BACKGROUND: The aim was to investigate compliance by ethnic groups to the mammography screening programme in the City of Copenhagen over six years and to look at developments over time. MATERIAL AND METHODS: Mammography screening has, since 1 April 1991, been offered free of charge to all women between 50 and 69 years of age in the City of Copenhagen. Data on women born in Poland, Turkey, Yugoslavia, and Pakistan divided into five-year groups were compared to that of women born in Denmark and all other foreign-born women. Data from 1991 to 1997 were grouped according to the mammography performed, the offer refused, or non-appearance. RESULTS: Whereas 71% of Danish-born women accepted mammography, compliance by foreign-born women was significantly lower. The offer was accepted by 36% of Pakistanis, 45% of Yugoslavians, 53% of Turks, and 64% of Poles. Compliance fell in all ethnic groups with advancing age. Of the Danish women, 16% failed to keep the appointment. The corresponding percentages were 52 for Pakistanis, 48 for Yugoslavians, 41 for Turks, and 23 for Poles. The proportion of women who actively refused the offer was similar in all groups. The number of invited women fell during the period. CONCLUSIONS: The lower participation of women from the countries under study might have various explanations: among them the language barrier, procedure-related factors, and a lower incidence of breast cancer in the countries of origin.
The purpose of this study is to determine if access to medical care and utilization of cancer screenings differs between women in the United States and Canada. This study examined this question by comparing women in Canada to women in the United States who have insurance coverage and those who do not.
This study used data from the 2002/03 Joint Canada United States Survey of Health and examined access to medical care and cancer screenings. A binary probit model was used to address several measures of access to medical care and cancer screening utilization.
This study finds five significant differences between insured American and Canadian women. Canadian women are better off in terms of ever having a mammogram, having a regular doctor, and having access to needed medicine, but fare worse in terms of having had a recent mammogram and having perceived unmet healthcare needs. With the exception of having recent mammograms, there is no statistical difference between uninsured and insured American women.
Although this study does not show that one group is strictly better off, it does show that there are significant differences between the two groups of women.
Basic conventional methods of secondary cancer prevention are clinically reviewed. The authors hold that further extensive development of present-day organisational patterns (wider screening coverage of population, growing number of objective diagnostic techniques) shows no promise in inducing positive trends of cancer outcome statistics. Scientifically validated diminution of precancer definition is stated. Selection of population at risk for cancer and proper examination of these risk groups seem most perspective in improvement of cancer statistics.
Adherence to long-term pharmacological treatment for chronic conditions is often less than optimal. Till date, a limited number of population-based studies have assessed adherence to adjuvant hormonal therapy in breast cancer, a therapy with proven benefits in terms of reductions of recurrence and mortality. We aimed to examine rates of adherence and early discontinuation in Sweden where prescribed medications are subsidized for all residents and made available at reduced out-of-pocket costs. Individual-level data were obtained from Regional Clinical Quality Breast Cancer Registers, the Swedish Prescribed Drug Register, and several other population-based registers. Multivariate logistic regression was used to analyze factors associated with adherence to prescribed medication for a period of 3 years. Between January 1 and December 31, 2005, 1,741 patients in central Sweden were identified with estrogen receptor positive breast cancer, and at least one prescription dispensation of either tamoxifen or an aromatase inhibitor. Of these women, 1,193 (69%) were fully adherent to therapy for 3 years (medication possession ratio of 80% or higher and a maximum of 180 days between refills). During the 3-year follow-up, 215 women (12%) had prematurely discontinued therapy. Adherence was positively associated with younger age, large tumor size, being married, and being born in the Nordic countries, while no clear association was observed with education or income. During the 3 years of follow-up, 31% of women were non-adherent to therapy. Further efforts must be undertaken to promote adherence over the entire recommended treatment period.
We conducted a survey of a representative sample of all primary care physicians in the province of Québec to ascertain their patterns of preventive practice with respect to cancer in four anatomical sites: breast, colon-rectum, cervix, and lung. A stratified random sample of 430 physicians in general practice was interviewed individually and weighted population estimates derived. Physicians report teaching breast self-examination to their patients (96 per cent), performing breast examination (99 per cent), taking pap tests routinely (91 per cent), and pursuing anti-smoking counseling (98 per cent). Very few of them report submitting their patients over 50 years of age to annual mammography (8 per cent) or checking for occult blood in stools in patients over 45 years of age (15 per cent). Many still use routine chest X-rays as an early detection measure of cancer of the lung (77 per cent); an estimated 41 per cent use sputum cytology for the same purpose. Preventive practices, when in-use, are carried out mainly in the context of major encounters with patients such as general check-ups. Less than 28 per cent of the population is estimated to be reached by this strategy for prevention. The unrealized potential for prevention through capitalizing on all encounters with primary care physicians is important, and should stimulate creative efforts to enhance preventive activities in medical practice.
Cites: Med Care. 1982 Oct;20(10):1040-57132464
Cites: N Engl J Med. 1978 Mar 9;298(10):567-8625313
Cites: Lancet. 1976 Jun 5;1(7971):1228-3158269
Cites: N Engl J Med. 1977 Mar 17;296(11):601-8402571
Breast cancer patient advocacy groups emerged in the 1990s to support and empower women with breast cancer. Women with cancer and oncologists tend to have divergent perspectives on how breast cancer prevention should be defined and what the priorities for research should be. As their American counterparts have done, breast cancer patient advocates in Canada are seeking greater participation in decision making with respect to research. To date they have had more input into research policy decisions than into the planning of specific projects. In 1993 the National Forum on Breast Cancer recommended that women with breast cancer should have more input into the research process; breast cancer patient advocates will continue to actively pursue this objective.
The framework project of the Advisory Committee on Cancer Control (ACOCC), National Cancer Institute of Canada (NCIC), was based on the NCIC/ACOCC conceptual framework for bridging the gap between research and action. The project was carried out under the auspices of the Sociobehavioural Cancer Research Network (SCRN) of the NCIC. It focused on 3 research areas of cancer control research: smoking control, palliative care and screening for breast cancer. In this introductory paper, the criteria and methodology used for the framework project are described, the main features of the framework are outlined and the definitions of terms used in the framework are summarized. It was expected that the framework project would lead to a better understanding of the strengths and weaknesses of the NCIC/ACOCC conceptual framework. The project was also expected to assist the SCRN in its ongoing efforts to develop and refine an action-oriented research agenda.
The study was concerned with analysis of the second stage of evaluation of a breast self-examination training program aimed at early detection of cancer. A total of 60,079 of women were recruited into the WHO/USSR Project in Moscow in 1985-1988: study group--30,465 and controls--29,614. At 6 months, 52.5% of women performed breast self-examination on a regular basis whereas at 12 months the percentage decreased to 42.0. Breast cancer was diagnosed in 6 out of 11,548 females of the study group (stage I--1 case, stage II--3 and stage III--2 cases) and in 10 out of 23,083 controls (stage I--2, stage II--5, stage III--2 and stage IV--1 patient). In the study group, medical advice was sought 4.5 times more frequently than in controls.