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The Role of Effective Communication to Enhance Participation in Screening Mammography: A New Zealand Case  [PDF]
Margaret A. Brunton
International Journal of Environmental Research and Public Health , 2009, DOI: 10.3390/ijerph6020844
Abstract: Changes in the organisation of health care have dominated policy initiatives over the past two decades in many countries. An increasing reliance on public health initiatives to prevent or detect disease early has resulted in an increase in programs that screen for cancer in the community. In turn, this accentuates the need to persuasively communicate the value of such initiatives to encourage continued participation. Merely placing screening programs into a community setting is not sufficient to ensure that adequate numbers will voluntarily participate regularly to achieve anticipated cost and mortality savings in the population. In this research the influence of managing communication in a public screening mammography program was investigated. The results revealed that significant opportunities were overlooked for reassurance and information during the physical mammography process. In turn, this highlights the influence of constraints imposed by the structure of the screening program and the resources allocated to the process. This research suggests that it is important to address multiple influences, including ethnic differences, when asking questions about the effectiveness of public health policy, particularly when considering the choices women make about ongoing participation in breast screening programs.
Physical and technical aspects of quality assurance in mammography in the Republic of Srpska  [PDF]
Ciraj-Bjelac Olivera F.,Praskalo Jovica ?.,Davidovi? Jasna ?.,?ivkovi? Monika M.
Nuclear Technology and Radiation Protection , 2011, DOI: 10.2298/ntrp1102171c
Abstract: Breast cancer is the most frequent malignant neoplasm affecting the female population. In order to reduce its morbidity and mortality rate, a mammography screening campaign has been established in both entities of Bosnia and Herzegovina. In this paper, a brief survey is given on the mammography screening practice in the Republic of Srpska. As an illustration, results of measurements of technical parameters, including mean glandular dose, for 31 mammography units are presented. Large fluctuations in dose among different measuring sites were found, unacceptable not only from the standpoint of mammography screening, but in clinical mammography as a whole. Subsequently, a series of quality control tests and corrective measures throughout the mammography imaging chain are proposed, in line with international guidelines and newly promulgated national legislation. Dose optimization and image quality improvement are the first and foremost goals to be achieved in order to setup a successful mammography screening program.
Budget Impact Analysis of Switching to Digital Mammography in a Population-Based Breast Cancer Screening Program: A Discrete Event Simulation Model  [PDF]
Mercè Comas, Arantzazu Arrospide, Javier Mar, Maria Sala, Ester Vilaprinyó, Cristina Hernández, Francesc Cots, Juan Martínez, Xavier Castells
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0097459
Abstract: Objective To assess the budgetary impact of switching from screen-film mammography to full-field digital mammography in a population-based breast cancer screening program. Methods A discrete-event simulation model was built to reproduce the breast cancer screening process (biennial mammographic screening of women aged 50 to 69 years) combined with the natural history of breast cancer. The simulation started with 100,000 women and, during a 20-year simulation horizon, new women were dynamically entered according to the aging of the Spanish population. Data on screening were obtained from Spanish breast cancer screening programs. Data on the natural history of breast cancer were based on US data adapted to our population. A budget impact analysis comparing digital with screen-film screening mammography was performed in a sample of 2,000 simulation runs. A sensitivity analysis was performed for crucial screening-related parameters. Distinct scenarios for recall and detection rates were compared. Results Statistically significant savings were found for overall costs, treatment costs and the costs of additional tests in the long term. The overall cost saving was 1,115,857€ (95%CI from 932,147 to 1,299,567) in the 10th year and 2,866,124€ (95%CI from 2,492,610 to 3,239,638) in the 20th year, representing 4.5% and 8.1% of the overall cost associated with screen-film mammography. The sensitivity analysis showed net savings in the long term. Conclusions Switching to digital mammography in a population-based breast cancer screening program saves long-term budget expense, in addition to providing technical advantages. Our results were consistent across distinct scenarios representing the different results obtained in European breast cancer screening programs.
