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Morote J, Borque-Fernando Á, Esteban LE, Picola N, Muñoz-Rodriguez J, Paesano N, Ruiz-Plazas X, Muñoz-Rivero MV, Celma A, García-de Manuel G, Miró B, Abascal JM, Servian P. Reducing the demand for magnetic resonance imaging scans and prostate biopsies during the early detection of clinically significant prostate cancer: Applying the Barcelona risk-stratified pathway in Catalonia. Urol Oncol 2024; 42:115.e1-115.e7. [PMID: 38342654 DOI: 10.1016/j.urolonc.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/07/2023] [Accepted: 09/29/2023] [Indexed: 02/13/2024]
Abstract
PURPOSE To analyze the reduction in multiparametric magnetic resonance imaging (mpMRI) demand and prostate biopsies after the hypothetical implementation of the Barcelona risk-stratified pathway (BCN-RSP) in a population of the clinically significant prostate cancer (csCaP) early detection program in Catalonia. MATERIALS AND METHODS A retrospective comparation between the hypothetical application of the BCN-RSP and the current pathway, which relied on pre-biopsy mpMRI and targeted and/or systematic biopsies, was conducted. The BCN-RSP stratify men with suspected CaP based on a prostate specific antigen (PSA) level >10 ng/ml and a suspicious rectal examination (DRE), and the Barcelona-risk calculator 1 (BCN-RC1) to avoid mpMRI scans. Subsequently, candidates for prostate biopsy following mpMRI are selected based on the BCN-RC2. This comparison involved 3,557 men with serum PSA levels > 3.0 ng/ml and/or suspicious DRE. The population was recruited prospectively in 10 centers from January 2021 and December 2022. CsCaP was defined when grade group ≥ 2. RESULTS CsCaP was detected in 1,249 men (35.1%) and insignificant CaP was overdeteced in 498 (14%). The BCN-RSP would have avoid 705 mpMRI scans (19.8%), and 697 prostate biopsies (19.6%), while 61 csCaP (4.9%) would have been undetected. The overdetection of insignificant CaP would have decrease in 130 cases (26.1%), and the performance of prostate biopsy for csCaP detection would have increase to 41.5%. CONCLUSION The application of the BCN-RSP would reduce the demand for mpMRI scans and prostate biopsies by one fifth while less than 5% of csCaP would remain undetected. The overdetection of insignificant CaP would decrease by more than one quarter and the performance of prostate biopsy for csCaP detection would increase to higher than 40%.
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Affiliation(s)
- Juan Morote
- Department of Urology, Vall d´Hebron Hospital, and Department of Surgery, Universitat Autònoma de Barcelona, Barcelona Spain.
| | | | - Luis E Esteban
- Department of Applied Mathematics, Escuela Universitaria Politécnica La Almunia, Universidad de Zaragoza, Zaragoza, Spain
| | - Natàlia Picola
- Department of Urology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | | | | | - Xavier Ruiz-Plazas
- Department of Urology, Hospital Universitari Joan XXIII, Tarragona, Spain
| | | | - Anna Celma
- Department of Urology, Vall d´Hebron Hospital, and Department of Surgery, Universitat Autònoma de Barcelona, Barcelona Spain
| | | | - Berta Miró
- Unit of Statistics and Bioinformatics. Vall d´Hebron Reseach Institute, Barcelona, Spain
| | - José M Abascal
- Department of Urology, Parc de Salut Mar, and Department of Surgery, Universitat Pompeu Fabra, Barcelona, Spain
| | - Pol Servian
- Department of Urology, Hospital Germans Trias i Pujol, Badalona, Spain
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Christy SM, Castro-Figueroa EM, Lopez J, Sutton SK, McIntyre M, Garcia J, Cortes C, Vidal AV, Gwede CK, Marzán M, Jimenez J, Vadaparampil ST. Changes in Cancer Screening Knowledge Among a Prospective Cohort of Spanish-Speaking Hispanic Community Outreach Event Participants in Florida and Puerto Rico. J Cancer Educ 2024; 39:18-26. [PMID: 37702848 DOI: 10.1007/s13187-023-02368-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 09/14/2023]
Abstract
The current study examined cancer prevention and early detection awareness (pre-workshop) and changes in knowledge (from pre- to post-workshop) among Hispanic/Latino (H/L) community members who participated in Spanish-language educational outreach events in Puerto Rico (PR) and Florida (FL). Spanish-language educational outreach events were comprised of an educational session lasting approximately 45-60 min and were delivered to groups in rural and urban community settings by a single trained community health educator (CHE). The research team assessed sociodemographic characteristics, personal and familial cancer health history, as well as awareness and knowledge (pre-test) of a range of cancer prevention and screening topics. Following the presentation, participants completed a post-test knowledge survey which also measured likelihood of engaging in cancer screening, cancer preventive behaviors, and cancer research as a result of information presented during the session. Change in the average knowledge score was evaluated using a paired samples t-test. Post-session likelihood of completing cancer screening and preventive behaviors and engaging in cancer research were examined using descriptive statistics and group/site comparisons. The percentage reporting awareness of screening procedures ranged from 33% (PSA test) to 79% (mammogram). H/L in PR reported higher percentage of stool blood test awareness when compared to H/L in FL (χ2(1)= 19.20, p<.001). The average knowledge score increased from 5.97 at pre-test to 7.09 at post-test (Cohen's d=0.69). The increase was significant across all participants (t(315)= 12.4, p<.001), as well as within the FL site (t(124)= 6.66, p<.001, d=0.59) and the PR site (t(190)=10.66, p<.001, d=0.77). Results from this study suggest that educational outreach events delivered to H/L community members by a CHE are valuable strategies to address challenges regarding cancer screening knowledge and engagement in multiple behaviors.
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Affiliation(s)
- Shannon M Christy
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
| | | | - Jomar Lopez
- Formerly With H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Steven K Sutton
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - McKenzie McIntyre
- Formerly With H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jennifer Garcia
- Formerly With H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | | | - Clement K Gwede
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | | | | | - Susan T Vadaparampil
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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Espina C, Feliu A, Maza M, Almonte M, Ferreccio C, Finck C, Herrero R, Dommarco JR, de Almeida LM, Arrossi S, García PJ, Garmendia ML, Mohar A, Murillo R, Santamaría J, Tortolero-Luna G, Cazap E, Gabriel OO, Paonessa D, Zoss JW, Luciani S, Carvalho A, Schüz J. Latin America and the Caribbean Code Against Cancer 1st Edition: 17 cancer prevention recommendations to the public and to policy-makers (World Code Against Cancer Framework). Cancer Epidemiol 2023; 86 Suppl 1:102402. [PMID: 37852725 DOI: 10.1016/j.canep.2023.102402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/02/2023] [Accepted: 06/15/2023] [Indexed: 10/20/2023]
Abstract
Preventable risk factors are responsible of at least 40% of cases and almost 45% of all cancer deaths worldwide. Cancer is already the leading cause of death in almost half of the Latin American and the Caribbean countries constituting a public health problem. Cost-effective measures to reduce exposures through primary prevention and screening of certain types of cancers are critical in the fight against cancer but need to be tailored to the local needs and scenarios. The Latin America and the Caribbean (LAC) Code Against Cancer, 1st edition, consists of 17 evidence-based recommendations for the general public, based on the most recent solid evidence on lifestyle, environmental, occupational, and infectious risk factors, and medical interventions. Each recommendation is accompanied by recommendations for policymakers to guide governments establishing the infrastructure needed to enable the public adopting the recommendations. The LAC Code Against Cancer has been developed in a collaborative effort by a large number of experts from the region, under the umbrella strategy and authoritative methodology of the World Code Against Cancer Framework. The Code is a structured instrument ideal for cancer prevention and control that aims to raise awareness and educate the public, while building capacity and competencies to policymakers, health professionals, stakeholders, to contribute to reduce the burden of cancer in LAC.
