oalib
Search Results: 1 - 10 of 100 matches for " "
All listed articles are free for downloading (OA Articles)
Page 1 /100
Display every page Item
Introduction of organised mammography screening in Tyrol: results following first year of complete rollout
Willi Oberaigner, Martin Daniaux, Sabine Geiger-Gritsch, Rudolf Knapp, Uwe Siebert, Wolfgang Buchberger
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-673
Abstract: Working from the results of the pilot phase, we extended the organised mammography system to all counties in Tyrol. All women living in Tyrol and covered by compulsory social insurance were invited for a mammography, in the age group 40-59 annually and in the age group 60-69 biennially. Screening mammography was offered mainly by radiologists in private practice, with further assessment performed at hospitals. Using the screening database, all well-established performance indicators were analysed and compared with accepted/desired levels as per the EU guidelines.From June 2008 to May 2009, 120,440 women were invited. Per 1000 mammograms, 14 women were recalled for further assessment, nine underwent biopsy and four cancer cases were detected. Of invasive breast cancer cases, 32.3% and 68.4% were ≤ 10 mm and ≤ 15 mm in size, respectively, and 79.2% were node-negative. The positive predictive value for further assessment and for biopsy was 25.9% and 39.9%, respectively. Estimated two-year participation rate was 57.0%. In total, 14 interval cancer cases were detected during one year of follow-up; this is 18.4% of the background incidence rate.In Tyrol, Austria, an organised mammography screening program was implemented in a smooth transition from an existing spontaneous screening system and was completely rolled out within a short time. The high level of performance already seen in the pilot phase was maintained after rollout, and improvements resulting from the pilot phase were affirmed after one year of complete rollout.Breast cancer is the leading cause of female cancer death in all industrialised countries (and also worldwide), and the breast is also the leading incident cancer site for females [1]. Therefore, screening methods for breast cancer are of greatest public health importance. A recently published Cochrane Review, which assessed the effect of mammography screening for breast cancer on mortality and morbidity concluded that screening is likely to reduce bre
Breast cancer incidence and mortality in Tyrol/Austria after fifteen years of opportunistic mammography screening
Willi Oberaigner, Wolfgang Buchberger, Thomas Frede, Rudolf Knapp, Christian Marth, Uwe Siebert
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-86
Abstract: To study time trends in breast cancer incidence and mortality, we applied the age-period-cohort model by Poisson regression to the official mortality data covering more than three decades from 1970 to 2006 and to the incidence data ranging from 1988 to 2006. In addition, for incidence data we analysed data on breast cancer staging and compared these with EU guidelines.For the analysis of time trend in breast cancer mortality in age groups 40-79, an age-period-cohort model fits well and shows for years 2002-2006 a statistically significant reduction of 26% (95% CI 13%-36%) in breast cancer mortality as compared to 1992-1996.We see only slight non-significant increases in breast cancer incidence. For the past five years, incidence data show a 10% proportion of in situ cases, and of 50% for cases in stages II+.The opportunistic breast cancer screening programme in Tyrol has only in part exploited the mortality reduction known for organised screening programmes. There seems to be potential for further improvement, and we recommend that an organised screening programme and a detailed screening database be introduced to collect all information needed to analyse the quality indicators suggested by the EU guidelines.Breast cancer (BC) is the leading cause of female cancer death in all industrialised countries (and also worldwide) and the breast is also the leading incident cancer site for females [1]. Therefore, screening methods for BC are of greatest public health importance. Efficiency and efficacy of organised mammography screening programmes have been proven in large randomised trials conducted in Europe and North America. For several years already, organised mammography screening programmes have been recommended in the EU[2]. Austria is one of the European countries where up to 2006 no organised programmes were implemented, but where coverage in spontaneous mammography screening could have been rather high. In a micro-census conducted in Austria in 2006-2007, more tha
Should breast cancer survivors be excluded from, or invited to, organised mammography screening programmes?
