Bibliographies: 'Screening; Breast cancer; Colorectal cancer' – Grafiati (2024)

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Background and context: Colorectal cancer is the 3rd leading cause of cancer-related mortalities, which can be prevented by early screening. However, inadequate knowledge regarding the importance of early screening contributes to low cancer screening rates in the population. Aims: A collaborative initiative between David Omenukor Foundation and Fight Colorectal Cancer Organization strives to cancer awareness and screening in the population. Strategy: The David Omenukor Foundation organized a 5-km WALK-A-THON in Mesquite, Texas, on March 10, 2018, as part of the activities to observe the March Colorectal Cancer Awareness Month. During the event, participants received free screening for colorectal, breast, and prostate cancers. Free cholesterol, diabetes, and blood pressure testing were also done because of the impact of these comorbidities on health outcomes. Education experts on cancer were available to teach aspects of healthy diets and exercise. Two cancer patients and a survivor also shared their experiences. Program/Policy process: The program seeks to increase cancer awareness among populations and promote the culture of early and regular screening. Outcomes: Free colorectal and breast cancer screenings were provided to 270 people. About 60 people received free prostate-specific antigen (PSA) test, whereas 135 people received fecal occult blood testing. Similarly, 75 women received mammogram testing. The total number of patients who received colorectal cancer screening increased from 50 on 11th March 2017 to 135 on March 11th, 2018. Impact: The foundation created awareness of all forms of cancer and emphasized the value of early screening as the most effective to avoid the cancer scourge. The participants benefitted from nutritional advice as one strategy for reducing the risk of colorectal cancer. The event indicated that the campaign on early screening for detection was beginning to catch up. Regular interactive events and screenings increase knowledge of cancer and reduce disparities in cancer screening in the community.

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Abstract Background Cancer screening is a complex process encompassing risk assessment, the initial screening examination, diagnostic evaluation, and treatment of cancer precursors or early cancers. Metrics that enable comparisons across different screening targets are needed. We present population-based screening metrics for breast, cervical, and colorectal cancers for nine sites participating in the Population-based Research Optimizing Screening through Personalized Regimens consortium. Methods We describe how selected metrics map to a trans-organ conceptual model of the screening process. For each cancer type, we calculated calendar year 2013 metrics for the screen-eligible target population (breast: ages 40–74 years; cervical: ages 21–64 years; colorectal: ages 50–75 years). Metrics for screening participation, timely diagnostic evaluation, and diagnosed cancers in the screened and total populations are presented for the total eligible population and stratified by age group and cancer type. Results The overall screening-eligible populations in 2013 were 305 568 participants for breast, 3 160 128 for cervical, and 2 363 922 for colorectal cancer screening. Being up-to-date for testing was common for all three cancer types: breast (63.5%), cervical (84.6%), and colorectal (77.5%). The percentage of abnormal screens ranged from 10.7% for breast, 4.4% for cervical, and 4.5% for colorectal cancer screening. Abnormal breast screens were followed up diagnostically in almost all (96.8%) cases, and cervical and colorectal were similar (76.2% and 76.3%, respectively). Cancer rates per 1000 screens were 5.66, 0.17, and 1.46 for breast, cervical, and colorectal cancer, respectively. Conclusions Comprehensive assessment of metrics by the Population-based Research Optimizing Screening through Personalized Regimens consortium enabled systematic identification of screening process steps in need of improvement. We encourage widespread use of common metrics to allow interventions to be tested across cancer types and health-care settings.

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Abstract We estimate the marginal benefits of population-based cancer screening by comparing cancer test and detection rates on either side of US guideline-recommended initiation ages (age 40 for breast cancer and age 50 for colorectal cancer during the study period). Using a regression discontinuity design and self-reported test data from national health surveys, we find test rates for breast and colorectal cancer increase at the guideline age thresholds by 109% and 78%, respectively. Data from cancer registries in twelve US states indicate that cancer detection rates increase at the same thresholds by 50% and 49%, respectively. We estimate significant effects of screening on earlier breast cancer detection (1.2 cases/1000 screened) at age 40 and colorectal cancer detection (1.1 cases/1000 individuals screened) at age 50. Forty-eight and 73% of the increases in breast and colorectal case detection occur among middle-stage cancers (localized and regional) with most of the remainder among early-stage (in-situ). Our analysis suggests that the cost of detecting an asymptomatic case of breast cancer at age 40 via population-based screening is $107,000–134,000 and that the cost of detecting an asymptomatic case of colorectal cancer at age 50 is $473,000–485,000.

