Organized breastcancerscreening programs ensure that eligible women have regular access to high quality mammography screening in accordance with Canadian guidelines. Since 2008, the NewBrunswickBreastCancerScreeningServices (NBBCSS) program has been under the leadership of the NewBrunswickCancer Network (NBCN). The monitoring and evaluation of the NBBCSS program provides an opportunity for stakeholders to understand the impact of early detection on reducing morbidity and mortality from breastcancer. This report provides an overview of how well the program is achieving these goals, as well as identifying potential areas of opportunity for program enhancement. In this report, the recommended performance indicators have been analyzed at both Provincial and Health Zone levels. The Geographic Information Systems (GIS) has also been used to interpret and visualize the results across different geographic areas in the province.
In developing countries, breastcancer survival rates are much lower than in developed countries, mainly because cancer is diagnosed in later stages. In the United States, 60% of breastcancer cases are diagnosed in stages 0 and I, with survival rates of 98% . Whereas in Uganda less than 20% of patients are diagnosed in these early stages and more than 80% in the most advanced stages (III and IV) [2,5]. The main reasons for presentation of breastcancer patients in advanced stages could be related to the lack of access to breastcancerscreening [5,6] delayed help-seeking for breastcancer symptoms and barriers to accessing health care services . In addition it may be due to tumor biology factors [8,9] and lack of awareness .
There are many factors involved in failure to undertake mammography. These are patient and system related. Some are related to poor literacy, fatalistic fears and external decision making pressures . Anxiety and stress also play a role . New strategies to reduce the late presentation of breastcancer are considered important. Devi and colleagues  were able to reduce the prevalence of Stage III and Stage IV breast cancers from 60% to 35% by educating health staff on the theoretical and practical aspects of breastcancer and by strengthening pub- lic awareness programs and referral system for positive cases. Similarly in Singapore, Chang and colleagues found that up to 20% of patients were still presenting with Stage III and Stage IV breastcancer . Surprising- ly the stage and tumour size at presentation in this study was quite late with a mean invasive tumour size of 32 mm versus 35 mm, and a significant over representation of stage III and IV and regional and metastatic disease in those failing to be risk assessed and screened.
This systematic review, stimulated by inconsistency in secondary evidence, reports the benefits and harms of breastcancer (BC) screening and their determinants according to systematic reviews. A systematic search, which identified 9 , 976 abstracts, led to the inclusion of 58 reviews. BC mortality reduction with screening mammography was 15 – 25% in trials and 28 – 56% in observational studies in all age groups, and the risk of stage III+ cancers was reduced for women older than 49 years. Overdiagnosis due to mammography was 1 – 60 % in trials and 1 – 12 % in studies with a low risk of bias, and cumulative false- positive rates were lower with biennial than annual screening (3 – 17% vs 0.01 – 41%). There is no consistency in the reviews’ conclusions about the magnitude of BC mortality reduction among women younger than 50 years or older than 69 years, or determinants of benefits and harms of mammography, including the type of mammography (digital vs screen-film), the number of views and the screening interval. Similarly, there was no solid evidence on determinants of benefits and harms or BC mortality reduction with screening by ultrasonography or clinical breast examination (sensitivity ranges, 54 – 84% and 47 – 69%, respectively), and strong evidence of unfavourable benefit-to-harm ratio with breast self-examination. The reviews’ conclusions were not dependent on the quality of the reviews or publication date. Systematic reviews on mammography screening, mainly from high-income countries, systematically disagree on the interpretation of the benefit-to-harm ratio. Future reviews are unlikely to clarify the discrepancies unless new original studies are published.
In Kenya, cervical cancer cases are estimated at 4802 and a mortality of about 2451 annually according to the Kenya Demographic Health Survey . Cancer of the cervix ranks as the first leading cause of female cancer deaths in Kenya among women aged 15 to 44 years, at 3.2% far from the expected 70% coverage despite a previous preventive strategic plan in place . By the year 2012 there were approximately 10 to 15 new cases of cervical cancer in Nairobi each week according to the Kenya Cancer Registry . Thus, it’s evident that if no inter- ventions are put in place the disease will claim more lives than estimated in years to come. With the newcancer prevention strategic plan being rolled out by Ministry of Health (MOH), its success will be based on identifying and ad- dressing the challenges experienced in the previous programs . The devel- opment of cervical cancer takes some time with the cells developing into pre- cancerous cells before progressing to true invasive cancer. If women access screeningservices at the stage of precancerous stage, then the progression of the disease can be arrested with a good prognosis since this stage of cervical cancer is curable. One of the most associated causes of cervical cancer development is the Human Papilloma Virus (HPV) which contributes to over 50% of all diag- nosed cases .