Lauro Bucchi
BMC Health Services Research , 2011, DOI: 10.1186/1472-6963-11-249
Abstract: Problems with mammographic surveillance of breast cancer survivors include: weak evidence of a reduction in mortality; lack of evidence in favour of one setting or the other; lack of evidence-based guidelines for the frequency and duration of surveillance; disproportionate emphasis placed on the first few years post-treatment, probably dictated by surgical and oncological priorities; a variety of screening policies, as these women are permanently or temporarily or partially excluded from many - but not all - organised screening programmes worldwide; an even greater disparity in follow-up protocols used in the clinical setting; a paucity of data on compliance to mammographic surveillance in both settings; and a difficulty in coordinating the roles of health care providers. In the future, the use of mammography in breast cancer survivors will be influenced by the inclusion of women aged > 69 years in organised screening programmes and the implementation of multidisciplinary breast units, and will probably be investigated by research activities on individual risk assessment and risk-tailored screening. In the interim, current problems can be partially alleviated with some technical solutions in screening data recording, patient flows, and care coordination.Mammographic surveillance of breast cancer survivors is situated at the crossroads of numerous different specialist areas of breast cancer control and management. The solutions for current problems probably lie in some important modifications in the conventional screening procedure that are underway or under study. These developments appear to be directed towards a partial modification of the screening rationale, with an adaptation to meet the diversified breast care needs of women. The complexity of the matter constitutes a call to action for several entities to eliminate the barriers to effective research in this field.The prevalence of breast cancer (BC) in developed countries has steadily increased over recent de
Overdiagnosis in organised mammography screening in Denmark. A comparative study
Karsten J J?rgensen, Per-Henrik Zahl, Peter C G?tzsche
BMC Women's Health , 2009, DOI: 10.1186/1472-6874-9-36
Abstract: We collected incidence rates of carcinoma in situ and invasive breast cancer in areas with and without screening over 13 years with screening (1991-2003), and 20 years before its introduction (1971-1990). We explored the incidence increase comparing unadjusted incidence rates and used Poisson regression analysis to compensate for the background incidence trend, variation in age distribution and geographical variation in incidence.For the screened age group, 50 to 69 years, we found an overdiagnosis of 35% when we compared unadjusted incidence rates for the screened and non-screened areas, but after compensating for a small decline in incidence in older, previously screened women. Our adjusted Poisson regression analysis indicated a relative risk of 1.40 (95% CI: 1.35-1.45) for the whole screening period, and a potential compensatory drop in older women of 0.90 (95% CI: 0.88-0.96), yielding an overdiagnosis of 33%, which we consider the most reliable estimate. The drop in previously screened women was only present in one of the two screened regions and was small in absolute numbers.One in four breast cancers diagnosed in the screened age group in the Danish screening programme is overdiagnosed. Our estimate for Denmark is lower than that for comparable countries, likely because of lower uptake, lower recall rates and lower detection rates of carcinoma in situ.Overdiagnosis in cancer screening is defined as the detection of cancers that would otherwise not have been detected in the remaining life-span of the individuals [1]. It is mainly caused by the detection of slow-growing cancers that do not manifest clinically before people die from other causes [2], but may also be due to identification of borderline malignancies, or cancers that were bound to regress [3,4].Overdiagnosis is arguably the most important harm of screening, as healthy people are being diagnosed with and treated for cancer unnecessarily, which carries great personal costs, both physically and psycho
Performance data of screening mammography at a dedicated breast health centre
JP Apffelstaedt
South African Medical Journal , 2008,
Abstract: Background. Mammographic screening has become part of routine health care. We present a first analysis of screening mammography in a dedicated breast health centre in Africa. Objective. To establish a performance benchmark and provide data for health care policy and funding decisions on screening mammography. Method. All mammography performed between January 2003 and August 2008 was entered into a prospective database. Mammography was performed exclusively by certified mammographers and double-read by experienced readers. Results. Outcomes were classified in a simplified classification system based on the Breast Imaging Reporting and Data System (BIRADS). In 40 - 49-year-old women, 3 192 mammograms led to a recall rate of 4.7%, a biopsy rate of 1.9% and a cancer diagnosis rate of 3.8 per 1 000 examinations; for women of 50 years and older, the corresponding figures were 4 446, 5.4%, 2.6% and 9.7 per 1 000. Of the cancers detected, 31% were in situ and, of the invasive cancers, 81% were node-negative. These figures were established by a dedicated surgeon-led team and fall within the range expected in organised screening programmes in resource-rich environments, providing a first benchmark for screening mammography in Africa. South African Medical Journal Vol. 98 (12) 2008: pp. 950-953
Breast cancer screening in the Czech Republic: time trends in performance indicators during the first seven years of the organised programme
Ondrej Majek, Jan Danes, Miroslava Skovajsova, Helena Bartonkova, Lucie Buresova, Daniel Klimes, Petr Brabec, Pavel Kozeny, Ladislav Dusek
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-288
