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1.
Medicine (Baltimore) ; 99(17): e19954, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332679

RESUMO

The Hunan provincial government has implemented a free breast cancer screening program for rural women aged 35 to 64 years from 2016, under a 2015 policy aimed at of poverty eradication and improving women's health in China. However, there has been no population study of the breast cancer screening program in China to date, especially considering exploring differences related to the area's poverty status. We explored differences in risk factors, clinical examination results, and clinicopathological features among breast cancer patients in poor compared with non-poor counties in rural areas of Hunan province from 2016 to 2018 using χ and Fisher's exact test, and multivariate logistic regression analysis. A total of 3,151,679 women from rural areas participated in the screening program, and the breast cancer prevalence was 37.09/10. Breast cancer prevalence was lower in poor (29.68/10) than in non-poor counties (43.13/10). There were differences between breast cancers in poor and non-poor counties in terms of cysts, margins, internal echo, blood flow in solid masses in the right breast on ultrasound examination, lump structure in mammograms, and clinicopathological staging and grading in pathological examinations. Breast cancer in poor counties was more likely to be diagnosed at later stages as determined by ultrasound, mammography, and pathological examinations. Furthermore, indexes of the breast screening program including early detection, prevalence, pathological examination, and mammography examination were lower in poor compared with non-poor counties. Multivariate logistic regression analysis showed that education, ethnicity, reproductive history and the year 2017 were associated with an increased risk of breast cancer in poor counties (odds ratio >1, P < .05). In conclusion, women in poor areas were more likely to be diagnosed with breast cancer at a later stage compared with women in non-poor areas. Women in poor areas of Hunan province should therefore have better access to diagnostic and clinical services to help rectify this situation.


Assuntos
Neoplasias da Mama/diagnóstico , Governo Local , Programas de Rastreamento/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adulto , Neoplasias da Mama/epidemiologia , China/epidemiologia , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Modelos Logísticos , Mamografia/estatística & dados numéricos , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Áreas de Pobreza , Fatores Socioeconômicos
2.
BMC Health Serv Res ; 20(1): 114, 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-32050951

RESUMO

BACKGROUND: The study's purpose was to examine the effectiveness of different reminder strategies on first-time free mammography screening among middle-aged women in Taiwan. METHODS: A quasi-experimental design with random assignment was adopted to divide the participants into three Reminder Strategies groups (mail reminder, telephone reminder, and combined mail and telephone reminders) and one control group. This study recruited 240 eligible middle-aged women, and 205 of them completed the study. Upon the completion of data collection, mail reminders were provided to women of the first group; telephone reminders were provided to the second group; mail followed by telephone reminders were provided to the third group, and the usual postcards were provided to the control group 1 month after the interventions. Two follow-up assessments were conducted 1 and 3 months after the intervention to collect mammography-screening behaviors from all groups. RESULTS: The findings showed that, compared to the control group, more participants in the intervention groups underwent mammography screening after receiving reminder interventions. Telephone contact as reminder was found to have the most significant influence among the interventions (OR = 5.0556; 95% CI = 2.0422-13.5722). CONCLUSIONS: Government and healthcare providers are recommended to consider adopting the telephone reminder strategy to encourage women to undergo their first-time mammography screening.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Sistemas de Alerta , Neoplasias da Mama/prevenção & controle , Feminino , Humanos , Pessoa de Meia-Idade , Taiwan , Telefone
3.
Med Hist ; 64(1): 52-70, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31933502

RESUMO

Mammographic screening for breast cancer is a widely used public health approach, but is constantly a subject of controversy. Medical and historical research on this topic has been mainly conducted in Western Europe and North America. In Brazil, screening mammography has been an open topic of discussion and a challenge for health care and public health since the 1970s. Effectively, Brazilian public health agencies never implemented a nationwide population-based screening programme for breast cancer, despite the pressures of many specific groups such as advocacy associations and the implementation of local programmes. This article examines the complex process of incorporating mammography as a diagnostic tool and the debates towards implementing screening programmes in Brazil. We argue that debates about screening for breast malignancies, especially those conducted in the late twentieth and early twenty-first centuries, took place in a context of change and uncertainty in the Brazilian health field. These discussions were strongly affected both by tensions between the public and the private health care sectors during the formative period of a new Brazilian health system, and by the growing role of civil society actors. Our study investigates these tensions and their consequences. We use several medical sources that discussed the topic in Brazil, mainly specialised leading oncology journals published between 1950 and 2017, medical congress reports for the same period, books and theses, institutional documents and oral testimonies of health professionals, patients and associations collected in the framework of the 'The History of Cancer' project from the Oswaldo Cruz Foundation and Brazilian National Cancer Institute.