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Affiliation(s)
- Carolina Espina
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France.
| | - Ariadna Feliu
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
| | - Mauricio Maza
- Pan American Health Organization (PAHO), Cancer Prevention and Control, Washington, DC 20037, United States
| | - Maribel Almonte
- World Health Organization (WHO), Department of Sexual and Reproductive Health and Research, Geneva, Switzerland
| | - Catterina Ferreccio
- Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Advanced Center for Chronic Diseases ACCDIS, Santiago, Chile
| | - Carolyn Finck
- Departamento de Psicología, Universidad de los Andes, Bogotá, Colombia
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA, Costa Rica
| | | | - Liz Maria de Almeida
- National Cancer Institute of Brazil (INCA), Prevention and Surveillance, Rio de Janeiro, Brazil
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad (CEDES), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | | | | | - Alejandro Mohar
- Instituto Nacional de Cancerología, Instituto de Investigaciones Biomédicas (UNAM), Tlalpan, Mexico
| | - Raúl Murillo
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | | | - Eduardo Cazap
- Sociedad Latinoamercia y del Caribe de Oncología Médica (SLACOM), Red de Institutos e Instituciones Nacionales de Cáncer (RINC-SLACOM), Buenos Aires, Argentina
| | - Owen O Gabriel
- Owen King EU Hospital, Department of Oncology, Saint Lucia
| | - Diego Paonessa
- Asociación Latina e Ibérica Contra el Cáncer (ALICC), Buenos Aires, Argentina
| | - J Walter Zoss
- Red de Institutos e Instituciones Nacionales de Cáncer (RINC-SLACOM), Rio de Janeiro, Brazil
| | - Silvana Luciani
- Pan American Health Organization (PAHO), Cancer Prevention and Control, Washington, DC 20037, United States
| | - Andre Carvalho
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
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Tang A, Chandler S, Torkington J, Harris DA, Dhruva Rao PK. Adapting the investigation of patients on urgent suspected cancer pathway with lower gastrointestinal symptoms across Wales during COVID-19. Ann R Coll Surg Engl 2023; 105:S35-S41. [PMID: 35616545 PMCID: PMC10390240 DOI: 10.1308/rcsann.2021.0366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic necessitated the introduction of revised diagnostic pathways for assessing urgent suspected cancer (USC) referrals. Combinations of faecal immunochemical testing (FIT) and minimal preparation computed tomography (CT) scans (MPCT) were used to manage referrals and prioritise access to clinical services or invasive tests. The effectiveness of these pathways across Wales is evaluated in this study. METHODS All consecutive patients referred from primary care on the USC pathway between 15 March and 15 June 2020 were included to reflect the effect of full lockdown measures. Data collected included demographics, presenting symptom(s), investigations and timelines and patient outcomes up to 90 days following initial referral. RESULTS A total of 1,050 patients across eight sites in Wales were included. Of these 1,050 patients, 52.6% were female with median age 68 (21-97) years; 50.5% had first-line clinical review, of which 61.1% were virtual consultations; 49.5% had primary investigations; 26.7% of patients had FIT and 13.1% had MPCT. COVID-response pathways achieved a 29.9% reduction in use of colonoscopy as first-line investigation and 79% of patients avoided face-to-face consultations altogether during this first wave of the pandemic. Overall, 6.8% of USC referrals were diagnosed with colorectal cancer (CRC). Median timescale from diagnosis to treatment for CRC was 65 (4-175) days. The negative predictive value (NPV) for FIT in this cohort was 99.6%. MPCT as the first modality had a NPV of 99.2%. CONCLUSION A modified investigation pathway helped maintain cancer diagnosis rates during the pandemic with improved resource utilisation to that used prepandemic.
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Affiliation(s)
- A Tang
- Singleton Hospital, Swansea Bay University Health Board, UK
| | - S Chandler
- Singleton Hospital, Swansea Bay University Health Board, UK
| | | | - D A Harris
- Singleton Hospital, Swansea Bay University Health Board, UK
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AlWaheidi S. Promoting cancer prevention and early diagnosis in the occupied Palestinian territory. J Cancer Policy 2023; 35:100373. [PMID: 36493987 DOI: 10.1016/j.jcpo.2022.100373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
Cancer is the second leading cause of mortality in the occupied Palestinian territory (oPt), and a more than 65 % rise in all cancer mortality is expected by 2030, with potentially devastating consequences which could overwhelm an already strained Palestinian health system. Advanced stage at diagnosis and the pervasive shortages in basic treatment options are to blame These factors are accompanied by a lack of infrastructure and trained human resources, the absence of reliable and timely data, and poorly coordinated healthcare systems. At present, resources for cancer control in the country are not only inadequate, but some of them are misallocated because of decisions that have been made that have not been based on evidence. This could lead to a waste of badly needed resources in a system that is already gravely short of funding. This paper highlights the challenges facing national primary cancer prevention measures in the oPt that will be needed to reduce exposure to cancer-related risk factors. The paper aims to provide evidence-based recommendations on how the oPt can detect in good time and thus treat the three most common cancers in the country - lung, breast, and colorectal cancer.
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Affiliation(s)
- Shaymaa AlWaheidi
- Centre for Cancer, Society, and Public Health, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, Great Maze Pond, Guys Campus, London SE1 9RT, UK.
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6
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Zhou X, Zheng H, Fu H, Dillehay McKillip KL, Pinney SM, Liu Y. CRAG: de novo characterization of cell-free DNA fragmentation hotspots in plasma whole-genome sequencing. Genome Med 2022; 14:138. [PMID: 36482487 PMCID: PMC9733064 DOI: 10.1186/s13073-022-01141-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
The fine-scale cell-free DNA fragmentation patterns in early-stage cancers are poorly understood. We developed a de novo approach to characterize the cell-free DNA fragmentation hotspots from plasma whole-genome sequencing. Hotspots are enriched in open chromatin regions, and, interestingly, 3'end of transposons. Hotspots showed global hypo-fragmentation in early-stage liver cancers and are associated with genes involved in the initiation of hepatocellular carcinoma and associated with cancer stem cells. The hotspots varied across multiple early-stage cancers and demonstrated high performance for the diagnosis and identification of tissue-of-origin in early-stage cancers. We further validated the performance with a small number of independent case-control-matched early-stage cancer samples.