Abstract: The CBCSP is monitored using an information system consisting of three principal components: 1) the national cancer registry, 2) a screening registry collecting data on all screening examinations, further assessments and final diagnoses at accredited programme centres, and 3) administrative databases of healthcare payers. Key performance indicators from the European Guidelines have been adopted for continuous monitoring.Breast cancer incidence in the Czech Republic has steadily been increasing, however with a growing proportion of less advanced stages. The mortality rate has recently stabilised. The screening registry includes 2,083,285 records on screening episodes between 2002 and 2008. In 2007-2008, 51% of eligible women aged 45-69 were screened. In 2008, the detection rates were 6.1 and 3.7 per 1,000 women in initial and subsequent screening respectively. Corresponding recall rates are 3.9% and 2.2%, however, it is necessary to pay attention to further assessment performed during the screening visits. Benign to malignant open biopsy ratio was 0.1. Of invasive cases detected in screening, 35.6% was less than 10 mm in diameter. Values of early performance indicators, as measured by both crude and standardized estimates, are generally improving and fulfil desirable targets set by European Guidelines.Mammography screening in the Czech Republic underwent successful transformation from opportunistic prevention to an organised programme. Values of early indicators confirm continuous improvement in different aspects of process quality. Further stimulation of participation through invitation system is necessary to exploit the full potential of screening mammography at the population level.Breast cancer is the most frequent malignant neoplasm in women worldwide [1]. In the past, its incidence and mortality in Central and Eastern European countries were significantly lower than in Western Europe. Yet recent changes in reproductive behaviour of women accompanied by signific
Mammography stages of change in middle-aged women with schizophrenia: An exploratory analysis
Laurie A Lindamer, Emily Wear, Georgia Sadler
BMC Psychiatry , 2006, DOI: 10.1186/1471-244x-6-49
Abstract: This study tested the hypothesis that women with schizophrenia adhere to mammography screening guidelines at the same rate as other same-age women. The study also investigated the validity of the Health Belief (HB) and Stages of Change (SOC) models for breast cancer screening among women with schizophrenia.Socio-demographic and clinical variables, as well as knowledge, attitudes, and barriers were assessed as a function of stage of change related to breast cancer screening in 46 women with schizophrenia.Women with schizophrenia were statistically less likely to be adherent to the screening recommendations than those without schizophrenia. Some support was found for the validity of the HB and SOC models for breast cancer screening in women with schizophrenia. Women in the Precontemplation stage had significantly higher negative attitude scores compared to Contemplation and Action/Maintenance stages (59.7, 45.7, and 43.2, respectively), and there was a trend for more barriers in the Precontemplation group (4.6, 2.6, 2.7 respectively).Given the small sample size, further research on the rates of breast cancer screening in women with schizophrenia is warranted. Nonetheless, these data suggest that providers who care for women with schizophrenia may need to make take additional measures to ensure that this population receives appropriate screening so as to not put them at greater risk for a late-stage diagnosis of breast cancer. Furthermore, these pilot data suggest that HB and SOC theory-based interventions may be valid for increasing mammography rates in women with schizophrenia.In the last decade, the overall incidence of breast cancer has remained stable, while mortality has decreased [1]. Some, but not all, studies showed that rates of late-stage diagnoses have decreased [2-5]. At least a portion of the success in reducing breast cancer-related morbidity and mortality can be attributed to the early detection afforded by regular use of screening mammography among wom
Organised Behaviour and Organised Identity  [PDF]
Vincenzo Ruggiero
Beijing Law Review (BLR) , 2010, DOI: 10.4236/blr.2010.11003
Abstract: There is growing body of literature which offers reviews of the concepts of organised crime and political vio- lence, while documenting the official efforts to address such concepts jointly and treat them as a single issue. It would be intriguing to investigate how members of organised criminal groups and violent political groups re- spectively react to such official efforts. In my own memory, when the ‘mafiosi’ happened to share a prison in- stitution with members of the Red Brigades, they would steer away from those idealist Communists who got nothing out of killing. The former, when overcoming the disgust they felt in the presence of those who in their eyes adopted an incomprehensible political stance, and perhaps even a despicable sexual lifestyle, would simply suggest: “don’t make revolution, make money, you cretin!”. The latter, in their turn, would deal with the former as one deals with yet a different version of the economic and political power against which they fought. Echoes of this are found in an example coming from Greece itself, where the Courts have attempted to term ‘common’ rather than ‘political’ the offences attributed to the Revolutionary Organisation November 17. The fact that or- ganised crime is guided by material motivations and terrorism by political ones may be seen as irrelevant by of- ficial agencies pursuing the objective of degrading the ‘enemy’ whoever that might be. Therefore, the ceremo- nies of degradation, including the choice of an ad hoc vocabulary, may well serve the task, as the mad, the drug user and the terrorist constitute an undistinguishable mob in the face of which quibbling differences may just obstruct the criminal justice process. The purpose of this paper is to try and clarify a number of issues that we encounter when dealing with organised crime and political violence respectively.
