Relevant bibliographies by topics / Breast screening services

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  1. Journal articles
  2. Dissertations / Theses
  3. Books
  4. Book chapters
  5. Conference papers
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Academic literature on the topic 'Breast screening services'

Author: Grafiati
Published: 19 February 2023

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Journal articles on the topic "Breast screening services"

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Trivedi, Usha, Toma S. Omofoye, Cindy Marquez, Callie R. Sullivan, Diane M. Benson, and Gary J. Whitman. "Mobile Mammography Services and Underserved Women." Diagnostics 12, no. 4 (April 5, 2022): 902. http://dx.doi.org/10.3390/diagnostics12040902.

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Breast cancer, the second most common cause of cancer in women, affects people across different ages, ethnicities, and incomes. However, while all women have some risk of breast cancer, studies have found that some populations are more vulnerable to poor breast cancer outcomes. Specifically, women with lower socioeconomic status and of Black and Hispanic ethnicity have been found to have more advanced stages of cancer upon diagnosis. These findings correlate with studies that have found decreased use of screening mammography services in these underserved populations. To alleviate these healthcare disparities, mobile mammography units are well positioned to provide convenient screening services to enable earlier detection of breast cancer. Mobile mammography services have been operating since the 1970s, and, in the current pandemic, they may be extremely helpful. The COVID-19 pandemic has significantly disrupted necessary screening services, and reinstatement and implementation of accessible mobile screenings may help to alleviate the impact of missed screenings. This review discusses the history and benefits of mobile mammography, especially for underserved women.
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Hine, D. "Establishing and Managing Breast Screening Services." Journal of Management in Medicine 4, no. 1 (January 1989): 67–73. http://dx.doi.org/10.1108/eb060529.

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Newman, Gina. "Social media is changing breast screening services." Cancer Nursing Practice 19, no. 1 (January 7, 2020): 14. http://dx.doi.org/10.7748/cnp.19.1.14.s12.

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Buttimer, Andreas. "Customer focus in breast cancer screening services." International Journal of Health Care Quality Assurance 22, no. 5 (July 17, 2009): 514–24. http://dx.doi.org/10.1108/09526860910975625.

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Pollack, Erica B., Daniel R. Mollura, Alice Chong, Susan C. Harvey, and John R. Scheel. "A Global Perspective on Screening." Journal of Breast Imaging 2, no. 4 (July 2020): 296–303. http://dx.doi.org/10.1093/jbi/wbaa047.

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Abstract Breast cancer is emerging as a major global public health problem. Incidence and mortality continues to rise in low- and middle-income countries (LMICs). A significant and growing disparity exists between high-income countries and LMICs in the availability of screening services and associated preventable mortality. However, population imaging-based screening programs are not appropriate for all settings. Planners should perform a thorough assessment of the target setting prior to implementing any breast cancer detection program, as appropriate guidelines vary according to the resources available. Financial, social, and cultural barriers to breast cancer care need to be addressed to sustainably improve the morbidity and mortality of the populations and make efficient use of available services. Creative approaches, such as mobile and portable imaging and bundling of services, can facilitate the installation of early breast cancer detection programs in LMICs. While image-based screening programs are not initially resource-appropriate in many LMICs, planners can work towards this goal as part of their comprehensive breast cancer detection strategy.
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Kolo, H. T. "Increasing Breast and Cervical Cancer Screening Uptake in Women of Child-Bearing Age in Niger State, Nigeria." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 213s. http://dx.doi.org/10.1200/jgo.18.85900.

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Background: Prevalence of breast and cervical cancer are on the increase in the developing countries despite the knowledge of how these diseases can be prevented through screening. Reproductive rights, Advocacy, Safe space and Empowerment Foundation (RAISE) initiated breast and cervical cancer screening program in Niger State as part of its reproductive health services. The program is hereby evaluated with the aim of improving its performance toward reducing burden of these diseases in Niger State. Aim: To evaluate the breast and cervical cancer screening program, to report the experience from the program, and to recommend necessary changes and scaling up of best practices. Methods: Audit of the breast and cervical cancer screening program was conducted. The basic components of cervical cancer screening programs; screening uptake, screening services, treatment of screen positives, follow-up and referrals were audited against previously set standards for the program. The difference in screening uptake for breast and cervical cancer was evaluated for better understanding of factors determining screening uptake in Niger state. Results: Between 18 July 2016 and 30 April 2018, 2035 women between the age of 15-75 years were screened for breast cancer and 1258 women between the age of 20-55 years were screened for cervical cancer, representing about 38% higher uptake of breast cancer screening compared with cervical cancer. The parity range of these women is 0-20. The mean age and parity for women screened during the audit period were; 35 years and 8 for breast cancer, while 29 years and 7 for cervical cancer. Fifty-two (2.56%) of the 2035 women screened for breast cancer had a palpable lump in either 1 or both breasts, while 4 (0.3%) of the 1258 women screened for cervical cancer had a positive result (aceto-white lesions) treated with cryotherapy. The women have low socioeconomic status with predominantly farmers, petty traders and housewives earning less than $2 per day. Most of the women are illiterate with little or no form of education. Other possible barriers for low uptake of breast and cervical cancer screening is lack of transportation, religious and cultural beliefs, shyness and lack of sensitization. Conclusion: Screening uptake is still very poor despite massive awareness campaign. The current awareness creation strategy has not been able to create needed demand for the available screening services. A total overhaul of awareness creation strategies is therefore advocated.
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Jenkins, C., T. T. Ngan, N. B. Ngoc, T. B. Phuong, L. Lohfeld, M. Donnelly, H. V. Minh, and L. Murray. "Strengthening Screening and Detection Services for Breast Cancer in Vietnam." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 52s. http://dx.doi.org/10.1200/jgo.18.39100.