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Affiliation(s)
- Xionghui Zhou
- grid.239573.90000 0000 9025 8099Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229 USA ,grid.35155.370000 0004 1790 4137Present address: Hubei Key Laboratory of Agricultural Bioinformatics, College of Informatics, Huazhong Agricultural University, Wuhan, 430070 China
| | - Haizi Zheng
- grid.239573.90000 0000 9025 8099Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229 USA
| | - Hailu Fu
- grid.239573.90000 0000 9025 8099Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229 USA
| | - Kelsey L. Dillehay McKillip
- grid.24827.3b0000 0001 2179 9593University of Cincinnati Cancer Center, Cincinnati, OH 45229 USA ,grid.24827.3b0000 0001 2179 9593Department of Pathology & Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45229 USA
| | - Susan M. Pinney
- grid.24827.3b0000 0001 2179 9593University of Cincinnati Cancer Center, Cincinnati, OH 45229 USA ,grid.24827.3b0000 0001 2179 9593Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH 45229 USA
| | - Yaping Liu
- grid.239573.90000 0000 9025 8099Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229 USA ,grid.24827.3b0000 0001 2179 9593University of Cincinnati Cancer Center, Cincinnati, OH 45229 USA ,grid.239573.90000 0000 9025 8099Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229 USA ,grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229 USA ,grid.24827.3b0000 0001 2179 9593Department of Electrical Engineering and Computing Sciences, University of Cincinnati College of Engineering and Applied Science, Cincinnati, OH 45229 USA
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Korous KM, Cuevas AG, Chahoud J, Ogbonnaya UC, Brooks E, Rogers CR. Examining the relationship between household wealth and colorectal cancer screening behaviors among U.S. men aged 45-75. SSM Popul Health 2022; 19:101222. [PMID: 36105558 PMCID: PMC9464961 DOI: 10.1016/j.ssmph.2022.101222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 11/12/2022] Open
Abstract
Colorectal cancer (CRC) is the third leading cause of cancer-related death among men in the United States (U.S.), particularly among men aged 45 years and older. Early-detection screening remains a key method of decreasing CRC-related deaths, yet socioeconomic barriers exist to planning and completing CRC screening. While accumulating evidence shows income disparities in CRC screening prevalence, a dearth of research has investigated wealth disparities. This study aimed to determine whether household wealth was associated with CRC screening uptake and future screening intent. In February 2022, we sent an online survey to potential participants; U.S. men aged 45–75 years were eligible to participate. We examined four CRC screening behaviors as outcomes: ever completing a stool-based or exam-based screening test, current screening status, and future screening intent. Household net wealth, determined by self-reported household wealth and debt, was the primary predictor. We used logistic regression to estimate odds ratios (ORs) and their 95% confidence interval (CI). Of the study participants (N = 499), most self-identified as Non-Hispanic White, were aged 50–64 years, and had previously completed a CRC screening test. Results revealed that, among men aged 45–49 years, higher net wealth decreased the odds of ever completing a stool- or exam-based test (OR = 0.58, 95% CI: 0.33, 0.98; OR = 0.55, 95% CI: 0.31, 0.94, respectively). By contrast, among men aged 50–75 years, higher net wealth increased the odds of being current with CRC screening (OR = 1.40, 95% CI: 1.03, 1.92). Net wealth was unassociated with CRC screening intent. These findings suggest that household net wealth, rather than income, is an important socioeconomic factor to consider in relation to uptake of CRC early-detection screening. The financial and social cognitive mechanisms linking household wealth to CRC screening behaviors merit future research and intervention. Wealth was associated with U.S men's adherence to screening for colorectal cancer. Age modified the association between wealth and colorectal cancer screening uptake. Wealth reduced the odds of past colorectal screening completion for men 45–49 years.
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Affiliation(s)
- Kevin M Korous
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, 84108, USA.,Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Adolfo G Cuevas
- Community Health, School of Arts and Sciences, Tufts University, Medford, MA, 02155, USA
| | - Jad Chahoud
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 33612, USA
| | - Uchenna C Ogbonnaya
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, 84108, USA
| | - Ellen Brooks
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, 84108, USA
| | - Charles R Rogers
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, 84108, USA.,Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
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Jugniot N, Massoud TF, Dahl JJ, Paulmurugan R. Biomimetic nanobubbles for triple-negative breast cancer targeted ultrasound molecular imaging. J Nanobiotechnology 2022; 20:267. [PMID: 35689262 PMCID: PMC9185914 DOI: 10.1186/s12951-022-01484-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/25/2022] [Indexed: 01/04/2023] Open
Abstract
Triple-negative breast cancer (TNBC) is a highly heterogeneous breast cancer subtype with poor prognosis. Although anatomical imaging figures prominently for breast lesion screening, TNBC is often misdiagnosed, thus hindering early medical care. Ultrasound (US) molecular imaging using nanobubbles (NBs) capable of targeting tumor cells holds great promise for improved diagnosis and therapy. However, the lack of conventional biomarkers in TNBC impairs the development of current targeted agents. Here, we exploited the homotypic recognition of cancer cells to synthesize the first NBs based on TNBC cancer cell membrane (i.e., NBCCM) as a targeted diagnostic agent. We developed a microfluidic technology to synthesize NBCCM based on the self-assembly property of cell membranes in aqueous solutions. In vitro, optimal NBCCM had a hydrodynamic diameter of 683 ± 162 nm, showed long-lasting US contrast enhancements and homotypic affinity. In vivo, we demonstrated that NBCCM showed increased extravasation and retention in a TNBC mouse model compared to non-targeted NBs by US molecular imaging. Peak intensities and areas under the curves from time-intensity plots showed a significantly enhanced signal from NBCCM compared to non-targeted NBs (2.1-fold, P = 0.004, and, 3.6-fold, P = 0.0009, respectively). Immunofluorescence analysis further validated the presence of NBCCM in the tumor microenvironment. Circumventing the challenge for universal cancer biomarker identification, our approach could enable TNBC targeting regardless of tumor tissue heterogeneity, thus improving diagnosis and potentially gene/drug targeted delivery. Ultimately, our approach could be used to image many cancer types using biomimetic NBs prepared from their respective cancer cell membranes.
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Affiliation(s)
- Natacha Jugniot
- Molecular Imaging Program at Stanford (MIPS), and Bio-X Program, Department of Radiology, School of Medicine, Stanford University, Stanford, CA, 94305-5427, USA.,Canary Center at Stanford for Cancer Early Detection, Department of Radiology, School of Medicine, Stanford University, Stanford, CA, 94305-5427, USA
| | - Tarik F Massoud
- Molecular Imaging Program at Stanford (MIPS), and Bio-X Program, Department of Radiology, School of Medicine, Stanford University, Stanford, CA, 94305-5427, USA
| | - Jeremy J Dahl
- Canary Center at Stanford for Cancer Early Detection, Department of Radiology, School of Medicine, Stanford University, Stanford, CA, 94305-5427, USA
| | - Ramasamy Paulmurugan
- Molecular Imaging Program at Stanford (MIPS), and Bio-X Program, Department of Radiology, School of Medicine, Stanford University, Stanford, CA, 94305-5427, USA. .,Canary Center at Stanford for Cancer Early Detection, Department of Radiology, School of Medicine, Stanford University, Stanford, CA, 94305-5427, USA. .,Molecular Imaging Program at Stanford (MIPS), Canary Center for Cancer Early Detection at Stanford, Stanford University School of Medicine, 3155 Porter Drive, Palo Alto, CA, 94304, USA.