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Background: For a decade, most population-based cancer screenings in China are performed by primary healthcare institutions. To assess the determinants of performance of primary healthcare institutions in population-based breast, cervical, and colorectal cancer screening in China. Methods: A total of 262 primary healthcare institutions in Tianjin participated in a survey on cancer screening. The survey consisted of questions on screening tests, the number of staff members and training, the introduction of the screening programs to residents, the invitation of residents, and the number of performed screenings per year. Logistic regression models were used to analyze the determinants of performance of an institution to fulfil the target number of screenings. Results: In 58% and 61% of the institutions between three and nine staff members were dedicated to breast and cervical cancer screening, respectively, whereas in 71% of the institutions ≥10 staff members were dedicated to colorectal cancer screening. On average 60% of institutions fulfilled the target number of breast and cervical cancer screenings, whereas 93% fulfilled the target number for colorectal cancer screening. The determinants of performance were rural districts for breast (OR = 5.16 (95%CI: 2.51–10.63)) and cervical (OR = 4.17 (95%CI: 2.14–8.11)) cancer screenings, and ≥3 staff members dedicated to cervical cancer screening (OR = 2.34 (95%CI: 1.09–5.01)). Conclusions: Primary healthcare institutions in China perform better in colorectal than in breast and cervical cancer screening, and institutions in rural districts perform better than institutions in urban districts. Increasing the number of staff members on breast and cervical cancer screening could improve the performance of population-based cancer screening.

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6501 Background: Effective cancer screening leads to a substantial increase in the detection of earlier stages of cancer, while decreasing the incidence of later stage cancer diagnoses. Timely screening programs are critical in reducing cancer-related mortality in both breast and colorectal cancer by detecting tumors at an early, curable stage. The COVID-19 pandemic resulted in the postponement or cancellation of many screening procedures, due to both patient fears of exposures within the healthcare system as well as the cancellation of some elective procedures. We sought to identify how the COVID-19 pandemic has impacted the incidence of early and late stage breast and colorectal cancer diagnoses at our institution. Methods: We examined staging for all patients presenting to UCSD at first presentation for a new diagnosis of malignancy or second opinion in 2019 and 2020. Treating clinicians determined the stage at presentation for all patients using an AJCC staging module (8th edition) in the electronic medical record (Epic). We compared stage distribution at presentation in 2019 vs 2020, both for cancers overall and for colorectal and breast cancer, because these cancers are frequently detected by screening. Results: Total numbers of new patient visits for malignancy were similar in 2019 and 2020 (1894 vs 1915 pts), and stage distribution for all cancer patients was similar (stage I 32% in 2019 vs 29% in 2020; stage IV 26% in both 2019 and 2020). For patients with breast cancer, we saw a lower number of patients presenting with stage I disease (64% in 2019 vs 51% in 2020) and a higher number presenting with stage IV (2% vs 6%). Similar findings were seen in colorectal cancer (stage I: 22% vs 16%; stage IV: 6% vs 18%). Conclusions: Since the COVID-19 pandemic, there has been an increase in incidence of late stage presentation of colorectal and breast cancer, corresponding with a decrease in early stage presentation of these cancers at our institution. Cancer screening is integral to cancer prevention and control, specifically in colorectal and breast cancers which are often detected by screening, and the disruption of screening services has had a significant impact on our patients. We plan to continue following these numbers closely, and will present data from the first half of 2021 as it becomes available.

