer patients: A 5-year follow-up population-based study

Background and aimsThere are few prospective data about the use of surveillance colonoscopy and the risk of recurrent neoplasia in first degree relatives (FDRs) of colorectal cancer (CRC) patients. We examined the use and yield of surveillance colonoscopy in a population-based screening program (Trentino, Italy) Methods1252 FDRs have been included in this study. We calculated compliance (percentage of FDRs who underwent surveillance colonoscopy among those eligible), appropriateness of colonoscopy (appropriate if performed within 6 months of the guidelines recommended interval) and diagnostic yield for neoplasia. We compared these data with those of 765 individuals without a family history (FH) of CRC who underwent screening colonoscopy in the same period (controls). ResultsCompliance and appropriateness were higher in FDRs than in controls (93.0% vs. 48.0%; p < 0.001; 59.6% vs. 18.8%; p < 0.0001, respectively). Younger age, female sex, FH of CRC and both non-advanced adenomas (nAA) and advanced adenomas (AA) at screening colonoscopy were predictors of appropriate surveillance. The cumulative incidence of nAA and AA was similar in FDRs and controls (31.7% and 4.9% in FDRs, including three invasive cancers; 32.4% and 5.8% in controls, respectively). ConclusionFH does not increase the risk of AA in a 5-year follow-up; appropriate surveillance practices in FDRs could be highly expected in an organized screening program.

Abstract PD2-16: Risk of breast cancer after a false-positive screening mammogram in relation to mammographic abnormality: A population-based study in British Columbia

Abstract Background Breast cancer screening by mammography has been shown to reduce breast cancer mortality, however false positive recall rates have consistently been identified as a harm of organized screening. The extent to which these recalled women are at increased risk of future breast cancer remains unclear. Methods The British Columbia Cancer Agency Screening Mammography Program (SMP), the first organized breast screening program in Canada offers screening mammography for women aged 40-74 since 1988. All women who had two or more screening mammograms between1988-2013 within the SMP were included in the study. They were followed until a breast cancer diagnosis, last screen date +5 years, or end of follow-up on Dec 31, 2013, whichever came first. The relative risk (RR) of breast cancer for women with a false-positive test compared with women with negative tests was estimated with Poisson regression, adjusted for age, and five calendar periods. Results A total of 772,289 women with 4.82 million screening mammograms and a median follow up of 11.8 years were included. There were 238,860 women with false positive findings and 26,950 cancers of which 16,084 screen detected and 10,866 non screen detected. Women without any false positive mammogram had a cancer incidence rate of 245/100 000 person-years at risk, whereas women with a false-positive test had an absolute rate of 447/100 000 person-years at risk. The adjusted RR [Value (95% CI)] of breast cancer after the first false-positive test was 1.73(1.68-1.77) for all, 1.65(1.61-1.70) for invasive, and 2.13(2.01-2.27) for in situ cancers respectively. The RR remained increased beyond 8 years after the false-positive test. Of the 5157 screen detected cancers after the first false positive test, 3358 (65%) were on the ipsilateral breast while 1799 (35%) were on the contralateral breast. Women with only one, two, three or four+ false positive test(s) had RR of 1.88(1.83-1.93), 1.42(1.35-1.49), 1.17(1.05-1.30), and 1.08(0.87-1.34) respectively for all cancers. Women with breast density &amp;gt;50% at the time of false positive test had a twofold risk of breast cancer with a RR of 2.07(1.99-2.14), while those with breast density &amp;lt;50% had a RR of 1.58(1.54-1.63). When stratified for mammographic features found on the first false positive mammogram, architectural distortion plus mass had the highest RR 4.68(3.16-6.93) for invasive cancers while calcifications alone and calcifications plus asymmetry had highest RR 5.57(4.88-6.36) and 4.07(2.49-6.66) for in situ cancers. Conclusion False positive mammogram correlates with an increased risk of developing breast cancer. 65% of the screen detected breast cancers post false positive mammogram occur in the ipsilateral breast. Mammographic abnormality features of the false positive mammogram are found to be predictors for the type of future breast cancer. Mammographic features at the time of recall predicts risk of subsequent cancer and may warrant increased surveillance. Citation Format: Rajapakshe R, Miao H, Sam J, Farnquist B, Hartman M. Risk of breast cancer after a false-positive screening mammogram in relation to mammographic abnormality: A population-based study in British Columbia [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD2-16.

