Return For Screening Research Articles

Lost to follow up?: A qualitative study of why some patients do not pursue lung cancer screening

Although national guidelines recommend lung cancer screening for adults at high risk, only a small proportion of eligible adults in the US have been screened. The goal of this study was to understand barriers to screening among a specific but important population: patients who have been referred for screening, but who have not completed the test. We used semi-structured interviews to explore barriers to screening among patients at two academic, safety-net primary care practices. We included patients who had been referred for screening at least 6 months prior but who had not completed the test. Among interviewees (N = 16) a consistent theme was a lack of knowledge about the purpose and process of screening. Despite being referred for lung cancer screening, participants expressed that they knew little about how screening was performed or what it was intended to achieve. Preferences and values also played a role in why some participants did not return for screening. Our findings suggest that lack of knowledge about screening is an important barrier to use, as patients are unlikely to prioritize a test if they know little about it.

Prevalence of cervical intraepithelial neoplasia and its associated factors among women attending healthcare services in Eastern Uganda

Cervical malignancy is still the leading cause of death for middle-aged women in the developing world. In Uganda, literature has shown that, cervical cancer incidence and death rates was 45.6 and 25 per 100,000 women respectively. However, the actual magnitude of cervical malignancy in Uganda might be higher since most of the cases are never reported. This study assessed the prevalence of cervical intraepithelial neoplasia among women from hospitals in Eastern Uganda. This was a longitudinal study, with follow-up until diagnosis of high-grade cervical intraepithelial neoplasia (CIN). One thousand and seventy seven women aged 15-55 years were recruited into the study. Pap-smear tests were conducted on all study participants. Women who had abnormal cytology were referred for immediate colposcopic and histological assessment. Surveillance was maintained on these women, and treatment postponed, until there was histological evidence of high-grade CIN (CIN2 or CIN3). At that point women were treated. Those that were pap smear negative were advised to return for screening for three consecutive negative smears before they were allowed to leave the study. Factors associated with cervical cancer were obtained by use of questionnaires. The general prevalence of CIN among women in Eastern Uganda was 416/1077 (38.6%). Two hundred and fourteen, 214/1077(19.9%) had severe CIN3, 180/1077(16.7%) had moderate CIN2, and 22/1077(2.0%) had mild CIN1. Older women aged 45-55-years were frequently diagnosed with the advanced disease stage as compared with young adults aged 15-24 who were less commonly diagnosed with the disease. The study showed that age, use of contraceptives, history of STI and HIV status had statistical significant association with development of cervical intraepithelial neoplasia among the studied participants. There is need for routine surveillance of precancerous lesions and treatment in a timely manner. Key words: Cervical intraepithelial neoplasia, risk factors, cervical cancer.

Compliance With Screening Mammography Guidelines After a False-Positive Mammogram

PurposeTo assess whether women with a false-positive mammogram who do return for screening are less likely to be compliant with screening mammography guidelines than are women with a negative mammogram. MethodsThis institutional review board-approved, HIPAA-compliant retrospective cohort study includes women >40 years old who received 9,385 consecutive, nonbaseline screening mammograms between December 1, 2012 and December 31, 2013. Using linear regression, we evaluated differences in time between mammograms by prior recall status, after adjusting for location of current mammogram (outpatient office versus mobile unit) and age. Using Fisher's exact test, we evaluated the association between compliance with screening guidelines and the recall status on prior mammogram, and compared by location the proportions of noncompliant women who were recalled from prior mammogram. ResultsTime between mammograms does not differ based on prior recall status (P = .83). There is no association between compliance with screening mammography guidelines and recall status on prior mammogram (ACR guidelines P = .398, United States Preventive Services Task Force guidelines P = .416). Noncompliant women recalled on prior mammogram are more likely to undergo mammography at the outpatient office rather than the mobile unit (ACR guidelines P = .0004, United States Preventive Services Task Force guidelines P = .0032). ConclusionsA prior false-positive mammogram is not a significant deterrent to compliance with screening guidelines in those women who return for screening.

Quantification of Adequate Bowel Preparation for Screening or Surveillance Colonoscopy in Men

