mass screening Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2012;34(2):86-91
DOI 10.1590/S0100-72032012000200008
PURPOSE: To evaluate the actions of the "Um Beijo Pela Vida" Program developed in a Brazilian Northeast city to increase adherence to breast cancer screening by women registered by the Brazilian Family Health Strategy for breast cancer screening. METHODS: A quantitative approach was used to evaluate the coverage of screening actions for aged 40 years-old or more. Community workers from the nine Family Health Teams of the town carried out an active search. The percentage of eligible women who were screened for breast cancer by clinical breast examination or mammography, mammogram classification according to BI-RADS®, women screened who were referred for further testing and treatment, and the number of breast cancers detected were collected by means of a structured questionnaire, analyzed with the EPI-INFO TM software and compared to previously defined patterns. RESULTS: 3,608 women were included, corresponding to 68.4% of the target population registered in the Brazilian Family Health Strategy. Coverage rates of clinical breast examination for women aged 40 to 49 years-old and of mammograms for women aged 50 to 69 years-old were 58.9 and 56.7%, respectively. All women with highly suspicious mammographic lesions were submitted to fine needle aspiration or core biopsy (100%). Six new cases of cancer were detected and 80% of the standards established for this evaluation were carried out. CONCLUSIONS: The evaluation of the actions of the Program suggests its adequacy considering the degree of fulfillment of the previously defined requirements.
Summary
Rev Bras Ginecol Obstet. 2012;34(2):86-91
DOI 10.1590/S0100-72032012000200008
PURPOSE: To evaluate the actions of the "Um Beijo Pela Vida" Program developed in a Brazilian Northeast city to increase adherence to breast cancer screening by women registered by the Brazilian Family Health Strategy for breast cancer screening. METHODS: A quantitative approach was used to evaluate the coverage of screening actions for aged 40 years-old or more. Community workers from the nine Family Health Teams of the town carried out an active search. The percentage of eligible women who were screened for breast cancer by clinical breast examination or mammography, mammogram classification according to BI-RADS®, women screened who were referred for further testing and treatment, and the number of breast cancers detected were collected by means of a structured questionnaire, analyzed with the EPI-INFO TM software and compared to previously defined patterns. RESULTS: 3,608 women were included, corresponding to 68.4% of the target population registered in the Brazilian Family Health Strategy. Coverage rates of clinical breast examination for women aged 40 to 49 years-old and of mammograms for women aged 50 to 69 years-old were 58.9 and 56.7%, respectively. All women with highly suspicious mammographic lesions were submitted to fine needle aspiration or core biopsy (100%). Six new cases of cancer were detected and 80% of the standards established for this evaluation were carried out. CONCLUSIONS: The evaluation of the actions of the Program suggests its adequacy considering the degree of fulfillment of the previously defined requirements.
Summary
Rev Bras Ginecol Obstet. 2010;32(5):241-246
DOI 10.1590/S0100-72032010000500007
PURPOSE: to assess the knowledge, attitude and practice of breast self-examination (BSE) of women from the municipality of São Luís (MA), Brazil, and associated socio-demographic variables. METHODS: prospective and cross-sectional study, with conglomerate sampling, in which 552 women from 14 census sections of São Luís were included during the period from January to September 2003. The knowledge, attitude and practice (dependent variables) were evaluated by means of analysis of the responses of the women as "adequate" or "inadequate". The main independent variables were: age, schooling, family income and marital and menopausal status. The χ2 test was used to determine the association between categorical variables and the measurement of the crude/adjusted Odds Ratio (OR) after multivariate analysis by means of logistic regression. RESULTS: although 1/3 of the studied population did not know about BSE, the group of women who were informed about it showed adequate knowledge (60.9%), practice (59.5%) and attitude (90%). The family history of breast cancer (8.9%) was not associated with better knowledge and practice. The media (63.6%) was found to be important in disseminating information about BSE. After multivariate analysis, women with a partner (OR=1.9) presented more adequate knowledge; women older than 50 years (OR=11.7) had a better attitude towards BSE; women with more than five years of schooling (OR=2) and with a partner (OR=1.7) were associated with a more correct practice of BSE. CONCLUSION: most of the patients know and practice the BSE in São Luís and their attitude towards the procedure is extremely positive. There was a great participation of the media in the dissemination of information concerning BSE.
