Age as a factor in breast cancer knowledge,attitudes and screening behaviour.

OBJECTIVE: To determine whether there are age-related differences in knowledge, attitudes and behaviour with respect to breast cancer and whether the differences reflect the age-specific Canadian recommendations on breast cancer screening. DESIGN: Telephone survey. SETTING: Two cities and five towns and their surrounding areas in Alberta. PARTICIPANTS: The age-specific, randomly selected sample comprised 1284 women aged 40 to 75 years who did not have breast cancer. Of the 1741 eligible women who were contacted, 1350 (78%) agreed to participate; 66 were excluded because of age ineligibility or a history of breast cancer. MAIN OUTCOME MEASURE: Frequency of knowledge, attitudes and behaviour with respect to breast cancer, by age group. RESULTS: Knowledge of breast cancer risk factors was generally low and decreased with age. Few women were aware of the Canadian recommendations on breast self-examination, physical examination of the breasts by a health care practitioner and mammographic screening. Older women believed they were less susceptible to breast cancer than younger women and were less likely to have positive attitudes toward screening. Self-examination was performed 9 to 15 times per year by 424 women (33%), and 810 (63%) had been examined by a health care professional in the past year. Although 664 (52%) had undergone mammography, the proportion decreased with age after age 59. The main barriers to mammography were lack of physician referral and the woman''s belief that the procedure is unnecessary if she is healthy. CONCLUSIONS: Education is needed to increase breast cancer knowledge, promote the Canadian recommendations for early detection of breast cancer and decrease negative beliefs about the disease. Changes in the behaviour of women and physicians are needed to increase the use of breast self-examination, clinical breast examination by a health care professional and mammographic screening. Reaching women in the upper range (60 to 69 years) of the target group for mammographic screening should be a focus in promoting early detection of breast cancer.     

Does genetic counseling have any impact on management of breast cancer risk?

Despite there being an increasing literature on the impact of cancer genetic counseling on risk perception and mental health, there is a lack of data describing impact on risk management. Genetic counseling and testing for cancer predisposition genes aims to improve the future health of those at high risk through appropriate surveillance and screening. However, management of breast cancer risk in women with a family history of this disease is an area of controversy. Counseling services may recommend specific risk management options to women, who then rely on their local screening service to make provision. This study investigated the impact of genetic counseling on management of breast cancer risk in women attending Cancer Family Clinics. A total of 293 women attending four genetic clinics were enrolled. Rates of breast self-examination, clinical breast examination, mammography, biopsy, detected cancers, and other screenings were documented. Participants' perceived benefits and barriers to mammography were assessed along with cancer worry. Results show that rates of mammography, clinical breast examination, and breast self-examination were increased following clinic attendance (p < 0.001). Women in the under 35 age-group had limited access to screening. Rates for biopsy and detected cancers were low. Women reported positive attitudes to mammography, with few reported barriers. Contrary to previous studies, there was no evidence that anxiety about breast cancer impedes uptake of health surveillance methods. Genetic counseling had a positive impact on management of breast cancer risk. Whether this translates into future health gains remains to be established.     

宫颈癌研究新进展

宫颈癌是威胁女性健康的最常见的主要恶性肿瘤之一,据统计全世界每年新发现有数万女性患有宫颈癌这种癌症,越来越多的妇女死于宫颈癌。宫颈癌也是一种预防的肿瘤,其致病因素多种多样,包括初次性生活的年龄、吸烟、HPV、HSV、HCMV、EBV等因素。目前的检测方法有巴氏涂片法、薄层液基细胞学涂片法、宫颈组织活检及宫颈管刮术、HPV-DNA检测、计算机辅助细胞学检测系统等方法可以诊断宫颈癌。早期诊断、早期检查对宫颈癌的预防和治疗具有积极作用,同时降低宫颈癌的死亡率。     

Cytologic detection of cervical cancer; four years' experience with routine smear examination in private practice