Self-sampling with HPV mRNA analyses from vagina and urine compared with cervical samples

BackgroundIn order to increase coverage in the organized cervical screening program, self-sampling with HPV analyses has been suggested. ObjectivesThe aim was to compare human papillomavirus (HPV) mRNA detection in vaginal and urine self-collected samples with clinician-taken cervical samples and the corresponding clinician-taken histological specimens. Study designSelf-collected vaginal, urine and clinician-taken cervical samples were analyzed from 209 women with the Aptima mRNA assay (Hologic Inc, MA, USA). Cervical cytology, colposcopy, biopsy and/or the loop electrosurgical excision procedure (LEEP) were performed in every examination. ResultsThe sensitivity of the HPV mRNA test in detecting high-grade squamous intraepithelial lesions (HSIL)/adenocarcinoma in situ (AIS)/cancer cases was as follows: for the vaginal self-samples 85.5% (95% CI; 75.0–92.8), the urinary samples 44.8% (95% CI; 32.6–57.4), and for routine cytology 81.7% (95% CI; 70.7–89.9). For the clinician-taken cervical HPV samples the sensitivity of the HPV mRNA test in detecting HSIL/AIS/cancer was 100.0% (95% CI; 94.9–100.0). The specificity of the HPV mRNA was similar for the clinician-taken cervical HPV samples and the self-samples: 49.0% vs. 48.1%. The urinary HPV samples had a specificity of 61.9% and cytology had a specificity of 93.3%. ConclusionThe sensitivity of the Aptima HPV mRNA test in detecting HSIL/AIS/cancer from vaginal self-samples was similar to that of routine cytology. The Aptima HPV mRNA vaginal self-sampling analysis may serve as a complement in screening programs.

Sociodemographic and lifestyle determinants of non-attendance for cervical cancer screening in Lithuania, 2006–2014

ObjectivesIn 2004, Lithuania started the Nationwide Cervical Cancer Screening Programme. The aim of the study was to estimate the trend in the uptake of cervical cancer (CC) screening in Lithuania during 2006–2014 and to identify sociodemographic and lifestyle factors associated with non-attendance for screening. Study designCross-sectional studies. MethodsThe data of 4248 women aged 25–60 years who participated in population-based cross-sectional surveys of Lithuanian Health Behaviour Monitoring were analysed. The postal surveys of independent random samples were conducted every second year. Participation in screening was determined by asking women whether they have had a Pap smear test within the last 3 years. Associations of non-attendance with sociodemographic characteristics and lifestyle factors were assessed by multivariate logistic regression analysis. ResultsThe proportion of women who reported taking a test for CC within 3 years was continuously increasing from 60.0% in 2006 to 74.2% in 2014. The likelihood of not being screened was lower among older as compared to younger women (odds ratio=0.70; 95% confidence interval = 0.61–0.82). Non-attendance was associated with lower education, being single, having rare contacts with a doctor, low physical activity, and obesity. In addition, older women who smoked and consumed alcohol at least once a week were more likely to have never been screened. ConclusionsEstablished social and behavioural determinants of non-attendance for CC screening should be used for optimising CC prevention in Lithuania. The implementation of organised screening programme using innovative screening methods might increase attendance and reduce inequalities.

Screening for prostate cancer: are organized screening programs necessary?

