Screening mammography, public perceptions, and medical liability

Screening in Public Health and Clinical Care: Similarities and Differences in Definitions, Types, and Aims - A Systematic Review

INTRODUCTION

The concept of screening can be many times misleading to many people. This may be partly due to the way screening is described and explained in textbooks and journal articles.

AIM

To review prominent public health and epidemiology textbooks, dictionaries, and relevant journal publications for definitions and examples of screening, with the aim of identifying common usages and concepts, as well as sources of potential confusion.

MATERIALS AND METHODS

Commonly available epidemiology and public health textbooks and peer reviewed journals were searched for definitions and examples of screening. The search located seven journal articles, 10 textbooks, and one dictionary. The search platforms used were Pubmed, BIOSIS, EMBASE, Medline-OVID and Scopus under the Epidemiology and Biostatics subject head listed with Life Sciences.

RESULTS

Descriptions of screening give varying emphasis to whether it is a test or a program, the aims of screening, the setting in which it is conducted, eligibility criteria, who initiates and who is intended to benefit and whether the condition being screened is an infectious or chronic disease or a risk-elevated state. Four essentially different 'types' of screening are described, using seven terms and occasionally contradictory examples. The detection of asymptomatic infectious cases is gradually changing from screening to surveillance as part of infection control.

CONCLUSION

Voluntary screening programs rely on high participation to be effective and support and trust of the public are essential for the continued success of the public health profession. Consistent terminology is important for patients, providers and policymakers to understand what screening is and is not. Clear definitions are needed if we are to evaluate and communicate the risks and benefits of screening in public health.

Breast cancer screening in England and the United States: a comparison of provision and utilisation

OBJECTIVES

Comparing breast cancer screening across countries within the context of some of the benefits and harms offers the opportunity to improve effectiveness through mutual learning.

METHODS

This paper describes the provision of breast cancer screening in England and the United States. The various recommendations for accessing breast cancer screening in the two countries are set out and the organisation of services including quality assurance, incentives and performance mechanisms considered.

RESULTS

In the United States, younger women are routinely screened; they are less likely to benefit and more likely to be harmed. The utilisation of breast cancer screening amongst eligible women is broadly comparable in the two countries. However, there are differences in technical performance; the reasons for these including radiological reading procedures and cultural factors are explored.

CONCLUSIONS

Despite a well-functioning screening programme, breast cancer mortality and survival in England are poor relative to other countries. Emphasis for American improvement should be on reducing false-positive recall rates, while the English NHS could supplement existing efforts to understand and improve comparatively poor survival and mortality.

Autoantibodies to tailor-made panels of tumor-associated antigens in breast carcinoma

Autoantibodies (AAbs) to tumor-associated antigens (TAAs) have been identified in the sera of cancer patients. In a previous review published in this journal, we have focused on recent knowledge related to circulating AAbs to individual TAAs in breast carcinoma. This review will focus on recent knowledge related to AAb assays to tailor-made panels of TAAs in breast carcinoma. So far, AAb assays to the following tailor-made panels of TAAs have been assessed in breast carcinoma: (1) p53, c-myc, HER2, NY-ESO-1, BRCA2, and MUC1, (2) IMP1, p62, Koc, p53, c-MYC, cyclin B1, and survivin, (3) PPIA, PRDX2, FKBP52, HSP-60, and MUC1, (4) MUC1, HER2, p53, and IGFBP2, (5) p53, HER2, IGFBP-2, and TOPO2α, (6) survivin and livin, (7) ASB-9, SERAC1, and RELT, and (8) p16, p53, and c-myc. Assessment of serum AAbs to a tailor-made panel of TAAs provides better sensitivity to diagnosis of breast carcinoma than measuring serum AAbs to a single TAA. Nevertheless, measurement of serum AAbs to a panel of TAAs for screening and early diagnosis of breast carcinoma is still investigational and should be carried out along with traditional diagnostic studies.

Autoantibodies to tumor-associated antigens in breast carcinoma

Autoantibodies (AAbs) to tumor-associated antigens (TAAs) have been identified in the circulation of patients with cancer. This paper will focus on recent knowledge related to circulating AAbs to TAAs in breast carcinoma. So far, the following TAAs have been identified to elicit circulating AAbs in breast carcinoma: p53, MUC-1, heat shock proteins (HSP-27, HSP-60, and HSP-90), HER2/neu/c-erb B2, GIPC-1, c-myc, c-myb, cancer-testis antigens (NY-ESO-1), BRCA1, BRCA2, endostatin, lipophilin B, cyclin B1, cyclin D1, fibulin, insulin-like growth factor binding protein 2 (IGFBP-2), topoisomerase II alpha (TOPO2α), and cathepsin D. Measurement of serum AAbs to one specific TAA only is of little value for screening and early diagnosis of breast carcinoma; however, assessment of AAbs to a panel of TAAs may have promising diagnostic potential.