Simplified Papanicolaou smear techniques appear to be adaptable to private clinical practice when experienced cytodetection laboratory facilities are available. A private physician's office seems potentially an efficient, economical and practical place for detection of cervical cancer by use of the smear technique as a routine part of examination of patients. In a series here reported upon, examination of 11,207 cervical smears taken at the first examination of patients of all ages led to diagnosis of unsuspected malignant disease in 80 cases-in all instances at a stage when it should be easily curable. Cancer was not detected in examination of 6,060 smears taken later from women who had had a "negative" smear at the time of first examination, which seems to indicate that the first screening was reasonably accurate. In a few cases, early cancer was detected when smears were reported as "atypical" or "suspicious." Such reports demand as careful follow-up as do "positive" reports. There are dangers and limitations in wide-spread clinical application of screening by this method. Care must be observed in the development of programs for its use lest the potential benefits in early detection be outweighed by the dangers from misuse.     

CYTOLOGIC DETECTION OF CERVICAL CANCER—Four Years' Experience with Routine Smear Examination in Private Practice

Simplified Papanicolaou smear techniques appear to be adaptable to private clinical practice when experienced cytodetection laboratory facilities are available. A private physician''s office seems potentially an efficient, economical and practical place for detection of cervical cancer by use of the smear technique as a routine part of examination of patients.In a series here reported upon, examination of 11,207 cervical smears taken at the first examination of patients of all ages led to diagnosis of unsuspected malignant disease in 80 cases—in all instances at a stage when it should be easily curable. Cancer was not detected in examination of 6,060 smears taken later from women who had had a “negative” smear at the time of first examination, which seems to indicate that the first screening was reasonably accurate.In a few cases, early cancer was detected when smears were reported as “atypical” or “suspicious.” Such reports demand as careful follow-up as do “positive” reports.There are dangers and limitations in wide-spread clinical application of screening by this method. Care must be observed in the development of programs for its use lest the potential benefits in early detection be outweighed by the dangers from misuse.     

Artificial light at night: melatonin as a mediator between the environment and epigenome

The adverse effects of excessive use of artificial light at night (ALAN) are becoming increasingly evident and associated with several health problems including cancer. Results of epidemiological studies revealed that the increase in breast cancer incidents co-distribute with ALAN worldwide. There is compiling evidence that suggests that melatonin suppression is linked to ALAN-induced cancer risks, but the specific genetic mechanism linking environmental exposure and the development of disease is not well known. Here we propose a possible genetic link between environmental exposure and tumorigenesis processes. We discuss evidence related to the relationship between epigenetic remodelling and oncogene expression. In breast cancer, enhanced global hypomethylation is expected in oncogenes, whereas in tumour suppressor genes local hypermethylation is recognized in the promoter CpG chains. A putative mechanism of action involving epigenetic modifications mediated by pineal melatonin is discussed in relation to cancer prevalence. Taking into account that ALAN-induced epigenetic modifications are reversible, early detection of cancer development is of great significance in the treatment of the disease. Therefore, new biomarkers for circadian disruption need to be developed to prevent ALAN damage.     

Ethiopian women's breast cancer self-examination practices and associated factors. A systematic review and meta-analysis

BackgroundBreast neoplasm is the most frequently diagnosed and the leading cause of cancer death in the vast majority of the countries. Breast cancer self-examination is a check-up of a woman does at home to look for changes or problems in the breast tissue. The benefit of early recognition is for early treatment that is more effective, higher long-term survival rates and better quality of life. The aim of this review was to determine the pooled prevalence of breast cancer self-examination practice and identify its associated factors among Ethiopian women.MethodsGoogle Scholar, PubMed, Science Direct, web of science, and Cochrane Library were used for search of articles. This review includes thirty four articles conducted in Ethiopia between 2011 and 2020. The review contains 14,908 women to determine the ever pooled prevalence of breast cancer self-examination practice. Health workers and students made up 28.35% of the total participants. Data were extracted using a standardized data extraction format prepared in Microsoft Excel and analyzed with Stata 14. To assess heterogeneity I² test were used. A random effect meta-analysis model was used to estimate the pooled breast cancer self-examination (BCSE) practice of Ethiopian women. Moreover associated factors were also assessed.ResultsIn Ethiopian women, the overall ever and regular pooled breast cancer self-examination practice was 36% (95% CI: 28, 43) and 16% (95% CI: 28, 43) respectively. The ever pooled prevalence for health workers or students was 53% (95% CI: 41, 65), whereas for other participants it was 25% (95% CI: 19, 30). Good knowledge about breast self-examination (AOR: 3.69: 95% CI: 2.70, 5.05), positive attitude towards BCSE (AOR: 2.72: 95% CI: 1.74, 4.24), Getting to know people with breast cancer(AOR: 2.77: 95% CI: 1.51, 5.09), family history of breast cancer (AOR: 2.49: 95% CI: 1.60, 3.88) and personal history of breast cancer (AOR: 2.26: 95% CI: 1.70, 3.01) were associated factors to BCSE practice among Ethiopian women. All of the studies included in this review were conducted in a cross-sectional design was a limitation of this review and meta-analysis.ConclusionThis review and meta-analysis showed the ever and regular pooled prevalence of BCSE among Ethiopian women. More than one third of Ethiopian women ever practiced BCSE. We recommend that awareness creation should be perform in order to tackle the risk of breast cancer.     