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Chari ST, Maitra A, Matrisian LM, Shrader EE, Wu BU, Kambadakone A, Zhao YQ, Kenner B, Rinaudo JAS, Srivastava S, Huang Y, Feng Z. Early Detection Initiative: A randomized controlled trial of algorithm-based screening in patients with new onset hyperglycemia and diabetes for early detection of pancreatic ductal adenocarcinoma. Contemp Clin Trials 2022; 113:106659. [PMID: 34954100 PMCID: PMC8844106 DOI: 10.1016/j.cct.2021.106659] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/24/2021] [Accepted: 12/18/2021] [Indexed: 02/03/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is the only leading cause of cancer death without an early detection strategy. In retrospective studies, 0.5-1% of subjects >50 years of age who newly develop biochemically-defined diabetes have been diagnosed with PDAC within 3 years of meeting new onset hyperglycemia and diabetes (NOD) criteria. The Enriching New-onset Diabetes for Pancreatic Cancer (ENDPAC) algorithm further risk stratifies NOD subjects based on age and changes in weight and diabetes parameters. We present the methodology for the Early Detection Initiative (EDI), a randomized controlled trial of algorithm-based screening in patients with NOD for early detection of PDAC. We hypothesize that study interventions (risk stratification with ENDPAC and imaging with Computerized Tomography (CT) scan) in NOD will identify earlier stage PDAC. EDI uses a modified Zelen's design with post-randomization consent. Eligible subjects will be identified through passive surveillance of electronic medical records and eligible study participants randomized 1:1 to the Intervention or Observation arm. The sample size is 12,500 subjects. The ENDPAC score will be calculated only in those randomized to the Intervention arm, with 50% (n = 3125) expected to have a high ENDPAC score. Consenting subjects in the high ENDPAC group will undergo CT imaging for PDAC detection and an estimate of potential harm. The effectiveness and efficacy evaluation will compare proportions of late stage PDAC between Intervention and Observation arm per randomization assignment or per protocol, respectively, with a planned interim analysis. The study is designed to improve the detection of sporadic PDAC when surgical intervention is possible.
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Affiliation(s)
| | - Anirban Maitra
- University of Texas M.D. Anderson Cancer Center, Houston TX
| | | | | | - Bechien U. Wu
- Kaiser Permanente Southern California, Los Angeles CA
| | | | - Ying-Qi Zhao
- Fred Hutchinson Cancer Research Center, Seattle WA
| | | | - Jo Ann S. Rinaudo
- Division of Cancer Prevention, National Cancer Institute, Bethesda MD
| | - Sudhir Srivastava
- Division of Cancer Prevention, National Cancer Institute, Bethesda MD
| | - Ying Huang
- Fred Hutchinson Cancer Research Center, Seattle WA
| | - Ziding Feng
- Fred Hutchinson Cancer Research Center, Seattle WA
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Harkemanne E, Duyver C, Leconte S, Bugli C, Thomas L, Baeck M, Tromme I. Melanoma Diagnostic Practices of French-Speaking Belgian General Practitioners and the Prospective Study of Their Pigmented Skin Lesion Diagnostic Accuracy and Management. J Cancer Educ 2021; 36:1316-1324. [PMID: 32448923 DOI: 10.1007/s13187-020-01770-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
General practitioners (GPs) are among the main actors involved in early melanoma diagnosis. However, melanoma diagnostic accuracy and management are reported to be insufficient among GPs in Europe. The primary aim of this observational prospective study was to shed light on melanoma diagnostic practices among French-speaking Belgian GPs. The second aim was to specifically analyse these GPs' pigmented skin lesion diagnostic accuracy and management. GPs from the five French-speaking districts of Belgium were asked to complete a questionnaire, before taking part in a melanoma diagnostic training session. First, we assessed the GPs' current melanoma diagnostic practices. Then, their pigmented skin lesion diagnostic accuracy and management were evaluated, through basic theoretical questions and clinical images. These results were subsequently analysed, according to the GPs' sociodemographic characteristics and medical practice type. In total, 89 GPs completed the questionnaire. Almost half of the GPs (43%; CI = [33;54]) were confronted with a suspicious skin lesion as the main reason for consultation once every 3 months, while 33% (CI = [24;43]) were consulted for a suspicious lesion as a secondary reason once a month. Prior to training, one-third of the GPs exhibited suboptimal diagnostic accuracy in at least one of six "life-threatening" clinical cases among two sets of 10 clinical images of pigmented skin lesions, which can lead to inadequate patient management (i.e. incorrect treatment and/or inappropriate reinsurance). This study underlines the need to train GPs in melanoma diagnosis. GPs' pigmented skin lesion diagnostic accuracy and management should be improved to increase early melanoma detection.
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Affiliation(s)
- E Harkemanne
- Dermatology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium.
| | - C Duyver
- Centre Académique de Médecine Générale (CAMG), UCLouvain, Brussels, Belgium
| | - S Leconte
- Centre Académique de Médecine Générale (CAMG), UCLouvain, Brussels, Belgium
| | - C Bugli
- Statistical Methodology and Computing Service (SMCS), Louvain-la-Neuve, Belgium
| | - L Thomas
- Dermatology Department, Lyon Cancer Research Center INSERM, Université Lyon 1, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - M Baeck
- Dermatology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium
| | - I Tromme
- Dermatology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium
- King Albert II Cancer and Hematology Institute, Cliniques universitaires Saint-Luc, Brussels, Belgium
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11
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Reich M, Buki LP. Colorectal cancer screening in Uruguay: current assessment and roadmap for the future. Psicol Reflex Crit 2021; 34:20. [PMID: 34185179 PMCID: PMC8241939 DOI: 10.1186/s41155-021-00178-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/25/2021] [Indexed: 11/24/2022] Open
Abstract
Cancer is a leading cause of death worldwide and is expected to remain a public health concern for years to come. Within Latin America, Uruguay has the highest colorectal cancer rates. Heeding past calls to action, in this article we provide a critical assessment of colorectal cancer needs and opportunities in Uruguay with a focus on developing a roadmap for future action. First, we provide an overview of risk factors, screening procedures and guidelines, and screening rates. Next, we provide an overview of psychosocial factors that influence colorectal cancer screening, with the goal of providing guidance for future behavioral health promotion initiatives in Uruguay. In this effort, we present four conceptual models that may be used for interventions: the ecological systems theory, informed decision-making, the health beliefs model, and the health literacy model. Subsequently, we propose using an integrated model based on the ecological systems theory and health literacy model to develop national, local, and community-based interventions to increase screening rates and lower the colorectal cancer burden in Uruguay. We close the paper with a summary and implications section, including recommendations for future research programs focused on the assessment of factors that influence screening.
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Affiliation(s)
- Micaela Reich
- Universidad Católica del Uruguay, Montevideo, Uruguay.
| | - Lydia P Buki
- University of Miami, Coral Gables, Florida, 33146, USA
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12
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Li H, Jiang F, Du Y, Li N, Chen Z, Cai H, Guo Y, Hong G. Identification of differential DNA methylation alterations of ovarian cancer in peripheral whole blood based on within-sample relative methylation orderings. Epigenetics 2021; 17:314-326. [PMID: 33749504 DOI: 10.1080/15592294.2021.1900029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Leukocyte cell proportion changes affect the detection of cancer-associated aberrant DNA methylation alterations in peripheral blood samples. We aimed to detect cellular DNA methylation changes in ovarian cancer (OVC) blood samples avoiding the above-mentioned cell-composition effects. Based on the within-sample relative methylation orderings (RMOs) of CpG loci in leukocyte subtypes, we developed the Ref-RMO method to detect aberrant methylation alterations from OVC blood samples. Stable CpG pairs with consistent RMOs in different leukocyte subtypes were determined, more than 99% of which retained their RMO patterns in peripheral whole blood (PWB) in independent datasets. Based on the stable CpG pairs, significantly reversed CpG pairs were detected from OVC PWB samples, which were relative to clinical information such as age, subtype, grade, stage, or CA125 level. Results showed 439 CpG loci were determined to be significant differential DNA methylations between OVC and healthy blood samples. They were mainly enriched in KEGG pathways, such as cytokine-cytokine receptor interaction, apoptosis, proteoglycans in cancer, and immune-associated Gene Ontology terms. STRING analysis showed that they tended to have functional interactions with cancer-associated genes recorded in the COSMIC database. Leukocyte cellular differential DNA methylations could be identified by the proposed RMO-based method from OVC PWB samples, which were cancer-associated aberrant signals against cell-composition effects.
