Association of Previous Clinical Breast Examination With Reduced Delays and Earlier-Stage Breast Cancer Diagnosis Among Women in Peru.

IMPORTANCE: Mammographic screening is impractical in most of the world where breast cancers are first identified based on clinical signs and symptoms. Clinical breast examination may improve early diagnosis directly by finding breast cancers at earlier stages or indirectly by heightening women's awareness of breast health concerns. OBJECTIVE: To investigate factors that influence time to presentation and stage at diagnosis among patients with breast cancer to determine whether history of previous clinical breast examination is associated with earlier presentation and/or earlier cancer stage at diagnosis. DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional analysis of individual patient interviews using a validated Breast Cancer Delay Questionnaire, 113 (71.1%) of 159 women with breast cancer treated at a federally funded tertiary care referral cancer center in Trujillo, Peru, from February 1 through May 31, 2015, were studied. MAIN OUTCOMES AND MEASURES: Method of breast cancer detection and factors that influence time to and stage at diagnosis. RESULTS: Of 113 women with diagnosed cancer (mean [SD] age, 54 [10.8] years; age range, 32-82 years), 105 (92.9%) had self-detected disease. Of the 93 women for whom stage was documented, 45 (48.4%) were diagnosed with early-stage disease (American Joint Committee on Cancer [AJCC] stage 0, I, or II), and 48 (51.6%) were diagnosed with late-stage disease (AJCC stage III or IV). Mean (SD) total delay from symptom onset to initiation of treatment was 407 (665) days because of patient (mean [SD], 198 [449] days) and health care system (mean [SD], 241 [556] days) delay. Fifty-two women (46.0%) had a history of clinical breast examination, and 23 (20.4%) had undergone previous mammography. Women who underwent a previous clinical breast examination were more likely to have shorter delays from symptom development to presentation compared with women who had never undergone a previous clinical breast examination (odds ratio, 2.92; 95% CI, 1.30-6.60; P = .01). Women diagnosed with shorter patient delay were more likely to be diagnosed with early-stage disease (AJCC stage 0, I, or II) than those with longer patient delay (31 [58.5%] vs 11 [30.6%], P = .01). Women who underwent a previous clinical breast examination were more likely to be diagnosed with early-stage disease compared with women who had never undergone previous clinical breast examination; this relationship remained significant after controlling for insurance and household income (odds ratio, 2.44; 95% CI, 1.01-5.95; P = .048). CONCLUSIONS AND RELEVANCE: In a population in which most breast cancers are self-detected, previous clinical breast examination was associated with shorter patient delay and earlier stage at breast cancer diagnosis. In regions of the world that lack mammographic screening, the routine use of clinical breast examination may provide a resource-appropriate strategy for improving breast cancer early diagnosis.

La informática aplicada a la salud reproductiva posibilita una mejor práctica clínica: [revisión] / Better clinical practice made possible by IT in reproductive health: [review]

En abril de 2006, los US Centers for Disease Control and Prevention (CDC) publicaron normativas clínicas acerca de la salud reproductiva con el objetivo de promover mejoras en la evolución de los embarazos en Estados Unidos. La integración de la salud reproductiva en la práctica cotidiana todavía representa un desafío para los médicos clínicos. Esto se debe en parte a la percepción de que la salud reproductiva es una prestación agregada en lugar de un aspecto integral de la atención primaria de las mujeres en edad fértil. La provisión de estas prestaciones por los sistemas de atención primaria se ha limitado debido a la falta de promoción de métodos clínicos que contribuyan a la evaluación del riesgo y los procesos de intervención. Las novedades en el contexto de la informática aplicada a la salud expanden las posibilidades de perfeccionar los importantes servicios de la salud reproductiva en la actividad médica cotidiana. Una revisión de estos avances informáticos relacionados con la salud reproductiva podría contribuir a la optimización de estos servicios por parte de los médicos clínicos.(AU)

La informática aplicada a la salud reproductiva posibilita una mejor práctica clínica: [revisión] / Better clinical practice made possible by IT in reproductive health: [review]

En abril de 2006, los US Centers for Disease Control and Prevention (CDC) publicaron normativas clínicas acerca de la salud reproductiva con el objetivo de promover mejoras en la evolución de los embarazos en Estados Unidos. La integración de la salud reproductiva en la práctica cotidiana todavía representa un desafío para los médicos clínicos. Esto se debe en parte a la percepción de que la salud reproductiva es una prestación agregada en lugar de un aspecto integral de la atención primaria de las mujeres en edad fértil. La provisión de estas prestaciones por los sistemas de atención primaria se ha limitado debido a la falta de promoción de métodos clínicos que contribuyan a la evaluación del riesgo y los procesos de intervención. Las novedades en el contexto de la informática aplicada a la salud expanden las posibilidades de perfeccionar los importantes servicios de la salud reproductiva en la actividad médica cotidiana. Una revisión de estos avances informáticos relacionados con la salud reproductiva podría contribuir a la optimización de estos servicios por parte de los médicos clínicos.

Sexual networks of pregnant women with and without HIV infection.

OBJECTIVES: To determine the relationship of HIV infection in pregnant women to sexual network size and other risk factors. DESIGN: Case-control study of women attending the public maternity hospital in Lima, Peru. METHODS: We interviewed 75 HIV-seropositive women, 41 of their most recent male partners, and two control groups totaling 137 uninfected pregnant women and 70 of their most recent male partners. Each woman's sexual network size was estimated through second and third-generation partnerships over the past year, 5 years and lifetime. RESULTS: Few HIV-seropositive women reported behavioral risk factors for HIV infection, but 79% of male partners were HIV seropositive. Risk factors in male partners included sex with a female sex worker (FSW) or with another man (MSM). The mean 5-year sexual network sizes through the second generation (8.4 persons for HIV-seropositive women, and 2.5 and 1.9 for women in the two control groups) predicted HIV in the women, independently of her own number of partners. These differences were largely attributable to the number of partners reported by male partners. Using data from concurrent studies of FSW and MSM, estimates of 5-year sexual network sizes through the third-generation, excluding contacts with FSW which were protected by consistent condom use, were 672 persons for HIV-seropositive women, and 160 and 224 for women in the two control groups. CONCLUSIONS: HIV infection risk among pregnant women in Lima depends largely on their male partners' risk behaviors. Even monogamous women had very large sexual networks.

Determinants and prevalence of HIV infection in pregnant Peruvian women.

OBJECTIVES: To determine age-specific seroprevalence, risk factors, and risk markers for heterosexually-acquired HIV infection among pregnant women. DESIGN: Cross-sectional study of 12436 consecutive pregnant women in Lima, Peru in 1996-1997. METHODS: Standardized interviews, serologic tests for HIV and syphilis, bivariate and multivariate analysis. RESULTS: HIV seropositivity was confirmed in 58 women (0.5%). Only 22.6% were married, and only 12% of HIV infected women reported >or=2 sex partners ever. In multivariate analyses HIV infection was associated with: short duration of current relationship; two risk behaviors of women themselves (early onset of sexual activity and number of past sexual relationships); women's perceptions of two risk behaviors of partners (partner is a 'womanizer,' and partner uses illegal drugs); inadequate prenatal care; and four additional risk factors or markers (history of sexually transmitted disease, tuberculosis, or abortion in the women; and diagnosis of HIV/AIDS in a partner). CONCLUSIONS: HIV infection was related both to women's own risk behaviors and to the perceived risk behaviors of their sexual partners. Underlying societal factors related to heterosexual HIV infection, including deferral of marriage, warrant further study.