Summary
Rev Bras Ginecol Obstet. 2010;32(5):241-246
DOI 10.1590/S0100-72032010000500007
PURPOSE: to assess the knowledge, attitude and practice of breast self-examination (BSE) of women from the municipality of São Luís (MA), Brazil, and associated socio-demographic variables. METHODS: prospective and cross-sectional study, with conglomerate sampling, in which 552 women from 14 census sections of São Luís were included during the period from January to September 2003. The knowledge, attitude and practice (dependent variables) were evaluated by means of analysis of the responses of the women as "adequate" or "inadequate". The main independent variables were: age, schooling, family income and marital and menopausal status. The χ2 test was used to determine the association between categorical variables and the measurement of the crude/adjusted Odds Ratio (OR) after multivariate analysis by means of logistic regression. RESULTS: although 1/3 of the studied population did not know about BSE, the group of women who were informed about it showed adequate knowledge (60.9%), practice (59.5%) and attitude (90%). The family history of breast cancer (8.9%) was not associated with better knowledge and practice. The media (63.6%) was found to be important in disseminating information about BSE. After multivariate analysis, women with a partner (OR=1.9) presented more adequate knowledge; women older than 50 years (OR=11.7) had a better attitude towards BSE; women with more than five years of schooling (OR=2) and with a partner (OR=1.7) were associated with a more correct practice of BSE. CONCLUSION: most of the patients know and practice the BSE in São Luís and their attitude towards the procedure is extremely positive. There was a great participation of the media in the dissemination of information concerning BSE.
Summary
Rev Bras Ginecol Obstet. 2010;32(4):191-197
DOI 10.1590/S0100-72032010000400007
PURPOSE: to assess compliance with the recommendations for opportunistic breast cancer screening by mammography. METHODS: 460 women from the town of Taubaté, São Paulo, Brazil, were followed-up prospectively after the index mammography, 327 of them attended by the public health system and 133 by the private system. We evaluated the prevalence of mammography repetition, the adherence rates and predictive factors associated with the current recommendations of mammographic screening. The association of the outcomes with the independent variables was studied by obtaining the risk rates (RR) and the respective 95% confidence intervals (95%CI). The adjusted prevalence rates were calculated by the COX regression model. RESULTS: although more than 90% of the studied women repeated the mammography at least once, the rate of correct compliance with the recommendations of mammographic screening, with repetition of the procedure every 24 months, was low (about 30% of the study sample). The preditive factors associated with compliance with mammographic screening were related to the unequal access to public or private healthcare services (RR=1.77; 95%CI=1.26-2.48) and to previous screening (RR=3.07; 95%CI=1.86-5.08). CONCLUSION: we concluded that compliance with the recommendations of opportunistic mammographic screening for breast cancer was low in both studied population segments.
Summary
Rev Bras Ginecol Obstet. 2010;32(4):191-197
DOI 10.1590/S0100-72032010000400007
PURPOSE: to assess compliance with the recommendations for opportunistic breast cancer screening by mammography. METHODS: 460 women from the town of Taubaté, São Paulo, Brazil, were followed-up prospectively after the index mammography, 327 of them attended by the public health system and 133 by the private system. We evaluated the prevalence of mammography repetition, the adherence rates and predictive factors associated with the current recommendations of mammographic screening. The association of the outcomes with the independent variables was studied by obtaining the risk rates (RR) and the respective 95% confidence intervals (95%CI). The adjusted prevalence rates were calculated by the COX regression model. RESULTS: although more than 90% of the studied women repeated the mammography at least once, the rate of correct compliance with the recommendations of mammographic screening, with repetition of the procedure every 24 months, was low (about 30% of the study sample). The preditive factors associated with compliance with mammographic screening were related to the unequal access to public or private healthcare services (RR=1.77; 95%CI=1.26-2.48) and to previous screening (RR=3.07; 95%CI=1.86-5.08). CONCLUSION: we concluded that compliance with the recommendations of opportunistic mammographic screening for breast cancer was low in both studied population segments.
Summary
Rev Bras Ginecol Obstet. 2009;31(10):508-512
DOI 10.1590/S0100-72032009001000007
PURPOSE: to check epidemiological data from a breast diagnostic clinic. METHODS: mammographies from 35,041 patients were studied, within a period of 2 years and 7 months, from 2004 to 2006, 32,049 (91.5%) of them from screening, and 2,992 from symptomatic patients (8.5%). The calculated parameters were: detection rate of the screening patients, percentage of cancer among the symptomatic patients, rate of biopsy indication, percentage of minimal, in situ, and stage 0-1 carcinomas, recall rate, and predictive value of mammographies considered as abnormal and of biopsies' indications in screening patients. RESULTS: 228 diagnoses of breast cancer were made, 111 in screening patients (0.34% detection rate) and 117 in symptomatic patients (3.91% detection rate). The number of biopsies' recommendations among screening patients was 544 (1.7% of those patients). There were 28% of minimal carcinomas, 10% of in situ carcinomas and 93% of stage 0-1 carcinomas among the screening patients. Recall rate was 19%. Positivity of mammographies considered as abnormal (VPP1) was 1.65%. The rate of biopsies' positivity (VPP2) was 21.9%. CONCLUSIONS: this study brings important epidemiological data for the audit of mammographic screening, rare among us. Data have been analyzed as compared to what is recommended by the literature, the detection rate and the percentage of minimal and in situ carcinomas found being comparable to the established values, but with the VPP value lower than the ideal.