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Affiliation(s)
- Hongdong Li
- School of Medical Information Engineering, Gannan Medical University, Ganzhou, China
| | - Fengle Jiang
- Department of Bioinformatics, Fujian Medical University, Fuzhou, China
| | - Yuhui Du
- School of Medical Information Engineering, Gannan Medical University, Ganzhou, China
| | - Na Li
- School of Medical Information Engineering, Gannan Medical University, Ganzhou, China
| | - Zhihong Chen
- School of Medical Information Engineering, Gannan Medical University, Ganzhou, China
| | - Hao Cai
- Medical Big Data and Bioinformatics Research Centre, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - You Guo
- Medical Big Data and Bioinformatics Research Centre, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Guini Hong
- School of Medical Information Engineering, Gannan Medical University, Ganzhou, China.,Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, PR China
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13
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Curtin BF, Gamble LA, Schueler SA, Ruff SM, Quezado M, Miettinen M, Fasaye GA, Passi M, Hernandez JM, Heller T, Koh C, Davis JL. Enhanced endoscopic detection of occult gastric cancer in carriers of pathogenic CDH1 variants. J Gastroenterol 2021; 56:139-146. [PMID: 33206267 PMCID: PMC9169699 DOI: 10.1007/s00535-020-01749-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/02/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Germline inactivating variants in the CDH1 tumor suppressor gene impart an elevated lifetime risk of diffuse gastric cancer. The current endoscopic surveillance method depends upon random gastric biopsies for early cancer detection. METHODS Asymptomatic adults with pathogenic or likely pathogenic CDH1 variants referred for endoscopic gastric cancer surveillance were included in this retrospective cohort. Upper gastrointestinal endoscopy was performed according to the consensus Cambridge method, in the early period, or a systematic (Bethesda) protocol as part of an ongoing natural history study. The primary outcome measure was cancer detection. RESULTS Collectively, 135 endoscopic surveillance procedures were performed in 120 patients. Twenty-six (19%, 26/135) procedures were performed using Cambridge method and 109 (81%) using the Bethesda protocol. Gastric signet ring cell carcinomas were detected in 15% (4/26) using the Cambridge method and 36% (40/109) using the Bethesda protocol (p < 0.05). Almost half (44.2%, 53/120) of patients later elected for prophylactic total gastrectomy, of whom 51 (96%, 51/53) had a signet ring cell carcinoma (T1a) discovered by histopathology. On a per endoscopy basis, the false-negative rates of detection using Cambridge method and Bethesda protocol were 80% (12/15) and 37.7% (17/45), respectively (p < 0.01). CONCLUSIONS Gastric cancer detection was more frequent with implementation of a systematic surveillance protocol in CDH1 variant carriers. Given the decision for prophylactic surgery is often made by patients in the context of family history and pathologic result of surveillance biopsies, we propose the Bethesda protocol offers patients an opportunity to make more informed decisions.
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Affiliation(s)
- Bryan Franklin Curtin
- Digestive Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
- Division of Gastroenterology and Motility, Mercy Medical Center, Baltimore, MD, USA
| | - Lauren Ann Gamble
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Samuel Ali Schueler
- Digestive Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Samantha Marilyn Ruff
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Martha Quezado
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Markku Miettinen
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Grace-Ann Fasaye
- Genetics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Monica Passi
- Digestive Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jonathan Matthew Hernandez
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Theo Heller
- Digestive Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Christopher Koh
- Digestive Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jeremy Lee Davis
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA.
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Finney Rutten LJ, Jacobson DJ, Jenkins GD, Fan C, Weiser E, Parks P, Doroshenk M, Limburg PJ, St Sauver JL. Colorectal cancer screening completion: An examination of differences by screening modality. Prev Med Rep 2020; 20:101202. [PMID: 32995145 PMCID: PMC7516167 DOI: 10.1016/j.pmedr.2020.101202] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/26/2020] [Accepted: 08/30/2020] [Indexed: 01/08/2023] Open
Abstract
Average-risk colorectal cancer (CRC) screening is broadly recommended, using one of several endorsed test options. However, CRC screening participation rates remain below national goals. To gain further insights regarding recent, population-based patterns in overall and test-specific CRC screening participation, we conducted a retrospective study of adults, ages 50-75 years, utilizing comprehensive data resources from the Rochester Epidemiology Project (REP). Among residents of Olmsted County, MN eligible and due for CRC screening, we identified 5818 residents across three annual cohorts who completed screening between 1/1/2016 and 12/31/2018. We summarized CRC screening rates as incidence per 1000 population and used Poisson regression to test for overall and mode-specific CRC trends. We also analyzed rates of follow-up colonoscopy within 6-months after a positive stool-based screening result. While no significant differences over time were observed in overall CRC screening incidence rates among those due for screening, we observed a statistically significant increase in mt-sDNA test and statistically significant decreases in screening colonoscopy and FIT/FOBT test completion rates; differences in screening overall and by modality were observed by age, sex, and race/ethnicity. The diagnostic colonoscopy follow-up rate within six months after a positive stool-based test was significantly higher following mt-sDNA (84.9%) compared to FIT/FOBT (42.6%). In this retrospective, population-based study, overall CRC screening incidence rates remained stable from 2016 to 2018, while test-specific rates for mt-sDNA significantly increased and decreased for colonoscopy and FIT/FOBT. Adherence with follow-up colonoscopy after a positive stool-based test was significantly higher among patients who underwent mt-sDNA screening compared to FIT/FOBT.
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Affiliation(s)
- Lila J Finney Rutten
- Population Health Science Program, Robert D. and Patricia E. Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Debra J Jacobson
- Population Health Science Program, Robert D. and Patricia E. Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Gregory D Jenkins
- Population Health Science Program, Robert D. and Patricia E. Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Chun Fan
- Population Health Science Program, Robert D. and Patricia E. Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Emily Weiser
- Exact Sciences Corporation, Madison, WI, United States
| | - Philip Parks
- Exact Sciences Corporation, Madison, WI, United States
| | | | - Paul J Limburg
- Exact Sciences Corporation, Madison, WI, United States
- Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jennifer L St Sauver
- Population Health Science Program, Robert D. and Patricia E. Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
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15
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Thanapal MR, Thin N, Alagaratnam S, Walshe M, Parmar C, Bhan C, Mukhtar H. Straight-to-test colonoscopy: Has it improved the detection of colorectal cancer? A 7- year review. Surgeon 2020; 19:e146-e152. [PMID: 33121877 DOI: 10.1016/j.surge.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/18/2020] [Accepted: 09/06/2020] [Indexed: 12/01/2022]
Abstract
AIM Early diagnosis of colorectal cancer (CRC) improves outcome. Straight-To-Test (STT) pathway was introduced in Whittington Hospital in 2012. The aim was to reduce the time to first oncological treatment and minimise unnecessary outpatient clinic appointments. However, this pathway has added significant burden to the trust in terms of number of procedures to be done.We assessed the diagnostic yield and the effectiveness of this pathway in improving the time to diagnosis of colorectal cancer. We also performed a cost-effective analysis and discussed the current literature along with interventions to further improve the benefits of STT investigations. METHOD This is a prospectively collected data of all patients who underwent STT examinations in a single centre from January 2012 till December 2018. The parameters collected were patient details, procedures performed, findings and discharge plan. We also performed a cost-effective analysis. RESULTS A total 1648 (90.8%) of patients identified suitable for STT pathway underwent colonoscopy or flexible sigmoidoscopy. From this, 764 (50.2%) patients had diagnosed pathology and CRC was detected in 50(3%) of the patients. We also estimated annual savings of £ 21,599.54 (£151,196.76 in seven years). Patients on the STT pathway took 25 days to obtain results as compared to 40 days in the standard pathway. The decision to take the patient off the cancer pathway was shortened by 3 weeks. CONCLUSION STT pathway has proven to be safe and cost-effective means of investigation. However, further improvement is needed in the implementation to make it a sustainable. mode of investigation in long run and increase the pickup rate of colorectal cancer through STT.