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e19197 Background: Despite the low five-year expected survival of patients with advanced cancer, it has been suggested that up to 1.7% of patients aged 65 and older with advanced cancer may continue to undergo screening for colorectal cancer and up to 8.9% of female patients 65 and older with an advanced cancer may receive a screening mammography.1 The intent of our study was to determine the rate of colorectal and breast cancer screening in men ages 50-75 and women ages 40-75 after these patients were diagnosed with an advanced cancer. Methods: The medical records of 208 patients (median age 63.5, range 42-75) with a diagnosis of stage IV colorectal, prostate, breast, liver, gastroesophageal, skin, uterine, bladder, kidney and stage III-IV pancreatic and lung cancer were reviewed for documentation of a screening mammography, colonoscopy or FIT-DNA testing after the patient was diagnosed with an advanced cancer. Results: Overall, 4.8% of patients were screened for colorectal cancer and 10% of the females received at least one mammogram. The screening mammography rate in patients less than 64 years of age was 13.3% and the colorectal screening rate in this age group was 4.4%. In patients 65 and older, the screening mammography rate was 7% and the colorectal screening rate was 5.2%. Conclusions: Colorectal and breast cancer screening rates in patients with advanced cancer were higher within our fully integrated healthcare system in comparison to previously reported findings in patients 65 and older. In addition, the rate of screening with mammography may be more prevalent amongst patients 64 or younger with advanced cancer in comparison to patients 65 and older with a similar diagnosis. The next phase of this quality improvement project involves disabling health maintenance prompts within the electronic medical record of patients with advanced cancer. References: 1. Sima, C. S., Panageas, K. S., & Schrag, D. (2010). Cancer screening among patients with advanced cancer. Jama, 304(14), 1584-1591. doi:10.1001/jama.2010.1449 [doi].

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Because age alone is not an indicator of health, there is no clear consensus among the various cancer screening guidelines on when to stop cancer screening. For breast, cervical, and colorectal cancer, there are recommended screening tests, while, for other gynecologic cancers, there are not. When discussing with older women patients when to stop cancer screening, we encourage practitioners to review the goals of the screening test, assess the health and functional status of the patient, and discuss her values and health goals. To facilitate this discussion, we review proposed frameworks for determining when to screen older patients for cancer. We also review the concepts of “well” and “frail” older adults. Finally, we review the current screening recommendations for breast, gynecological, and colorectal cancers, and the reasoning behind them, from the United States Preventative Screening Task Force, the American Cancer Society, the American College of Obstetricians and Gynecologists, and the American Geriatric Society.

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We examined clinical stage distribution and proportion of screen-detected cases of stomach, colorectal, lung, female breast and cervical cancer by sex and age group using Osaka Cancer Registry data from 2000–2014. The proportion of local or in situ stage cancer had increased for all age groups in all sites, except stomach cancer in the 0–49 years group and female breast cancer in the 80 years and older group. The proportion of screen-detected cases had increased during the study period for all age groups in all cancer sites. While the proportion increased noticeably in the younger groups, there was only a slight increase in the older groups. Regarding stomach, colorectal and lung cancers, the proportion of local and in situ stage had similarly increased in the 65–79 years and 80 years and older age groups compared with younger groups, despite lower exposure to cancer screening. Regarding breast and cervical cancers, the increases in local and in situ cancer paralleled the increase in screen-detected cases. These findings suggest that the increases in early stage stomach, colorectal and lung cancers might be due not only to the expansion of screening programs but also the development of clinical diagnostic imaging or other reasons. The increases in local and in situ stage breast and cervical cancers seemed to be due to the expansion of screening. Continued monitoring of trends in cancer incidence by clinical stage may be helpful for estimating the effectiveness of screening.

