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A study used a large, geographically diverse group of patients to assess the effect of computer-aided detection on the performance of screening mammography in community-based settings. Results showed that the use of computer-aided detection was associated with reduced accuracy of interpretation of screening mammograms, but the increased rate of biopsy with the use of such detection was not clearly associated with improved detection of invasive breast cancer.

Objective. To understand mammographers' perception of individual women's breast cancer risk. Materials and Methods. Radiologists interpreting screening mammography examinations completed a mailed survey consisting of questions pertaining to demographic and [...]

The relationship between the use of antibiotics and the risk of breast cancer was studied. The study reveals that the use of antibiotics is associated with increased risk of incident and fatal breast cancer.

Breast implants may make breast cancer diagnosis by mammography more difficult, according to a study of approximately 1 million women. Among women with breast implants, mammography only identified 45% of the women who had breast cancer. Among women without breast implants, mammography identified 67% of those who had breast cancer. Breast implants do not make breast cancer worse.

The success of fecal occult blood‐based colorectal cancer screening programs is dependent on repeating screening at short intervals (ie, every 1‐2 years). We conducted a literature review to assess measures that have been used to assess longitudinal adherence to fecal‐based screening. Among 46 citations identified and included in this review, six broad classifications of longitudinal adherence were identified: (a) stratified single‐round attendance, (b) all possible adherence permutations, (c) consistent/inconsistent/never attendance, (d) number of times attended, (e) program adherence and (f) proportion of time covered. Advantages and disadvantages of these measures are described, and recommendations on which measures to use based on data availability and scientific question are also given. Stratified single round attendance is particularly useful for describing the yield of screening, while programmatic adherence measures are best suited to evaluating screening efficacy. We recommend that screening programs collect detailed longitudinal, individual‐level data, not only for the screening tests themselves but additionally for diagnostic follow‐up and surveillance exams, to allow for maximum flexibility in reporting adherence patterns using the measure of choice. What's new? Fecal‐based screening for colorectal cancer requires testing at short intervals, usually every one to two years. Consequently, screening program effectiveness is dependent on adherence to repeat screening. Here, the authors describe a literature review aimed at identifying measures to assess adherence to fecal‐based screening over time. In total, six broad categories of measures of longitudinal adherence were identified. Categories varied in amount of individual‐level data required for calculation and in suitability to address specific scientific questions. The authors further provide recommendations for choice of measure to assess longitudinal adherence. [ABSTRACT FROM AUTHOR]

A carefully constructed preventive medicine plan that takes a population-based approach to problem identification and develops prevention strategies for both the community and individual may be an effective way of improving overall public health. A group health cooperative in Washington state developed a program that looked at the population as a whole to identify problem areas that could be verified through medical records. Physicians and community members were then allowed to develop prevention programs that involved intervention at the individual and community levels. Such intervention stressed the role of the patient and gave physicians freedom to target underlying factors of larger health trends. Twenty years after the program began, late-stage breast cancer rates had fallen 32%, the percentage of patients who smoked fell from 25% to 17% and head injuries from bicycle accidents decreased 67% due to increased use of helmets., This article reviews lessons from 20 years of experience in development and provision of clinical preventive services at Group Health Cooperative of Puget Sound, a large health maintenance organization. Critical factors for enhancing service include the use of a population-based epidemiologic viewpoint coupled with specific evidence-based criteria to examine issues; involvement of practitioners in the process; a systems approach to implementation focused on predisposing factors of the practitioners and enabling factors in the practice, organizational, and community environments; feedback of program outcomes; and the use of automated clinical information systems. Outcome results from our clinical prevention efforts include a 32% decrease in late-stage breast cancer (1 989 to 1990); 89% of 2-year-old children with complete immunizations (1994); decrease in adult smokers from 25% to 17% (1985 to 1994); and an increase in bicycle safety helmet use among children from 4% to 48% along with a 67% decrease in bicycle-related head injuries (1987 to 1992). Systematic population-based approaches to the development and provision of clinical preventive services targeting the one-to-one level of primary care and multiple infrastructure levels of care are forging a synthesis of clinical medicine and public health approaches. This approach will become pervasive as clinical information systems improve, risk information is captured routinely, and practitioners gain skills in the art of patient risk behavior change and population-based care.

It has been clearly demonstrated that mammography can reduce significantly breast cancer mortality among women ages 50 or older (1,2). Consequently, the National Cancer Institute (NCI) issued cancer control objectives […]

Objectives. In a health maintenance organization that mails letters to women recommending that they schedule mammograms, we conducted a randomized trial to evaluate simple methods of increasing the use of screening mammography. Methods. Using a 2 x 2 factorial design, we tested the effects of (1) mailing the recommendation letter from each woman's primary care physician rather than from the program director and (2) sending a subsequent reminder postcard. Results. Sending a reminder postcard nearly doubled the odds that women would get mammograms within I year (participate). The letter from the woman's personal physician had no effect. Attending a clinic more than 45 minutes from the screening center, being a current smoker, or being in fair or poor health were negatively associated with subsequently obtaining a mammogram. The odds of participation doubled if women had had previous mammograms. Conclusions. When preceded by written recommendations to schedule mammograms, reminder postcards effectively increased participation. Future randomized trials to promote use of screening mammography should compare interventions with a reminder condition. (Am J Public Health. 1994;84:571-574), Mailing a reminder postcard to women who received a letter recommending a mammogram appears to significantly increase the likelihood of getting the mammogram. A study of 1,331 women between the ages of 50 and 79 who were members of the Group Health Cooperative of Puget Sound, Washington, evaluated the effectiveness of different methods of communicating with patients. The group was divided into four similar subgroups, each of which received different kinds of communication. Women in the control group were treated as usual for an enrollee in the Cooperative and received the standard letter sent by the Breast Cancer Screening Program's medical director recommending a first mammogram. Women in the second group received the Program's letter and a follow-up reminder postcard two months later. Women in the third group received a letter signed by their primary care physician. Women in the fourth group received a letter from their physician followed by a reminder postcard. The reminder postcards nearly doubled the number of women who received mammograms, regardless of who signed the initial letter.