Effects of Population Based Screening for Chlamydia Infections in The Netherlands Limited by Declining Participation Rates  [PDF]
Boris V. Schmid, Eelco A. B. Over, Ingrid V. F. van den Broek, Eline L. M. Op de Coul, Jan E. A. M. van Bergen, Johan S. A. Fennema, Hannelore M. G?tz, Christian J. P. A. Hoebe, G. Ardine de Wit, Marianne A. B. van der Sande, Mirjam E. E. Kretzschmar
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0058674
Abstract: Background A large trial to investigate the effectiveness of population based screening for chlamydia infections was conducted in the Netherlands in 2008–2012. The trial was register based and consisted of four rounds of screening of women and men in the age groups 16–29 years in three regions in the Netherlands. Data were collected on participation rates and positivity rates per round. A modeling study was conducted to project screening effects for various screening strategies into the future. Methods and Findings We used a stochastic network simulation model incorporating partnership formation and dissolution, aging and a sexual life course perspective. Trends in baseline rates of chlamydia testing and treatment were used to describe the epidemiological situation before the start of the screening program. Data on participation rates was used to describe screening uptake in rural and urban areas. Simulations were used to project the effectiveness of screening on chlamydia prevalence for a time period of 10 years. In addition, we tested alternative screening strategies, such as including only women, targeting different age groups, and biennial screening. Screening reduced prevalence by about 1% in the first two screening rounds and leveled off after that. Extrapolating observed participation rates into the future indicated very low participation in the long run. Alternative strategies only marginally changed the effectiveness of screening. Higher participation rates as originally foreseen in the program would have succeeded in reducing chlamydia prevalence to very low levels in the long run. Conclusions Decreasing participation rates over time profoundly impact the effectiveness of population based screening for chlamydia infections. Using data from several consecutive rounds of screening in a simulation model enabled us to assess the future effectiveness of screening on prevalence. If participation rates cannot be kept at a sufficient level, the effectiveness of screening on prevalence will remain limited.
Cost-effectiveness of MRI compared to mammography for breast cancer screening in a high risk population
Susan G Moore, Pareen J Shenoy, Laura Fanucchi, John W Tumeh, Christopher R Flowers
BMC Health Services Research , 2009, DOI: 10.1186/1472-6963-9-9
Abstract: A Markov model was created to compare annual breast cancer screening over 25 years with either breast MRI or mammography among young women at high risk. Data from published studies provided probabilities for the model including sensitivity and specificity of each screening strategy. Costs were based on Medicare reimbursement rates for hospital and physician services while medication costs were obtained from the Federal Supply Scale. Utilities from the literature were applied to each health outcome in the model including a disutility for the temporary health state following breast biopsy for a false positive test result. All costs and benefits were discounted at 5% per year. The analysis was performed from the payer perspective with results reported in 2006 U.S. dollars. Univariate and probabilistic sensitivity analyses addressed uncertainty in all model parameters.Breast MRI provided 14.1 discounted quality-adjusted life-years (QALYs) at a discounted cost of $18,167 while mammography provided 14.0 QALYs at a cost of $4,760 over 25 years of screening. The incremental cost-effectiveness ratio of breast MRI compared to mammography was $179,599/QALY. In univariate analysis, breast MRI screening became < $50,000/QALY when the cost of the MRI was < $315. In the probabilistic sensitivity analysis, MRI screening produced a net health benefit of -0.202 QALYs (95% central range: -0.767 QALYs to +0.439 QALYs) compared to mammography at a willingness-to-pay threshold of $50,000/QALY. Breast MRI screening was superior in 0%, < $50,000/QALY in 22%, > $50,000/QALY in 34%, and inferior in 44% of trials.Although breast MRI may provide health benefits when compared to mammographic screening for some high risk women, it does not appear to be cost-effective even at willingness to pay thresholds above $120,000/QALY.In the United States, one in eight women will be diagnosed with breast cancer during her lifetime [1]. In 2008, an estimated 182,460 cases of breast cancer will occur, accoun