Assuntos
Neoplasias da Mama/história , Detecção Precoce de Câncer/história , Mamografia/história , Brasil , Neoplasias da Mama/diagnóstico por imagem , Assistência à Saúde/história , Feminino , História do Século XX , História do Século XXI , Humanos , Mamografia/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Saúde Pública/história , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/história
4.
Int J Cancer ; 146(3): 850-860, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31001839

RESUMO

Advanced breast cancer (BC) is associated with heavier treatments and poorer prognosis than early BC. Despite mammographic screening, advanced BC incidence remains stable. Little is known about risk factors differentially associated with advanced BC. We analyzed factors predicting for postmenopausal advanced vs. early BC in the E3N cohort. E3N has been prospectively following 98,995 French women aged 50-65 years at baseline since 1990. Hazard ratios (HRs) and 95% confidence intervals (CIs) for advanced and early invasive BC were estimated with multivariate Cox competing risk hazard models. With a median follow-up of 15.7 years, 4,941 postmenopausal BC were diagnosed, including 1,878 (38%) advanced BC. Compared to early BC, advanced BC was differentially associated with excess weight (HR 1.39 [95% CI = 1.26-1.53] vs. 1.08 [95% CI = 1.00-1.17], phomogeneity < 0.0001) and living in a rural area (HR 1.14 [95% CI = 1.00-1.31] vs. 0.93 [95% CI = 0.82-1.04], phomogeneity 0.02). Excess weight was the only differential risk factor for advanced BC for hormone-dependent BC and for women compliant with screening recommendations. Previous mammography was associated with reduced advanced BC risk (HR 0.86 [95% CI = 0.73-1.00]) and increased early BC risk (HR 1.36 [95% CI = 1.18-1.56], phomogeneity < 0.0001), but only for hormone-dependent BC. Excess weight appears to be mostly associated with advanced BC, especially hormone-dependent BC. These results add to the evidence for maintaining weight within the recommended limits.


Assuntos
Neoplasias da Mama/epidemiologia , Mamografia/estatística & dados numéricos , Pós-Menopausa , Ganho de Peso , Idoso , Índice de Massa Corporal , Mama/diagnóstico por imagem , Mama/patologia , Neoplasias da Mama/patologia , Neoplasias da Mama/prevenção & controle , Feminino , Seguimentos , França/epidemiologia , Humanos , Incidência , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Medição de Risco , Fatores de Risco
5.
Rev Bras Epidemiol ; 22: e190069, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31826123

RESUMO

INTRODUCTION: Mammography is the main screening test for early detection of breast cancer; however, its access is not equal for all women in Brazil. The objective of this study was to analyze the factors associated with not having this examination done in a period of less than two years in Brazil and according to macro-region, considering sociodemographic characteristics, health conditions, lifestyle, and the use of health services. METHOD: Cross-sectional study using data from the National Health Survey in Brazil (Pesquisa Nacional de Saúde - PNS). The sample consisted of 10,571 women (≥40 years old) living in all Brazilian regions. Poisson regression model with hierarchical approach was used to estimate prevalence ratios. RESULTS: The characteristics associated with not getting a mammogram were: age ≥60 years, low schooling, living without a partner, negative health self-rating, having some chronic disease, no regular exercise, not getting a clinical breast examination for up to one year or a Pap smear for up to three years, not seeing a doctor in the last year, not having health insurance, feeling discriminated by a health professional, and being enrolled in a family care unit. Sociodemographic factors were prominent in the North and Northeast, while in other regions, health conditions and health behavior were predominant. CONCLUSION: Variables related to the use of health services were especially important in not getting a mammogram. Measures should be taken in each macro-region of Brazil to reduce disparities in access to mammography.