Already in 1991 when the prostate-specific antigen (PSA) test was proposed as a diagnostic test, screening for prostate cancer (PCa) was considered controversial due to the considerable risk of detecting latent PCa. Randomised controlled trials were initiated to assess the potential of PSA-based screening in reducing disease-specific mortality. Harms and benefit were closely monitored and both were confirmed. A reduction in mortality was seen and at the same time the initial fear of unnecessary testing and over diagnosis became reality. This triggered professional organizations to adapt their guidelines and to focus on shared decision making (SDM) and selective screening for those men considered at high risk. Unfortunately implementation of guidelines into daily clinical practice is bothersome. As a result many men are being (re)tested while not being at risk and the potential benefit being unclear. This raises the question on whether PSA screening should be organized in controlled programs. While the PSA test will remain the mainstay of PCa early detection many other additional tests (biomarkers/imaging) are currently being tested in large population-based initiatives as a first step to organized programs in selective groups of men.

AB156. 148. A systematic review of the rate of interval cancers and associated endoscopy processes

Background: Colon cancer is the second most common cause of cancer death and an important cause of morbidity. The natural history of carcinogenesis, via the adenoma-carcinoma sequence, permits screening, which reduces the relative risk of mortality by up to 16%. Interval cancers—those that develop between scheduled screening investigations—limit the quality and efficacy of organised screening programmes. Quantifying the rates of interval cancers and delineating associated endoscopy processes are crucial to inform quality improvement interventions.

Clinical Image Quality and Sensitivity in an Organized Mammography Screening Program

PurposeThe study sought to examine the association between clinical image quality of mammograms and screening sensitivity. MethodsFour radiologists evaluated the clinical image quality of 374 invasive screen-detected cancers and 356 invasive interval breast cancers for which quality evaluation of screening mammograms could be assessed from cancers diagnosed among participants in the Quebec Breast Cancer Screening Program in 2007. Quality evaluation was based on the Canadian Association of Radiologists accreditation criteria, which are similar to those of the American College of Radiology. The association between clinical quality and screening sensitivity was assessed by logistic regression. Adjusted sensitivity and adjusted sensitivity ratios were obtained through marginal standardization. No institutional review board approval was required. ResultsA proportion of 28% (206 of 730) of screening mammograms had lower overall quality for the majority of assessments. Positioning was the quality attribute that was the most frequently deficient. The 2-year screening sensitivity reached 68%. Sensitivity of screening was not statistically associated with the overall quality (ratio of 2-year sensitivity = 1.03; 95% confidence interval: 0.93-1.15) or with any quality attributes (positioning, exposure, compression, sharpness, artifacts, contrast). Results were similar for the 1-year sensitivity. ConclusionsAlthough not all mammograms in the Quebec screening program met the optimum quality required by the Canadian Association of Radiologists or American College of Radiology accreditation, the screening mammograms produced in this population-based organized screening program reached a high enough level of quality so that the remaining variation in quality is too little to impair screening sensitivity.

Estimates of cancer burden in Puglia.

A regional population-based cancer registry that provides incidence and survival data has become active only recently. Since it is important to know the time trends of basic epidemiological indicators to understand the cancer burden in the region, this paper will provide incidence, prevalence and mortality estimates in the region for seven major cancers for the period 1970-2015. The estimates were obtained by applying the MIAMOD method, a statistical back-calculation approach to derive incidence and prevalence figures starting from mortality and relative survival data. Survival was modeled on the basis of published data from the Italian cancer registries. The incidence rates are estimated to be still increasing for female breast cancer, colorectal cancer in men and skin melanoma in both sexes. By contrast, the incidence rates indicate a decreasing trend for cervix uteri cancer and stomach cancer, the latter both in men and women. For these cancers an analogous trend is observed for mortality, confirming the reduction of the risk factors related to these cancer types. The incidence rates for lung cancer and prostate cancer in men were estimated to rise, reach a peak, and then decrease in the last part of the considered period. Prevalence increased for all the considered cancers except cervix cancer. The increase was striking for breast cancer and less pronounced for stomach cancer in both genders. This paper provides a description of the burden of the major cancers until 2015. The results highlight the need to reinforce effective preventive measures to contrast cancers related to an unhealthy lifestyle and to increase the compliance with organized screening programs to reduce the colorectal and breast cancer burden.