Trends in incidence and detection of advanced breast cancer at biennial screening mammography in The Netherlands: a population based study
Joost Nederend, Lucien EM Duijm, Adri C Voogd, Johanna H Groenewoud, Frits H Jansen, Marieke WJ Louwman
Breast Cancer Research , 2012, DOI: 10.1186/bcr3091
Abstract: We included a consecutive series of 351,009 screening mammograms of 85,274 women aged 50-75 years, who underwent biennial screening at a Dutch breast screening region in the period 1997-2008. Two screening radiologists reviewed the screening mammograms of all advanced screen detected and advanced interval cancers and determined whether the advanced cancer (tumor > 20 mm and/or lymph node positive tumor) had been visible at a previous screen. Interval cancers were breast cancers diagnosed in women after a negative screening examination (defined as no recommendation for referral) and before any subsequent screen. Patient and tumor characteristics were compared between women with advanced cancer and women with non-advanced cancer, including ductal carcinoma in situ.A total of 1,771 screen detected cancers and 669 interval cancers were diagnosed in 2,440 women. Rates of advanced cancer remained stable over the 12-year period; the incidence of advanced screen-detected cancers fluctuated between 1.5 - 1.9 per 1,000 screened women (mean 1.6 per 1,000) and of advanced interval cancers between 0.8 - 1.6 per 1,000 screened women (mean 1.2 per 1,000). Of the 570 advanced screen-detected cancers, 106 (18.6%) were detected at initial screening; 265 (46.5%) cancers detected at subsequent screening had been radiologically occult at the previous screening mammogram, 88 (15.4%) had shown a minimal sign, and 111 (19.5%) had been missed. Corresponding figures for advanced interval cancers were 50.9% (216/424), 24.3% (103/424) and 25.1% (105/424), respectively. At multivariate analysis, women with a ≥ 30 months interval between the latest two screens had an increased risk of screen-detected advanced breast cancer (OR 1.63, 95%CI: 1.07-2.48) and hormone replacement therapy increased the risk of advanced disease among interval cancers (OR 3.04, 95%CI: 1.22-7.53).We observed no decline in the risk of advanced breast cancer during 12 years of biennial screening mammography. The majority of
Role of MR and digital mammography for screening
DD Dershaw
Breast Cancer Research , 2007, DOI: 10.1186/bcr1689
Abstract: Digital mammography images the breast using the identical information obtained in screen-film mammography. The image is processed, stored and displayed electronically. This conveys several advantages over film techniques, but the approval of digital mammography by the US Food and Drug Administration has been based on comparable ability to detect cancer, not any diagnostic advantage.Four prospective studies comparing digital and film mammography on the same patients have shown that for population-based screening there is no advantage for digital over film. The last and largest of these studies [1] initially reported an advantage for several subgroups of women for digital screening. Later analysis of data from this study, however, concluded that only women with dense breasts may benefit and that screening of entire populations with digital mammography is excessively costly and not beneficial.Analysis of MR as a screening tool has been directed at women with greatly elevated lifetime risk of developing breast cancer. The ability of MR to detect a large percentage of cancers in these women earlier than mammography, sonography or physical examination and at a stage at which they should be curable has been clearly demonstrated. This has lead the American Cancer Society, along with others, to recommend the use of MR to annually screen women with at least a 20% lifetime risk of developing breast cancer starting at age 25 years. Those at less risk were not included due to lack of supporting data and concern over excessive biopsies in those women.