Univariate sensitivity analyses were performed on each individual cost, probability and utility in order to explore the effect that variation in model parameters can have on the incremental cost-effectiveness of the MRI strategy. Probabilities and utilities were varied over the ranges derived from their 95% confidence intervals. Variations in costs were based on estimated minimums and maximums from Medicare reimbursement data for hospital, physi- cian, and laboratory services according to the methodol- ogy described in recently published work . Costs for drugs were varied according to the minimum and maxi- mum medication costs from the FSS. Both low and high incremental cost-effectiveness ratios (ICERs) were recorded in univariate analyses and parameters were var- ied across their distributions in probabilistic sensitivity analyses. Net health benefit assessments were performed using a $50,000/QALY willingness-to-pay threshold and alternative threshold values were examined. The values of individual model parameters above or below which MRI became cost-effective were recorded as thresholds. In addition to the univariate sensitivity analyses, a probabil- istic sensitivity analysis was performed with 10,000 Monte Carlo simulations to assess the robustness of the findings in the base case. Confidence ranges for the incre- mental cost and effectiveness of both screening strategies were recorded. Normal distributions were used with base The Markov model
(Williams and Calnan, 1996; Griffiths, 1999a; Roberts, 2002). Cancer is one of the health problems most feared by midlife women (Griffiths, 1995) and many women have personal, embodied experience of breastcancer or know of someone who has experienced breastcancer. This is borne out in the prevalence rates: one in nine women in the UK will develop it at some point in their lives (Office of National Statistics, 2005). In addition, breastcancer has a high public profile – it is four times more likely to be headline news than any other cancer (Saywell cited in Gibbon, 2007: 2). Women actively participate in screening and even demand services. In the 1970s, the women’s health movement largely advocated self-help in place of institutionalized medicine that was seen as paternalistic and disempowering, but by the 1980s some women’s groups were advocating mammography and campaigning for more services (Fitzpatrick, 2006). The 1990s saw the growth of preventative health campaigns around the disease in the UK, alongside a culture of disease-specific activism, promoting mammography and breast awareness (Gibbon, 2007). However, criticism continues from some women’s groups, particularly in relation to the high level of corporate involvement in breast awareness campaigns and the lack of attention to environmental factors in causing breastcancer (Ehrenreich, 2001; Potts, 2004). It can also be argued that liberal models of choice in relation to medical decision making are flawed due to a lack of attention to the workings of power, the inherent uncertainties in medical knowledge, and the almost impossible complexity of factors relating to health (Roberts, 2007: 146). Evidence about the causes of most breastcancer is insufficient to calculate an individual’s risk.
The multifaceted nature of our intervention was both a strength and a limitation. We used multiple evidence- based strategies at the same time to try and increase our screening rates which may have made our intervention more successful. However, it also means that we were not able to assess the relative contribution of each method in increasing cancerscreening rates. It is notable, however, that our gains in cancerscreening were main- tained during a period where we welcomed an add- itional 5,000 new patients to our practice, many of whom had not previously had a family doctor. Others have also found that multifaceted interventions in primary care are a promising approach to improving screening rates. 9 11 Our intervention was also dependent on information we received via the provincial cancerscreening registry but other aspects of our intervention are still generalizable to practices in other jurisdictions that can generate lists of overdue patients from their EMR.
both in developed and developing countries. Most women present with breastcancer at advanced stages when little treatment benefit can be derived. Kenyans aged 18 years and above are at risk of developing breastcancer. Seventy to eighty percent of cancer cases in the country are screened at later stages due to a lack of awareness, inadequate diagnostic facilities, lack of treatment facilities, high cost of treatment and high poverty index. Early detection and screening as cornerstones for breastcancer control play a pivotal role in reducing related mortalities. At Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kisumu, the number screened for breastcancer is actually low (averagely 4-5 patients on monthly basis).This cross sectional study assessed knowledge, attitude and practices of female outpatients on breastcancerscreening hence will induce appropriate interventions e.g. education and correct practice. From the targeted population, systematic random sampling was used to select female outpatients aged 18 to 65 years seeking medical services at JOOTRH. Data was collected using structured questionnaires and then analyzed by SPSS. Seventy five point nine percent of the study population had knowledge on breastcancerscreening but very few were seeking screening. Fear and preference of health care provider were at 37.9% and 23.5% respectively and this was observed to have affected attitude of study population towards (BCS). Other than BSE at 69.1%, the rest screening methods were poorly practiced due to lack of knowledge. Association between knowledge and attitude was determined by chi-square. This study found no association between knowledge and attitude among the respondents on breastcancerscreening (p>0.05). The study recommends that health care providers should employ provider initiated breastcancerscreening, carry out mobile out reaches to sensitize and attend to more women, create awareness in the community on breastcancerscreening and counselors to be trained on breastcancerscreening so as to screen and provide psychological support to the presumed breastcancer cases.