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Background: The incidence of breast cancer has increased consistently in Vietnam over the past two decades. Data from 2012 indicates an increase from an age-standardized rate of 16.2 per 100,000 in 2002, to 23.0 per 100,000 in 2012. Despite this, and consistent studies indicating late diagnosis, there has been a lack of empirical studies on what breast cancer services exist and how they function across different levels of the Vietnamese health system. Aim: Our project sought to examine the accessibility, affordability, and appropriateness of breast cancer services in Vietnam with the objective of making recommendations to strengthen service delivery. Methods: The project used a mixed-methods approach, collecting data through self-administered questionnaires (n=69) and in-depth interviews (n=23) with health professionals working at facilities across all four levels of the Vietnamese health system (national, provincial, district, & commune). We completed in-depth interviews with women (n=12) diagnosed with breast cancer, focusing on their experiences of accessing and using services. Our study was located across three provinces, representing the northern, central, and southern regions of the country. Results: Our results show that screening activities for breast cancer in the community are not systematically organized or provided. There are no stand-alone screening campaigns for breast cancer and facility-based opportunistic screening is limited. There is scope for strengthening the primary and secondary levels of the Vietnamese health system to detect, diagnose and treat breast cancer. Increased autonomy and support for commune-level health stations to conduct screening activities, the systematic incorporation of opportunistic screening, and the extension of breast cancer-specific training for commune and district level health care staff are potential areas for strengthening. Conclusion: Our study suggests that there should be concerted efforts to implement the Ministry of Health's strategic objectives to decentralise and strengthen commune and district levels of the health system in relation to detection, diagnosis and treatment of breast cancer. No studies have been conducted that pilot interventions to provide systematic and comprehensive breast cancer services at the lower levels of the health system. Specific attention should be given to increasing autonomy and support for commune level health stations to conduct screening activities; for the systematic incorporation of opportunistic screening; and the extension of breast cancer-specific training for commune and district level health care staff.
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Paajanen, Hannu, Lea Pulliainen, Niilo Hendolin, Heikki Hermunen, Markku Helle, and Peter B. Dean. "The Demands of Screening Mammography on Surgical Inpatient Services of Breast Cancer." American Surgeon 67, no. 7 (July 2001): 648–53. http://dx.doi.org/10.1177/000313480106700712.

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A nationwide mammographic screening of women ages 50 to 59 years commenced in Finland in January 1987. We studied the demands of screening on surgical inpatient services by comparing the treatment strategy, volume of breast biopsies, and hospital stay before and after implementation of mass screening of women age 50 to 59. Approximately 20 patients per 100,000 inhabitants were referred annually from mass screening for surgical biopsies, in half of which cancer was detected. In 1985 through 1986 (before screening) we operated on 134 patients suspected of having breast cancer. After the first (in 1990) and the second (in 1995) round of mammographic screening we operated on 161 patients in 2 years suspected of having breast cancer. Concurrently 25 of 92 cancers (27%) were found only because of the screening. Before the screening period clinical symptoms and palpable tumors were cause for referral to surgery in 84 per cent of the cases and abnormal mammography in only 16 per cent. During screening these ratios were 34 and 61 per cent, respectively. The number of Tis-1 cancers (<2 cm) increased from 44 per cent before screening to 70 per cent during screening. In contrast the number of T2 cancers (2–4 cm) decreased from 40 to 20 per cent. The mammographic screening did not increase the hospital stay of patients. We conclude that the mammographic screening program of all women age 50 to 59 years increased the number of surgical biopsies in our hospital by only 30 per cent. Breast cancer was found at an earlier stage during screening. More than one-fourth of breast cancers are currently found through the mass screening program in Finland.
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Kennedy, Linda S., Suyapa A. Bejarano, Tracy L. Onega, Derek S. Stenquist, and Mary D. Chamberlin. "Opportunistic Breast Cancer Education and Screening in Rural Honduras." Journal of Global Oncology 2, no. 4 (August 2016): 174–80. http://dx.doi.org/10.1200/jgo.2015.001107.

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Purpose In Honduras, the breast cancer burden is high, and access to women’s health services is low. This project tested the connection of community-based breast cancer detection with clinical diagnosis and treatment in a tightly linked and quickly facilitated format. Methods The Norris Cotton Cancer Center at Dartmouth College partnered with the Honduran cancer hospital La Liga Contra el Cancer to expand a cervical cancer screening program, which included self-breast exam (SBE) education and clinical breast exams (CBEs), to assess patient attitudes about and uptake of breast cancer education and screening services. The cervical cancer screening event was held in Honduras in 2013; 476 women from 31 villages attended. Results Half of the women attending elected to receive a CBE; most had concerns about lactation. Clinicians referred 12 women with abnormal CBEs to La Liga Contra el Cancer for additional evaluation at no cost. All referred patients were compliant with the recommendation and received follow-up care. One abnormal follow-up mammogram/ultrasound result was negative on biopsy. One woman with an aggressive phyllodes tumor had a mastectomy within 60 days. Multimodal education about breast cancer screening maximized delivery of women’s health services in a low-tech rural setting. Conclusion The addition of opportunistic breast cancer education and screening to a cervical cancer screening event resulted in high uptake of services at low additional cost to program sponsors. Such novel strategies to maximize delivery of women’s health services in low-resource settings, where there is no access to mammography, may result in earlier detection of breast cancer. Close follow-up of positive results with referral to appropriate treatment is essential.
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Al-Hanawi, Mohammed Khaled, Rubayyat Hashmi, Sarh Almubark, Ameerah M. N. Qattan, and Mohammad Habibullah Pulok. "Socioeconomic Inequalities in Uptake of Breast Cancer Screening among Saudi Women: A Cross-Sectional Analysis of a National Survey." International Journal of Environmental Research and Public Health 17, no. 6 (March 20, 2020): 2056. http://dx.doi.org/10.3390/ijerph17062056.