Assuntos
Neoplasias da Mama/diagnóstico , Acesso aos Serviços de Saúde/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Brasil , Doença Crônica , Estudos Transversais , Autoavaliação Diagnóstica , Detecção Precoce de Câncer/métodos , Escolaridade , Feminino , Equidade em Saúde , Inquéritos Epidemiológicos , Humanos , Seguro Saúde , Pessoa de Meia-Idade
6.
Medicine (Baltimore) ; 98(48): e18101, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770231

RESUMO

This retrospective study aimed to improve the diagnostic accuracy of breast lymphoma (BL) by analyzing the findings of BL on mammography and magnetic resonance imaging (MRI).Fifteen patients with breast lymphoma (BL, Primary/Secondary: 13/2) were confirmed by pathology. The imaging findings of those patients were analyzed by 2 senior radiologists.BL commonly showed significant enhancement with penetrating vessels and septation in masses on dynamic contrast-enhanced MRI (DCE-MRI). Diffusion limitation of BL is more pronounced than breast cancer on diffusion weighted imaging.The study suggests that the penetrating vessels and diffusion restriction of lesions are helpful for the diagnosis and differential diagnosis of BL.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Aumento da Imagem/métodos , Linfoma/diagnóstico por imagem , Imagem por Ressonância Magnética/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Adulto , Meios de Contraste , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética/métodos , Imagem de Difusão por Ressonância Magnética/estatística & dados numéricos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Mamografia/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos
8.
Public Health ; 177: 135-142, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31563701

RESUMO

OBJECTIVES: Cross-sectional data from Alberta's Tomorrow Project (ATP) were used to assess the association between perceived susceptibility (PS) to developing cancer and mammography screening behaviour. STUDY DESIGN: Cross-sectional study. METHODS: ATP participants between 35 and 70 years of age who reported being free of chronic conditions were included in the study (n = 1803). PS was measured using three variables: participants' estimate of their personal PS of developing cancer, compared to others, on a 5-point Likert scale; participants' estimate of the percentage of people in their age group who would be diagnosed with cancer; and participants' estimate of their own chance (expressed as a percentage) of being diagnosed with cancer. Multivariable logistic regression models, adjusting for age, marital status, work status, education, family history, and place of residence, were used to explore the association of interest. RESULTS: PS of developing cancer was modestly yet significantly associated with mammography screening behaviour for two of the three PS variables. Specifically, the adjusted odds of mammography screening were 1.20 times greater for each one-unit increase in personal PS of developing cancer (95% confidence interval [CI] = 1.07-1.36 [P = 0.003]) and 1.01 times greater for each one-unit increase in both participants' estimate of the percentage of people who would develop cancer (95% CI = 1.00-1.01 [P = 0.05]) and participants' estimate of their own chance of developing cancer (95% CI = 1.00-1.01 [P = 0.02]). CONCLUSIONS: Understanding how certain factors, such as PS, are associated with screening behaviour is important to help address the underutilization of cancer screening.


Assuntos
Atitude Frente a Saúde , Neoplasias da Mama/psicologia , Detecção Precoce de Câncer/psicologia , Mamografia/psicologia , Adulto , Idoso , Alberta , Neoplasias da Mama/prevenção & controle , Estudos Transversais , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Humanos , Mamografia/estatística & dados numéricos , Pessoa de Meia-Idade , Medição de Risco , Inquéritos e Questionários
9.
Isr Med Assoc J ; 21(9): 612-614, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31542907