Informing women about their breast density is feasible and would be valued by some BreastScreen clients to help understand the accuracy of their screening test. However, without agreed protocols for screening women with dense breasts, increases in supplemental screening as observed in other settings would, in Australia, shift screening costs to clients and Medicare. This would reduce equity of access to population screening, and maintaining BreastScreen’s usual standard of monitoring and quality management (such as screen-detected and interval cancer diagnoses, and imaging and biopsy rates) would require data linkage between BreastScreen and other services.
Diekmann et al  evaluated the diagnostic benefits of CEDM over conventional mammography. They found an increase in sensitivity from 0.43 to 0.62 on using CEDM, and also observed better sensitivity in the case of dense tissues. This is a potentially useful benefit as it is known that conventional mammography is not very sensitive in detecting cancer in dense breast tissues. . Two basic CEDM techniques are under development: temporal subtraction and dual-energy techniques. Temporal subtraction CEDM imaging produces high-energy digital mammography images and subtraction of pre-contrast from the post-contrast images. Dual-energy subtraction imaging exploits the energy dependence of X-ray attenuation through materials of different compositions in the breast, specifically iodine and soft tissues. A pair of low- and high-energy images is obtained after contrast and then the two images are combined to enhance areas of contrast uptake. This newbreast imaging method can be easily implemented clinically using a current digital mammography system with minor adaptations and commercially available iodinated contrast agent. Initial clinical experience has shown the ability of CEDM to map the distribution of neo-vasculature induced by cancer using mammography.
A large proportion of respondents in this study agreed that having a mammogram is painful and this would deter them so as to avoid pain. A review of low and middle income countries revealed that fear of a painful mammogram would bar women from seeking screeningservices (17). Similarly, a study from Nigeria (35) also found that 50% of the respondents thought that mammography was harmful. The findings of this study were inconsistent with those of a study carried out in Jordan (2) where majority of the respondents were undecided on whether mammography was painful. In our study, majority of the respondents agreed that performing a self-breast examination would cause them to worry about breastcancer. This might explain why out of the 18 respondents only 3 respondents examined themselves monthly with most of the respondents examining themselves after long intervals of time (27). Health education should thus include information that lessens worries and fear towards the various screening modalities (2).
Community Health Services Division administers Breast and Cervical CancerServices (BCCS), which provides statewide breast and cervical cancerscreening and diagnostic services to low-income women who do not have other sources of payment for these services. Additional services may include case management, technical assistance and training for contractors, information and education activities for the public and contractors, and surveillance and evaluation of the BCCS program. Reducing mortality from breast and cervical cancer is the primary purpose of the program.
MAIN FINDINGS Respondents indicated that the screening age groups, the age for beginning clinical breast examination, and the instructions to patients about breast self-examination should be harmonized. Letters to patients should be shortened, simplified, and endorsed by physicians. Screening mammography reports should include more details and be clearer about patient follow-up. The need for patients to sign authorization forms for transmission of information related to their participation in the QBCSP should be reinforced by their physicians. Following abnormal mammogram results, services and procedures should be simplified and delays in appointments decreased. Referral for “orphan patients” (ie, patients without family physicians) should be supervised by nurse
Abstract Early detection of breastcancer is desirable to prevent progression to advanced disease. This subject has been one of significant study and debate for women at normal risk, and recommendations continue to evolve. However, with regard to women at high risk, the recommendations from various health care professional organizations, including the U.S. Preventive Services Task Force, are different and also inconsistent concerning when to begin screening and which modalities should be used. We review several randomized controlled trials and consensus opinions regarding when to begin screening for breastcancer and how to best screen women at high risk. Specifically, we address women with known personal history of breastcancer, prior mantle radiation or specific family history (including genetic family history) of breastcancer. The purpose of this inquiry is to present current evidence and suggest a clinical pathway regarding the screening of women at high risk for breastcancer. (J Patient-Centered Res Rev. 2015;2:38-42.)
Thus, the quest to get policy to respond to research is not new and researchers have often seen it as their moral duty and their historically ordained role to harangue reluctant governments into action. Seen in this light, the roles played by public health researchers in the case studies that follow will come as no surprise. The capacity of the ‘two communities’ theory to cope with this feisty view of the role of the researcher is limited. This is not to say that there is consensus among public health researchers on the matter of advocacy. There are some public health researchers who eschew policy activism and think that they should stick to science (Samet 2000). In the case of Needle and Syringe Programs for example, Moss regrets the implications for the perceived independence of epidemiology occasioned by epidemiologists engaging in ‘moral crusades’ (Moss 2000a). Des Jarlais disagrees with him, arguing that when lives are at stake, research and advocacy are inseparable (Des Jarlais 2000). Those coming from the perspective of the critical social sciences, particularly feminist researchers, are willing to join epidemiologists in advocacy on behalf of disempowered groups (Lawless, Kippax et al. 1996; Waterston 1997).