The Diagnostic Accuracy of Digitized Mammography
M. Guiti,A.R. Azizian,N. Riyahi Alam,M. Shakiba
Iranian Journal of Radiology , 2008,
Abstract: Background/Objective: Digitized mammography has several advantages over screen-film radiography in data storage and retrieval, making it a useful alternative to screen-film mammography in screening programs. The purpose of this study was to determine the diagnostic accuracy of digitized mammography in detecting breast cancer. "nPatients and Methods: 185 women (845 Images) were digitized at 600 dpi. All images were reviewed by an expert radiologist. The mammograms were scored on a scale of breast imaging reporting and data system (BIRADS). The definite diagnosis was made either on the pathologic results of breast biopsy, or upon the follow-up of at least one year. The overall diagnostic accuracy of digitized mammography was calculated by the area under receiver operating characteristic curve."nResults: 242 sets of mammograms had no lesions. The total counts of masses, microcalcifications or both in one breast were 39 (11%), 42 (12%), and 25 (7%), respectively. There were 321 (92%) benign and 27 (8%) definite malignant lesions. The diagnostic accuracy of digitized images was 96.34% (95% CI: 94%-98%)."nConclusion: The diagnostic accuracy of digitized mammography is comparably good or even better than the published results. The digitized mammography is a good substitute modality for screen-film mammography in screening programs.
Get screened: a pragmatic randomized controlled trial to increase mammography and colorectal cancer screening in a large, safety net practice
Kevin Fiscella, Amanat Yosha, Samantha K Hendren, Sharon Humiston, Paul Winters, Pat Ford, Starlene Loader, Raymond Specht, Shirley Pope, Amna Adris, Steven Marcus
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-280
Abstract: "Get Screened" is an American Cancer Society-sponsored randomized controlled trial designed to promote mammography and colorectal cancer screening in a primary care practice serving low-income patients. Eligible patients who are past due for mammography or colorectal cancer screening are entered into a tracking registry and randomly assigned to early or delayed intervention. This 6-month intervention is multimodal, involving patient prompts, clinician prompts, and outreach. At the time of the patient visit, eligible patients receive a low-literacy patient education tool. At the same time, clinicians receive a prompt to remind them to order the test and, when appropriate, a tool designed to simplify colorectal cancer screening decision-making. Patient outreach consists of personalized letters, automated telephone reminders, assistance with scheduling, and linkage of uninsured patients to the local National Breast and Cervical Cancer Early Detection program. Interventions are repeated for patients who fail to respond to early interventions. We will compare rates of screening between randomized groups, as well as planned secondary analyses of minority patients and uninsured patients. Data from the pilot phase show that this multimodal intervention triples rates of cancer screening (adjusted odds ratio 3.63; 95% CI 2.35 - 5.61).This study protocol is designed to assess a multimodal approach to promotion of breast and colorectal cancer screening among underserved patients. We hypothesize that a multimodal approach will significantly improve cancer screening rates.The trial was registered at Clinical Trials.gov NCT00818857Poor, underserved-minority, and uninsured patients have lower rates of cancer screening than other Americans. Lower rates of screening contribute to disparities in cancer mortality. For example, African Americans have higher incidence of colorectal cancer (CRC), yet are screened at lower rates. This represents an example of the inverse care law (similar
Page 1 /100
Display every page Item


Home
Copyright © 2008-2017 Open Access Library. All rights reserved.