RESUMO

BACKGROUND: Young women concerned about a breast cancer diagnosis will visit breast care centers and request breast cancer screening, including imaging studies, on their initial visit. OBJECTIVES: To explore the role of breast examination and breast ultrasound in self-referred asymptomatic women under the age of 40 years. METHODS: We identified 3524 women under the age of 40 at our medical clinic from 1 January 2010 until 1 June 2014. Of this group, 164 women with above average breast cancer risk were excluded and 233 were excluded because of breast complaints. Of 3127 women, 220 underwent breast ultrasound following the initial visit to the clinic and formed the study group. RESULTS: Of 220 women evaluated with ultrasound, 68 had prior positive clinical findings. Of this group 8 women had no sonographic findings, and in the remaining 60, a total of 30 simple cysts, 15 fibroadenomas, and 15 suspicious solid masses were identified. One infiltrating ductal carcinoma and one ductal carcinoma in situ were found in a biopsy. The remaining 152 of the 220 total women who underwent breast ultrasound without showing prior physical findings did not require follow-up. CONCLUSIONS: In the absence of clinical findings during physical breast examination, the addition of breast ultrasonography does not provide additional information to supplement the physical examination in self-referred women under age 40 who do not have any major risk factors for developing breast cancer.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/epidemiologia , Mamografia/estatística & dados numéricos , Ultrassonografia Mamária/estatística & dados numéricos , Adulto , Mama/diagnóstico por imagem , Feminino , Humanos , Israel/epidemiologia , Exame Físico/estatística & dados numéricos , Risco , Adulto Jovem
10.
BMC Womens Health ; 19(1): 116, 2019 09 13.
Artigo em Inglês | MEDLINE | ID: mdl-31519195

RESUMO

BACKGROUND: Breast cancer is the most prevalent cancer in women, and in those with a positive family history, it is important to perform mammography. One of the probable barriers in doing mammography is fatalism. METHODS: This is a descriptive/cross-sectional study conducted on 400 women residing in Isfahan, Iran, randomly selected in 2017. Sampling was done randomly among the enrolled women in Health Integrity System. The data collection tool was a questionnaire regarding the demographic-fertility information and fatalism. The data analysis was done by SPSS software. A P-value < 0.05 was considered statistically significant. RESULTS: The results showed that the mean rate of fatalism was 59.5 ± 23.2 in women with the experience of mammography, and 65.9±18.7 in women without the experience. Moreover, the mean rate of fatalism was 73.1±15.2 in subjects with a family history of breast cancer, and 59.3 ± 22.5 in those no family history related to this condition. Accordingly, fatalism was statistically significant associated (P < 0.001) with a family history of breast cancer and experience of mammography. There was no significant relationship between demographic information and fatalism (P > 0.05). CONCLUSION: The results indicated that fatalism in women with no experience of mammography was higher than in those with a positive history. Regarding the necessity of mammography in women with a family history of breast cancer, the required interventions seem to be essential to changing the viewpoints of women regarding the importance and effect of mammography as a screening method for breast cancer.


Assuntos
Neoplasias da Mama/psicologia , Detecção Precoce de Câncer/psicologia , Predisposição Genética para Doença/psicologia , Mamografia/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adulto , Neoplasias da Mama/diagnóstico , Estudos Transversais , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Irã (Geográfico) , Mamografia/estatística & dados numéricos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Inquéritos e Questionários
11.
Cancer Control ; 26(1): 1073274819874122, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31502471

RESUMO

OBJECTIVE: Analysis of interval cancers is critical in determining the sensitivity of screening and represents an objective measure of the quality of mammography screening program (MSP). METHODS: Period analyzed: from 2006 to 2012. The rate of screen-detected, interval cancers and program sensitivity were measured. A comparison of screen-detected and interval cancers was performed. RESULTS: During the period of the study, 429 473 women were screened and 1297 were found to have cancer. The overall screen-detected cancer rate was 30.2 per 10 000 women screened. Four hundred thirty-one case of interval cancers have occurred during the period of the study. The interval cancer ratio (ICR) was 0.25. Overall sensitivity of MSP amounted to 75.1%. Slightly lower sensitivity was found among the youngest age-group, especially for those with lobular cancers. Interval cancers were bigger in size, more often with metastases in lymph nodes, than screen-detected cancers, but these differences were not statistically significant. CONCLUSIONS: Overall program sensitivity in Lithuania is about 75%, ICR is 0.25, and these parameters are comparable to other European countries.


Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Idoso , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Lituânia , Linfonodos/patologia , Mamografia/métodos , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
12.
Cancer Causes Control ; 30(10): 1045-1055, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31428890

RESUMO

PURPOSE: Previous studies suggesting that rural US women may be less likely to have a recent mammogram than urban women are limited in either scope or granularity. This study explored urban-rural disparities in US breast cancer-screening practices at the national, regional, and state levels. METHODS: We used data from the 2012, 2014, and 2016 Behavioral Risk Factor Surveillance Systems surveys. Logistic models were utilized to examine the impact of living in an urban/rural area on mammogram screening at three geographic levels while adjusting for covariates. We then calculated average adjusted predictions (AAPs) and average marginal effects (AMEs) to isolate the association between breast cancer screening and the urban/rural factor. RESULTS: At all geographic levels, AAPs of breast cancer screening were similar among urban, suburban, and rural residents. Regarding "ever having a mammogram" and "having a recent mammogram," urban women had small but significantly higher adjusted probabilities (AAP: 94.6%, 81.1%) compared to rural women (AAP: 93.5%, 80.2%). CONCLUSIONS: While urban-rural differences in breast cancer screening are small, they can translate into tens of thousands of rural women not receiving mammograms. Hence, there is a need to continue screening initiatives in these areas to reduce the number of breast cancer deaths.


Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade
13.
Comput Methods Programs Biomed ; 179: 104995, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31443864

RESUMO

BACKGROUND AND OBJECTIVE: This study aims to develop and evaluate a unique global mammographic image feature analysis scheme to predict likelihood of a case depicting the detected suspicious breast mass being malignant for breast cancer. METHODS: From the entire breast area depicting on the mammograms, 59 features were initially computed to characterize the breast tissue properties at both spatial and frequency domain. Given that each case consists of two cranio-caudal and two medio-lateral oblique view images of left and right breasts, two feature pools were built, which contain the computed features from either two positive images of one breast or all the four images of two breasts. Next, for each feature pool, a particle swarm optimization (PSO) method was applied to determine the optimal feature cluster followed by training a support vector machine (SVM) classifier to generate a final score for predicting likelihood of the case being malignant. To test the scheme, we assembled a dataset involving 275 patients who had biopsy due to the suspicious findings on mammograms. Among them, 134 are malignant and 141 are benign. A ten-fold cross validation method was used to train and test the scheme. RESULTS: The classification performance levels measured by the areas under ROC curves are 0.79 ± 0.07 and 0.75 ± 0.08 when applying the SVM classifiers trained using image features computed from two-view and four-view images, respectively. CONCLUSIONS: This study demonstrates feasibility of developing a new global mammographic image feature analysis-based scheme to predict the likelihood of case being malignant without lesion segmentation.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mamografia/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Algoritmos , Densidade da Mama , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Mamografia/estatística & dados numéricos , Curva ROC , Interpretação de Imagem Radiográfica Assistida por Computador/estatística & dados numéricos , Máquina de Vetores de Suporte
14.
BMC Health Serv Res ; 19(1): 446, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269933

RESUMO

BACKGROUND: Through the Choosing Wisely Canada (CWC) campaign, national medical specialty societies have released hundreds of recommendations against health care services that are unnecessary, i.e. present little to no benefit or cause avoidable harm. Despite growing interest in unnecessary care both within Canada and internationally, prior research has typically avoided taking a national or even multi-jurisdictional approach in measuring the extent of the issue. This study estimates use of three unnecessary services identified by CWC recommendations across multiple Canadian jurisdictions. METHODS: Two retrospective cohort studies were conducted using administrative health care data collected between fiscal years 2011/12 and 2012/13 to respectively quantify use of 1) diagnostic imaging (spinal X-ray, CT or MRI) among Albertan patients following a visit for lower back pain and 2) cardiac tests (electrocardiogram, chest X-ray, stress test, or transthoracic echocardiogram) prior to low-risk surgical procedures in Alberta, Saskatchewan, and Ontario. A cross-sectional study of the 2012 Canadian Community Health Survey was also conducted to estimate 3) the proportion of females aged 40-49 that reported having a routine mammogram in the past two years. RESULTS: Use of unnecessary care was relatively frequent across all three services and jurisdiction measured: 30.7% of Albertan patients had diagnostic imaging within six months of their initial visit for lower back pain; a cardiac test preceded 17.9 to 35.5% of low-risk surgical procedures across Alberta, Saskatchewan, and Ontario; and 22.2% of Canadian women aged 40-49 at average-risk for breast cancer reported having a routine screening mammogram in the past two years. CONCLUSIONS: The use of potentially unnecessary care appears to be common in Canada. This investigation provides methodology to facilitate future measurement efforts that may incorporate additional jurisdictions and/or unnecessary services.