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Timely and adequate screening for breast cancer could improve health outcomes and reduce health costs. However, the utilization of free breast cancer screening services among Saudi women is very low. This study aims to investigate socioeconomic inequalities in breast cancer screening among Saudi women. The data of this study were extracted from the nationally representative Saudi Health Interview Survey, conducted in 2013; the study included 2786 Saudi women. Multivariate logistic regression, the concentration curve, and the concentration index were used to examine, illustrate, and quantify income- and education-related inequalities in three outcomes: Knowledge about self-breast examination (SBE), clinical breast examination (CBE) received in the last year, and mammography, that has ever been previously carried out. Results showed a marked socioeconomic gradient in breast cancer screening services. The concentration index by income was 0.229 (SBE), 0.171 (CBE), and 0.163 (mammography). The concentration index by education was 0.292 (SBE), 0.149 (CBE), and 0.138 (mammography). Therefore, knowledge about breast cancer screening, and the utilization of screening services, were more concentrated among richer and better-educated women. Poorer and less educated women had less knowledge about self-breast examination, and had considerably less adherence to clinical breast examination and mammography. The findings are helpful for policy makers to devise and implement strategies to promote equity in breast cancer screening among Saudi women.
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Dissertations / Theses on the topic "Breast screening services"

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Chen, Hsiu-Hsi. "Mathematical models for progression of breast cancer and evaluation of breast cancer screening." Thesis, University of Cambridge, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.388263.

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McDonald, Marian. "Breast screening and the consequences of recall for further assessment." Thesis, University of Huddersfield, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.285587.

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Johnston, Katharine. "The cost and production of breast screening in the United Kingdom." Thesis, Brunel University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.324647.

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Maloy, Frances. "The demand for breast cancer screening services : an inquiry into the importance of cost as an impediment to use /." Thesis, Connect to this title online; UW restricted, 1999. http://hdl.handle.net/1773/7389.

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DeBoard, Ruth Ann. "Breast Abnormalities: Identification of Indicators that Facilitate Use of Health Services for Diagnosis and Treatment of Breast Cancer." Diss., The University of Arizona, 2010. http://hdl.handle.net/10150/195625.

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Problem: There is a lack of knowledge about women who are screened for breast cancer, have an abnormal finding on mammogram, and then do not return in a timely manner for diagnostics and treatment. Lack of follow- up likely constitutes delayed treatment and poorer outcomes. Delays may result in later entry into the health system with advanced disease, more extensive and expensive care, burdening resources. Late stage breast cancer likely results in poorer health outcomes or early death.Purpose and Aims: The purpose of this research is to describe contextual characteristics at the health delivery level as well as individual characteristics of women with abnormal mammography, and their association with use of follow- up health services. Particularly, this research examines the differences between women who are early and late responders after an abnormal mammogram.Population: The participants were a convenience sample of 380 women who participated in mobile breast cancer screening. A subset of women with inconclusive or abnormal mammogram findings was the focus of analysis.Methods: This research utilized a descriptive design with quantitative data collection through participant survey at mobile mammogram screening events in multiple urban and rural Arizona sites. Participants requiring further health care were followed by chart review. Analysis of correlations with the outcome variable: time to first follow- up appointment for recommended health care in women with abnormal mammograms was conducted.Findings: Data indicated the time to the first follow- up appointment ranged from 1- 110 days with follow- up for 77.4% of participants within 60 days, 6.5% within 60-90 days, and 16.1% without follow- up after 90 days. Significant relationships between contextual and individual characteristics and follow- up were found. Categories included organizational health system characteristics of geographic location, clinical breast exam and shared case management; individual characteristics of beliefs including value of health care; finance including out of pocket costs and perceptions of financial assistance; perceived needs including breast symptoms; and satisfaction with the last health visit and mammograms in general.Implications: Recognition of barriers to follow- up after breast cancer screening is important for development of interventions to improve outcomes and has implications for screening and treatment management programs, community health centers and private practice. Health disparity related to screening without adequate options for access to health care is ethically untenable. Nurses are well positioned to reduce barriers to health care.
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Kidd, Julie. "Socioeconomic variations in breast cancer incidence, survival and the uptake of screening : a case study in Merseyside." Thesis, University of Liverpool, 1997. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.266094.

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Batarfi, Nahid. "Saudi women's experiences, barriers, and facilitators when accessing breast and cervical cancer screening services." Thesis, University of York, 2012. http://etheses.whiterose.ac.uk/7558/.

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Background: Breast cancer is considered the most common cancer among females followed by cancers of the cervix, lung, and stomach. Its mortality can be avoided by early detection. Aim: This thesis aimed to explore Saudi women’s barriers facilitators and experiences, when accessing breast and cervical cancer screening services in the United Kingdom (UK) and Saudi Arabia. Methods: A mixed method approach was used to fulfil the thesis objectives. A quantitative questionnaire was administered to 503 Saudi women living in the United Kingdom and in Kingdom of Saudi Arabia. This was followed up by a qualitative study using seven focus groups discussions. Results: Survey and focus groups provided some consistent findings regarding Saudi women’s perceptions, knowledge, beliefs of the barriers and facilitators in accessing both breast and cervical cancer screening services in the UK and Saudi Arabia. Fear of having cancer and lack of knowledge of the importance of early detection, particularly in cervical cancer were major findings with regard to barriers to attend screening services. However, being employed and highly educated was correlated with better knowledge and awareness of the signs, symptoms, and treatment of both breast and cervical cancer. Participants shared their responsibilities with health professionals and the structure of the health system in the arrangement of early screening of breast and cervical cancers. Additionally, they suggested the role of media, education, and use of places such as mosques in disseminating information about the importance of early cancer detection. Conclusion: While the data reported in this thesis are encouraging, rich and diverse, conclusions must be drawn with caution. Important barriers included health and cultural beliefs and attitudes, language and unsupportive attitudes of health professionals. A majority of Saudi participants believed educational programs would increase breast and cervical cancer awareness and knowledge and use of screening services. The health belief model was utilized to structure and explain the thesis findings and analysis.
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De, Azevedo Moreira Reis Marta. "Evaluation of healthcare management issues in the provision of clinincal services for familial breast/ovarian cancer /." St Andrews, 2009. http://hdl.handle.net/10023/728.

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de, Azevedo Moreira Reis Marta. "Evaluation of healthcare management issues in the provision of clinical services for familial breast/ovarian cancer." Thesis, University of St Andrews, 2009. http://hdl.handle.net/10023/728.