Estimates of cancer burden in Lazio.

Since 1983 a population-based cancer registry has been operating in Lazio which provides incidence and survival data and covers the entire Latina province, amounting to 10% of the regional population. The aim of this paper is to provide estimates of the incidence, mortality and prevalence for seven major cancers in the Lazio region for the period 1970-2015. The estimates were obtained by applying the MIAMOD method, a statistical back-calculation approach to derive incidence and prevalence figures starting from mortality and relative survival data. Survival was modeled on the basis of published data from the Italian cancer registries. In 2012 the most frequent cancer sites were breast, colon-rectum and prostate with 5,529, 5,315 and 4,759 new diagnosed cases, respectively. The cancers with increasing incidence trends were breast cancer, lung cancer and skin melanoma in women, and prostate cancer, colorectal cancer and melanoma in men. The incidence rates of uterine cervix and stomach cancer decreased. The male lung cancer rates increased, reaching a peak in the late 1980s, and then decreased. Prevalence increased for all the considered cancers except cervix cancer. In 2012 breast, colorectal and prostate cancer had the highest prevalence, with 68,239, 36,617 and 33,934 prevalent cases, respectively. In the final period of the study the mortality declined for all cancers except female lung cancer. In 2012, the highest mortality rates were estimated for lung cancer in both men and women, with 89 and 40 deaths per 100,000, respectively. These estimates give a useful description of the present and future cancer patterns in the Lazio region. Incidence, mortality and prevalence projections provide new information for health resource planning. Furthermore, they point to the need to reinforce the organized screening programs, especially for breast and colorectal cancer.

Women's satisfaction with mammography and predictors of participation in an organized breast cancer screening program: Perspectives of a Local Health Unit in Rome

ObjectivesThe aims of the study were to evaluate satisfaction with the mammography service of the Local Health Unit RMA (Rome, Lazio Region) among women who have attended the program and to identify the predictors of participation. Study designCross-sectional study. MethodsA telephone-based questionnaire was administered to women eligible for mammography screening. The respondents were randomly selected and interviewed by the health center staff. ResultsA total of 502 women were interviewed, of which 264 (52.6%) have attended the screening program at least once. The attendees received the invitation letter more often than the non-attendees (88.3% vs 77.7%; P = 0.002), were more willing to participate (85.6% vs 69.3%; P = 0.001), they considered the letter very clear (15% vs 10.8%; P = 0.003), and information obtained through the hotline appropriate (64.7% vs 56.7%; P = 0.002). Overall satisfaction was high. Critical issues were lack of response from the hotline staff, medium-long waiting time for the results and further examinations. Age >61 years (odds ratio [OR] = 2.747; 95% confidence interval [CI] = 1.842–4.096), receiving the invitation letter (OR = 2.539; 95% CI = 1.519–4.242), and intention to participate (OR = 3.086; 95% CI = 1.938–4.915) were significantly associated with participation in the screening program. ConclusionsWomen's satisfaction with mammography is an important aspect of service utilization. Implementation of strategies to reduce waiting time, increase operating hours, and improve the invitation procedure and the hotline service could enhance satisfaction and attendance rate.

The impact of compression force and pressure at prevalent screening on subsequent re-attendance in a national screening program

