BACKGROUND: The Edinburgh randomised trial of breast-cancer screening recruited women aged 45-64 years from 1978 to 1981 (cohort 1), and those aged 45-49 years during 1982-85 (cohorts 2 and 3). Results based on 14 years of follow-up and 270,000 woman-years of observation are reported. METHODS: Breast-cancer mortality rates in the intervention group (28,628 women offered screening) were compared with those in the control group (26,026) with adjustment for socioeconomic status (SES) of general medical practices. Rate ratios were derived by means of logistic regression for the total trial population and for women first offered screening while younger than 50 years. Analyses were by intention to treat. FINDINGS: Initial unadjusted results showed a difference of just 13% in breast-cancer mortality rates between the intervention and control groups (156 deaths [5.18 per 10,000] vs 167 [6.04 per 10,000]; rate ratio 0.87 [95% CI 0.70-1.06]), but the results were influenced by differences in SES by trial group. After adjustment for SES, the rate ratio was 0.79 (95% CI 0.60-1.02). When deaths after diagnosis more than 3 years after the end of the study were censored the rate ratio became 0.71 (0.53-0.95). There was no evidence of heterogeneity by age at entry and no evidence that younger entrants had smaller or delayed benefit (rate ratio 0.70 [0.41-1.20]). No breast-cancer mortality benefit was observed for women whose breast cancers were diagnosed when they were younger than 50 years. Other-cause mortality rates did not differ by trial group when adjusted for SES. INTERPRETATION: Our findings confirm results from randomised trials in Sweden and the USA that screening for breast cancer lowers breast-cancer mortality. Similar results are reported by the UK geographical comparison, UK Trial of Early Detection of Breast Cancer. The results for younger women suggest benefit from introduction of screening before 50 years of age.
Comment In: Lancet. 1999 Jun 5;353(9168):1896-710371561
To determine if inequities in access to osteoporosis investigation [dual-energy x-ray absorptiometry (DXA) testing] and treatment (bisphosphonate, calcitonin, and/or raloxifene) exist among older women in a region with universal health care coverage.
Community-dwelling women aged 65-89 years residing within 2 regions of Ontario, Canada were randomly sampled. Data were collected by standardized telephone interview. Potential correlates of DXA testing (verified by physician records), and current treatment were grouped by type as: "predisposing characteristics," "enabling resources," or "need factors" based on hypothesized relationships formulated before data collection. Variables associated with each outcome independent of "need factors" identified inequities in the system.
Of the 871 participants (72% response rate), 55% had been tested by DXA and 20% were receiving treatment. Using multiple variable logistic regression to adjust for need factors, significant inequities in access to DXA testing existed by age, health beliefs, education, income, use of preventive health services, region, and provider sex. DXA testing mediated access to treatment; 34% of those having had a DXA were treated compared with 2% of those who did not. Among women with osteoporosis, correctly reporting that their DXA test indicated osteoporosis and higher perceived benefits of taking pharmacological agents for osteoporosis were associated with treatment.
Significant inequities in access to fracture prevention exist in a region with universal health care coverage. Improved access to DXA and better communication to patients of both their DXA results and the benefits of treatment has the potential to reduce the burden of osteoporosis.
The aim of this study was to assess the acceptability of human immunodeficiency virus (HIV) testing among migrants in Finland and the factors contributing to non-acceptance.
The Finnish Migrant Health and Wellbeing Study 'Maamu' was the first national population-based Health Interview and Examination Survey (HIS/HES) among migrants in Finland. A total of 386 Kurdish, Russian and Somali immigrants in Helsinki participated in the study.
Despite the participants' different sociodemographic backgrounds, a high rate of test acceptability (92%, 95% CI 90-95) was achieved. HIV test acceptance was associated with pretest counselling, ability to understand spoken Finnish or Swedish and employment status. No participants tested positive for HIV.
The results imply that a universal HIV testing strategy is well accepted in a low-HIV prevalence immigrant population and can be included in a general health examination in immigrant population-based surveys.
The prevalence levels of 12 health practices in the United States and Canada are compared in this study: smoking; drinking status; average daily alcohol consumption; physical activity; eating breakfast; use of seatbelts and child safety restraints; ownership of smoke detectors; recency of blood pressure checks, breast examinations, and Pap tests; and practice of breast self-examination. Data for two additional variables--drinking and driving and blood pressure awareness--are shown for the two countries, but the statistics cannot be strictly compared. Data are presented for four age groups by sex and for three levels of education. Trends in smoking and seatbelt use between 1979 and 1985 are also discussed.
BACKGROUND AND METHODS: The purpose of this article was to examine differences in demographics, general health status, and utilization of breast and cervical cancer screening for subgroups of American Indians and Alaska Natives (AIAN) using the 2001 California Health Interview Survey. RESULTS: The statewide distribution of California American Indians, non-California AIANs, and unknown AIANs are 10%, 51%, and 39%, respectively. Significant differences exist among the 3 tribal subgroups. CONCLUSIONS: Overall, AIAN women aged 40+ years are close to the Healthy People 2010 goals for receipt of a mammogram in the past 2 years and for receipt of a Pap test ever and in the past 3 years. Less than 5% of AIAN in California report Indian Health Service coverage.