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Despite there being pragmatic national guidelines for assigning risk to women with a family history of breast cancer, the evidence base is still sparse. There are three major questions: First, how can an assignment of "low" risk be made most efficiently? Second, what are the actual outcomes for higher-risk women enrolled in special surveillance programmes? Third, what are the costs and benefits of current management of members of breast cancer families? My thesis reviews the evolution of clinical services for familial breast cancer and the existing literature in the field. I describe the gathering of information from the service records of the Tayside Breast Cancer Family History Clinic and from specific research exercises that involved collaboration with other centres in the UK and abroad. My findings are as follows: 1. Histories provided by the families are not sufficient to assign risk accurately. They must be extended and verified from other records by clinical geneticists. Women assigned a low risk can be informed by post, but some may require further support. The 2004 NICE guidelines for assigning risk are fairly accurate, but may under-estimate it for some women aged 45--55 years. 2. Annual screening of young women at increased risk results in detection of most cancers at a curable stage. Women who carry BRCA1 mutations fare less well, even when tumours are detected at an apparently early stage. 3. Costs of accurate risk assessment are outweighed by savings from the better targeting of surveillance programmes. Early cancer detection in young women enrolled in these programmes achieves a substantial gain in life expectancy at a cost of £3,700 per quality adjusted life year (QALY). Prophylactic surgery for carriers of BRCA1 mutations is highly cost-effective. The thesis concludes with a discussion as to how these findings might be extended and clinical practice improved in the future.
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Homan, Sherri G. "Predicting repeat mammography screening for underserved women 50 years of age and older in Missouri /." free to MU campus, to others for purchase, 1999. http://wwwlib.umi.com/cr/mo/fullcit?p9962532.

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Books on the topic "Breast screening services"

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Great Britain. Parliament. House of Commons. Health Committee. Breast cancer services. London: HMSO, 1995.

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Great Britain. Parliament. House of Commons. Health Committee. Breast cancer services. London: HMSO, 1995.

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Dodd, Maureen Elizabeth. Participation in breast screening: Non-attendance for breast screening in the Eastern Health and Social Services Board : a health promotion perspective. [s.l: The Author], 1994.

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Great Britain. Parliament. House of Commons. Health Committee. Breast cancer services: Minutes of evidence, Thursday 16 March 1995. London: HMSO, 1995.

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Council, Southern Health and Social Services. Breast screening in Newry and Mourne: Women's experiences and attitudes. Lurgan: SHSSC, 2002.

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Calman, Kenneth C. Breast cancer services in Exeter and quality assurance for breast screening: Report to the Secretary of State. [U.K.]: [Department ofHealth], 1997.

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Kerrison, Sue. After screening: A report on diagnostic services for breast cancer in the Greater London Area. London: Greater London Association of Community Health Councils, 1990.

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Houston, Frances A. Breast cancer screening: Is it acceptable to women in the Eastern Health and Social Services Board?. [s.l: The Author], 1993.

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Horton, P. W. Systematic management of quality for breast screening units: A framework for ensuring quality outcomes for the women. Sheffield: NHSBSP Publications, 1995.

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Scotland, NHS. Breat screening: East of Scotland breast screening service local report - November 2003. Edinburgh: NHS Quality Improvement Scotland, 2003.

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Book chapters on the topic "Breast screening services"

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Benn, Carol. "Perspective from South Africa and sub-Saharan Africa." In Breast cancer: Global quality care, edited by Lieve Wierinck, Benjamin Baelus, Emilie Hoogland, Donata Lerda, Robert Mansel, Cary Kaufman, and Luzia Travado, 377–85. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198839248.003.0036.

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Abstract: A continent-wide review of surgical management of breast care in Africa described a disproportionate number of black African patients presenting with locally advanced and metastatic disease (stage 3 or 4). Only 25% presented with early-stage disease (stage 1 or 2). Investment in breast cancer research and treatment in low- and middle-income countries (LMICs) should be a global health priority. In South Africa and other LMICs the first screening goal is to reduce late presentation and late-stage disease through community-based population-level screening combined with open access to health care services for any women with breast symptoms. The aim is to decrease current provider-dependent delays. Increased availability of multidisciplinary teams functioning in specialist centres should improve access and thus decrease the numbers of locally advanced breast cancers presenting, with a knockdown effect on decreasing low survival rates.
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Duggan, Catherine, Benjamin O. Anderson, Eduardo Cazap, Paul A. El-Tomb, and Nagi S. El Saghir. "Optimization of Breast Cancer Management in Low- and Middle-Income Countries." In Breast cancer: Global quality care, edited by Lieve Wierinck, Benjamin Baelus, Emilie Hoogland, Donata Lerda, Robert Mansel, Cary Kaufman, and Luzia Travado, 386–88. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198839248.003.0037.

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Abstract: Breast cancer mortality can be decreased by increasing awareness, and by improving access to early detection, screening programmes, and advanced care, as long as appropriate infrastructure and properly trained health care professionals are available. Low-income countries face many challenges, including spreading community awareness that breast cancer is a treatable disease. It must be clear that it is potentially curable, when discovered early enough and with the presence of basic pathology services and treatment options. The Breast Health Global Initiative consensus made clear recommendations to optimize breast care in low- and middle-resource countries.
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Ashton, John. "Population health care." In Practising Public Health, 142–74. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780198743170.003.0006.

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This chapter addresses the value of health services as a public health measure and makes the case for the use of public health skills in health service planning. The question as to what sort of health services are most appropriate to optimize population health is explored with reference to the development of the World Health Organization Alma Ata Declaration with its emphasis on the eight elements of primary health care. The application of epidemiological thinking in National Health Service frameworks for health care is described. Examples of the use of a public health approach in health care planning include: planned parenthood and family planning services; population-based diabetic retinopathy screening; and whole-system health care transformation in the county of Cumbria. Also covered are the proactive role of the mainstream media in taking the public on a journey of change and the handling of serious clinical service failure in the form of inappropriate organ retention at the Alder Hey Children’s Hospital, breast screening failure in a Cumbrian hospital, and a corporate clinical disaster at the Morecambe Bay University Hospitals.
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Travado, Luzia, Jane Turner, Julia Rowland, Barry Bultz, and Paul Jacobsen. "Psycho-Oncological Care and Survivorship." In Breast cancer: Global quality care, edited by Hans Junkermann, Wolfgang Buchberger, Sylvia Heywang-Köbrunner, Michael Michell, Alexander Mundinger, Carol Benn, and Sophia Zackrisson, 218–33. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198839248.003.0020.