Summary
Rev Bras Ginecol Obstet. 2009;31(10):508-512
DOI 10.1590/S0100-72032009001000007
PURPOSE: to check epidemiological data from a breast diagnostic clinic. METHODS: mammographies from 35,041 patients were studied, within a period of 2 years and 7 months, from 2004 to 2006, 32,049 (91.5%) of them from screening, and 2,992 from symptomatic patients (8.5%). The calculated parameters were: detection rate of the screening patients, percentage of cancer among the symptomatic patients, rate of biopsy indication, percentage of minimal, in situ, and stage 0-1 carcinomas, recall rate, and predictive value of mammographies considered as abnormal and of biopsies' indications in screening patients. RESULTS: 228 diagnoses of breast cancer were made, 111 in screening patients (0.34% detection rate) and 117 in symptomatic patients (3.91% detection rate). The number of biopsies' recommendations among screening patients was 544 (1.7% of those patients). There were 28% of minimal carcinomas, 10% of in situ carcinomas and 93% of stage 0-1 carcinomas among the screening patients. Recall rate was 19%. Positivity of mammographies considered as abnormal (VPP1) was 1.65%. The rate of biopsies' positivity (VPP2) was 21.9%. CONCLUSIONS: this study brings important epidemiological data for the audit of mammographic screening, rare among us. Data have been analyzed as compared to what is recommended by the literature, the detection rate and the percentage of minimal and in situ carcinomas found being comparable to the established values, but with the VPP value lower than the ideal.
Summary
Rev Bras Ginecol Obstet. 2008;30(11):556-560
DOI 10.1590/S0100-72032008001100005
PURPOSE: to evaluate whether the sample adequacy influences the detection of precursor cervical cancer lesions. METHODS: a transversal study from January 2004 to December 2005. A number of 10,951 results of cervical cytotopathological exams from users of the National Health System (Sistema Único de Saúde, SUS) in Goiânia, Goiás , Brazil, was studied. These women had spontaneously looked for the services from the Family Health Program or from the Basic Units of Health. Samples were collected by medical doctors and nurses, through the conventional technique to detect cervical cancer. The analyzed smears were classified by the Bethesda System, the sample adequacy being defined along the routine screening and categorized as: satisfactory, satisfactory but presenting factors that might partially jeopardize the analysis, and unsatisfactory. Results were stored in the Epi-Info 3.3.2 program. The χ2 test was used to compare altered results with the adequacy of the samples from cytopathological smears. Differences with probability of rejection of the null hypothesis lower than 5% (p<0.05) were considered as significant. RESULTS: From 10,951 smears, 51.1% were classified as having satisfactory adequacy for analysis, 46.6% as satisfactory, but presenting some limiting factors, and 2.3%, as unsatisfactory. The main factors which have partially jeopardized the analysis were: lack of endocervical cells (52.2%), dried smears (22.8%), purulence (14.9%), or smears with some thick areas (9.5%). There was a higher rate of altered smears when the sample had been classified as satisfactory for analysis and with representation of endocervical cells ASC-US (2.3%), ASC-H (0.6%), LSIL (3.2%), HSIL (1.7%) and 0.3% of AGC. Differences were significant when p=0.001. The rate of low and high grade lesions was higher when the smears were satisfactory for analysis. CONCLUSIONS: the rate of precursor uterine cervix cancer lesions varies according to the sample adequacy, and the main adequacy limitations of the sample are mainly related to the collection condition.
