Top PDF Breast Cancer Screening: A Stochastic DEA Study

Breast Cancer Screening: A Stochastic DEA Study

Breast Cancer Screening: A Stochastic DEA Study

The goal of screening tests for breast cancer is early detection and treatment with a consequent reduction in mortality caused by the disease. Screening tests, however, might produce misleading diagnoses and potentially significant emo- tional, financial and health costs. The effectiveness of a breast screening program has effects on the quality of life of the target population. Even if the screening units regularly attain coverage targets, it remains essential to ensure that women receive the same high standard of service wherever they live. In order to assess the relative efficiency of individual screening units we use stochastic D.E.A. models, which can be used as reliable tools for external audit. The technique is tested on breast cancer screening data of two Italian regions.
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KNOWLEDGE, ATTITUDES AND PRACTICES TOWARDS BREAST CANCER SCREENING PROGRAMS AMONG IRANIAN RURAL FEMALE POPULATIONS IN NORTH OF IRAN

KNOWLEDGE, ATTITUDES AND PRACTICES TOWARDS BREAST CANCER SCREENING PROGRAMS AMONG IRANIAN RURAL FEMALE POPULATIONS IN NORTH OF IRAN

effectiveness of monthly BSE is unclear. As a significant numbers of women detect masses when they are bathing or dressing; monthly BSE can help women become more aware of their health status [10-13]. Although, there are some emphases on performing BSE, evidences show that less than 20% of Iranian women conducting regular BSE [14]. Based on the results of researches which have done in Iran, The researchers concluded that Iranian women did not know how to perform BSE [15]. The economic dependency coupled with illiteracy and ignorance particularly in rural women increases their risk of breast cancer. Researches show that rural residence itself, particularly residence in an isolated rural location, is a risk factor for not having received a screening CBE and mammogram, which lends credence to arguments for improving access to mammography in rural settings, particularly remote ones [16-18]. So, it seems that rural women have low awareness. Actually lack of knowledge about the benefit of early breast cancer screening is a significant barrier for some women to seek mammography [19]. On the other hand, on the basis of health behaviors distribution models in human society, many epidemiologists believe that the increase of knowledge and improvement of attitudes and beliefs concerning promotion of breast cancer screening programs among rural female populations [20, 21]. Several studies have shown that the knowledge and perception of rural women directly influence their attendance and accepting or screening behavior [22-25]. Although in Asia and Middle East, especially in Iran the incidence of breast cancer is rapidly increasing, but just a few studies have examined the knowledge, attitude and practice of women toward breast cancer and prevention programs in Iran. These studies are often of small sample size and targeted women in especial profession [1, 23]. In Iran, however, there are no regular population-based screening programs, and no prevention programs for controlling cancers, suggesting that knowledge about risk factors, symptoms, the benefits of early cancer-screening guidelines and the use of health care clinics for cancer treatment, especially breast cancer, may be low in the Iranian population [23-28]. In this study, we reported data derived from an investigation of the knowledge, attitudes, and practices regarding breast cancer and prevention programs, especially BSE, among Iranian rural female population.
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Knowledge, attitude and practice of female undergraduate students toward breast cancer screening: using breast self examination as a case study

Knowledge, attitude and practice of female undergraduate students toward breast cancer screening: using breast self examination as a case study

Breast cancer remains the most common cancer related cause of death among women. Late diagnosis and presentation seen among our patients reflect paucity of knowledge about breast cancer and breast cancer screening programmes. This study determines the knowledge based of our university undergraduate female students about breast cancer and breast self examination an inexpensive technique for breast cancer screening. It is a questionnaire based prospective study among university undergraduate female students here in referred to as respondents who were given open ended structured questionnaires to collect relevant data about breast cancer and breast self examination. Out of four hundred and fifty nine (97.04%) of the respondents who had knowledge about breast cancer, only 201 (42.49%) of them heard about breast cancer screening. However, 95 (47.26%) of the 201 respondents agreed that breast cancer can be detected early through breast cancer screening. Eighty four (17.75%) respondents have heard about self breast examination out of which only about a third (36.90%) practice it. Considering the knowledge on self breast examination only 3 (9.67%) out of the thirty one respondents who practiced it, perform it correctly. In conclusion most of our respondents have heard about breast cancer but have insufficient knowledge on breast cancer and breast cancer screening to harness the effective positive attitude towards self breast examination.
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Trends in incidence and detection of advanced breast cancer at biennial screening mammography in The Netherlands: a population based study

Trends in incidence and detection of advanced breast cancer at biennial screening mammography in The Netherlands: a population based study