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Abstract: Around 32–60% of breast cancer patients have high levels of distress related to the impact of their disease and treatment consequences on their lives. There is evidence that psychosocial care and interventions can reduce the emotional impact of cancer and improve the quality of life for women affected by breast cancer. Inequalities in cancer care across countries contribute to different outcomes for patients. Psychosocial morbidity associated with cancer adds to the cancer burden if left unaddressed. However, psycho-oncological services are irregularly provided across countries and regions and do not cover entire populations. To improve patient outcomes, it is necessary to integrate distress screening and psycho-oncological care into standard cancer care from diagnosis, across treatment through all phases of disease, and survivorship as a vital part of comprehensive high-quality cancer care. Psycho-oncology professionals are aware of the need and the evidence. Responsibility for improvements must rest with all health professionals, services, and administrators involved in cancer care. ‘Whole of patient care’ requires ‘whole of system’ response.
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Eid, Mahmoud, and Isaac Nahon-Serfaty. "Ethics, Risk, and Media Intervention." In Oncology, 637–59. IGI Global, 2017. http://dx.doi.org/10.4018/978-1-5225-0549-5.ch023.

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Breast cancer incidence and mortality rates are of concern among Latin American women, mainly due to the growing prevalence of this disease and the lack of compliance to proper breast cancer screening and treatment. Focusing on Venezuelan women and the challenges and barriers that interact with their health communication, this paper looks into issues surrounding women's breast cancer, such as the challenges and barriers to breast cancer care, the relevant ethics and responsibilities, the right to health, breast cancer risk perception and risk communication, and the media interventions that affect Venezuelan women's perceptions and actions pertaining to this disease. In particular, it describes an action-oriented research project in Venezuela that was conducted over a four-year period of collaborative work among researchers, practitioners, NGOs, patients, journalists, and policymakers. The outcomes include positive indications on more effective interactions between physicians and patients, increasing satisfactions about issues of ethical treatment in providing healthcare services, more sufficient and responsible media coverage of breast cancer healthcare services and information, a widely supported declaration for a national response against breast cancer in Venezuela, and the creation of a code of ethics for the Venezuelan NGO that led the expansion of networking in support of women's breast cancer healthcare.
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Wierinck, Lieve, Benjamin Baelus, Emilie Hoogland, Donata Lerda, Robert Mansel, Cary Kaufman, and Luzia Travado. "European Perspective." In Breast cancer: Global quality care, edited by Lieve Wierinck, Benjamin Baelus, Emilie Hoogland, Donata Lerda, Robert Mansel, Cary Kaufman, and Luzia Travado, 339–50. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198839248.003.0032.

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Abstract: Cancer is a major health concern in the EU. Currently, it is the second largest cause of death in Europe, and, due to the rapidly ageing population, its prevalence is increasing. Cancer is expected to affect one in two people in the future. Given this significant impact on society, policymakers at both the European and national levels have devoted much attention to the battle against cancer. It should be noted, however, that the EU’s leverage within health policy is limited to complementing national policies through coordination or information sharing. By providing a framework for cooperation between national entities, the EU promotes efficient research and development, propagates best practices regarding cancer prevention and treatment, encourages information exchange, and regulates the use of carcinogenic substances. It facilitates coordination and cooperation by bringing stakeholders together and harmonizing the cancer policy between member states. The European quality assurance scheme for breast cancer services (the ‘European QA scheme’) covers the entire pathway of care from screening to end-of-life care, and it is person-centred and evidence-based. The European QA scheme is being developed for European countries, but its use, implementation, and impact may extend beyond geographic boundaries.
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Aunger, Robert. "Build." In Reset, 81–102. Oxford University Press, 2020. http://dx.doi.org/10.1093/med-psych/9780197532638.003.0006.

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In most cases, programmers don’t have complete knowledge of the behavioral situations they wish to change in some way. There may be a rather abstract sense that many people would like to exercise more or take advantage of breast screening exam services, but little knowledge of what kinds of things would induce people to leave their current patterns of behavior behind, to adopt a new daily routine incorporating exercise, or actually go out to get a mammogram. This chapter outlines numerous ways that programmers can learn the information they need to produce creative campaigns and interventions.
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Salehi, Fatemeh, Leila Mashhadi, Kamran Khazeni, and Zahra Ebrahimi. "Management of Cancer Patients in the COVID-19 Crisis Using Telemedicine: A Systematic Review." In Studies in Health Technology and Informatics. IOS Press, 2022. http://dx.doi.org/10.3233/shti220969.

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Background: Telemedicine can provide a solution for disease management during the COVID-19 pandemic. This literature review aims to explore the role of telemedicine during the COVID-19 pandemic for management of cancer patients. Method: A comprehensive systematic search was conducted in PubMed, Science Direct, EMBASE, and Web of Science databases for the papers published until April 2021. Studies were included in case they had practically used telemedicine in the management of cancer patients during the COVID-19 crisis. Results: After screening 2614 titles and abstracts and reviewing 305 full-texts, 16 studies were found to be eligible. The results indicated that most of the patients contacted by telemedicine services mostly used to intract with patients breast cancer (n=4, 25%). The most common use of telemedicine was the provision of virtual visit services (n=10, 62.25%). Besides, communication was most frequently provided by live video conferences (n=11, 68.75%). Conclusion: Telemedicine can provide continued access to necessary health services in oncology care and serve as an important role in pandemic planning and response.
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"HIV: pregnancy." In Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health, edited by Laura Mitchell, Bridie Howe, D. Ashley Price, Babiker Elawad, and K. Nathan Sankar, 653–58. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198783497.003.0056.

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Opt-out antenatal screening for HIV has >97% uptake in the UK. This ensures early identification of women with HIV, in order to initiate antiretroviral therapy and other interventions in order to reduce mother-to-child transmission. Rates of mother-to-child transmission of HIV in developed countries have consequently fallen to <1%. This chapter describes pre-conception advice, starting and monitoring treatment during pregnancy, obstetric considerations for women with HIV, and neonatal post-exposure prophylaxis, monitoring, and feeding advice. There is now good safety data for many antiretrovirals during pregnancy. Until recently, mothers with HIV who insisted on breast feeding would have been referred to social services, although increasing evidence shows that women with undetectable viral load and good adherence to antiretrovirals have a low risk of HIV transmission.
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Harvey, James, Sue Down, Rachel Bright-Thomas, John Winstanley, and Hugh Bishop. "The National Health Service Breast Screening Programme (NHSBSP)." In Breast Disease Management, 7–18. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199215065.003.0002.