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Affiliation(s)
- Mohana Raj Thanapal
- Department of General Surgery, Whittington Hospital, Magdala Avenue, London, N19 5NF, United Kingdom.
| | - Noel Thin
- Department of General Surgery, Whittington Hospital, Magdala Avenue, London, N19 5NF, United Kingdom
| | - Swethan Alagaratnam
- Department of General Surgery, Whittington Hospital, Magdala Avenue, London, N19 5NF, United Kingdom
| | - Maria Walshe
- Department of General Surgery, Whittington Hospital, Magdala Avenue, London, N19 5NF, United Kingdom
| | - Chetan Parmar
- Department of General Surgery, Whittington Hospital, Magdala Avenue, London, N19 5NF, United Kingdom
| | - Chetan Bhan
- Department of General Surgery, Whittington Hospital, Magdala Avenue, London, N19 5NF, United Kingdom
| | - Hasan Mukhtar
- Department of General Surgery, Whittington Hospital, Magdala Avenue, London, N19 5NF, United Kingdom
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16
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Holt CL, Tagai EK, Santos SLZ, Scheirer MA, Bowie J, Haider M, Slade J. Web-based versus in-person methods for training lay community health advisors to implement health promotion workshops: participant outcomes from a cluster-randomized trial. Transl Behav Med 2020; 9:573-582. [PMID: 29955889 DOI: 10.1093/tbm/iby065] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Project HEAL (Health through Early Awareness and Learning) is an implementation trial that compared two methods of training lay peer community health advisors (CHAs)-in-person ("Traditional") versus web-based ("Technology")-to conduct a series of three evidence-based cancer educational workshops in African American churches. This analysis reports on participant outcomes from Project HEAL. Fifteen churches were randomized to the two CHA training methods and the intervention impact was examined over 24 months. This study was conducted in Prince George's County, MD, and enrolled 375 church members age 40-75. Participants reported on knowledge and screening behaviors for breast, prostate, and colorectal cancer. Overall, cancer knowledge in all areas increased during the study period (p < .001). There were significant increases in digital rectal exam (p < .05), fecal occult blood test (p < .001), and colonoscopy (p < .01) at 24 months; however, this did not differ by study group. Mammography maintenance (56% overall) was evidenced by women reporting multiple mammograms within the study period. Participants attending all three workshops were more likely to report a fecal occult blood test or colonoscopy at 24 months (p < .05) than those who attended only one. These findings suggest that lay individuals can receive web-based training to successfully implement an evidence-based health promotion intervention that results in participant-level outcomes comparable with (a) people trained using the traditional classroom method and (b) previous efficacy trials. Findings have implications for resources and use of technology to increase widespread dissemination of evidence-based health promotion interventions through training lay persons in community settings.
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Affiliation(s)
- Cheryl L Holt
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Erin K Tagai
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Sherie Lou Zara Santos
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | | | - Janice Bowie
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Muhiuddin Haider
- School of Public Health, Institute for Applied Environmental Health, University of Maryland, College Park, MD, USA
| | - Jimmie Slade
- Community Ministry of Prince George's County, Upper Marlboro, MD, USA
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17
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Luu XQ, Lee K, Lee YY, Suh M, Kim Y, Choi KS. Acceptance on colorectal cancer screening upper age limit in South Korea. World J Gastroenterol 2020; 26:3963-3974. [PMID: 32774070 PMCID: PMC7385558 DOI: 10.3748/wjg.v26.i27.3963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/06/2020] [Accepted: 07/04/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Korea National Cancer Screening Program currently provides screening for colorectal cancer (CRC) for adults older than 50 years with no upper age limit. In general, people are likely to only pay attention to the benefits of cancer screening and to neglect its risks. Most consider the benefits of cancer screening as being far greater than the risks and are unaware that any potential benefits and harms can vary with age.
AIM To report acceptance of an upper age limit for CRC screening and factors associated therewith among cancer-free individuals in Korea.
METHODS The present study analyzed data from the Korea National Cancer Screening Survey 2017, a nationally representative random sample of 4500 Korean individuals targeted for screening for the five most common types of cancer. A total of 1922 participants were included in the final analysis. The baseline characteristics of the study population are presented as unweighted numbers and weighted proportions. Both univariate and multivariate logistic regression models were developed to examine factors related with acceptance of an upper age limit for CRC screening; subgroup analysis was also applied.
RESULTS About 80% (1554/1922) of the respondents agreed that CRC screening should not be offered for individuals older than 80 years. Specifically, those who had never been screened for CRC had the highest acceptance rate (91%). Overall, screening history for CRC [screened by both fecal occult blood test and colonoscopy, adjusted odds ratio (aOR) = 0.33, 95%CI: 0.22-0.50] and other cancers (aOR = 0.55, 95%CI: 0.34-0.87), as well as a family history of cancer (aOR = 0.66, 95%CI: 0.50-0.87), were negatively associated with acceptance of an upper age limit for CRC screening. In contrast, metropolitan residents (aOR = 1.86, 95%CI: 1.29-2.68) and people who exercised regularly (aOR = 1.42, 95%CI: 1.07-1.89) were more likely to accept an upper age limit. After subgrouping, we found gender, marital status, and lifetime smoking history among never-screened individuals and residential region, family history of cancer, and physical activity among never-screened individuals to be associated with acceptance of an upper age limit.
CONCLUSION This study describes acceptance of an upper age limit for CRC screening and factors associated with it, and provides perspectives that should be considered, in addition to scientific evidence, when developing population-based cancer screening policies and programs.
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Affiliation(s)
- Xuan Quy Luu
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si 10408, South Korea
| | - Kyeongmin Lee
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si 10408, South Korea
| | - Yun Yeong Lee
- National Cancer Control Institute, National Cancer Center, Goyang-si 10408, South Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang-si 10408, South Korea
| | - Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang-si 10408, South Korea
| | - Kui Son Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si 10408, South Korea
- National Cancer Control Institute, National Cancer Center, Goyang-si 10408, South Korea
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Abstract
This article begins with a brief overview of risk factors for colorectal neoplasia in inflammatory bowel disease to concretize the approach to risk stratification. It then provides an up-to-date review of diagnosis and management of dysplasia in inflammatory bowel disease, which integrates new and emerging data in the field. This is particularly relevant in an era of increased attention to cost- and resource-containment from the health systems vantage point, coupled with a heightened prioritization of patient quality of life and shared decision-making. Also provided is a brief discussion of the status of newer therapeutic techniques, such as endoscopic submucosal dissection.