Of 1,771 screen detected cancers, 570 were advanced cancers and 1,164 non advanced cancers. The tumor stages of the remaining 37 screen detected cancers could not be properly classified, including TxN- cancers (negative lymph nodes but unknown tumor size) and T1Nx cancers (invasive cancers ≤ 20 mm with unknown lymph node status); these were excluded from further analysis. A total of 290 cancers had been detected at an initial screening round, consisting of 105 advanced can- cers (36.2%) and 185 non-advanced cancers. At subse- quent screening, a total of 1,444 cancers had been detected, comprising 466 advanced cancers (32.3%) and 978 non-advanced cancers (36.2% versus 32.3%, p < 0.001). The proportion of advanced screen-detected can- cers per 2-year screening period fluctuated between 28.7% (2003/2004) and 35.4% (2007/2008) (p = 0.6, Table 1). Univariate analysis showed no statistically sig- nificant differences between women with advanced or non-advanced breast cancer regarding family history of breast cancer, use of hormone replacement therapy, per- centage initial screens, interval between screens, prior visibility or breast density (Table 2). Compared to non- advanced cancers, advanced screen detected cancers were more frequently characterized by abnormal densi- ties and less frequently by suspicious microcalcifications at screening (p < 0.001) and comprised more invasive lobular cancers and fewer invasive ductal cancers (p < 0.001, Table 2).
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Patient Delay in Accessing Breast Cancer Care in a Sub Saharan African Country: Uganda

Patient Delay in Accessing Breast Cancer Care in a Sub Saharan African Country: Uganda

In this study the majority of women discovered their own lumps through non-routine incidental circumstances. Self detection is mostly possible when the tumor size is about 2.5 cm [26]. It is also easier to find if it is relatively close to the skin and with the tumor to breast size ratio is in favour. Tumors at 25 mm are technically stage II or beyond. The challenge remains as to what other possibilities are available to getting women present earlier to the appropriate points of care in the context of non-existent breast cancer screening programs. The BSE and CBE practices are currently not supported by evidence [27,28]. Innovative low cost technologies may be the way forward [29], exploring the use of the breast light at community level maybe one of such ideas [30,31]. Creating awareness at village community level recently piloted in Sudan deserves attention [32].
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Improving breast cancer screening in Australia: a public health perspective

Improving breast cancer screening in Australia: a public health perspective

Any changes to current screening protocols should be shown to significantly improve on the current program for the whole population without inadvertently reducing its effectiveness for specific subpopulations, with an acceptable balance of costs, benefits and harms. Although modelling studies can generate estimates of net value, such as cost-effectiveness ratios of various strategies and the number needed to screen per cancer death prevented, determining what constitutes sufficient and appropriate evidence to warrant changes to policy and practice requires expert population health and high-level guidance suited to the local health system. Cancer Council Australia is leading a Federal Government–funded project gathering evidence to support consensus-based decision making, aligning with the framework presented here. 36 In addition, information
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Women’s Performance of Breast Cancer Screening (Breast Self Examination, Clinical Breast Exam and Mammography)

Women’s Performance of Breast Cancer Screening (Breast Self Examination, Clinical Breast Exam and Mammography)

Breast cancer is preventable through early detection and healthy lifestyles that improve women’s health and decrease the costs relating to cancer death [6]. Therefore, effective screening programs are the best way to detect cancer before experiencing any symptoms [7]. Breast cancer screening methods include breast self-examination (BSE), clinical breast examination (CBE) and mammograms [8]. These effective ways of screening are consistent with and show that there is relatively little current emphasizing on the first published results of the New York randomized control trial in 1997 [9].
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What Are the Recommended Timing and Screening Modalities for Women at Higher Risk of Developing Breast Cancer? A Clin-IQ

What Are the Recommended Timing and Screening Modalities for Women at Higher Risk of Developing Breast Cancer? A Clin-IQ

A cross-sectional study comparing screening mammography in women with history of breast cancer in one or more first-degree relatives against those of similar age without such history found more cancers in the first group (6.1/1,000 vs. 4.0/1,000), corresponding to that in average-risk women a decade older. However, the sensitivity of mammography increases with age (87.0% for age 60–69 years; 67.9% for age 30–39) and is less beneficial in younger women. Nevertheless, mammography has a higher positive predictive value (3.7% in the first group vs. 2.9%, P=0.001) in those with a family history positive for breast cancer. 12
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Observed and predicted risk of breast cancer death in randomized trials on breast cancer screening

Observed and predicted risk of breast cancer death in randomized trials on breast cancer screening