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Conference papers on the topic "Breast screening services"

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Blanco, EC, IM Ribeiro, CCP Nascimento, CA da Silva, CF Abrah㯀, and MM Borges. "Abstract P5-09-12: The importance of education for adherence to mammographic screening in the Brazilian public health services." In Abstracts: Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium; December 8-12, 2015; San Antonio, TX. American Association for Cancer Research, 2016. http://dx.doi.org/10.1158/1538-7445.sabcs15-p5-09-12.

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Queiroz, Andrei Alves de, Gustavo Machado Badan, Marilucia Batina Fernandes Moreira, and Amanda Neves Machado. "IMPACT OF COVID-19 ON BREAST CANCER TUMOR SIZE AT DIAGNOSIS." In Scientifc papers of XXIII Brazilian Breast Congress - 2021. Mastology, 2021. http://dx.doi.org/10.29289/259453942021v31s1006.

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Introduction: In 2020, COVID-19 affected the whole world, determining a pandemic situation, with recommendations for social isolation and lockdown. In the state of São Paulo, the shutdown of non-essential services was determined on March 22, 2020. Medical appointments and routine imaging exams were postponedand little is known about the impact on screening delay and the diagnosis of neoplasms. Considering that survival and cure of breast cancer are directly related to an early diagnosis, the size of these malignant tumors can be used in researching the delay in breast cancer diagnoses. Objectives: To evaluate the impact of the pandemic on the size of breast cancer in histological diagnosis, as well as on the number of diagnostic procedures performed at our hospital. Methods: Through a retrospective, analytical and crosssectional study, we analyzed data regarding tumors with histological results of malignancy of core needle breast biopsies guided by ultrasound performed at a private hospital in São Paulo between January 1, 2019 and December 31, 2020. The mean tumor sizes were compared to identify differences between prepandemic and pandemic periods. The prepandemic period (PRE) was established between January 1, 2019 and March 31, 2020, and the pandemic period (PAN) was considered from April 1 to December 31, 2020. Based on the sample size, this study has the power of 80% to detect a variation of 1 cm in the mean tumor size. Results: A total of 493 core needle biopsies were identified in 443 patients. A total of 103 (20.1%) biopsies in 94 patients were malignant. In the PAN group, 36 cases of cancer were diagnosed (4 cases/month), while the PRE group diagnosed 67 cases (4.5 cases/month). The mean size of PRE tumors was 1.66 cm, while in PAN tumors it was 2.21, showing a difference of 0.55 cm without statistical significance (95%CI 0.12–1.21; p=0.12). When considering staging (TNM – Tumor, Node, Metastases), the stages T1, T2 and T3 had no significant difference among the groups (p=0.12). The age at diagnosis of malignant lesions ranged from 30 to 82 years in the PRE period, and from 34 to 85 years in the PAN period. The mean age of patients with malignant lesions diagnosed in PAN was higher than PRE, without statistical significance (59.2 vs 56.0; p=0.30). Despite the fewer biopsies performed in both periods, (p <0.001), there was no statistical difference in the number of biopsies with malignant results (p=0.18), since there were proportionally more diagnoses of malignancy in the PAN period (28.6% vs. 18.3%; RR 1.14; 95%CI 1.01–1.29; p=0.02). Conclusions: Although the pandemic affected breast cancer screening, no statistically significant increase in the mean size of tumors has been diagnosed in this service so far.
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Opdyke, KM, MG Pagaduan, K. Gates-Ferris, CA Ricci, and M. Hurlbert. "P1-11-14: Gender and Sexual Orientation of Clients Who Were Linked to Breast Cancer Screening Services through Outreach and Education Supported by the Avon Breast Health Outreach Program." In Abstracts: Thirty-Fourth Annual CTRC‐AACR San Antonio Breast Cancer Symposium‐‐ Dec 6‐10, 2011; San Antonio, TX. American Association for Cancer Research, 2011. http://dx.doi.org/10.1158/0008-5472.sabcs11-p1-11-14.

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Torres, Essie T., and Alice R. Richman. "Abstract A34: Using a community-based breast health intervention to reduce structural barriers in accessing breast cancer screening services among underserved rural Latina and black women in Eastern North Carolina." In Abstracts: Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; November 13-16, 2015; Atlanta, Georgia. American Association for Cancer Research, 2016. http://dx.doi.org/10.1158/1538-7755.disp15-a34.

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Bluethmann, SM, JD Allen, C. Hernandez, KM Opdyke, K. Gates-Ferris, M. Hurlbert, and E. Harden. "Abstract P5-14-02: Women's responses to changes in US Preventive Services Task Force mammography screening guidelines: results from focus groups among ethnically diverse women." In Abstracts: Thirty-Fifth Annual CTRC‐AACR San Antonio Breast Cancer Symposium‐‐ Dec 4‐8, 2012; San Antonio, TX. American Association for Cancer Research, 2012. http://dx.doi.org/10.1158/0008-5472.sabcs12-p5-14-02.

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Hallum-Montes, RM, KM Opdyke, M. Aliaga, M. Hurlbert, and K. Gates-Ferris. "Abstract P5-13-11: Characteristics of women under age 40 years served by organizations funded to conduct education and outreach to link medically underserved women with breast cancer screening services through the Avon breast health outreach program." In Abstracts: Thirty-Sixth Annual CTRC-AACR San Antonio Breast Cancer Symposium - Dec 10-14, 2013; San Antonio, TX. American Association for Cancer Research, 2013. http://dx.doi.org/10.1158/0008-5472.sabcs13-p5-13-11.