Adherence to screening may indirectly help assess whether a prior screening examination deters women from returning for a subsequent examination. We investigated whether compression force and pressure in mammography were associated with re-attendance among prevalently screened women in the organized breast cancer screening program in Norway. Data on compression force (kg) and pressure (kPa) from women's first screening examination in the program (prevalent screening) and subsequent re-attendance were available for 31,225 women aged 50–68, screened during 2007–2013. Crude re-attendance rates and log-binomial regression models estimating the prevalence ratio of re-attendance were used to identify the association between compression force or pressure and re-attendance two-years later. Age and year at prevalent screening, county of residence, screening result (negative or false positive), breast volume, and breast density were included in analyses. Overall, 27,197 (87.1%) women re-attended the program. Re-attendance was highest for women who received a compression force of 10.0–13.9 kg (87.5%) or pressure of 9.0–17.9 kPa (87.8%) and lowest for those who received a compression force of <10.0 kg (85.0%) or pressure of <9.0 kPa (84.7%). The adjusted prevalence of re-attendance was 3% lower for women who received low compression force (<10.0 kg) and 2% lower for women who received low compression pressure (<9.0 kPa) relative to the reference groups (10.0–13.9 kg and 9.0–17.9 kPa, respectively). Future research related to re-attendance should also include information about women's experience of pain, anxiety and stress, as well as image quality.

Evaluation of a model demonstration programme for the control of cervical cancer in rural China: A cross-Sectional study on existing databases from 2009 to 2014

BackgroundSince 2009, a nationwide free cervical cancer screening project in rural China has been gradually expanded. Here, we evaluated a demonstration screening programme in rural China to facilitate the development of the comprehensive guidelines for quality assurance of the cervical cancer screening in Rural China. MethodsThe organised cervical cancer screening programme in Zhushan county was evaluated for both ongoing activities and outcome impact from 2009 through 2014. A descriptive analysis of performance indicators and outcome measures related to screening was conducted. ResultsOf the 73,847 Pap tests performed in 2009–2014, 69127 (93.6%) were in the target age group (25–64). The screening coverages by township were between 10% to 30% in each 2-year screening round. About half of eligible women underwent at least once Pap test over the six-year period. The recall rates for the second and third period were 11.3% and 17.2%, respectively. The annual truncated age-standardized incidence rate seemed to be stable with some variation during the first four years after the initiation of the organised screening programme and dropped in the later two years. ConclusionOur results indicate that the cervical cancer screening programme in Zhushan county was successful in terms of decreasing the cervical cancer burden. Though 2-year coverage was around 18%, the overall 6-year coverage reached 49.5%. We recommend a set of indicators compiled from the regular monitoring process and the methods to estimate the achievement of the programme based on the limited budget and resources available in the area.

Patient safety by analyzing the information not provided in the requisition orders of cervical cytology test

ABSTRACT Introduction: Cervical cancer is a serious public health problem because of its high incidence and mortality in developing countries and is, therefore, a priority in global health. Organized screening programs can reduce the incidence and mortality of cervical cancer due to the early detection of precancerous lesions. Objective: To evaluate the incomplete information from cervical cytology test requisitions of the National Cancer Control Programme of the Brazilian Ministry of Health (MoH), verifying the percentage of non-completion in a municipality in western Parana, Brazil. Methods: A retrospective and quantitative study was carried out, based on data from cervical cytology test requisitions, from women attended by the Unified Health System [Sistema Unico de Saude (SUS)] in a municipality in western Parana from May 2014 to May 2015. Results: The failure to provide the information occurred in 9,010 (40.9%) requisitions. The information not provided is mandatory for the health team responsible for collecting this exam in accordance with MoH guidelines. Conclusion: There is a need for professional training about filling in the information on requisitions, because they collaborate with the increase of the sensitivity and specificity of the cytology test, thus allowing more reliable results that aid in patient safety.