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Background: Behavioral interventions and evidence based guidelines along the cancer control continuum can reduce the burden of cancer.Objectives: This dissertation aims to increase our understanding of colorectal cancer screening (CRCS) decisional conflict and breast cancer survivorship care. This project: 1) assesses CRCS decisional conflict in a general population, 2) uses the Theory of Triadic Influence to model and evaluate direct and indirect associations between CRCS decisional conflict and colonoscopy adherence, 3) assesses post-treatment breast cancer care.Methods: Data from a questionnaire administered to randomly selected adults, 50-75 years, living in six MN communities (N=1,268) and the 2010 Behavioral Risk Factor Surveillance System (BRFSS) (N=1,024, women ages 27-99) were used. Multivariable logistic regression was used to identify characteristics associated with high CRCS decisional conflict; then structural equation modelling (SEM) was performed to assess direct and indirect associations of CRCS decisional conflict and colonoscopy adherence. Using BRFSS data, multivariable logistic regression was performed to assess the association between years since diagnosis and the type of clinician providing the majority of care for breast cancer survivors after treatment completion.Results: Greater colonoscopy barriers (OR=1.04; 95% CI: 1.02-1.05) and CRCS-specific confusion (OR=1.12; 95% CI: 1.10-1.15) as well as a healthcare provider not discussing CRCS options (OR=1.67; 95% CI: 1.18-2.37) were associated with increased odds of high CRCS decisional conflict. A similar relationship was found in the SEM analyses: both greater levels of perceived colonoscopy barriers and CRCS confusion were associated with higher decisional conflict (standardized total effects=0.42 and 0.39, respectively, p-values < 0.01). CRCS decisional conflict was associated with increased non-adherence to colonoscopy. This relationship was mediated by CRCS-specific self-efficacy and intention (standardized total effect=0.14, p-value <0.01). Among breast cancer survivors, women 0–1 and 2–3 years since diagnosis were 2.1-2.6 times more likely to have a cancer-related clinician providing the majority of care compared to women 6+ years since diagnosis (95% CIs: 1.0-4.3; 1.4-4.6).Conclusions: Decreasing colonoscopy barriers and CRCS-specific confusion could decrease CRCS decisional conflict and ultimately increase CRCS uptake. National policies to move breast cancer follow-up care to a primary care provider might be well-received by cancer survivors.

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Contexte. L’augmentation de la participation au dépistage organisé des cancers et la réduction des inégalités sociales et géographiques de participation représentent un enjeu de santé publique majeur. Objectifs. Evaluer l’efficience de 2 interventions visant à augmenter la participation et à réduire les inégalités dans le dépistage organisé des cancers en France. Méthodes. Nous avons réalisé une analyse coût-efficacité du point de vue du financeur: 1) d’une invitation à une unité de mammographie mobile (MM) dans le dépistage du cancer du sein à partir de données rétrospectives (n=37461), 2) d’un accompagnement personnalisé (AP) («patient navigation») dans le dépistage du cancer colorectal à partir d’un essai contrôlé randomisé (n=16250). Résultats. Le coût incrémentiel par dépistage supplémentaire comparé au dépistage habituel était: 1) de 611€ [492-821] pour l‘invitation au MM (+3.8% [2,8-4,8], +23.21€ [22.64-23.78]), et 2) de 1212€ [872-1978] pour l‘AP (+3.3% [1.5-5.0], +39.70€). L’efficacité et l’efficience étaient plus importantes dans les zones défavorisées et dans les zones éloignées pour le MM, alors qu’elles étaient moins favorables dans les zones défavorisées pour l’AP. Conclusion. La MM et l’AP peuvent réduire les inégalités en étant plus efficient dans les zones éloignées et les zones défavorisées pour la MM, alors que pour y parvenir, l’AP devrait cibler les sujets défavorisés, bien que n’étant pas la stratégie la plus efficiente. Les recherches doivent être poursuivies pour déterminer les conditions optimales de l’intégration du MM dans le dépistage, et pour améliorer l’efficacité et l’efficience de l’AP, qui ne peut être recommandé en l’état pour l’instant
Background. Increasing participation in organized cancers screening and reducing social and geographical inequalities in participation represent a major public health issue. Objectives. To determine the costeffectiveness of 2 interventions aiming at increasing participation and reducing inequalities in organized cancer screening in France Methods. We conducted a cost-effectiveness analysis from the payer's perspective: 1) of an invitation to a mobile mammography unit (MM) unit for breast cancer screening from retrospective data (n = 37461), 2) of a patient navigation program (PN) for colorectal cancer screening from a randomized controlled trial (n = 16250). Results. The incremental cost per additional screen compared with usual screening was: 1) € 611 [492-821] for the invitation to the MM (+ 3.8% [2.8-4.8], + € 23.21 [22.64-23.78] ), and 2) of € 1 212 [872-1 978] for PN (+ 3.3% [1.5-5.0], + 39.70 €). Effectiveness and cost-effectiveness were greater in deprived areas and in remote areas for MM, whereas they were less favorable in deprived areas for PN. Conclusion. MM and PN can reduce inequalities while being more efficient in remote areas and in deprived areas for MM, while, to achieve this, PN should target deprived people, even if being not the most efficient strategy. Research needs to be pursued to determine the optimal conditions for MM integration in organized breast cancer screening, and to improve the effectiveness and cost-effectiveness of PN, which can not be recommended as experimented for now