Assuntos
Técnicas de Imagem Cardíaca/estatística & dados numéricos , Dor Lombar/diagnóstico por imagem , Mamografia/estatística & dados numéricos , Procedimentos Desnecessários , Canadá/epidemiologia , Estudos Transversais , Humanos , Sobremedicalização , Estudos Retrospectivos , Procedimentos Desnecessários/estatística & dados numéricos
15.
Plast Reconstr Surg ; 144(2): 265-275, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348325

RESUMO

BACKGROUND: Fat grafting is a powerful and increasingly used technique in breast reconstruction. However, fat necrosis can lead to palpable postoperative changes that can induce anxiety and lead to unplanned diagnostic studies. The authors' aim in this study was to evaluate the incidence, type, and timing of these unanticipated studies; the specialty of the ordering provider; and the factors that trigger the ordering process. METHODS: A retrospective chart review was conducted for patients from 2006 to 2015 who underwent fat grafting as part of implant-based breast cancer reconstruction and had at least 1-year follow-up after fat grafting. RESULTS: From 2006 to 2015, 166 patients underwent fat grafting as part of implant-based breast reconstruction. Forty-four women (26.5 percent) underwent at least one imaging procedure. Thirteen women (7.8 percent) underwent 17 biopsies. For a palpable mass, the initial imaging test most commonly ordered was ultrasound, followed by mammography/ultrasound. The percentage of patients with a diagnosis of fat necrosis on mammography, ultrasound, and biopsy was 4.2, 12.7, and 5.4 percent, respectively. Seven patients (4.2 percent) had distant metastases. Tissue diagnosis of local recurrence was never identified. Mean follow-up was 2.4 years. CONCLUSIONS: Fat-grafting sequelae may lead to early unplanned invasive and noninvasive procedures initiated by a variety of providers. In this study, fat grafting had no impact on local recurrence rate. As use of fat grafting grows, communication among breast cancer care providers and enhanced patient and caregiver education will be increasingly important in optimizing the multidisciplinary evaluation and monitoring of palpable breast lesions. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Tecido Adiposo/transplante , Implante Mamário/métodos , Implantes de Mama , Neoplasias da Mama/cirurgia , Tecido Adiposo/diagnóstico por imagem , Adulto , Idoso , Biópsia/estatística & dados numéricos , Neoplasias da Mama/diagnóstico por imagem , Necrose Gordurosa/etiologia , Feminino , Humanos , Imagem por Ressonância Magnética , Mamografia/estatística & dados numéricos , Mastectomia/estatística & dados numéricos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Ultrassonografia Mamária/estatística & dados numéricos
16.
Cien Saude Colet ; 24(7): 2745-2760, 2019 Jul 22.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31340291

RESUMO

This article discusses trends in health inequalities and access to health services across the regions of Brazil using data from household surveys conducted between 1998 and 2013. Social inequality was measured based on the ratio between the extremes of years of schooling considering two age groups (18 to 59 years and 60 years and over). The findings show a decline in health status and increase in prevalence of diabetes and hypertension in both age groups, which may be related to the expansion of primary healthcare. The findings regarding the percentage of people who had had a medical appointment in the last 12 months show that low levels of inequalities persist despite a general improvement in access. Despite an increase in the percentage of people with up to 3 years of schooling who had had a dental appointment in the last year, significant inequalities persist. The percentage of people who reported being admitted to hospital in the last 12 months was greater among people with up to 3 years of schooling throughout the study period. The hospitalization rate decreased in both age groups across almost all regions. The proportion of women aged between 50 and 69 years with up to 3 years of schooling who had had a mammogram increased, leading to a decrease in inequality. The findings show the need to ensure the continuity of household surveys to monitor inequalities in access to health care services by region and social group.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde , Disparidades nos Níveis de Saúde , Nível de Saúde , Adolescente , Adulto , Fatores Etários , Idoso , Brasil , Escolaridade , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Mamografia/estatística & dados numéricos , Pessoa de Meia-Idade , Atenção Primária à Saúde/organização & administração , Classe Social , Inquéritos e Questionários , Adulto Jovem
17.
BMC Health Serv Res ; 19(1): 387, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200700

