Risk of advanced proximal neoplasms according to distal colorectal findings: comparison of sigmoidoscopy-based strategies.

BACKGROUND: Screening for colorectal cancer with sigmoidoscopy benefits from the fact that distal findings predict the risk of advanced proximal neoplasms (APNs). This study was aimed at comparing the existing strategies of postsigmoidoscopy referral to colonoscopy in terms of accuracy and resources needed. METHODS: Asymptomatic individuals aged 50-69 years were eligible for a randomized controlled trial designed to compare colonoscopy and fecal immunochemical test. Sigmoidoscopy yield was estimated from results obtained in the colonoscopy arm according to three sets of criteria of colonoscopy referral (from those proposed in the UK Flexible Sigmoidoscopy, Screening for COlon REctum [SCORE], and Norwegian Colorectal Cancer Prevention [NORCCAP] trials). Advanced neoplasm detection rate, sensitivity, specificity, and number of individuals needed to refer for colonoscopy to detect one APN were calculated. Logistic regression analysis was performed to identify distal findings associated with APN. All statistical tests were two-sided. RESULTS: APN was found in 255 of 5059 (5.0%) individuals. Fulfillment of UK (6.2%), SCORE (12.0%), and NORCCAP (17.9%) criteria varied statistically significantly (P < .001). The NORCCAP strategy obtained the highest sensitivity for APN detection (36.9%), and the UK approach reached the highest specificity (94.6%). The number of individuals needed to refer for colonoscopy to detect one APN was 6 (95% confidence interval [CI] = 4 to 7), 8 (95% CI = 6 to 9), and 10 (95% CI = 8 to 12) when the UK, SCORE, and NORCCAP criteria were used, respectively. The logistic regression analysis identified distal adenoma ≥10 mm (odds ratio = 3.77; 95% CI = 2.52 to 5.65) as the strongest independent predictor of APN. CONCLUSIONS: Whereas the NORCCAP criteria achieved the highest sensitivity for APN detection, the UK recommendations benefited from the lowest number of individuals needed to refer for colonoscopy.

Opinión y participación de los médicos de familia de la Comunidad de Madrid en el programa regional de detección precoz de cáncer de mama en 2007 / Opinion and participation in the regional early breast cancer detection program in 2007 on the part of family physicians from a health district in the Autonomous Community of Madrid, Spain

Fundamento: La mamografía de cribado es el método más efectivo para la detección precoz de cáncer de mama. El objetivo de nuestro estudio es valorar el grado de conocimiento, opinión y participación de los médicos de familia de la Comunidad de Madrid en el programa de detección precoz de cáncer de mama. Métodos: La población de estudio fueron los médicos de familia del Area 7 de Madrid. Se diseñó un cuestionario anónimo autoadministrado, con 30 preguntas, agrupadas en características del médico, y opinión sobre los programas de detección precoz de cáncer de mama. Resultados: Se obtuvo un respuesta del 46%. El 94% de los médicos creen que es función suya informar a sus pacientes acerca de las actividades preventivas, incluidas el cribado de cáncer de mama, y el 95% creen que su consejo es útil para convencer a las mujeres a que se realicen una mamografía. El 72% cree que le falta información sobre el programa. Durante el periodo de realización de mamografías en su centro, el 24% pregunta siempre o casi siempre a las mujeres si tienen dudas o quieren más información, el 43% si les ha llegado la citación y el 95% les aconsejan que se realicen la mamografía. Conclusiones: Los médicos de familia tienen buena opinión del programa de detección precoz de cáncer de mama, y creen en la efectividad de su consejo para mejorar la participación en él. Refieren falta de información, y en pocas ocasiones informan a la mujer sobre el programa (AU)

Background: Mammogram screening is the most effective method for the early detection of breast cancer. The objective of this study is to evaluate the degree of knowledge, the opinion and the participation in the early breast cancer detection program on the part of the family physicians of the Autonomous Community of Madrid. Methods: The population studied was comprised of family physicians from Madrid Health District Seven. An anonymous, self-administered questionnaire comprised of 30 questions grouped into physician’s characteristics and opinion concerning the early breast cancer detection programs. Results: A total of 46% of the physicians replied. A total of 94% of the physicians believed that it is their duty to inform their patients concerning preventive activities, including breast cancer screening, and 95% believed their advice to be useful for convincing women to have a mammogram. A total of 72% believed information to be lacking on this program. During the time when mammograms are being taken at their centres, 24% of the physicians surveyed always or almost always ask the women if they have any doubts or would like further information, 43% having set up appointments for them and 95% advising them to have a mammogram taken. Conclusions: The family physicians have a good opinion of the early breast cancer detection program and feel their advice to be effective for improving the participation in the program. They report lack of information and inform women about the program to only a small degree (AU)