New applications of biological monitoring for environmental exposure and susceptibility monitoring. Report of the 7th International Symposium on Biological Monitoring in Occupational and Environmental Health

Validated biological monitoring methods are used in large-scale monitoring programmes involving determination of ubiquitous environmental pollutants such as metals and pesticides. Some programmes focus on children's exposure, and policies to prevent adverse health effects. Most of these initiatives are aimed at characterizing trends. Some of these programmes are designed to investigate the role of certain exposures in disease. Fewer new biological monitoring methods were presented during the present meeting than in previous meetings. All of these new methods used mass spectrometric-based detection and quantification. There is an increasing use of biomarkers to study genetic polymorphisms of enzyme systems involved in both toxification pathways and metabolite conjugation and DNA repair. At the meeting a discussion was started that could lead to a further harmonization of the scientific fundaments of the use of biological monitoring in occupational health with possible value also for applications in the field of environmental health.     

Socio-Economic and Health Access Determinants of Breast and Cervical Cancer Screening in Low-Income Countries: Analysis of the World Health Survey

Background

Breast and Cervical cancer are the two most common cancers among women in developing countries. Regular screening is the most effective way of ensuring that these cancers are detected at early stages; however few studies have assessed factors that predict cancer screening in developing countries.

Purpose

To assess the influence of household socio-economic status (SES), healthcare access and country level characteristics on breast and cervical cancer screening among women in developing countries.

Methods

Women ages 18–69 years (cervical cancer screening) and 40–69 years (breast cancer screening) from 15 developing countries who participated in the 2003 World Health Survey provided data for this study. Household SES and healthcare access was assessed based on self-reported survey responses. SAS survey procedures (SAS, Version 9.2) were used to assess determinants of breast and cervical cancer screening in separate models.

Results

4.1% of women ages 18–69 years had received cervical cancer screening in the past three years, while only 2.2% of women ages 40–69 years had received breast cancer screening in the past 5 years in developing countries. Cancer screening rates varied by country; cervical cancer screening ranged from 1.1% in Bangladesh to 57.6% in Congo and breast cancer screening ranged from 0% in Mali to 26% in Congo. Significant determinants of cancer screening were household SES, rural residence, country health expenditure (as a percent of GDP) as well as healthcare access.

Discussion

A lot more needs to be done to improve screening rates for breast and cervical cancer in developing countries, such as increasing health expenditure (especially in rural areas), applying the increased funds towards the provision of more, better educated health providers as well as improved infrastructure.     

HPV-DNA 亚型检测联合液基细胞学对宫颈癌 筛查的临床价值

目的:探讨HPV-DNA亚型检测联合液基细胞学对宫颈癌筛查的临床价值.方法:对自愿接受宫颈癌筛查的女性1462例作为研究对象,分别对其进行HPV-DNA亚型检测以及液基细胞学的检查,对于出现阳性的患者进行病理组织学检查.结果:HPV+TCT对宫颈癌早期病变以及癌变的检出率为69.67％明显高于HPV检查的56.28％以及TCT检查的63.89％(P＜0.05);HPV+TCT对GIN Ⅰ、CIN Ⅱ、CINⅢ、癌的检出率分别为91.67％,92.86％、91.67％以及100％.结论:采用HPV-DNA亚型检测联合液基细胞学对宫颈癌筛查,可明显提高其对癌前病变的检出率,是一种高效、简单的检测方法.     

