The impact of level of education on adherence to breast and cervical cancer screening: Evidence from a systematic review and meta-analysis.

OBJECTIVE: To assess the inequalities in adherence to breast and cervical cancer screening according to educational level. METHODS: A systematic review was carried out between 2000 and 2013 by querying an electronic database using specific keywords. Studies published in English reporting an estimation of the association between level of education and adherence to breast and/or cervical cancer screening were included in the study. Two different meta-analyses were carried out for adherence to breast and cervical cancer screening, respectively: women with the highest level of education and women with the lowest level of education were compared. The level of heterogeneity was investigated and subgroup analyses were carried out. RESULTS: Of 1231 identified articles, 10 cross-sectional studies were included in the analysis. The meta-analyses showed that women with the highest level of education were more likely to have both screenings with an overall OR=1.61 (95% CI 1.36-1.91; I(2)=71%) for mammography and OR=1.96 (95% CI 1.79-2.16; I(2)=0%) for Pap test, respectively. Stratified meta-analysis for breast cancer screening included only studies that reported guidelines with target age of population ≥50 years and showed a reduction in the level of heterogeneity and an increase of 36% in the adherence (95% CI 1.19-1.55; I(2)=0%). CONCLUSIONS: This study confirms and reinforces evidence of inequalities in breast and cervical cancer screening adherence according to educational level.

Wait watchers: the application of a waiting list active management program in ambulatory care.

OBJECTIVE: This study describes and evaluates the application of a waiting list management program in ambulatory care. DESIGN: Waiting list active management survey (telephone call and further contact); before and after controlled trial. SETTING: Local Health Trust in Veneto Region (North-East of Italy) in 2008-09. PARTICIPANTS: Five hundred and one people on a 554 waiting list for C Class ambulatory care diagnostic and/or clinical investigations (electrocardiography plus cardiology ambulatory consultation, eye ambulatory consultation, carotid vessels Eco-color-Doppler, legs Eco-color-Doppler or colonoscopy, respectively). INTERVENTION: Active list management program consisting of a telephonic interview on 21 items to evaluate socioeconomic features, self-perceived health status, social support, referral physician, accessibility and patients' satisfaction. A controlled before-and-after study was performed to evaluate anonymously the overall impact on patients' self-perceived quality of care. MAIN OUTCOME MEASURES: The rate of patients with deteriorating healthcare conditions; rate of dropout; interviewed degree of satisfaction about the initiative; overall impact on citizens' perceived quality of care. RESULTS: 95.4% patients evaluated the initiative as useful. After the intervention, patients more likely to have been targeted with the program showed a statistically significant increase in self-reported quality of care. CONCLUSIONS: Positive impact of the program on some dimensions of ambulatory care quality (health status, satisfaction, willingness to remain in the queue), thus confirming the outstanding value of 'not to leave people alone' and 'not to leave them feeling themselves alone' in healthcare delivery.

Socioeconomic disparities in the uptake of breast and cervical cancer screening in Italy: a cross sectional study.

BACKGROUND: Breast and cervical cancer screening are widely recognized as effective preventive procedures in reducing cancer mortality. The aim of this study was to evaluate the impact of socioeconomic disparities in the uptake of female screening in Italy, with a specific focus on different types of screening programs. METHODS: A cross-sectional study was conducted using data from the 2004-2005 national health interview survey. A sample of 15, 486 women aged 50-69 years for mammography and one of 35, 349 women aged 25-64 years for Pap smear were analysed. Logistic regression models were used to estimate the association between socioeconomic factors and female screening utilization. RESULTS: Education and occupation were positively associated with attendance to both screening. Women with higher levels of education were more likely to have a mammogram than those with a lower level (OR = 1.28; 95% CI = 1.10-1.49). Women of intermediate and high occupational classes were more likely to use breast cancer screening (OR = 1.77; 95% CI = 1.55-2.03, OR = 1.63; 95% CI = 1.40-1.91) compared to unemployed women. Women in the highest occupational class had a higher likelihood of cervical cancer screening compared to those in the lowest class (OR = 1.81; 95% CI = 1.63-2.01). Among women who attended screening, those with lower levels of education and lower occupational classes were more likely than more advantaged women to attend organized screening programs rather than being screened on the basis of their own initiative. CONCLUSIONS: Inequalities in the uptake of female screening widely exist in Italy. Organized screening programs may have an important role in increasing screening attendance and tackling inequalities.

Socio-economic status and prevention of cardiovascular disease in Italy: evidence from a national health survey.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death and disability in the world. Many cardiovascular risk factors can be prevented. We assessed whether socio-economic factors are associated with individual preventive behaviours in Italy. METHODS: A cross-sectional analysis of a nationally representative sample of 47,391 adults aged 40-69 years was undertaken using 2004-05 National Health Interview Survey data. Logistic regression models were developed to assess the association between socio-economic status (SES) and regular monitoring of blood pressure, cholesterol, body mass index and glycaemia. SES was estimated according to education and occupation. RESULTS: SES was significantly associated with regular monitoring of risk factors for CVD. The most educated were more likely to monitor cholesterol levels than those with less education [men odds ratio (OR) 1.64, 95% confidence interval (CI) 1.46-1.86; women OR 1.36, 95% CI 1.19-1.55]. Individuals in the highest occupational class controlled weight more frequently than those disadvantaged with an OR of 1.24 (95% CI 1.04-1.49) for men and an OR of 1.26 (95% CI 1.12-1.42) for women. CONCLUSION: Socio-economic disparities in the prevention of risk factors for CVD were clearly observed among Italian adults, generally favouring higher socio-economic groups.