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Selon l’OMS, le dépistage organisé s’appuie sur la participation volontaire des sujets qui sont recrutés dans la population, dans le cadre de campagnes de dépistage. En France, deux dépistages sont organisés par les pouvoirs publics : le dépistage du cancer du sein et le dépistage colorectal. L’objectif de cette thèse était d’étudier sous l’angle éthique et médicolégal, les programmes français de dépistage organisé des cancers.Les valeurs éthiques applicables aux programmes nationaux de dépistage font l’objet de recommandations européennes et sont déclinées en France, dans des cahiers des charges annexés aux textes juridiques mettant en œuvre les programmes de dépistage. D’autres textes de portée plus générale encadrent cette pratique en France.Détaillé dans un rapport publié par l’INCa, l’analyse éthique du programme de dépistage organisé du cancer du sein pointe la nécessité d’optimiser l’information des patientes et de renforcer la place et le rôle d’un professionnel de santé référent, de l’entrée dans le dépistage jusqu’à la sortie éventuelle vers la filière de soins.L’étude des préférences des médecins généralistes dans l’organisation du dépistage du cancer colorectal montre que les questions relatives à l’information du patient et aux modalités de recueil de son consentement, ainsi qu’au suivi des patients, jouent une véritable influence sur leur adhésion au programme, au regard du risque médicolégal
According to WHO, organized screening is based on the voluntary participation of subjects who are recruited into the population through screening campaigns. In France, two are organized by the government: breast cancer screening and colorectal cancer screening. The aim of this thesis was to study by an ethical and forensic approach, the French organized programs for cancer screening.Ethical values of national screening programs are subject to European recommendations. In France, they are available in documents attached to the legal texts implementing screening programs. Some others texts more general, frame this practice in France.Detailed in a report published by INCa, the ethical analysis of organized screening program for breast cancer points the need to optimize patients’ information and to strengthen the position and role of the referring health professional, from the entry in the screening to the eventual output to the care.The study of GPs’ preferences in the organization of screening for colorectal cancer shows that issues related to patient information and procedures for collecting of consent, as well as patient monitoring, play a real impact on their adherence to the program, in terms of forensic risk