乌鲁木齐妇女乳腺自查行为与认知现况分析

目的:了解乌鲁木齐妇女乳腺自查行为及认知情况。方法:采用自行设计的问卷对2041名来我院进行妇女病普查的受访者进行乳腺自查行为与认知情况调查。结果:定期、不定期、从不做乳腺自查的比例分别为28.7%、53%、18.3%。定期做乳腺自查受访者对相关知识认知情况较好于其它组,定期自查的受访者的乳腺自检各条目应答率高于不定期自查受访者。结论:乌鲁木齐妇女的乳腺自查率有待提高,自查行为存在不规律、不规范现象,应加强由医务人员主导的健康教育。     

Evaluation of the cervical cytology screening programme in an inner city health district.

District health authorities have been instructed to operate a cervical cytology call and recall screening programme using the age-sex registers held by family practitioner committees. A detailed evaluation of implementation in an inner London district showed that 477 out of 687 (69%) invitation letters sent to women by the family practitioner committee were either inaccurate or inappropriate: almost half of the recorded addresses were incorrect and a further fifth of the women were not eligible for a test. Overall, 90 women had a smear, which is only 13% of the total but 43% of those found to be eligible. The findings did not differ significantly with age. The findings have major implications not only for the effectiveness of call and recall for screening for cervical cancer but also for the future development of screening for breast cancer in such areas.     

Are women sufficiently well informed to provide valid consent for the cervical smear test?

Three hundred women attending colposcopy for the first time, following an abnormal cervical smear, were invited to fill in a questionnaire. This covered aspects of their understanding of the cervical smear test and the NHS Cervical Screening Programme (NHSCSP). In addition, it covered aspects of consent to the test. The response rate was 83%. Seventy percent thought that the NHSCSP is working well and 72% were aware that probably over 3000 cases of cervical cancer per year are being saved by the NHSCSP. However, 55% did not know that the death rate from cervical cancer is decreasing. 96% were aware that the main reason for a cervical smear is to prevent the development of cervical cancer, by finding early treatable abnormalities. Similarly, 94% were aware that the presence of abnormal cells on a cervical smear indicated a possible but not definitive indication of cervical precancer or cancer. Disappointingly, only 5 had seen the new NHSCSP information poster on the cervical smear test and only 44% had been given written information about the test. Consent for the test in 59% of women had been implied rather than expressed and 30% of women providing expressed consent had signed to that effect. In 42% of women, the smear taker or a doctor had failed to discuss the reason for having a cervical smear and had not explained about its advantages and limitations. In 72%, the smear taker or doctor had not explained that the cervical smear test can never be 100% accurate and that some laboratory errors are unavoidable. It is likely that women attending for colposcopy are a highly motivated cohort in relation to their understanding of the cervical smear test and the NHSCSP. Accordingly, understanding in the more general female population is likely to be considerably less. It would appear that women are often suboptimally informed to provide valid consent for the cervical smear test.     

Early diagnosis of testicular cancer

PURPOSE: The authors analyze their 3-year results of the "educational and early detection program for testicular cancer". The goals of the program are to reduce the duration of symptoms and to improve early detection. METHODS: Advertisements were placed in the media describing the early signs of testicular cancer, the risks factors, the correct method of self-investigation and the importance of early detection. Between 1 April, 1995 and 1 April, 1998 5056 volunteers were examined. They underwent physical and ultrasound examination of the testicles, and in case of suspicious findings, tumor markers (alpha-fetoprotein, human choriogonadotropin) were checked. RESULTS: Testicular tumors were found in 1.28% of patients with symptoms (testicular enlargement or nodules). No tumor was found in the population that was symptom-free, or in patients with pain, sensitivity to palpation, or unrelated complaints. Of the patients with a palpable lump and swollen testicles, 4.5 and 3.9% were found to have tumors respectively. In total 32 testicular tumors were detected in 30 patients: 15 (2 bilateral) seminomas, 13 non-seminomas and 4 benign tumors. The occurrence of malignant testicular tumors was most frequent, 1.6% in the age group between 15 and 40 years. The stages were as follows: 9 I/A, 9 I/B, 1 I/S, 3 II/A, 1 II/B and 2 III/B. One patient was lost to follow-up after castration. All the other patients achieved complete remission. CONCLUSION: Despite the increasing incidence of testicular cancer screening of asymptomatic men does not lead to detection of tumors. The awareness of the early signs associated with cancer, self-examination, ultrasound examination of the testicle help in establishing an early diagnosis, nevertheless a widescale program for the early detection of testicular cancer is not justifiable. Effective early detection should be based on an educational program for the population at risk, the appropriate training of doctors and staff engaged in the health care of the young, and the initiation and facilitation of early ultrasound examination at the first symptoms. Serum markers play a limited role in early diagnosis.     