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Machado, Samira Juliana de Moraes, Renato Cagnacci Neto, Marina Sonagli, Hirofumi Iyeyasu, and Fabiana Baroni Alves Makdissi. "ANALYTICAL CROSS-SECTIONAL STUDY TO ASSESS THE IMPACT OF THE COVID-19 PANDEMIC ON THE STAGING OF BREAST CANCER PATIENTS." In XXIV Congresso Brasileiro de Mastologia. Mastology, 2022. http://dx.doi.org/10.29289/259453942022v32s1003.

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Introduction: We are currently living in a state of pandemic by COVID-19, whose virus has high transmissibility and potential lethality. The World Health Organization recommended social isolation, and the Brazilian National Cancer Institute, following this guidance, proposed that the oncological treatment of low-to-moderate aggressive tumors be postponed, including breast cancer. In Brazil, the lockdown was a strategy to reduce the potential impact of the pandemic on health services; consequently, asymptomatic patients postponed their imaging tests this year. Considering this abrupt change in access to health care and in the routine of cancer screening, we theorize that the COVID-19 pandemic may have had a negative impact on diagnosis, treatment, and survival in breast cancer patients. Objective: The aim of this study was to analyze the staging at diagnosis of patients with breast cancer, before and during the pandemic, and to calculate if there was a statistical difference comparing the two groups studied. A secondary objective was to describe clinical and demographic characteristics. Methods: A single-center, cross-sectional analytical study with 1219 patients diagnosed with breast cancer (CID C50 or D05) treated at the Mastology Department of the AC Camargo Cancer Center from March 2019 to February 2021. The following epidemiological variables were evaluated: age at years at diagnosis, clinical staging at diagnosis (TNM 8th edition©), presence of comorbidities (risk group for severe COVID-19), family history of cancer, symptoms at diagnosis, and provenance. Descriptive variables and data analysis was performed using Pearson’s χ2 test or Fisher’s exact test. Results: In this study, 1002 patients were included, divided into two groups: prepandemic (574) and pandemic (428). Both groups had similar demographic and clinical characteristics. There was an increase in the frequency of symptomatic patients in the pandemic period 199 (46.5%) versus nonpandemic period 213 (37.1%) (p=0.003). Anatomical and clinical staging were similar between the groups, with no statistically significant difference. When analyzing the anatomical staging, comparing the prepandemic versus pandemic groups, we observed a higher frequency of tumors: T1 [262 (45.6%) vs. 170 (39.8%), p=0.376]; N0 [398 (69.2%) vs. 288 (67.4%), p=0.194]; M0 [552 (96.0%) vs. 415 (97.2%), p=0.614]. Regarding clinical staging, early malignant tumors (EC Tis, Ia–IIIa) were more frequent, corresponding to 521 (90.8%) prepandemic versus 390 (91.1%) pandemic (p=0.766). Conclusion: There was no significant variation between the groups in terms of staging at diagnosis, but more patients with symptoms related to breast cancer sought cancer care.
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Aquino, Renata Borges, Luiz Henrique Gebrim, Andre Mattar, and Jorge Yoshinori Shida. "TYPES OF SURGERY AND BREAST RECONSTRUCTIONS PERFORMED ON PATIENTS TREATED BY THE BRAZILIAN UNIFIED HEALTH SYSTEM AT PÉROLA BYINGTON HOSPITAL." In Scientifc papers of XXIII Brazilian Breast Congress - 2021. Mastology, 2021. http://dx.doi.org/10.29289/259453942021v31s1066.

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Introduction: Breast cancer is the most frequent cause of cancer death in women, also haunting them because surgical treatment can vary from expanded resection to mastectomy, causing aesthetic, functional, psychological and social damage. In Brazil, where 70% of the population is treated through the Unified Health System (SUS) and about 55% of cases are treated in advanced stages, most patients undergo mastectomy without immediate reconstruction. However, occasional mammographic screening carried out in some large cities has led to an increase in the number of diagnoses in the initial stages and, thus, a decrease in mortality from breast cancer, in addition to the possibility of less radical surgical treatments. Due to the scarcity of data in this population, we decided to perform an observational study at our institution. Objectives: This work aims at characterizing the types of surgical treatment that patients with breast cancer were submitted to at the Women’s Health Reference Center (CRSM) at Hospital Pérola Byington in São Paulo, SP, from 2015 to 2019 and the breast reconstructions carried out from January 2015 to December 2019. Methods: This is a retrospective, descriptive, observational study performed through the review of medical records of patients followed up at our service. Inclusion criteria were female patients diagnosed with malignant breast cancer treated with conservative and radical surgery, with or without immediate and late reconstruction in this 5-year period. Results: At CRSM, from 2015 to 2019, 9,097 surgical procedures were performed for the treatment of breast cancer. Radical surgeries represented 53.5%, with 2% of adenectomies. Regarding conservative surgeries, there were 4,222 procedures, 43.4% of which were quadrantectomies. From January 2015 to December 2019, 4,902 breast reconstructions were performed, 17.8% of which were immediate. Conclusions: Our data also showed 51.5% of patients underwent mastectomy due to the predominance of tumors in stages II and III. However, about 47% of patients were treated conservatively for their efforts to reduce the time to diagnosis, palpable lesions and the occasional screening performed in the city of São Paulo, resulting in a proportion of 46.5% of the patients who underwent conservative surgery. Breast reconstruction was performed in 46.8% of mastectomies, with only 82.4% being in a late stage.
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Vivian, Fernando, Daniela Boeira, Bruna Kikuchi Sacchielle, Gabriela Grechi Carrard, and Luiza Herdy Boechat Luz Tiago. "ANALYSIS OF THE EFFECTIVENESS OF MAMMOGRAPHIC SCREENING IN A PINK OCTOBER CAMPAING." In Scientifc papers of XXIII Brazilian Breast Congress - 2021. Mastology, 2021. http://dx.doi.org/10.29289/259453942021v31s1013.