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INTRODUCCIÓN: No existen documentos que describan las actividades de la enfermera en detección precoz del cáncer. Y por ello, se han identificado los siguientes objetivos: 1) Definir el rol de la enfermera en los programas de cribado de cáncer, 2) identificar los indicadores de la actividad, 3) y evaluar los cuidados enfermeros del programa de cribado de cáncer del Institut Català d’Oncologia en relación a la transmisión de la información.METODOLOGÍA: El primer objetivo se alcanzó mediante una revisión de la literatura sobre las actividades de la enfermera en los programas de cribado de cáncer. Posteriormente se utilizó metodología Delphi para contextualizar estas actividades en los programas poblacionales del territorio español. Y finalmente un estudio descriptivo en el que un grupo de expertos realizó un análisis para identificar las intervenciones de la taxonomía Nursing Interventions Classification.El segundo objetivo se resolvió mediante una revisión bibliográfica y el consenso del grupo de expertos.El tercer objetivo evaluaba uno de los indicadores (evaluación de la comprensión de la información), y se hizo a través de una encuesta transversal a los profesionales de atención primaria de L’Hospitalet de Llobregat. Se basó en una encuesta de los conocimientos sobre procedimientos de cribado de cáncer colorectal, factores de riesgo, recomendaciones de seguimiento posterior a la exploración diagnóstica y estrategias de derivación. Posteriormente, mediante un ensayo clínico controlado y aleatorizado por conglomerados (en 6 de 12 centros), se evaluó una intervención informativa.RESULTADOS: El panel de expertos identificó 25 actividades realizadas por las enfermeras del cribado de cáncer colorectal, y 17 por las de mama. Los expertos en taxonomía correlacionaron estas actividades con 15 intervenciones de la Nursing Interventions Classification.El grupo de expertos seleccionó 7 indicadores (adecuación y tiempo de espera de la derivación de participantes, entrega y disponibilidad del informe del proceso, comprensión de profesionales implicados en el proceso, satisfacción y la comprensión de participantes).Cuatro preguntas de la evaluación de la comprensión de los profesionales, tenían más del 60% de respuestas incorrectas. Estaban relacionadas con: factores de riesgo, colonoscopias de seguimiento, circuito de seguimiento. No se encontraron diferencias estadísticamente significativas entre el grupo intervención y el grupo control. Sin embargo, en nueve preguntas se aumentó el porcentaje de respuestas correctas en el grupo intervención, mayoritariamente relacionadas con el seguimiento posterior a la exploración diagnóstica.CONCLUSIONES: Las actividades de la enfermera de cribado de cáncer son actuar como gestora de casos y proporcionar información, que favorecen la continuidad y la coordinación durante el proceso. Sin embargo, la evaluación continuada de los programas de cribado en cáncer no incluye estos indicadores. Por ello, se proponen indicadores de adecuación y tiempo de espera de la derivación de participantes, entrega y disponibilidad del informe del proceso, comprensión de los profesionales implicados en el proceso,satisfacción y comprensión de participantes. La evaluación continuada de estos indicadores permite detectar áreas de mejora y tiene como finalidad diseñar e implementar intervenciones que contribuyan a mejorar la calidad de los programas. Los resultados obtenidos de la medición del indicador de comprensión de los profesionales implicados en el proceso revelan que, aunque conocen el proceso de cribado, hay algunos aspectos que podrían mejorar como son los principales factores de riesgo no modificables del cáncer colorrectal y las recomendaciones de seguimiento posterior al cribado. Para mejorarlos, se diseñó una intervención educativa basada en píldoras informativas. Esta intervención permitió mejorar ciertas áreas de conocimiento, pero no de forma significativa. Por lo tanto, es necesario diseñar e implementar estrategias dirigidas a incrementar el conocimiento de los profesionales de atención primaria respecto al circuito de los programas de cribado de cáncer colorectal.
OBJECTIVES: Define the role of the nurse in the cancer screening programs. Identify the indicators of the activity. Evaluate the nursing care of the cancer screening program Institut Català d'Oncologia.METHODOLOGY: The first objective was achieved through a review of the literature. Delphi methodology was used to contextualize these activities in population-based programs. And finally, a descriptive study to identify the interventions of the Nursing Interventions Classification.The second objective was solved through a literature review and an expert group consensus.The third objective and was done through a cross-sectional survey of primary care professionals. It was based on a survey of knowledge about colorectal cancer screening procedures, risk factors, post-diagnostic follow-up recommendations, and referral strategies. Subsequently, a cluster-randomized controlled trial evaluated an information intervention.RESULTS: The panel of experts identified 25 activities. The taxonomy experts correlated these activities with 15 interventions of the Nursing Interventions Classification.The expert group selected 7 indicators (adequacy and waiting time for referral of participants, delivery and availability of the process report, understanding of professionals involved in the process, satisfaction and understanding of participants).No statistically significant differences were found between the intervention group and the control group. However, in nine questions the percentage of correct answers in the intervention group was increased, mainly related to the follow-up after the diagnostic exploration.CONCLUSIONS: The activities of the cancer screening nurse are act as case manager and provide information, which favors continuity and coordination during the process. However, ongoing evaluation of cancer screening programs does not include these indicators. Therefore, indicators of adequacy and waiting time for referral, delivery and availability of the process report, understanding of the professionals, satisfaction and understanding of participants are proposed.The results obtained from the measurement of the indicator reveal that, although they are aware of the screening process, there are some aspects that could improve. To improve them, an educational intervention was designed and allowed to improve certain areas of knowledge, but not in a significant way. Therefore, it is necessary to design and implement strategies aimed at increasing the knowledge of primary care professionals.