To understand whether US and Canadian breast, colorectal and prostate cancer screening test utilization is consistent with US and Canadian cancer screening guideline information with respect to the age of screening initiation.
Cross-sectional, regression discontinuity.
Canada and the US.
Canadian and American women of ages 30-60 and men of ages 40-60.
None. Main Outcomes Measures Mammography, prostate-specific antigen (PSA) and colorectal cancer test use within the past 2 years.
We identify US and Canadian compliance with age screening information in a novel manner, by comparing test utilization rates of individuals who are immediately on either side of the guideline recommended initiation ages.
US mammography utilization within the last 2 years increased from 33% at age 39 to 48% at age 40 and 60% at age 41. US colorectal cancer test utilization, within the last 2 years, increased from 15% at age 49 to 18% at age 50 and 28% at age 51. US PSA utilization within the last 2 years increased from 37% at age 49 to 44% at age 50 and 54% at age 51. In Canada, mammography utilization within the last 2 years increased from 47% at age 49 to 57% at age 50 and 66% at age 51.
American and Canadian cancer screening utilization is generally consistent with each country's guideline recommendations regarding age. US and Canadian differences in screening due to guidelines can potentially explain cross-country differences in breast cancer mortality and affect interpretation of international comparisons of cancer statistics.
Colorectal cancer screening reduces colorectal cancer incidence and mortality. This population-based study was conducted to evaluate (i) the association between subject factors and colorectal screening participation and (ii) the lifetime prevalence of colorectal screening among the general population of Ontario, Canada. Population-based controls were recruited by the Ontario Familial Colorectal Cancer Registry during 1998-2000. The 1944 persons completed an epidemiologic questionnaire. Descriptive statistics were computed and step-wise multivariate logistic regression was used to estimate odds ratios and 95% confidence intervals. Overall, 23% of persons greater than 50 years of age reported ever having had colorectal cancer screening; 17% reported fecal occult blood test (FOBT), 6% sigmoidoscopy, and 4% colonoscopy. Family history of colorectal cancer, increased age, higher household income, and use of hormone replacement therapy (among women) were all significantly associated with ever having had colorectal cancer screening. The low prevalence of colorectal cancer screening among the target population suggests the need for an increased awareness of the public health importance of colorectal cancer screening.
BACKGROUND A high rate of attendance among women invited to the Norwegian Breast Cancer Screening Programme (NBCSP) is essential to achieve optimal effect, including reduction in breast cancer mortality. This article describes attendance in the programme by county, period and women's age at invitation.MATERIAL AND METHOD All women in the age group 50?-?69 years who are registered in the National Population Register are invited to attend the NBCSP every second year. In the study period 2007?-?2014, 2 142 369 invitations were sent, and 1 600 293 screening examinations were performed for 710 169 women. Use of the data is pursuant to the Cancer Registry Regulations.RESULTS Altogether 84 % of the women invited attended at least once in the study period. The average attendance rate per screening round was 75 %. In Rogaland, Nordland and Sogn og Fjordane counties more than 80 % attended, while in Oslo the figure was 62 %. The highest rate of attendance recorded was for women in the age group 62?-?67 years. The attendance in the prior screening round was of influence for reattendance.INTERPRETATION The mammography screening programme has a high level of acceptance among women in the target group. Possible reasons for the variation in attendance among the county districts should be identified.
Northeastern British Columbia, Canada, is undergoing in-migration of young people attracted by jobs in the oil/gas sectors. Chlamydia rates among youth ages 15-24 are increasing and exceed the provincial average by 22%. Testing for sexually transmitted infections (STIs) reduces the disease burden, contributing to prevention. We conducted ethnographic fieldwork, including interviews with 25 youth and 14 service providers, to document their perceptions regarding youth's access to STI testing. Five key barriers to access were identified: limited opportunities for access, geographic inaccessibility, local social norms, limited information, and negative interactions with providers. To address youths' needs, we recommend active STI prevention and testing service delivery models that incorporate a locally tailored public awareness campaign, outreach to oil/gas workers, condom distribution, expanded clinic hours and drop-in STI testing, specialized training for health care providers, and inter-sectoral partnerships between public health, non-profit organizations, and industry.
OBJECTIVES: Individuals with limited literacy have low rates of cancer screening and more advanced cancer when cancer is detected. We implemented breast cancer screening at an adult literacy center to see if students would participate and determine the rate of abnormalities detected. METHODS: The Anchorage Literacy Project (ALP), in collaboration with Providence Cancer Center (PCC), offered breast cancer screening, including mammograms, on site at ALP to all 40 female ALP students aged > or =40. Prior to screening, PCC and ALP staff provided education to students about breast cancer screening and mammograms, and information about the Alaska Breast and Cervical Health Check program that would pay for treatment if cancer was detected. RESULTS: Twenty-one women underwent screening. Three (14%) had significant abnormalities. CONCLUSIONS: Cancer screening can be provided on site in adult literacy programs. The rate of abnormalities detected through such screening may be higher than the rate in the general population.