Indications and the Outcome of the Mammography at Douala General Hospital (Cameroon)

Background: Recent reports indicate that the use of mammography in breast screening plays a major role in reducing breast cancer-related deaths. It helps to improve quality of care and patient information. However, in Cameroon, there are no organized general breast screening programs which give women the opportunity to regularly screen their breasts, except for the few who take their own initiative for breast screening. Purpose: This study aimed to list indications and results of mammography and/or breast ultrasounds at Douala General Hospital in order to determine the proportion of routine mammographic screening. Method: This descriptive cross-sectional study was carried out at Douala General Hospital using pre-established data sheets. The study recruited all patients who met the selection criteria and reported to the radiology and medical imaging department for breast screening using physical examinations, mammography and/or ultrasounds. Results: The study recruited 372 patients, 96.8% of whom were between 40 to 50 years old. The reasons given for the medical consultation were systematic screening (33.01%); pain (27.18%) and lumps (25.24%). Breast examination by inspection was normal in 87.1% of women, and by palpation in 66.7%. Mammography revealed nodular opacities (18.3%), spiculated images (4.3%) and micro calcifications (3.2%), while ultrasound identified fibroadenomas (16.48%) and cysts (6.18%). Suspicious lesions (ACR 4 and 5) were discovered in 7.6% of cases by mammography and 8.51% of cases by ultrasound. The results indicated that there was no significant association between the use of clinical examination and mammography (p = 0.754). The use of clinical examination alone for breast screening may not be sufficient. Conclusion: Our findings indicate that in Cemaroon, the routine screening mammography accounts for less than one-third (33.1%) of all indications. Benign lesions were most common, however 7.6% and 8.51% of suspicious malignant lesions were observed using mammography and ultrasound respectively.

Experiences and perceptions about undergoing mammographic screening: a qualitative study involving women from a county in Sweden

ABSTRACTPurpose: An organized population-based mammographic screening programme aims for an early detection of potential breast abnormalities so that treatment can commence. Continuous participation and a high attendance rate are vital for an effective programme. It is important to understand the underlying reasons for participation in mammographic screening, should there be factors that are amendable within reason and could be adjusted. Therefore, the invited women are valuable sources of information. This study aimed at describing the experiences and perceptions about mammographic screening of women from three municipalities in a Swedish county.Method: Six semi-structured focus-group discussions, each with four to five participants, were held. Content analysis was then conducted.Results: The screening procedure, such as staff professionalism, was covered. Other people’s opinions and the woman’s own understanding affected the women’s decisions on whether or not to undergo the procedure. Structural conditions, such as travel time and financial issues, were sources of concern. However, the offer to perform mammographic screening was perceived with gratitude.Conclusions: Structural conditions, risk and time perceptions, the screening procedure, attitudes towards undergoing it and appreciation of its benefit may influence the women’s continuous willingness to be screened, which in turn may affect public and individual health.

Screening mammography and breast self-examination: Attitudes and practices of women in the Eastern Province of Saudi Arabia

Background: The Eastern Province has the highest incidence of breast cancer in Saudi Arabia. The absence of an organized national education and screening program, combined with sociocultural factors, contributes to the presentation of advanced stages. Aim: This study was undertaken to assess the attitudes and practices of women in the Eastern Province toward screening mammography (SM) and breast self-examination (BSE). Subjects and Methods: A cross-sectional study was carried out using a structured questionnaire. Statistical Analysis: We used the Statistical Package for the Social Sciences. Double data entry procedures were used to assure quality and to detect errors in data entry. Frequency distributions were used to describe the data. Association between variables was evaluated by the Chi-square test, and a P≤ 0.05 was considered indicative of statistical significance. Results: A total of 611 females responded to the questionnaire. 12.4% reported having undergone mammography, 48.1% reported that they intended to do it in the future, while 12.7% reported having no intention to perform it. 43% reported performing BSE regularly. Sources of information about breast cancer and breast cancer screening included educational campaigns (27.8%) and media (27.8%). 75.2% of the respondents reported that their physician had no role in educating them about breast cancer screening. There was a significant relationship between the educational level of respondents and the practice of both BSE (P = 0.0001) and SM (P = 0.0000), as well as a significant association between the practice of mammography and having a relative diagnosed with cancer (P = 0.001). Conclusion: The results of our study revealed a low prevalence of breast cancer screening behaviors, 43% reported performing BSE, and only 12.4% had previously undergone SM. We strongly recommend that efforts must be carried out to increase the awareness of women.