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Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Ciências Farmacêuticas
As doenças oncológicas são um dos principais problemas a nível mundial e, em Portugal, representam a segunda causa de morte.Os rastreios oncológicos têm como objetivo a deteção precoce de cancro permitindo a redução da mortalidade e, muitas vezes, da incidência. Não existe um rastreio único para todos os tipos de cancro, mas sim exames específicos para os diferentes tipos. A sua realização deve ter como base uma ponderação dos riscos e benefícios em conjunto com o médico.Em Portugal, atualmente, apenas existe consenso relativamente à utilidade da realização dos programas de rastreio do cancro do colo do útero, do cancro da mama e do cancro colo-retal.Este trabalho tem como objetivo a revisão dos diferentes rastreios oncológicos realizados em Portugal no que respeita aos tipos de cancro pertencentes ao Plano Oncológico Nacional 2001-2005. Dada a sua importância, também será referido o cancro da próstata, o cancro da pele e os marcadores tumorais. Cancer is a worldwide major problem, being the second cause of death in Portugal. Cancer screenings are aimed at early cancer detection allowing the reduction of mortality and also often incidence. There is no single screen for all types of cancer, but specific tests for the various types. Its achievement should be based regarding the risks according to the medical opinion. In Portugal, currently, there is only consensus regarding the usefulness of the screening programs for cervical cancer, breast cancer and colorectal cancer. The current study aims to review the different cancer screenings performed in Portugal according the National Oncological Plan 2001-2005. Due to its importance, it will be also exposed prostate cancer, skin cancer and tumor markers.

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This diploma thesis deals with the national screening programs for cancer diagnosis. The goal of this thesis is to find a proper way how to evaluate the effectivity of screening programs as well as their influence on the intensity of mortality from certain types of cancer. For the purpose of finding out necessary information were used data related to the diagnosis of colorectal cancer, a diagnosis of cervical cancer and breast cancer in the population of the Czech Republic between 1977 - 2011. This thesis is divided into eight chapters. The first chapter is an introduction to the topic and contains the description of the main goals. The second chapter defines terms that are crucial for this thesis. The third chapter is devoted to data sources and institutions that collect different types of data and health statistics. The next chapter deals with the epidemiology of all described types of cancer and also provide information on risk factors and symptoms of the disease. The fifth chapter looks back at trends in mortality and incidence of the most common malignant tumors in the Czech Republic. The sixth chapter describes planning and implementation of screening processes. The seventh history of screening programs in the Czech Republic. The eighth chapter deals with the rules and regulations of the EU Council and the World Health Organization. The ninth chapter represents the final assessment of Czech screening programs, compared both to the WHO guidelines and the results in the world. The last chapter is including description of mortality and their reaction on screening programs. Text describes even comparison with two other European countries (Germany, France).

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Animal testing is still the common method to test the efficacy of new drugs, but tissue engineered in vitro models are becoming more acceptable for replacing and reducing animal testing in anti-cancer drug screening by developing in vitro three-dimensional (3D) tumour models for anti-cancer drug testing. In this study, three-dimensional (3D) culture methods were developed to mimic the tumour microenvironment. 3D culturing is to seed, maintain and expand cultured cells in three-dimensional space, in contrast to the traditional two-dimensional (2D) method in which the cells attach to the bottom of culture containers as monolayers. To mimic the intercellular interplay for tumour study, cell co-culture was applied. In this thesis, perfusion culture showed a better homeostasis for 3D tumour model growth over 17 days, with a more controllable working platform and a more reliable response-dose correlation for data interpretation. In the Matrigel sandwich system, the co-culture of breast cancer cells and endothelial cells demonstrated the morphology featuring a vascular network and tumour structures, with the thickness of the three-dimensional structure around 100µm and tubule length 200-400 µm, and maintained for 10 days. The comparisons studies between Matrigel sandwich and other methods suggest that though not fully characterised, Matrigel is still a valuable scaffold choice for developing co-culture 3D tumour model. Finally, the combination of perfusion and co-culture showed the potential of applying this model in angiogenesis assay, with a drug response profile combining cell viability and morphology to mimic in vivo tumour physiology.

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Background: Colorectal cancer is the third most commonly diagnosed cancer and the second leading cause of cancer death in Arizona. Given that by the year 2030 Arizona is expected to be the second most populated state in the U.S., it is imperative to evaluate whether this state has the colorectal screening capacity to accommodate the growing population.Methods: 338 members of the American College of Gastroenterology were invited to participate. Information for the total number of colonoscopies and sigmoidoscopies performed during an average week was ascertained by analyzing 105 surveys. We estimated the current and potential volume of screening procedures.Results: Physicians reported performing 8,717 endoscopic procedures weekly (7,990 colonoscopies and 727 sigmoidoscopies). They reported being able to increase their capacity by an additional 3,183 (36.5%) procedures a week (2,347 colonoscopies and 836 flexible sigmoidoscopies).Conclusions: Our findings suggest that Arizona has the ability to significantly expand its endoscopic capacity.