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Affiliation(s)
- Shailja C. Shah
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Steven H. Itzkowitz
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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19
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Brown J, Kaufman RE, Ariail M, Williams DL. Assessing patient navigation as a tool to address equity in cancer early detection. Transl Cancer Res 2019; 8:S421-S430. [PMID: 35117118 PMCID: PMC8799019 DOI: 10.21037/tcr.2019.05.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 05/22/2019] [Indexed: 11/26/2022]
Abstract
Background The Louisiana Breast and Cervical Health Program (LBCHP) provides breast and cervical cancer screenings at no cost to about 5,000 low-income women per year. LBCHP was designed to increase access to cancer screenings for low-income women, a traditionally underserved population. A main program component is the provision of patient navigation services. Patient navigation provides extra layers of patient-centered education and resources to assist with screening completion. Both rural and racial/ethnic minority populations are underserved and have benefited from patient navigation. The purpose of this study was to establish estimates of LBCHP’s eligible population and to measure the effect of patient navigation in reducing racial/ethnic and geographic (e.g., rural) inequities in cancer early detection. Methods This study analyzed program data from patients who received navigation services resulting in cervical and breast cancer screenings between July 01, 2016 and June 30, 2018. We used the combination of U.S. Census Bureau’s Small Area Health Insurance Estimates 2016 and the American Community Survey 2017 to calculate the number of eligible women by race/ethnicity and by parish (county). We used the 2010 Census to estimate the distribution of the rural population by city and parish. Using patient addresses, residences were categorized into urban, suburban and rural. Results The population of women ages 21–64 years in Louisiana is 1.3 million and almost half (46.7%) live at or under 250% of the federal poverty level (FPL). The poverty rate is much higher among LBCHP’s racial/ethnic minorities: 65.1% among Blacks and 58.5% among Latinx as compared to 35.5% among Whites. To be racially/ethnically equitable, LBCHP would aim to have the following client distribution: at least 47% Black and 5% Latinx. The population LBCHP served was 47% Black and 18% Latinx. While 27% of Louisiana is rural, only 17% of LBCHP’s women served are from rural areas. In contrast, 61% of the state is urban, while 72% of LBCHP’s women served live in urban areas. LBCHP’s clients had excellent follow-up rates after abnormal screening test results with well over 95% of all racial/ethnic groups having completed follow-up. Latinxs had a higher percentage of abnormal results than Blacks and Whites. Conclusions This study showed that LBCHP is achieving racial/ethnic equity in the client population that is served through patient navigation with LBCHP’s largest reach among the Latinx population. In addition, once clients receive screening, they have excellent follow-up rates for any abnormalities. Because LBCHP’s program goals include serving a high number of women, an unintended consequence is that LBCHP’s rural population is underserved.
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Affiliation(s)
- Janet Brown
- Department of Behavioral and Community Health Sciences, Louisiana State University Health New Orleans School of Public Health, New Orleans, LA, USA
| | - Randi E Kaufman
- Department of Health Policy and Systems Management, Louisiana State University Health New Orleans School of Public Health, New Orleans, LA, USA
| | - Molly Ariail
- Department of Behavioral and Community Health Sciences, Louisiana State University Health New Orleans School of Public Health, New Orleans, LA, USA
| | - Donna L Williams
- Department of Behavioral and Community Health Sciences, Louisiana State University Health New Orleans School of Public Health, New Orleans, LA, USA
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Ströbele L, Kantelhardt EJ, Traoré Millogo TFD, Sarigda M, Wacker J, Grosse Frie K. Prevalence of breast-related symptoms, health care seeking behaviour and diagnostic needs among women in Burkina Faso. BMC Public Health 2018; 18:447. [PMID: 29615015 PMCID: PMC5883529 DOI: 10.1186/s12889-018-5360-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/22/2018] [Indexed: 11/29/2022] Open
Abstract
Background The prevalence of breast cancer has been increasing in sub-Saharan Africa over the last few years. Patients often present with late stage disease, resulting in a high mortality rate. This study aims to estimate the prevalence of breast -related symptoms in the female population of Burkina Faso. The findings can be used to advise on adequate diagnostic health services for breast symptoms to ensure early detection and down-staging of breast cancer. Methods A cross-sectional, population based study of 996 women was conducted to investigate the proportion of women with breast-related symptoms. A semi-structured questionnaire was used to collect sociodemographic data, information about breast cancer knowledge and details about breast-related symptoms, health care seeking and medical care. Breast-related symptoms were categorised as currently present/not currently present to estimate the current prevalence of women requiring a diagnostic service. Results Among the 996 women, 120 reported having had a breast-related symptom in their life. Only 36 women sought medical advice and eight women had diagnostic confirmation by histological or imaging techniques. Current breast-related symptoms were reported by 33 women (3.3% of the sample). An extrapolation to Burkina Faso’s female population suggests that 184,562 women are in current need of diagnostic services due to any breast-related symptoms. Conclusions Imaging techniques at the community and referral level are needed in order to triage women with breast-related symptoms. Specialised services need to be strengthened to ensure appropriate diagnosis and treatment of breast diseases. Education campaigns among the general population and among health care professionals are required to increase awareness of breast cancer and improve prompt health care seeking and referral.
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Affiliation(s)
- Leonie Ströbele
- Martin-Luther-University Halle-Wittenberg, Institute for Medical Epidemiology, Biostatistics and Informatics, Magdeburger Straße 8, 06112, Halle, Germany
| | - Eva Johanna Kantelhardt
- Martin-Luther-University Halle-Wittenberg, Institute for Medical Epidemiology, Biostatistics and Informatics, Magdeburger Straße 8, 06112, Halle, Germany.,Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06097, Halle, Germany
| | | | - Maurice Sarigda
- Unité de Formation en Sciences de la Santé, Université Ouaga 1 Professeur Joseph Ki Zerbo 03 B.P. 7021, Ouagadougou, 03, Burkina Faso
| | - Jürgen Wacker
- Fürst-Stirum-Klinik Bruchsal, Gutleutstraße 1-14, 76646, Bruchsal, Germany
| | - Kirstin Grosse Frie
- Martin-Luther-University Halle-Wittenberg, Institute for Medical Epidemiology, Biostatistics and Informatics, Magdeburger Straße 8, 06112, Halle, Germany.