Bowel preparation is defined as adequate if it is sufficient for identification of polyps greater than 5 mm. However, adequate preparation has not been quantified. We performed a prospective observational study to provide an objective definition of adequate preparation, based on the Boston Bowel Prep Scale (BBPS, which consists of 0-3 points for each of 3 colon segments). We collected data from 438 men who underwent screening or surveillance colonoscopies and then repeat colonoscopy examinations within 60 days by a different blinded endoscopist (1161 colon segments total) at the West Haven Veterans Affairs Medical Center from January 2014 to February 2015. Missed polyps were defined as those detected on the second examination of patients with the best possible bowel preparation (colon segment BBPS score of 3) on the second examination. The primary outcome was the proportion of colon segments with adenomas larger than 5 mm that were missed in the first examination. We postulated that the miss rate was noninferior for segments with BBPS scores of 2 vs those with BBPS scores of 3 (noninferiority margin, <5%). Our secondary hypotheses were that miss rates were higher in segments with BBPS scores of 1 vs those with scores of 3 or of2. The adjusted proportion with missed adenomas greater than 5 mm was noninferior for segments with BBPS scores of 2 (5.2%) vs those with BBPS scores of 3 (5.6%) (a difference of -0.4%; 95% confidence interval [CI], -2.9% to 2.2%). Of study subjects, 347 (79.2%) had BBPS scores of 2 or greater in all segments on the initial examination. A higher proportion of segments with BBPS scores of 1 had missed adenomas larger than 5 mm (15.9%) than segments with BBPS scores of 3(5.6%) (a difference of 10.3%; 95% CI, 2.7%-17.9%) or 2(5.2%) (a difference of 10.7%; 95% CI, 3.2%-18.1%). Screening and surveillance intervals based solely on the findings at the first examination would have been incorrect for 16.3% of patients with BBPS scores of 3 in all segments, for15.3% with BBPS scores of 2 or 3 in all segments, and for 43.5% of patients with a BBPS score of 1 in 1 or more segments. Patients with BBPS scores of 2 or 3 for all colon segments have adequate bowel preparation for the detection of adenomas larger than 5 mm and should return for screening or surveillance colonoscopy at standard guideline-recommended intervals. Colon segments with a BBPS score of 1 have a significantly higher rate of missed adenomas larger than 5 mm than segments with scores of 2 or 3. This finding supports a recommendation for early repeat colonoscopic evaluation in patients with a BBPS score of 0 or 1 in any colon segment.

Effect of Human Papillomavirus vaccination of daughters on the cervical screening uptake of their non-vaccinated mothers.

This study investigated return to cervical screening rates for 112,451 under-screened mothers of daughters offered Human Papillomavirus (HPV) vaccination over two school academic years and a comparator group of women with no vaccine-eligible daughter. Mothers returned to screening more often than the comparator group: odds ratio (OR) 1.04 (95% confidence intervals 1.02-1.07) for lapsed and 1.57 (1.48-1.67) for never screened. Screening return was significantly higher in the year prior to HPV vaccination for lapsed mothers (OR = 1.06) and in the current vaccination year for lapsed and never screened mothers (OR = 1.05 and 1.16 respectively). The modest increase in screening attendance indicates a potential for the HPV vaccine programme to increase screening uptake of mothers.

P100 Assessment of bacterial sexually transmitted infection (STI) screening following sexual assault

BackgroundChlamydia trachomatis and Neiserria gonorrhoea screening following sexual assault is undertaken primarily for sexual health purposes but can potentially facilitate criminal investigation in cases of penetration at sexually naive sites....

Hierarchical dynamic time-to-event models for post-treatment preventive care data on breast cancer survivors

This paper considers modelling data arising in post-treatment preventive care settings, where cancer patients who have undergone disease-directed treatment discontinue seeking preventive care services. Clinicians and public health researchers are interested in explaining such behavioural patterns by modelling the time-to-receiving care while accounting for several patient and treatment attributes. A key feature of such data is that a noticeable number of patients would never return for screening, a concept subtly different from censoring, where an individual does not return for screening in the given time frame of the study. Models distinguishing between these two concepts are known as cure rate models and are often preferred for data where a significant part of the population never experienced the endpoint. Building upon recent work on hierarchical cure model framework we propose modelling a sequence of latent events with a piecewise exponential distribution that remedies oversmoothing encountered in existing models with different latent distributions. We investigate simultaneous regression on the cure fraction and the latent event distribution and derive a flexible class of semiparametric cure rate models.

ACRIN 6664: Patient acceptance and preferance of CT colonography compared to optical colonoscopy for colon cancer screening