Predicting mortality from cervical cancer after negative smear test results.

OBJECTIVE--To assess the relative protection against death from cervical cancer after two or more negative smear test results and compare it with the protection against invasive cancer estimated by an International Agency for Research on Cancer (IARC) working group in an analysis of data from 10 large screening programmes. DESIGN--Comparison of risk of death from cervical cancer after two or more negative smear results with the risk in unscreened women by using a model constructed with data from the British Columbia screening programme. MAIN OUTCOME MEASURES--Mortality from and incidence of invasive cancer. RESULTS--In women with two negative smear results estimates of protection against cervical cancer were about 50% higher when lethal invasive cancer was used as the criterion rather than all invasive cancer. This difference was due to these women being more likely to attend for further tests at which invasive cancer could be detected: screen detected cancer has a better prognosis than clinically diagnosed cancer. Screening intervals could be longer than three years: screening women aged 35-64 every five years was predicted to result in a 90% reduction in mortality from cervical cancer. CONCLUSION--Because protection from mortality is higher than protection from disease and because of the high costs and negative side effects of frequent screening, screening intervals should be longer than three years.     

Breast self-examination: importance of technique in early diagnosis.

Shortly after diagnosis of breast cancer 416 patients were interviewed about their use of screening procedures and the method of tumour detection. Although 72% reported that they performed breast self-examination (BSE), only 12% actually inspected and palpated their breasts monthly. BSE was not significantly associated with tumour size or involvement of the lymph nodes; however, thorough inspection was associated with smaller tumours, and careful palpation with the absence of palpable nodes. Of those who no longer or never had examined their breasts 40% reported having annual breast examinations by their physician and had significantly smaller tumours than did the others. Most of the women (86%) reported having detected their own tumours, and BSE did not significantly increase the likelihood of self-detection. The frequency of use of screening procedures was similar in a sample of women without breast cancer.     

Early diagnosis of breast cancer: experience in a consultant breast clinic.

Of 2839 women referred to a consultant breast clinic for clinical, mammographic and thermographic examination, 480 underwent biopsy and 126 were found to have cancer. Ten percent of the tumours were occult and were classified as very early biologic disease; they were identified by routine mammography in women whose breasts were clinically normal. Biopsy of solid mass lesions non-suspicious on mammography identified 20% of the cancers; half these lesions, classified as early biologic disease, were discovered by doctors at routine annual clinical breast examination, though the earliest cancers were detected by women who were confident and competent in monthly self-examination of the breasts. Biopsy of solid mass lesions suspicious on mammography identified 70% of the cancers; these were classified as late biologic disease. Skin or nipple dimpling or retraction was evident in two thirds of the patients; their lesions seemed to be later biologically than the lesions of the patients without clinical signs, and 75% had discovered the lesions themselves accidentally.     

子宫颈癌筛查方法的应用及研究进展

子宫颈癌是妇科常见恶性肿瘤之一,发病率居女性恶性肿瘤第二位。建立可持续、合理、有效的普查方法,早期发现癌前病变是防治宫颈癌的关键。目前宫颈癌筛查方法有宫颈细胞学筛查(巴氏涂片、液基薄层细胞学检测、细胞DNA定量分析技术)、肉眼观察辅以醋酸白和Lugol碘溶液检测法、阴道镜检查、病毒-HPV检测,本文就当前各种筛查方法的应用及研究进展进行概括。