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Wells KJ, Campbell K, Kumar A, Clark T, Jean-Pierre P. Effects of patient navigation on satisfaction with cancer care: a systematic review and meta-analysis. Support Care Cancer 2018; 26:1369-82. [PMID: 29497815 DOI: 10.1007/s00520-018-4108-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 02/11/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Patient navigation (PN) is a model of healthcare coordination designed to reduce barriers to achieving optimal health outcomes. Systematic reviews evaluating whether PN is associated with higher patient satisfaction with cancer care are lacking. METHODS We conducted a systematic review to synthesize evidence of comparative studies evaluating the effectiveness of PN programs to improve satisfaction with cancer-related care. We included studies reported in English that: (1) evaluated a PN intervention designed to increase satisfaction with cancer care; and (2) involved a randomized controlled trial (RCT) or non-RCT approach. Standardized forms were used to abstract data from studies. These data were evaluated for methodological quality, summarized qualitatively, and synthesized under a random effects model. RESULTS The initial search yielded 831 citations. Nine met inclusion criteria. Five had adequate data (1 RCT and 4 non-RCTs) to include in the meta-analysis. Methodological quality of included studies ranged from weak to strong, with half rated as weak. Findings of the RCTs showed a statistically significant increase in satisfaction with cancer care involving PN (standardized mean difference (SMD) = 2.30; 95% confidence interval 1.79, 2.80, p < 0.001). Pooled results from non-RCTs showed no significant association between PN and satisfaction with cancer-related care (standardized mean difference = 0.39; 95% confidence interval - 0.02, 0.80, p = 0.06). CONCLUSIONS Although PN has been widely implemented to improve cancer care, high-quality studies are needed to characterize the relationship between PN and satisfaction with cancer-related care.
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Abstract
MicroRNAs (miRNAs) are small non-coding RNAs that act as master regulators of many cellular processes. The expression of miRNAs is often deregulated in human tumors, causing the alteration of molecular mechanisms relevant for cancer progression. Importantly, miRNAs are detectable in the blood and their quantity fluctuations are the hallmark of pathogenic conditions, including cancer. Several groups reported the identification of circulating cell-free miRNAs (cf-miRNAs) in the human serum and plasma and demonstrated their diagnostic and prognostic utility. Other studies also shown that it may be feasible to apply such cf-miRNA signatures within screening programs in order to improve cancer early detection. Circulating cf-miRNAs therefore appear to be excellent candidates for blood-borne cancer biomarkers.
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Affiliation(s)
- Francesca Montani
- Molecular Medicine Program, Department of Experimental Oncology, European Institute of Oncology, Milan, Italy
| | - Fabrizio Bianchi
- Institute for Stem-cell Biology, Regenerative Medicine and Innovative Therapies (ISBReMIT), IRCCS Casa Sollievo della Sofferenza, Foggia, Italy
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Vieira RADC, Lourenço TS, Mauad EC, Moreira Filho VG, Peres SV, Silva TB, Lattore MDRDDO. Barriers related to non-adherence in a mammography breast-screening program during the implementation period in the interior of São Paulo State, Brazil. J Epidemiol Glob Health 2015; 5:211-9. [PMID: 26231397 PMCID: PMC7320532 DOI: 10.1016/j.jegh.2014.09.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 09/14/2014] [Accepted: 09/15/2014] [Indexed: 12/04/2022] Open
Abstract
Mammography is the best exam for early diagnosis of breast cancer. Developing countries frequently have a low income of mammography and absence of organized screening. The knowledge of vulnerable population and strategies to increase adherence are important to improve the implementation of an organized breast-screening program. A mammography regional-screening program was implemented in a place around 54.238 women, aged 40–69 years old. It was proposed to perform biannual mammography free of cost for the women. We analyze the first 2 years of the implementation of the project. Mammography was realized in 17.964 women. 42.1% of the women hadn’t done de mammography in their lives and these women were principally from low socio-economic status (OR = 2.99), low education (OR = 3.00). The best strategies to include these women were mobile unit (OR = 1.43) and Family Health Program (OR = 1.79). The incidence of early breast tumors before the project was 14.5%, a fact that changed to 43.2% in this phase. Multivariate analysis showed that the association of illiterate and the mobile unit achieve more women who had not performed mammography in their lives. The strategies to increase adherence to mammography must be multiple and a large organization is necessary to overpass the barriers related to system health and education.
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Affiliation(s)
| | - Tânia Silveira Lourenço
- Botucatu School of Medicine, UNESP, Brazil; Prevention Department, Barretos Cancer Hospital, Brazil
| | - Edmundo Carvalho Mauad
- Barretos Cancer Hospital, Brazil; Prevention Department, Barretos Cancer Hospital, Brazil
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Rahaei Z, Ghofranipour F, Morowatisharifabad MA, Mohammadi E. Determinants of Cancer Early Detection Behaviors:Application of Protection Motivation Theory. Health Promot Perspect 2015; 5:138-46. [PMID: 26290829 PMCID: PMC4539052 DOI: 10.15171/hpp.2015.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 02/10/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cancer is account for 13% of all deaths around the world and is the third cause of mortality in Iran. More than one third of these cases are pre-ventable and about 33% are curable with early detection. The aim of this study was to determine the predictors of cancer early detection (CED) behaviors applying Protection Motivation Theory (PMT). METHODS In this cross-sectional study, cluster sampling method was employed to recruit 260 individuals of above 20 years old in Yazd, Iran and a researcher designed questionnaire was completed through interviews for each of the respondents. PMT theoretical variables and CED behaviors were the basis of data collection procedure. RESULTS Participants acquired 64.47% of the protection motivation, 30.97% of the passive and 45.64% of the active behaviors‟ possible scores. Theory constructs predicted 19.8%, 15.6% and 9.6% of the variations for protection motivation, passive and active behavior respectively. Protection motivation was responsible for 3.6% of passive and 8% of active behaviors‟ variations. CONCLUSION Considering the scarceness of CED behaviors and the applicability of PMT in predicting these behaviors, utilization of the PMT‟s constructs in any interventional programs to accelerate CED behaviors could be an alternate methodological choice in the cancer control initiatives.
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Affiliation(s)
- Zohreh Rahaei
- Department of Health Education, Tarbiat Modares University, Tehran, Iran
| | - Fazlollah Ghofranipour
- Department of Health Education, Tarbiat Modares University, Tehran, Iran
- Corresponding Author: Ghofranipour Fazlollah Tel: +98 21 82883869;
| | | | - Eesa Mohammadi
- Department of Nursing, Tarbiat Modares University, Tehran, Iran
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Burón A, Grau J, Andreu M, Augé JM, Guayta-Escolies R, Barau M, Macià F, Castells A; en nombre del Grupo PROCOLON. [Colorectal Cancer Early Screening Program of Barcelona, Spain: Indicators of the first round of a program with participation of community pharmacies]. Med Clin (Barc) 2015; 145:141-6. [PMID: 25073826 DOI: 10.1016/j.medcli.2014.05.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 05/07/2014] [Accepted: 05/08/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVE The Colorectal Cancer Screening Program of Barcelona was implemented in December 2009 and involves pharmacies for the distribution and collection of screening tests. The aim of this article is to describe the main indicators of the first round of the Program (2010-2011), based on the ones suggested by the European Union. MATERIAL AND METHODS The target population of the Colorectal Cancer Screening Program of Barcelona includes men and women aged 50-69 years who live in the catchment areas of Hospital Clínic and Hospital del Mar. Screening consists of biennial immunochemical fecal occult blood testing, with colonoscopy as confirmatory procedure. RESULTS Target population comprised 197,795 persons. Participation rate was 43.6%, was higher among women and among those aged 60 and older. 2.1% of the eligible population stated to have been already screened for colorectal cancer. Overall positivity rate was 6.2%, higher among men and with a broad variability among health care areas. The detection rates of low- and high-risk adenoma, and of invasive cancer were 9.1 ‰, 21.7 ‰ and 3.1 ‰, respectively. 48.2% of tumors were stage i. CONCLUSIONS These results are considered satisfactory and consistent with those obtained in other programs and with European standards. Nevertheless, some areas for improvement have been identified. The high participation rate can be attributed, at least in part, to the type of test and to the involvement of community pharmacies.
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