We performed a systematic search on PubMed for articles on breast screening trials. We also searched reference lists in major reviews [17–19] and in publications on breast screening trials we already had. We retrieved all articles reporting original data of these trials. Three of us (PA, MB, MS) read the articles with looking for cancer-specific fatality data reported by categories of size or lymph-node status or stage. For the sake of finding comparable data on screening for other cancers, we performed a similar literature search for colorectal cancer. Fatality could be reported as a proportion of cancer patients who died because of the cancer or as a survival sta- tistics, which is the reverse of fatality. It could be reported as a measure of the risk (e.g., the haz- ard rate) to die from a large (more advanced) cancer compared to the risk to die from a small (less advanced) cancer. We also looked for breast screening trials that performed their own assessment of predicted numbers of breast cancer deaths.
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Knowledge, attitude, and behavior regarding breast cancer screening among women referring to health centers of Yazd city

Knowledge, attitude, and behavior regarding breast cancer screening among women referring to health centers of Yazd city

89 knowledge level about breast cancer and the screening method [23] . In Tehran, 61% of respondents stated that they knew about breast cancer screening programs [24] . Okobia et al. stated that overall, the knowledge level of Nigerian women is low [25] . Vahabi in her study with limited sample size of 50 subjects of Iranian women who immigrated to Toronto, Canada showed that more than 75% of them had a low knowledge level about breast cancer and its screening methods [19] . The knowledge level of Iranian women about breast cancer is low in another study on 21 women with high risk of cancer and 10 women with familial history of breast cancer (the sum total, 31 women). The previous study reported that Iranian women are very interested in individual health, but do not have enough knowledge about it. Totally, the Asian women's knowledge is low [17] .
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The role of private medical insurance in socioeconomic inequalities in cancer screening uptake in the Republic of Ireland

The role of private medical insurance in socioeconomic inequalities in cancer screening uptake in the Republic of Ireland

This study highlights that in the case of three of the cancers considered; possession of insurance is the central determinant to inequalities in uptake. Work by Kenkel (1994) has shown that insurance coverage for curative care encourages the use of screening as the earlier detection of a cancer is only valuable in the presence of earlier treatment interventions. While access to diagnostics and treatment may be more equitable in the case of breast cancer where arrangements for this have been made as part of the population-based screening initiative, as has been shown in the Republic of Ireland the perception may still remain that having insurance has a role to play in diagnosis and treatment (Harmon and Nolan, 2001). That those who hold private insurance may attach a higher value to health or possess a greater knowledge of how to use the healthcare system is possible and could offer an alternative explanation for the results. Given the work of Harmon and Nolan (2001) and O’Malley et al (2004) it would though be perverse to argue that the differential access insurance affords does not have a role in inequalities and is not acquired because of this.
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Do physician communication skills influence screening mammography utilization?

Do physician communication skills influence screening mammography utilization?

Doctor-patient communication involves integrating complex data and sharing of information in a collabora- tive fashion [53]. These skills are not developed through experience alone; they can be taught and assessed with evaluation [17,20]. This the first study confirming that standardized assessment of physician communication skills at the end of training is associated with outcomes in breast cancer screening during subsequent practice. In addition, we showed that end-of-training standardized test results for these physicianship-related skills are more strongly associated with future use of life-saving screening tests than test results for doctors ’ knowledge of preventive medicine. Future research should examine whether early interventions to enhance competence in communication skills for physicians with lower scores can increase their ability to provide patients with screen- ing procedures.
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SURVEY ON THE AWARENESS OF RISK FACTORS ASSOCIATED WITH BREAST CANCER AMONG WOMEN ATTENDING ANTE-NATAL CLINIC AT IMO STATE UNIVERSITY TEACHING HOSPITAL (IMSUTH), ORLU

SURVEY ON THE AWARENESS OF RISK FACTORS ASSOCIATED WITH BREAST CANCER AMONG WOMEN ATTENDING ANTE-NATAL CLINIC AT IMO STATE UNIVERSITY TEACHING HOSPITAL (IMSUTH), ORLU