4034 Background: Colorectal cancer screening must be repeated on a regular basis. Understanding patient perceptions and willingness to be rescreened will help to determine future compliance rates. The purpose of this study was to compare National CT Colonography Trial (NCTCT) screening participant experiences with CT colonography (CTC) and optical colonoscopy (OC), willingness to return for each procedure, and procedure preference. Methods: NCTCT participants underwent a single bowel preparation (BP). Participants were scheduled to receive CTC, followed by sedation and OC. Participants were asked to complete a questionnaire two weeks post-exam on physical discomfort and embarrassment during BP, CTC and OC and willingness to repeat CTC and OC (with or without BP) at different time intervals. McNemar's Test and logistic regression were used for statistical analysis. Results: 2310 of 2600 patients (89%) responded (1224 women, 1086 men). Mean age was 58.39 years (range 50–86). The participant population was 85% Caucasian, 11% African American and 4% other. Severe discomfort was reported by 7.1% participants with BP, 6.3% with CTC, and 2.2% with OC. Severe embarrassment was reported by 1.6% participants with BP, 1.3% with CTC, and 0.7% with OC. Forty-six percent of participants preferred CTC, 27.4% reported no preference, and 24.9% preferred OC (p&lt;0.001). Repeat screening with CTC is currently recommended every 5 years and with OC every 10 years. 80.5% of the participants were willing to be screened again with CTC in 5 years and 97.5 % were willing to be screened again with OC in 10 years (p&lt;0.001). If the screening interval for CTC were extended to ten years, 93.7% of participants were willing to return for screening (p&lt;0.001). If BP were unnecessary, 91.0% were willing to be rescreened with CTC in 5 years and 97.5% were willing to be rescreened with OC in 10 years (p&lt;0.001). Conclusions: NCTCT participants preferred CTC to OC, but their willingness to undergo repeat CTC was limited by the shorter interval between screenings currently recommended for CTC as opposed to OC. Improvements in technology that would eliminate the need for bowel preparation or extend the recommended screening interval would likely improve adherence to recommended repeat screening. [Table: see text]

Patients’ attitudes towards mydriasis for diabetic eye disease screening

The purpose of the questionnaire was to explore attitudes of patients towards mydriasis for diabetic retinopathy screening. Two groups of patients were invited to take part: group 1 comprised patients attending the diabetic clinic and had previous experience of mydriasis, group 2 patients attending the mobile screening unit for non-mydriatic digital retinal photograph and who were not previously used to receiving mydriatic eye drops. Basic demographic data was recorded and the volunteers invited to complete a questionnaire. 292 patients were recruited into group 1 (median age 63 years range 20-94) and 103 into group 2 (median age 68 years range 29-96). 42% of patients in group 2 indicated that they were unhappy with the use of dilating eye drops and 26% of this group reported that they may be discouraged from attending screening for diabetic retinopathy if drops were introduced. These figures were statistically lower in group 1 at 8% and 1-8% respectively (p < 0.001). Blurring of vision was identified as the most troublesome feature of the use of mydriasis for patients. A large proportion of patients drove themselves to their last screening appointment; 58% in group 2 and 39% in group 1. A third of all patients (33%) indicated that they worked outside the home. Many patients attending diabetic eye screening return to driving and work immediately after the appointment. Introduction of the use of routine drops may discourage attendance. Education and experience may have an important role in improving acceptability of mydriatic eye drops. Retinal screeners need to have clear guidelines with which to advise patients.

Psychological, Behavioral, and Interpersonal Impact of Human Papillomavirus and Pap Test Results

The purpose of this study was to explore the short-term psychological, behavioral, and interpersonal impact of human papillomavirus (HPV) and Pap results in adolescent and young adult women. Sexually active young women 14-21 years of age were recruited using a purposeful sampling strategy from a hospital-based teen health center. Participants underwent HPV DNA and Pap testing at baseline. At a follow-up visit 2 weeks later, they received test results and participated in individual interviews designed to examine the impact of test results. Interview data were analyzed using framework analysis, a qualitative analytical method. The mean age of the 100 participants was 17.2 years, and 82% were black. Fifty-one percent were HPV positive, and 23% had abnormal Pap tests. Psychological responses consisted of affective reactions to abnormal results, empowerment through knowledge of results, and self-confidence to prevent future disease. Personal behavioral intentions encompassed safe sexual behaviors, partner monitoring, and return for screening. Anticipated interpersonal consequences focused on the impact of communication about test results on relationships. Psychosocial and behavioral responses were influenced by the personal meaning participants derived from HPV and Pap results (e.g., perceptions of personal risk and anticipated stigma), cognitive understanding of test results, and such factors as coping mechanisms, locus of control, and relationship quality. An understanding of young women's responses to HPV and Pap test results may help guide clinical interventions designed to prevent possibly harmful psychosocial and interpersonal responses to HPV and Pap testing but promote healthy sexual behaviors and regular screening.

Consumer satisfaction with breast screening: a pilot study

One hundred and forty-six women registered with a general practice and 84 members of health authority staff, who had attended a breast screening unit by invitation, completed a postal questionnaire about their reactions to screening. The staff of the unit also recorded their observations. The letter of invitation and accompanying health education leaflet were favourably received, and most women were glad of the opportunity offered, although some experienced anxiety. Few practical problems were reported with regard to attending the clinic. In general, the facilities in the clinic were thought to be of a high standard but specific criticisms included problems with access and privacy and feelings of claustrophobia. Some women experienced anxiety or discomfort when the mammogram was being taken, but many favourable comments were made about the helpfulness of staff. Almost all women said that they would return for screening if invited again.