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Tejada-Tayabas LM, Salcedo LA, Espino JM. Medical therapeutic itineraries of women with breast cancer diagnosis affiliated to the People's Health Insurance in San Luis Potosí, central Mexico. CAD SAUDE PUBLICA 2015; 31:60-70. [PMID: 25715292 DOI: 10.1590/0102-311x00009114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 08/29/2014] [Indexed: 11/22/2022] Open
Abstract
This study aims to describe the medical itineraries followed by breast cancer women affiliated to the People's Health Insurance in San Luis Potosí, central Mexico. We used an ethnographic approach based on oral histories of 12 women diagnosed with breast cancer in the year prior to the first meeting. Two face-to-face sessions per participant lasting 60 minutes each were conducted followed by a telephone interview. Content and diachronic analyses were used. Three main itineraries were identified: (1) diagnostic process, (2) final diagnosis to treatment, and (3) cancer control and relapse. Findings suggested that infrastructure and human resources to adequately screen and timely diagnose breast cancer were scant and insufficiently trained, respectively. Deferral of medical assessment was related with lack of information about breast cancer consequences, with women being afraid of a positive result, and with economic constraints. The current screening program needs to be redesigned to prevent diagnostic delays, as these seem to explain the high frequency of advanced stages reported at the time of diagnosis.
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Torres-Mejía G, Smith RA, Carranza-Flores MDLL, Bogart A, Martínez-Matsushita L, Miglioretti DL, Kerlikowske K, Ortega-Olvera C, Montemayor-Varela E, Angeles-Llerenas A, Bautista-Arredondo S, Sánchez-González G, Martínez-Montañez OG, Uscanga-Sánchez SR, Lazcano-Ponce E, Hernández-Ávila M. Radiographers supporting radiologists in the interpretation of screening mammography: a viable strategy to meet the shortage in the number of radiologists. BMC Cancer 2015; 15:410. [PMID: 25975383 PMCID: PMC4436872 DOI: 10.1186/s12885-015-1399-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 04/29/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An alternative approach to the traditional model of radiologists interpreting screening mammography is necessary due to the shortage of radiologists to interpret screening mammograms in many countries. METHODS We evaluated the performance of 15 Mexican radiographers, also known as radiologic technologists, in the interpretation of screening mammography after a 6 months training period in a screening setting. Fifteen radiographers received 6 months standardized training with radiologists in the interpretation of screening mammography using the Breast Imaging Reporting and Data System (BI-RADS) system. A challenging test set of 110 cases developed by the Breast Cancer Surveillance Consortium was used to evaluate their performance. We estimated sensitivity, specificity, false positive rates, likelihood ratio of a positive test (LR+) and the area under the subject-specific Receiver Operating Characteristic (ROC) curve (AUC) for diagnostic accuracy. A mathematical model simulating the consequences in costs and performance of two hypothetical scenarios compared to the status quo in which a radiologist reads all screening mammograms was also performed. RESULTS Radiographer's sensitivity was comparable to the sensitivity scores achieved by U.S. radiologists who took the test but their false-positive rate was higher. Median sensitivity was 73.3 % (Interquartile range, IQR: 46.7-86.7 %) and the median false positive rate was 49.5 % (IQR: 34.7-57.9 %). The median LR+ was 1.4 (IQR: 1.3-1.7 %) and the median AUC was 0.6 (IQR: 0.6-0.7). A scenario in which a radiographer reads all mammograms first, and a radiologist reads only those that were difficult for the radiographer, was more cost-effective than a scenario in which either the radiographer or radiologist reads all mammograms. CONCLUSIONS Given the comparable sensitivity achieved by Mexican radiographers and U.S. radiologists on a test set, screening mammography interpretation by radiographers appears to be a possible adjunct to radiologists in countries with shortages of radiologists. Further studies are required to assess the effectiveness of different training programs in order to obtain acceptable screening accuracy, as well as the best approaches for the use of non-physician readers to interpret screening mammography.
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Affiliation(s)
- Gabriela Torres-Mejía
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, 62100, , Morelos, Mexico.
| | - Robert A Smith
- American Cancer Society, 250 Williams St., Atlanta, GA, 30303, USA.
| | - María de la Luz Carranza-Flores
- Centro de Diagnóstico Digital México-España, Secretaria de Salud Pública del Distrito Federal, Mariano Escobedo No. 148 col. Anáhuac, Ciudad de México D. F., 11320, Mexico.
| | - Andy Bogart
- Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave #1600, Seattle, WA, 98101, USA.
| | - Louis Martínez-Matsushita
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, 62100, , Morelos, Mexico.
| | - Diana L Miglioretti
- Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave #1600, Seattle, WA, 98101, USA.
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California, 1 Shields Ave, Davis, CA, 95616, USA.
| | - Karla Kerlikowske
- Department of Epidemiology and Biostatistics and the General Internal Medicine Section, University of California, 4150 Clement St, San Francisco, CA, 94121, USA.
- Department of Veterans Affairs, University of California, 4150 Clement St, San Francisco, CA, 94121, USA.
| | - Carolina Ortega-Olvera
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, 62100, , Morelos, Mexico.
| | - Ernesto Montemayor-Varela
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, 62100, , Morelos, Mexico.
| | - Angélica Angeles-Llerenas
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, 62100, , Morelos, Mexico.
| | - Sergio Bautista-Arredondo
- Dirección de Economía de la Salud, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, CP. 62100, Cuernavaca, Morelos, Mexico.
| | - Gilberto Sánchez-González
- Dirección de Economía de la Salud, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, CP. 62100, Cuernavaca, Morelos, Mexico.
| | - Olga G Martínez-Montañez
- Hospital de Oncología, Centro Médico Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Cuauhtemoc Doctores, Ciudad de México, D.F. 06720, Mexico.
| | - Santos R Uscanga-Sánchez
- Federación Mexicana de Colegios de Ginecología y Obstetricia, Nueva York 38, Col. Nápoles, Benito Juárez, Ciudad de México, D.F. 03810, Mexico.
| | - Eduardo Lazcano-Ponce
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, 62100, , Morelos, Mexico.
| | - Mauricio Hernández-Ávila
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, 62100, , Morelos, Mexico.
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