This study was conducted to determine the awareness of risk factors associated with breast cancer, its protective and screening measures among pregnant women attending ante-natal clinic at Imo State University Teaching Hospital (IMSUTH) Orlu, Imo State of Nigeria. Extensive literature review was made. A descriptive analysis was adopted for the study and a convenient sampling method used to obtain 180 respondents as the sample size with aid of self-structured questionnaire developed by the researcher for the purpose of data collection. The questions were derived from objective set for the study. Finding from the data collected shown that most (75%) of the participants had no knowledge of modifiable risk factors to breast cancer, (36.5%) had good knowledge of non-modifiable risk factors. Disparity of knowledge in variables of protective and screening measures showed that few subjects had good knowledge (20.2%) of protective measures and majority of them had no knowledge about protective measures. On screening measures, various disparities in knowledge also revealed their low awareness of these variables. Financial constrained and time were the primary limitations the researcher encountered. In view of the above findings, it was therefore recommended that, there should be more awareness of these variables not only to our pregnant women but also the society about the drivers of breast cancer and its protective measures, would go a long way to save our society women.
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Comparing breast cancer mortality rates before-and-after a change in availability of screening in different regions: Extension of the paired availability design

Comparing breast cancer mortality rates before-and-after a change in availability of screening in different regions: Extension of the paired availability design

π iA , π iCz = π iC , π iIz = π iI , and π iNz = π iN . In addition, by virtue of Assumption 4, there are basically no inconsistent receiv- ers, i.e. π iI = 0. If there is no screening in time period 0, so π iaz = π iCz = 0, and Assumption 4 only requires π iCz = π iC and π iNz = π iN , which is very plausible especially if one views public awareness as part of the screening intervention. Assumption 5 likely holds for type N subjects because the same prior history of no screening applies to both time periods 0 and 1. Thus we can reasonably assume that the probability of incident breast cancer death among type N subjects does not depend on time period, i.e., β iN0 = β iN1 ≡ β N . However, unless there is no screening in time period 0, Assumption 5 will not hold for type A subjects. The rea- son is that (i) screening is generally more available before time period 1 than before time period 0, and (ii) prior screening may affect the probability of incident cancer death if screening confers benefit.
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Modeling of Sic Power Semiconductor Devices For Switching Converter Applications

Modeling of Sic Power Semiconductor Devices For Switching Converter Applications

Introduction: The death rates from breast cancer have declined in the past decades; however, disparities between racial/ethnic groups remain. South Carolina has some of the largest health disparities in the nation, particularly breast cancer morbidity and mortality. The Best Chance Network was established to reduce the burden of breast cancer among disadvantaged women in the state. Although much has been done to identify factors related to breast cancer mortality, little has been done to examine the influence of geographic accessibility to health facilities and breast cancer mortality. The purpose of this study was to investigate whether travel distance to the screening referral provider and mammography facility are associated with breast cancer-specific and all-cause mortality among women participating in South Carolina’s Best Chance Network. We also sought to contrast and compare by race breast cancer-specific and all-cause survival among BCN participants. Methods: Women in South Carolina’s Best Chance Network, who
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Failure to Engage in Breast Screening and Risk Assessment Results in More Advanced Stage at Diagnosis

Failure to Engage in Breast Screening and Risk Assessment Results in More Advanced Stage at Diagnosis

Background: Although well established, population based screening and family risk assessment for breast cancer have come under increasing scrutiny. The concept of over diagnosis is increas- ingly cited in cancer publications. This study assessed the impact of failure to screen or risk assess patients attending with a new diagnosis of breast cancer. Methods: A retrospective review was undertaken of 200 consecutive patients diagnosed with breast cancer between January 2010 and September 2012 at Letterkenny Hospital. Appropriate screening was defined as biennial in those aged 50 - 66 and in those 40 - 49 with moderate/high family history risk (NICE criteria or IBIS cri- teria). Patient demographics, screening history, diagnosis date and stage (TNM) were documented. Patients with previous breast cancer were not included (n = 17). Results: 200 consecutive patients, whose mean age was 61 (range 28 - 99), were studied. 112/200 (56%) met no criteria for screen- ing or family history assessment, and 88/200 (44%) met criteria for either screening (in 56) or family history assessment (in 32). 61/88 (69.3%) meeting criteria did not have a mammogram or risk assessment. The stage of breast cancer was significantly earlier in those screened appropri- ately, with early stage cancer in n = 111/139 (79.9 %) and late in n = 28/139 (20.1%), compared with 38/61 (62.3%) and 23/61 (37.7%) in those failing to be screened appropriately (p = 0.01 χ 2
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Cost effectiveness of MRI compared to mammography for breast cancer screening in a high risk population

Cost effectiveness of MRI compared to mammography for breast cancer screening in a high risk population