RESUMO

BACKGROUND: Australia's Aboriginal and Torres Strait Islander women have poorer survival and twice the disease burden from breast cancer compared to other Australian women. These disparities are influenced, but not fully explained, by more diagnoses at later stages. Incorporating breast screening, hospital and out of hospital treatment and cancer registry records into a person-linked data system can improve our understanding of breast cancer outcomes. We focussed one such system on a population-based cohort of Aboriginal women in South Australia diagnosed with breast cancer and a matched cohort of non-Aboriginal women with breast cancer. We quantify Aboriginal and non-Aboriginal women's contact with publicly funded screening mammograms; quantify exposure to a selection of cancer treatment modalities; then assess the relationship between screening, treatment and the subsequent risk of breast cancer death. METHODS: Breast cancers registered among Aboriginal women in South Australia in 1990-2010 (N = 77) were matched with a random selection of non-Aboriginal women by birth and diagnostic year, then linked to screening records, and treatment 2 months before and 13 months after diagnosis. Competing risk regression summarised associations of Aboriginality, breast screening, cancer stage and treatment with risk of breast cancer death. RESULTS: Aboriginal women were less likely to have breast screening (OR = 0.37, 95%CIs 0.19-0.73); systemic therapies (OR = 0.49, 95%CIs 0.24-0.97); and, surgical intervention (OR = 0.35, 95%CIs 0.15-0.83). Where surgery occurred, mastectomy was more common among Aboriginal women (OR = 2.58, 1.22-5.46). Each of these factors influenced the risk of cancer death, reported as sub-hazard ratios (SHR). Regional spread disease (SHR = 34.23 95%CIs 6.76-13.40) and distant spread (SHR = 49.67 95%CIs 6.79-363.51) carried more risk than localised disease (Reference SHR = 1). Breast screening reduced the risk (SHR = 0.07 95%CIs 0.01-0.83). So too did receipt of systemic therapy (SHR = 0.06 95%CIs 0.01-0.41) and surgical treatments (SHR = 0.17 95%CIs 0.04-0.74). In the presence of adjustment for these factors, Aboriginality did not further explain the risk of breast cancer death. CONCLUSION: Under-exposure to screening and treatment of Aboriginal women with breast cancers in South Australia contributed to excess cancer deaths. Improved access, utilisation and quality of effective treatments is needed to improve survival after breast cancer diagnosis.


Assuntos
Neoplasias da Mama/diagnóstico , Disparidades em Assistência à Saúde/etnologia , Adulto , Neoplasias da Mama/etnologia , Neoplasias da Mama/mortalidade , Estudos de Coortes , Detecção Precoce de Câncer/normas , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Serviços de Saúde do Indígena/normas , Serviços de Saúde do Indígena/estatística & dados numéricos , Humanos , Mamografia/estatística & dados numéricos , Mastectomia/estatística & dados numéricos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Grupo com Ancestrais Oceânicos/etnologia , Sistema de Registros , Pesquisa , Estudos Retrospectivos , Austrália do Sul/etnologia
18.
Medicine (Baltimore) ; 98(24): e15869, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192918

RESUMO

Higher trait optimism and/or lower cynical hostility are associated with healthier behaviors and lower risk of morbidity and mortality, yet their association with health care utilization has been understudied. Whether these psychological attitudes are associated with breast cancer screening behavior is unknown. To assess the association of optimism and cynical hostility with screening mammography in older women and whether sociodemographic factors acted as mediators of these relationships, we used Women's Health Initiative (WHI) observational cohort survey data linked to Medicare claims. The sample includes WHI participants without history of breast cancer who were enrolled in Medicare Parts A and B for ≥2 years from 2005-2010, and who completed WHI baseline attitudinal questionnaires (n = 48,291). We used survival modeling to examine whether screening frequency varied by psychological attitudes (measured at study baseline) after adjusting for sociodemographic characteristics, health conditions, and healthcare-related variables. Psychological attitudes included trait optimism (Life Orientation Test-Revised) and cynical hostility (Cook Medley subscale), which were self-reported at study baseline. Sociodemographic, health conditions, and healthcare variables were self-reported at baseline and updated through 2005 as available. Contrary to our hypotheses, repeated events survival models showed that women with the lowest optimism scores (i.e., more pessimistic tendencies) received 5% more frequent screenings after complete covariate adjustment (p < .01) compared to the most optimistic group, and showed no association between cynical hostility and frequency of screening mammograms. Sociodemographic factors did not appear to mediate the relationship between optimism and screenings. However, higher levels of education and higher levels of income were associated with more frequent screenings (both p < .01). We also found that results for optimism were primarily driven by women who were aged 75 or older after January 2009, when changes to clinical guidelines lead to uncertainty about risks and benefits of screening in this age group. The study demonstrated that lower optimism, higher education, and higher income were all associated with more frequent screening mammograms in this sample after repeated events survival modeling and covariate adjustment.