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Colorectal cancer (CRC) is an important source of disease burden in the United Kingdom and developed world. It is often preventable through certain forms of screening of asymptomatic individuals, allowing for the timely detection and removal of pre-cancerous polyps (adenomas). It can also reduce mortality (in individuals who already have CRC) by detecting it at an earlier, more treatable stage. Computed Tomographic colonography (CTC) is a comparatively new test that is capable of detecting adenomas before they transition into cancer, meaning that it can identify people for whom polypectomy is warranted. Like the “gold standard” test of colonoscopy, it can detect most adenomas. It may also be perceived more positively than colonoscopy by screening invitees because the exam is less invasive, potentially increasing uptake and improving population health outcomes. Another possible advantage of CTC over colonoscopy is that it is possible to replace the burdensome full-laxative bowel preparation with reduced- or even non-laxative alternatives. However, these are likely to be associated with a reduction in sensitivity and specificity, resulting in more false negatives and false positives, and this may detract from its overall public acceptability. The main aims of this PhD were to investigate the public’s views about the optimum method of carrying out CTC, taking into account the trade-offs involved in bowel preparation options, and test whether a particular form of CTC had the potential to increase screening uptake compared with other preventative CRC screening tests (colonoscopy and flexible sigmoidoscopy). Chapter 1 consists of the background to CRC, screening, and the relevant tests. Chapter 2 introduces the issues of screening test preferences and uptake. Chapter 3 (Study 1) reports on a qualitative discussion group study that served as an initial exploration of public perceptions, values and preferences regarding CTC and colonoscopy. Chapter 4 (Study 2) reports on a qualitative interview study that compared patients’ experiences with CTC following non- or full-laxative preparation in order to inform a further qualitative study in Chapter 5 (Study 3), which explored public perceptions and preferences for different bowel preparations for CTC, specifically taking into account the trade-offs. A more systematic assessment was planned to quantify the extent to which preparation tolerability, sensitivity and specificity were valued and Chapter 6 (Study 4) consisted of a review of previous studies that used the selected approach (conjoint analysis) with the aim of identifying strengths and weaknesses in the existing literature. These findings were drawn on when designing Study 5 in Chapter 7, which consists of a particular form of conjoint analysis (a discrete choice experiment) to quantify public values of the main attributes of interest for CTC. The final study in Chapter 8 (Study 6) randomised participants to receive a hypothetical screening invitation for one of several preventative tests in order to measure how uptake of different forms of CTC might compare with colonoscopy and flexible sigmoidoscopy. Chapter 9 refers to findings from psychology that aims to broaden the perspective of how studies assess and interpret stated preferences for and perceptions regarding screening tests. Findings are then synthesised in Chapter 10, taking into account this broader literature. Participants consistently discriminated between CTC and colonoscopy across studies and appraised the former less negatively in terms of experiential characteristics. Participants were also consistent in anticipating the experience of non- and reduced-laxative preparation less negatively than full-laxative preparation. Results were more mixed in terms of appraisals of sensitivity and specificity in the context of CTC bowel preparation. The qualified interpretation presented here is that sensitivity is an influential attribute but specificity is not, when both are defined within a range of values considered plausible. Hence, although sensitivity and the anticipated experience of preparation were both important attributes, perceived gains arising from reducing preparation burden were offset by perceived costs from the corresponding reduction in diagnostic performance of CTC, leading to no clear overall preference for a particular preparation method. Furthermore, there was no evidence that screening uptake would be higher for different forms of CTC, or other preventive screening tests. The most robust method of confirming these findings would be direct comparisons of the tests in trials assessing actual screening behaviour.

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APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

This study examines and compares sociodemographic, health status, and health behavior patterns of screening for breast cancer, cervical cancer, and colorectal cancer among women aged 45 and over in the United States.

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APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

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