Archive for the ‘Cancer’ Category
Posted by James
We conducted a retrospective cohort study. Inclusion required a diagnosis of breast cancer, and it reported to the TriHealth tumor registry from 1991-2003. There are three TriHealth hospitals in Cincinnati, OH. This is the largest tumor registry in this geographical area. This region is approximately 89% Caucasian and 11% African-American. TriHealth dedicates a full-time nurse whose exclusive responsibility is the oversight of the tumor registry data. This nurse collects data from the patient, their chart and the treating physician. Patients are followed over time for the purposes of prognosis. For each patient, we collected data on race; AJCC stage at diagnosis; and 12 potential confounding variables, including topography, morphology, laterality, age, menopausal age, smoking status, estrogen and progesterone receptor status, marital status, menopausal status, family history of breast cancer in a first-degree relative and insurance status. Due to small number of patients in some stages, AJCC breast cancer stages 0 and 1 were analyzed as separate and combined stages, and stages 2A and 2B, and stages ЗА, 3B and 3C were collapsed in the analysis into stages 2 and 3, respectively. Use of the AJCC stage for research purposes has been utilized by previous authors. Races other than Caucasian and African-American were excluded due to small numbers (N=60).
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Posted by James
INTRODUCTION
Breast cancer is the most common cancer among women in the United States. It is diagnosed in approximately 240,000 women and kills an estimated 40,000 women each year. It is suspected that as the baby boomer population ages the absolute number of women diagnosed will rise by one-third over the next 20 years, increasing the number to 320,000 females diagnosed annually. The peak age of diagnosis is 45-65 years, with approximately 77% occurring in females age >50. Though screening recommendations vary among organizations, American Cancer Society guidelines for breast cancer screening consist of optional monthly self-breast exams starting at age 20, and clinical breast exams every 2-3 years until the age of 40, then annually. Yearly mammograms are initiated at the age of 40 as well, or earlier, based on preexisting risk factors. Multiple risk factors for breast cancer have been identified including: increasing age, presence in a first-degree relative, early menarche, nulliparity, delayed first pregnancy, prior personal history of breast cancer, endometrial cancer, abnormal breast biopsy, exogenous estrogen use, radiation exposure, geographical influence, diet and white race.
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Posted by Alex
Underscreened populations. Women are inadequately screened for several reasons. For women to enjoy the benefits of screening, they must first undergo the test. In Prince Edward Island, 57% of women diagnosed with invasive cancer of the cervix had not previously been screened. Eighty-six percent of women older than 60 diagnosed with invasive cancer had never been screened. Despite a population-based screening program in British Columbia since 1955, 15% of all women in that province have never had a Pap test. Nationally, twice as many women between the ages of 25 and 44 were not screened in 1990 as were not screened in 1985.
Many of the unscreened women are from immigrant communities, aboriginal communities, or core areas of our cities. Other groups shown to be under-screened include those living in remote areas; single, unemployed women; low-income earners; and older women.1213 The challenge these groups of women present to family physicians is more than a lack of compliance with cervical cancer screening. They frequently feel uncomfortable and unwelcome in physicians’ offices and thus attend infrequently.
There are both physician-specific and patient-specific barriers to cervical screening. To overcome these barriers, family physicians need to make preventive care a priority. When patients attend for any reason, family physicians need to encourage all women due for screening to undergo Pap tests, especially those who have never been screened. This requires effective communication of the purpose of screening as well as of the mechanics of the test.
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Posted by Alex
Most Pap smears in Canada are performed by family physicians. Despite the tremendous success of the Pap test in reducing the incidence of cancer of the cervix in Canada, 1350 new cases and 390 deaths were predicted to occur in 1996. Incidence rates have dropped from 21.6 per 1000 in 1969 to 10.4 per 1000 in 1990. To further reduce the incidence of invasive carcinoma of the cervix, we need to examine the role of family physicians as the primary providers of screening services.
The success of screening is directly related to the percentage of the target population who are screened and the reliability of the screening test performance. Family physicians have the opportunity and responsibility to influence both of these factors.
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