Assuntos
Mamografia/estatística & dados numéricos , Otimismo/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Idoso , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Revisão da Utilização de Seguros , Estudos Longitudinais , Medicare , Fatores Socioeconômicos , Estados Unidos , Saúde da Mulher
19.
Biomed Environ Sci ; 32(4): 242-249, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31217060

RESUMO

OBJECTIVE: To understand the distribution of the average glandular dose (AGD) in mammography by investigating 1,828 exposure parameters of 8 mammography machines in three cities, by using random sampling. METHODS: A survey of 8 mammography machines in three different cities, sampled using stratified random sampling methods, was performed, and 1,828 mammography exposure parameters were recorded. Incident air kerma (k) was measured by Quality-Assurance (QA) dosimeters, and AGD was calculated by series conversion coefficients based on a 3D detailed Monte Carlo breast model, published by Wang et al. RESULTS: The distribution of compressed breast thickness (CBT) fitted a normal distribution, while that of AGD fitted a skewed distribution. The mean value of CBT in a medio-lateral oblique (MLO) view was about 5.6% higher than that in the craniocaudal (CC) view, with significant statistical difference; mean value of AGD and CBT in the sample was 1.3 mGy and 4.6 cm, respectively. The AGD trended upward with increasing CBT, similar to the results of other researches. CONCLUSION: The mean AGD and CBT levels in our study for mammography practice in China were 1.3 mGy and 4.6 cm, respectively. AGD is influenced by manufacturer-specific variation as machine response to CBT changes and target/filter combination. The present study can provide evidence for establishing a diagnostic reference level in China.


Assuntos
Mamografia/estatística & dados numéricos , Doses de Radiação , Adulto , China , Feminino , Humanos , Pessoa de Meia-Idade
20.
Public Health ; 173: 42-47, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31254676

RESUMO

OBJECTIVES: The aim of this analysis was to examine the association between public healthcare eligibility combined with private health insurance (PHI) status and the uptake of breast and prostate cancer screening services among middle and older age groups in Ireland. STUDY DESIGN: This is a cross-sectional analysis using The Irish Longitudinal Study on Ageing (TILDA). METHODS: The analysis included 6902 people aged 50 years and older who completed an in-house interview as part of TILDA. The interview collects information on a range of demographic, socio-economic, health and health service usage variables including the uptake of cancer screening services. An eligibility variable was created using information on public healthcare entitlement and PHI status. The association between eligibility and the uptake of two cancer screening services-mammogram and prostate-specific antigen (PSA) test-was examined using weighted multivariate logistic regression analysis. RESULTS: The uptake of a mammogram and PSA testing was significantly higher in those with PHI. This relationship held after controlling for a range of confounders including health and socio-economic status. CONCLUSIONS: More research is required to identify the reasons for the higher uptake of cancer screening services among those with PHI, given that insurance does not confer any advantages in accessing these services. It is possible that the higher uptake is explained by differential access to secondary care services between those with and without PHI. Consideration of the integrated nature of healthcare systems is essential when seeking to maximise the uptake of services (such as cancer screening) that potentially involve multiple parts of the healthcare system.


Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Neoplasias/diagnóstico , Antígeno Prostático Específico , Neoplasias da Próstata/diagnóstico , Idoso , Neoplasias da Mama/prevenção & controle , Estudos Transversais , Definição da Elegibilidade , Feminino , Humanos , Seguro Saúde , Irlanda , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Neoplasias/prevenção & controle , Neoplasias da Próstata/prevenção & controle , Classe Social , Fatores Socioeconômicos
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