Summary
Rev Bras Ginecol Obstet. 2008;30(11):556-560
DOI 10.1590/S0100-72032008001100005
PURPOSE: to evaluate whether the sample adequacy influences the detection of precursor cervical cancer lesions. METHODS: a transversal study from January 2004 to December 2005. A number of 10,951 results of cervical cytotopathological exams from users of the National Health System (Sistema Único de Saúde, SUS) in Goiânia, Goiás , Brazil, was studied. These women had spontaneously looked for the services from the Family Health Program or from the Basic Units of Health. Samples were collected by medical doctors and nurses, through the conventional technique to detect cervical cancer. The analyzed smears were classified by the Bethesda System, the sample adequacy being defined along the routine screening and categorized as: satisfactory, satisfactory but presenting factors that might partially jeopardize the analysis, and unsatisfactory. Results were stored in the Epi-Info 3.3.2 program. The χ2 test was used to compare altered results with the adequacy of the samples from cytopathological smears. Differences with probability of rejection of the null hypothesis lower than 5% (p<0.05) were considered as significant. RESULTS: From 10,951 smears, 51.1% were classified as having satisfactory adequacy for analysis, 46.6% as satisfactory, but presenting some limiting factors, and 2.3%, as unsatisfactory. The main factors which have partially jeopardized the analysis were: lack of endocervical cells (52.2%), dried smears (22.8%), purulence (14.9%), or smears with some thick areas (9.5%). There was a higher rate of altered smears when the sample had been classified as satisfactory for analysis and with representation of endocervical cells ASC-US (2.3%), ASC-H (0.6%), LSIL (3.2%), HSIL (1.7%) and 0.3% of AGC. Differences were significant when p=0.001. The rate of low and high grade lesions was higher when the smears were satisfactory for analysis. CONCLUSIONS: the rate of precursor uterine cervix cancer lesions varies according to the sample adequacy, and the main adequacy limitations of the sample are mainly related to the collection condition.
Summary
Rev Bras Ginecol Obstet. 2007;29(8):402-407
DOI 10.1590/S0100-72032007000800004
PURPOSE: to evaluate the efficiency of the 100% rapid rescreening in the detection of false-negative results and to verify whether the results vary according to the adequacy of the sample and the woman’s age group. METHODS: to evaluate the efficiency of the rapid rescreening, the 5,530 smears classified as negative by the routine screening, after being submitted to the rapid rescreening of 100%, were compared with the rescreening of the smears on the basis of clinical criteria and 10% random rescreening. For statistical analysis, the variables were evaluated descriptively and the c² test and the Cochran-Armitage test were applied to compare results. RESULTS: of the 141 smears identified as suspicious according to the rapid rescreening method, 84 (59.6%) cases were confirmed in the final diagnosis, of which 36 (25.5%) were classified as atypical squamous cells of undetermined significance, five (3.5%) as atypical squamous cells that cannot exclude high-grade squamous intraepithelial lesion, 34 (24.1%) as low-grade squamous intraepithelial lesion, six (4.3%) as high-grade squamous intraepithelial lesion, and three (2.1%) as atypical glandular cells. Of the 84 suspect smears confirmed in the final diagnosis, 62 (73.8%) smears were classified as adequate and 22 (26.2%) as adequate but with some limitation, but no significant difference was observed with the woman’s age. CONCLUSIONS: the results of this study show that rapid rescreening is an efficient option for internal quality control for the detection of false-negative cervical smear results. In addition, it should be noted that rapid rescreening performed better when the sample was classified as adequate for analysis; however, it did not vary according to the woman’s age group.
Summary
Rev Bras Ginecol Obstet. 2007;29(8):402-407
DOI 10.1590/S0100-72032007000800004
PURPOSE: to evaluate the efficiency of the 100% rapid rescreening in the detection of false-negative results and to verify whether the results vary according to the adequacy of the sample and the woman’s age group. METHODS: to evaluate the efficiency of the rapid rescreening, the 5,530 smears classified as negative by the routine screening, after being submitted to the rapid rescreening of 100%, were compared with the rescreening of the smears on the basis of clinical criteria and 10% random rescreening. For statistical analysis, the variables were evaluated descriptively and the c² test and the Cochran-Armitage test were applied to compare results. RESULTS: of the 141 smears identified as suspicious according to the rapid rescreening method, 84 (59.6%) cases were confirmed in the final diagnosis, of which 36 (25.5%) were classified as atypical squamous cells of undetermined significance, five (3.5%) as atypical squamous cells that cannot exclude high-grade squamous intraepithelial lesion, 34 (24.1%) as low-grade squamous intraepithelial lesion, six (4.3%) as high-grade squamous intraepithelial lesion, and three (2.1%) as atypical glandular cells. Of the 84 suspect smears confirmed in the final diagnosis, 62 (73.8%) smears were classified as adequate and 22 (26.2%) as adequate but with some limitation, but no significant difference was observed with the woman’s age. CONCLUSIONS: the results of this study show that rapid rescreening is an efficient option for internal quality control for the detection of false-negative cervical smear results. In addition, it should be noted that rapid rescreening performed better when the sample was classified as adequate for analysis; however, it did not vary according to the woman’s age group.