With regard to breastcancer patients, radiation therapy after breast-conserving surgery is the standard of care for the majority, because radiation significantly reduces breastcancer recurrence (Early BreastCancer Trialists' Collaborative Group, 2011). Nevertheless, many women will forego radiation from “fearing the unknown,” “getting burnt,” “damaging internal parts,” and “anticipating tiredness” (Halkett et al., 2008).Fear of radiation may impact QoL both during and after, may decrease compliance with treatment and, ultimately, may add up the chances of having cancer recurrence (Early BreastCancer Trial ists' Collaborative Group, 2011; Badakhshi et al., 2013).The study found that there was a significant difference between the quality of cancer patients and radiotherapy. This is in agreement with a study with a 15-year follow-up period which demonstrated that women treated with surgery and radiation had very high QoL (Freedman et al., 2010).
Published data of the HIP trial provide clues about the non-screening factors implicated in this trial. The fatality of breastcancer patients with none or with one or more positive lymph nodes was 27% lower in the screening than in the control group (Table 2) . In the 1960s, no efficient chemotherapeutic adjuvant or therapeutic regimen existed, and the HIP cause of death committee was totally blinded as to the randomization status of women . The more plausible explanation for the lower fatality proceeds from data showing first that although women who did not participate to screening represented 35% of women in the screening group, only 25% (i.e., 74/299) of breast cases and 29% (i.e., 28/96) of breastcancer deaths occurred in these non-participants (S2 Table). Second that the breastcancer fatality in women invited to screening but who did not attend screening was lower than the fatality of interval cancers and of cancers in the control group (S2 Table). These data in non-partici- pants are clearly anomalous. In the Two-County trial, 27% of breastcancer deaths occurred in the 15% of women who did not participate to screening  and an abundant literature documents that breast cancers diagnosed in women not attending screening are more advanced and have a fatality rate 1.5 to 2 times greater than that of interval cancers or of can- cers in control women [24, 35–39]. Investigations of characteristics of women included in the HIP trial revealed that the tracing of women who refused screening had been arduous, which may have led to information gaps on cancer occurrence and causes of death for many of these women . So, the breastcancer mortality reduction in the HIP trial was most proba- bly due to the failure to register a substantial number of breastcancer deaths in non- participants.
introduced: “the establishment of Māori health care provider services and the development of cultural safety education” (Ellison-Loschmann & Pearce, 2006, p. 614). Fundamental approaches and philosophies that strengthen Māori-led primary healthcare include the use of Māori models of health, such as the ‘Te Whare Tapa Wha’ or ‘Te Wheke’ models of health, and the “promotion of positive Māori development” (p.614). Strategies used to help combat recognised access issues to appropriate services by these providers include the utilisation of mobile services, community and/or Marae-based clinics, provision of free or low-cost healthcare and care provided primarily by Māori clinicians (Durie, 2003; Ellison-Loschmann & Pearce; Jeffreys et al., 2005). This is successfully evidenced in one Māori-led organisation, the Korowai Aroha Health Centre in Rotorua, who is committed to providing culturally, appropriate nursing care to the region’s Māori population (Hand, 1998). Fully provided by Māori for Māori, this organisation continues to thrive and support equitable access to appropriate services for Māori. Literature (Ellison-Loschmann & Pearce; Hand) supports Māori healthcare providers have made an enormous impact on the overall health status of Māori, and without Māori participation poorer healthcare outcomes may be worse than they are. Nonetheless, Durie (2003) argues provision of healthcare that combines the conventional, westernised mainstream service with Māori-led services can exist in unison providing the appropriate service is the most beneficial in achieving individual needs.
Rupture- This is the development of a split or a hole in the silicone shell of a breast implant. Rupture does not necessarily create a medical problem; different fillers will react differently. In the majority of cases of silicone gel filled implants, the silicone gel will remain within the capsule that the body forms and can be removed if the ruptured implant is removed. Occasionally, the silicone can spread outside the capsule into the breast and create a series of lumps known as siliconomas. These may give rise to local symptoms such as tenderness. In a small number of cases the gel has been found in the breast tissue, the muscles under the breast, the armpit or (rarely) in the nerves into the arms. Breast tissue (if present) may be lost when implants are removed. If any symptoms such as excessive pain, burning sensation, lumps or aching occurs and cause concern, it is advisable to contact your surgeon or ask your GP to refer you.