Improved breast cancer survival following introduction of an organized mammography screening program among both screened and unscreened women: a population-based cohort study
Mette Kalager, Tor Haldorsen, Michael Bretthauer, Geir Hoff, Steinar O Thoresen, Hans-Olov Adami
Breast Cancer Research , 2009, DOI: 10.1186/bcr2331
Abstract: We constructed three cohorts of breast cancer patients: 1) the pre-program group comprising women diagnosed and treated before mammography screening began in their county of residence, 2) the post-program group comprising women diagnosed and treated through multidisciplinary breast cancer care units in their county but before they had been invited to mammography screening; and 3) the screening group comprising women diagnosed and treated after invitation to screening. We calculated Kaplan-Meier plots and multivariable Cox proportional hazard models.We studied 41,833 women with breast cancer. The nine-year breast cancer-specific survival rate was 0.66 (95%CI: 0.65 to 0.67) in the pre-program group; 0.72 (95%CI: 0.70 to 0.74) in the post-program group; and 0.84 (95%CI: 0.80 to 0.88) in the screening group. In multivariable analyses, the risk of death from breast cancer was 14% lower in the post-program group than in the pre-program group (hazard ratio 0.86; (95%CI: 0.78 to 0.95, P = 0.003)).After nine years follow-up, at least 33% of the improved survival is attributable to improved breast cancer management through multidisciplinary medical care.In many Western countries, breast cancer incidence is increasing, while mortality rates remain stable or are decreasing [1]. In the US, incidence rose slightly between 1987 and 2001 and then stabilized, with some evidence of decline through 2003. In contrast, death rates from breast cancer have been falling since 1990 [2]. Two obvious factors have contributed to this success: widespread use of systemic adjuvant treatment [3-5] and earlier diagnosis due to mammography screening [6,7]. The relative contributions of these factors are likely to differ between settings, population subgroups, and time periods. However, attempts to quantify them through statistical modelling suggest that in the US, adjuvants and mammography each contribute about half to the mortality reduction [8]. A Swedish study found about an 18% reduction in mort
Recall Rate in Screening Mammography, What is Optimal?
Maryam Moradi
Iranian Journal of Radiology , 2010,
Abstract: Recall rate is defined as the percentage of screening mammography for which further work up is recommended. As the recall rate increases, sensivity is increased but specificity and positive predictive value are decreased. It is a trade off between sensivity and specificity."nIndeed in all the women recalled, a very few cancer patients were diagnosed at the expence of an increased number of procedures for a large population of the non-cancerous group and the associated cost, time and anxiety."nThe purpose of this presentation is to review the main criteria for measured performance of screening mammography, the role of recall rate as a surrogate measure and discussing the target or optimal recall rate.
Level of awareness of mammography among women attending outpatient clinics in a teaching hospital in Ibadan, South-West Nigeria
Millicent O Obajimi, Ikeoluwapo O Ajayi, Abideen O Oluwasola, Babatunde O Adedokun, Adenike T Adeniji-Sofoluwe, Olushola A Mosuro, Titilola S Akingbola, Oku S Bassey, Eric Umeh, Temitope O Soyemi, Folasade Adegoke, Idiat Ogungbade, Chinwe Ukaigwe, Olufunmilayo I Olopade
BMC Public Health , 2013, DOI: 10.1186/1471-2458-13-40
Abstract: We conducted a hospital based cross sectional study to investigate the level of awareness of mammography among 818 randomly selected women attending the General Outpatient clinics (GOP) of the University College Hospital (UCH), Ibadan, Nigeria. Independent predictors of level of awareness of mammography were identified using multiple logistic regression analysis.The proportion of women who ever heard of mammography was 5%, and they demonstrated poor knowledge of the procedure. Those with primary or secondary levels of education were about three times less likely to be aware of mammography when compared with those with tertiary level of education ( OR = 0.3, 95% CI, 0.12 -- 0.73). Also, participation in community breast cancer prevention activities (OR = 3.4, 95% CI, 1.39 -- 8.36), and previous clinical breast examination (OR = 2.34, 95% CI, 1.10 -- 4.96) independently predicted mammography awareness. Newspapers and magazines appeared to be the most important sources of information about mammography screening.The level of awareness of mammography is poor among women attending outpatient clinics in the studied population. Interventions promoting awareness of this screening procedure should give particular attention to the illiterate and older women while clinicians performing breast examinations should utilize the opportunity to inform women about the mammography procedure. Promotion of educational articles on breast cancer and its screening methods via media remains vital for the literate.

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