Posted by James
California Cancer Registry collects information on every case of cancer diagnosed or treated in California. Standard data are abstracted from the medical record for each case by trained tumor registrars, according to Cancer Reporting in California: Volume 1, Abstracting and Coding Procedures for Hospitals and computerized using C/NET, a software package developed for tumor registries. C/NET meets all reporting requirements of the Surveillance, Epidemiology and End Results (SEER) program, the American College of Surgeons and the California Cancer Reporting System. The quality of data is maintained through periodic training programs for hospital registrars and field abstractors, reabstraction of a 10% sample of case finding, and computer edits for completion and consistency. Additional audits of case finding and data abstraction are conducted by the California Department of Health Services. Completeness of coverage is Completeness is estimated to be higher than 99% annually from 1988 through 1998.
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Posted by James
Modeling
Cost-effectiveness modeling of colorectal screening programs was done using a model developed at the Office for Technology Assessment (Washington, DC) and described in detail elsewhere. This model estimates the net present value of lifetime costs and years of life gained in a cohort of 100,000 50-year-old persons over a 35-year period from different colorectal cancer screening strategies using specified assumptions about the natural history of colorectal cancer and the adenoma or carcinoma sequence, the sensitivity and specificity of each screening technology for early cancer and polyps, the cost of screening, follow-up and postpolypecto-my surveillance procedures, and the incremental costs of treating colorectal cancer. Costs were taken from 2000 Medicare reimbursement rates. Costs were discounted to their present value at 5% per year. The main assumptions of the model are summarized in Table 1. Justification of model assumptions are based on reviews of the published literature. Read the rest of this entry »
Posted by James
Cancer screening in the United States has evolved to include the use of gender and race/ethnicity to stratify patient risk. Mammography is recommended only in women because of the low incidence of male breast cancer. Prostate cancer screening is recommended for most men at age 50 but is recommended for black men at age 45 because of high age-specific incidence rates in this group. We have shown that gender-specific racial/ethnic colorectal cancer disease patterns affect the cost-effectiveness of colorectal screening. Colorectal screening was much more cost-effective in black men than in other groups. Screening black men beginning at age 45 was similar in cost-effectiveness to screening white men and black women and more cost-effective than screening Latino and Asian men and nonblack women beginning at age 50. Differences were robust and persisted after doubling the polyp incidence rate for black men. The favorable cost-effectiveness ratio of screening black men largely reflected high age-specific colorectal cancer incidence rates in this group.
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Posted by James
Table 2 and Table 3 list age-specific incidence rates of colorectal cancer in California from 1988-1995 for men and women, respectively, of each of four racial and ethnic groups. Age-specific colorectal cancer incidence rates were highest in black men and lowest in Latino women. For most ages between 45-85, the rank of incidence rates was consistent (black men > white men > Asian men > black women > white women > Latino men > Asian women > Latino women).
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Posted by James
INTRODUCTION
Colorectal cancer will be diagnosed in approximately 131,000 Americans this year, and about 55,000 will die of the disease, making this cancer the second leading cause of death from cancer in this country. Colorectal cancer screening allows the detection of asymptomatic cancers that are more amenable to curative therapy and also allows the removal of adenomas that could subsequently develop into invasive cancer. Colorectal screening programs are proven to reduce the mortality from colorectal cancer. Nearly every case of colon cancer could be prevented if every American were to undergo periodic total colonic evaluation starting at a very young age. Such a program is impractical, however, and working groups of the American Cancer Society and others have published colorectal cancer screening guidelines that balance the medical benefits of screening against its costs.
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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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