The role of sonographic examination in the follow-up of gynecological neoplasms.

OBJECTIVE: The role and type of procedures of follow-up in patients with gynecological tumors are still a debatable issue. We prospectively analyzed the role of routine transabdominal and transvaginal ultrasound examination (US) in the detection of recurrent disease in gynecologic cancer patients. METHODS: Among 552 patients who underwent surgery for gynecological cancer, 385 were available for the analysis. Follow-up examinations included clinical examination, serum tumor marker assay, transvaginal and transabdominal sonography and CT scan/MRI. RESULTS: Positive US examination was documented in 83/385 patients (21.5%). In the overall series, the positive predictive value (PPV) of US examination was 100%, while the negative predictive value (NPV) was 92.7% failing to identify 22 cases of recurrences. When considering the subgroup of patients with positive clinical examination or abnormal tumor marker, positive US analysis was able to identify 66/66 cases of recurrence (PPV=100%), but exhibited an NPV of 22.2%, with 21/27 (77.8%) false negative cases. Conversely, in cases without clinical/serological signs of disease, positive US recognized all cases of recurrences (17/17, PPV=100%), and exhibited a very high NPV, with only 1 false negative case out of 275 (0.4%). The US detected recurrences appeared as a solitary lesion in 38/75 (50.6%) patients and in 28/75 (37%) appeared located centrally in the pelvis. The sonographic pattern of the ovarian recurrences was a solid lesion in most (33/40, 82%) cases. In the other gynecological tumors, the lesions appeared as solid masses in 33/35 (94%) cases. CONCLUSIONS: We showed that routine US might play a role in the follow-up of gynecologic malignancies, especially in the group of asymptomatic patients, while CT/MRI imaging might be more properly applied to patients with clinical or serological signs of disease.

Angiographic power 3-dimensional quantitative analysis in gynecologic solid tumors: feasibility and reproducibility.

OBJECTIVE: To determine the reproducibility of a simplified method of power Doppler 3-dimensional (3D) sonographic examination. METHODS: Twenty-nine patients with solid pelvic masses underwent transvaginal 3D power Doppler evaluation. The volume of interest was obtained by drawing the margins of the largest section of the mass in the 3 orthogonal planes. The 3D vascular parameters ("relative color," "average color," and "flow measure") obtained by our method were compared with those calculated by a manufacturer-suggested model based on several parallel section planes drawn on the longitudinal frames. The intraobserver variability was quantified on 5 different 3D images acquired by the same operator at 5-minute intervals for each patient. The intraobserver variability was also assayed in 10 patients at 24-hour intervals. Ten patients were scanned by a second sonographer for interobserver variability. RESULTS: There was high agreement between the 3D parameters obtained with the 2 methods. The 3D indices were similar in repeated observations at 5-minute intervals (median coefficients of variation for relative color, average color, and flow measure, 10.9, 4.5, and 13.0, respectively) and at 24-hour intervals (intraclass correlation coefficients for relative color, average color, and flow measure, 0.920, 0.978, and 0.978) and by the second sonographer (interclass correlation coefficients for relative color, average color, and flow measure, 0.978, 0.966, and 0.997). CONCLUSIONS: The acceptable rates of intraobserver and interobserver variability make this approach potentially suitable for research protocols.

Pelvic relapses of uterine neoplasms: transvaginal sonographic and Doppler features.

OBJECTIVE: To describe the sonographic and power Doppler features of pelvic relapses in endometrial and cervical cancer. METHODS: We retrospectively analyzed the preoperative transvaginal sonographic reports of 45 women with a histological diagnosis of pelvic relapse. The three diameters of the lesion were recorded; then the shape, margins, content (solid or cystic), and location were analyzed. A subjective assessment of the vascularization (vascular score) was obtained with power Doppler. RESULTS: Twenty-six patients had pelvic recurrence from endometrial cancer and 19 from cervical cancer. In 36 (80%) patients, the recurrence was a central pelvic mass located on the vaginal apex, while in six cases (13%), it was diagnosed as a pelvic side-wall recurrence, and in three (7%), the recurrence occupied the whole pelvis. The recurrences had diameters ranging from 1.0 to 6.8 cm (mean diameter: 3.0 cm, standard deviation: 1.5). In 44/45 cases (98%), the recurrence appeared as a solid nodular mass, while in one case (2%), it was defined as a cystic mass. In 32 (71%) women, the mass showed a hypoechoic content with respect to the surrounding bowel, while in 13 (29%), it manifested a nonhomogeneous content. Vascularization of the mass was assessed in all patients before surgery; in all cases, it was possible to visualize randomly dispersed blood vessels in the context of the relapse. The vascular score revealed scarce blood vessels in 19 relapses, moderate flow in 23, and abundant flow in three cases. CONCLUSIONS: Knowledge of the spectrum of ultrasonographic findings of pelvic relapses will help the physician in diagnosing a recurrent malignant disease at an early stage, when cure rates are high. The widespread availability and low cost of transvaginal sonography (TVS) support its use in routine surveillance of patients operated for uterine neoplasms.