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Introduction: The month of October was chosen to raise the population’s awareness of breast cancer, with strategic actions being taken in order to optimize an early diagnosis of malignant breast lesions, as well as their treatment. The city of Caxias do Sul annually promotes a health action on a Saturday in October, known as the Pink October Campaign. The analyzed campaign was on the first Saturday of October 2017, with the operation of all Basic Health Units (UBS), and according to recommendations from the Brazilian Society of Mastology, offering mammographic evaluation and screening for women over 40 years of age. Objectives: To identify the number of diagnoses of malignant neoplasms in women who underwent screening mammography in a municipal campaign, the number of examinations performed in the campaign, and the prevalence of the BI-RADS 4 and BI-RADS 5 categories. Methods: Observational, descriptive, and retrospective study. All patients who had mammograms requested in the Pink October campaign were identified. The BI-RADS 4 and 5 cases on mammography, or after the completion of a complementary ultrasound for presenting BI-RADS 0 on the initial mammography, were referred to a reference service and had a biopsy with a posterior segment. Results: 1220 mammograms were made. In the BI-RADS 4 category, nine patients were identified (0.73%); all had biopsies performed, and three patients had confirmed carcinoma: two of them with invasive carcinoma and one case with carcinoma in situ. There were two cases of BI-RADS 5 mammograms (0.16%), and both had pathological confirmation of malignancy through biopsy. The prevalence of BI-RADS 4 and 5 in this population was 0.73% and 0.16%, respectively. There were 126 BI-RADS 0 mammograms (10.33%), making it possible to perform 90 complementary breast ultrasound exams. Four cases were classified as BI-RADS 4, with a negative biopsy for malignancy, and one case of BI-RADS 5, with a diagnosis of invasive lobular carcinoma. Conclusions: The Pink October Campaign held in 2017 in Caxias do Sul provided the diagnosis of six cases of breast malignancy in women between 43 and 65 years of age, one of them still in the non-invasive stage (carcinoma in situ), representing 0.49% of the population tracked in the campaign.
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Feld, Laila Feld, Valeska Davi Caldoncelli de Andrade, Vania Ravizzini Manoel Sondermann, Rosana de Castro Ribeiro dos Santos, and Henrique Alberto Pasqualette. "EXPERIENCE WITH CONTRAST-ENHANCED MAMMOGRAPHY: BREAST CANCER DETECTION IN PATIENTS REFERRED TO PERCUTANEOUS BIOPSIES." In Scientifc papers of XXIII Brazilian Breast Congress - 2021. Mastology, 2021. http://dx.doi.org/10.29289/259453942021v31s1017.

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Introduction: Breast cancer is the leading cause of cancer deaths in the Brazilian female population, and it is the most common malignant tumor in women in the world. The only method that has proven to decrease breast cancer mortality is mammography and, therefore, screening programs are based on this test in several countries. However, its sensitivity in the general population ranges from 75% to 80%, being especially lower in the case of dense breasts, more common in young women, ranging from 30% to 48% in this group. The most sensitive method in the detection of breast cancer is magnetic resonance imaging, (80% to 97.8%, according to current studies), due to its ability of studying vascular changes in the tissues. Aiming to combine the morphological study provided by mammography with the analysis of tumor perfusion allowed by studies that use intravenous contrasts, contrast enhanced digital mammography (CEDM) or angiomammography was developed. Objective: Assess whether CEDM is an effective method in the detection of breast cancer, as well as its reliability to rule out the presence of malignancy. Methods: Patients were recruited at the time of attendance to the service for breast percutaneous biopsy of lesions detected on previous mamography and /or ultrassound examinations, previously requested by their physicians. Those who made themselves available to participate in this study did sign the Informed Consent Form (ICF). Patients were submited to bilateral mammographic study in craniocaudal and mediolateral oblique incidences, obtaining low-energy images and recombined high-energy images. Low-energy images, equivalent to digital mammography, were described and classified according to the BI-RADS lexicon. The contrasted studies were described in order to comply with the recommendations of the current literature, observing that, until the present, there is no standardization by BI-RADS for contrast mammography reports. These studies were compared to histopathological findings of biopsies, the gold standard in this study. Results: This is an ongoing investigation. From September 2019 to October 2020, 180 patients underwent CEDM and percutaneous biopsies. 27 had invasive ductal carcinomas (IDC) and 10 ductal carcinomas in situ (DCIS). 26 of the 27 IDC cases and all of the DCIS cases had positive CEDM findings. Among DCIS cases, six had no abnormal enhancement on CEDM, but were evident on a 2D study. The observed sensitivity was 97%. Conclusions: These preliminary results demonstrated that CEDM is a highly sensitive method for breast cancer detection, including for non-invasive lesions. The study is still in progress and further data is needed to describe the benefits of CEDM in breast cancer detection.
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Reports on the topic "Breast screening services"

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Yelena, Gorina, and Elgaddal Nazik. Patterns of Mammography, Pap Smear, and Colorectal Cancer Screening Services Among Women Aged 45 and Over. National Center for Health Statistics, June 2021. http://dx.doi.org/10.15620/cdc:105533.

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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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Lin, Yawei, Yi Chen, Rongrong Liu, and Baohua Cao. Effect of exercise on rehabilitation of breast cancer surgery patients: A systematic review and meta-analysis of randomized controlled trials. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, October 2022. http://dx.doi.org/10.37766/inplasy2022.10.0065.

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Review question / Objective: Exercise after breast cancer surgery has proved beneficial to rehabilitation. We evaluate the best exercise for different post-surgery complications. Information sources: China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, VIP China Science and Technology Journal Database, China Biology Medicine, EMBASE and PubMed databases were searched. Combinations of breast cancer (“breast tumor”,“breast carcinoma”,“mammary carcinoma”,“breast neoplasm”) and rehabilitation exercise (“exercise”,“physical therapy”) were employed when screening abstracts/keywords of articles. Two researchers independently searched, read the title and abstract of the literature, read the full text of the preliminary included literature, and extracted the data. In case of divergence, a third researcher was consulted.
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Rankin, Nicole, Deborah McGregor, Candice Donnelly, Bethany Van Dort, Richard De Abreu Lourenco, Anne Cust, and Emily Stone. Lung cancer screening using low-dose computed tomography for high risk populations: Investigating effectiveness and screening program implementation considerations: An Evidence Check rapid review brokered by the Sax Institute (www.saxinstitute.org.au) for the Cancer Institute NSW. The Sax Institute, October 2019. http://dx.doi.org/10.57022/clzt5093.

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Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.
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