Our study has some limitations that must be addressed. There are additional issues relevant to the management of women at high-risk for breast cancer that were not incor- porated in the model, and may influence the cost-effec- tiveness of screening with MRI. For example, although BRCA mutation carriers may choose to undergo prophy- lactic mastectomy, many do not choose this option, with estimates ranging from 0% to 54% of carriers [11,26]. Fur- thermore, some of the women are also at increased risk for ovarian cancer. The costs of radiation exposure due to annual mammography starting at an earlier age were not incorporated, nor were the costs of possible anxiety and stress from unnecessary biopsies stemming from false positive MRI screening. Any or all of these factors might alter the cost-effectiveness estimate. Finally, the results of our model should be interpreted with care given that the results of this cost-effectiveness analysis require compari- sons to data from observational studies, the Surveillance, Epidemiology and End Results Program, or clinical trials. All probabilities and utilities used to populate the model are estimates derived from the literature. Each of these estimates carries inherent uncertainty, as does using a hypothetical cohort. Possible selection bias associated with utilizing the Claus tables may affect our base case effectiveness and resource use estimates by either over or underestimating our base case model parameters. Moreo- ver, in our probabilistic sensitivity analysis, we did not assume that a correlation structure existed among the dis- tributions of the parameters. However, both univariate and probabilistic sensitivity analyses were performed to address uncertainty in parameter estimates by exploring variability in each probability, cost, and outcome esti- mate.
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Knowledge, Attitudes and Breast Cancer Screening Practices among Market Women in Thika Town, Kiambu County, Kenya

Knowledge, Attitudes and Breast Cancer Screening Practices among Market Women in Thika Town, Kiambu County, Kenya

Further analysis done showed that there was propensity for the uptake of screening for breast cancer to increase as the level of knowledge of symptoms increased. Having more children was associated with the knowledge of symptoms. The level of knowledge was higher among the respondents with two and above children; those who were younger and had worked for less than 10 years in the markets, earned more than Ksh 15,000 and were Catholics. A few selected characteristics were statistically significant with the knowledge of risk factors of cancer of the breast. They were age, marital status, level of education, main sources of income, number of children and being Christian. In this study majority of the younger respondents were more knowledgeable compared the older respondents. Kisiangani et.al (23) similarly found that the younger participants who took part in their qualitative study appeared to have a better understanding of the cancer, its signs and symptoms as well as lifestyle issues that predispose people to breast cancer and screening as opposed to older participants. According to data presented in the Kenya Demographic and Health Survey, (13), most women in Kiambu County (90.2%) have given birth in a hospital where they have been taught on various aspects of breast cancer by healthcare professionals (13).
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Screening for breast cancer : medicalization, visualization and the embodied experience

Screening for breast cancer : medicalization, visualization and the embodied experience

wider project, that there is simultaneous confusion since some women are falsely reassured by mammography screening; feeling they are ‘OK’, that is to say risk free, for the three years after it has taken place (Griffiths et al., 2005; Griffiths et al., 2006). It is almost as though the visualized breasts, the ones dealt with by mammography, are ‘parked’ for three years. They are not part of the woman’s lived body and so remain unchanged, outside of their daily experience. This runs counter to the breast awareness message and encourages women to become less aware of their own breasts between screenings, with potentially negative implications for early detection of cancers by the women themselves. Pfeffer has noted that ‘BA [breast awareness] demands a 24/7 state of vigilance whereas, in sending out invitations every three years, the NHSBSP [National Health Service Breast Screening Programme] suggests that a different time frame is important. Women found these conflicting messages about the significance of time confusing’ and therefore may assume that screening mammography and breast awareness are ‘interchangeable’ (Pfeffer, 2004a: 228). However, at present, only half of all breast cancers found in women in the age group invited for mammography screening are diagnosed at screening. The other half, occur in women who do not attend screening or who find the cancer in the time between screenings (Advisory committee on Breast Cancer Screening, 2006).
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Breast cancer screening: evidence of benefit depends on the method used

Breast cancer screening: evidence of benefit depends on the method used

Despite these improvements, a major problem that arises if the case-control study is conducted within the context of a population screening program is that women who do not participate in screening generally have a poorer outcome [14-17] for reasons that are not related to screening, thus inducing an observed lesser exposure to screening among the cases [18]. A growing number of data documents that, compared with women participating in screening mammography, non-participating women have characteristics associated with a higher risk of dying from breast cancer, such as higher rates of obesity and lower compliance to treatments, and the influence of these characteristics on the risk of breast cancer death exists in the absence of screening [19-21]. So, although a number of non-participants die from breast cancer for reasons unrelated to screening, results of case-control studies may suggest that these deaths are due to not having been screened. This bias in results has been termed the ‘ self- selection bias ’ . As the International Agency for Research on Cancer (IARC) Handbook on Breast Cancer Screening concluded, ‘ Observational studies of screening, such as cohort and case-control studies, may give biased measures
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