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The increased uses of mammography and breast physical examination are part of the early detection objectives of the National Cancer Institute and have become a national priority. However, there are limitations in resources, mammographic equipment, and trained personnel. One approach has been to limit mammographic screening to women who belong to increased risk groups. Unfortunately, research has shown this technique to be ineffective, since it fails to include a large number of women who are likely to develop breast cancer. A more workable solution is to vary the recommended interval of mammographic screening, depending upon the risk category of the individual. This method has several advantages. More women are recommended to have mammographic screening, and yet the total number of screenings need not increase. In addition, the small but finite risks of mammographic screening are more concentrated among the women who are also the most likely to benefit. (The risks of the screening itself are, in fact, smaller than the risks involved with following up what would otherwise turn out to be false positives reports.) Such a program of risk determination has been instituted in a large northwest health maintenance organization (HMO) serving 400,000 members. After completing a questionnaire and noting such factors as age of first menstruation, nulliparity, first birth over 30, breast cancer in a first degree relative, and so forth, the woman is assigned to one of four risk categories. Women in the lowest category have mammography only when referred by their physician. In the next three categories, women are suggested to have mammographic exams at five-, three-, and one-year intervals. The net result is that within this HMO the number of mammographic exams has not increased, but the percentage of women over 40 who are eligible for mammography has risen from 57 to 83 percent. (Consumer Summary produced by Reliance Medical Information, Inc.)

Context: A link between measles virus-containing vaccines and inflammatory bowel disease (IBD) has been suggested by recent studies. Objective: To address whether receipt or timing of measles-containing vaccine (MCV) increases risk for IBD. Design: A case-control study. Setting: Four large health maintenance organizations (HMOs) that are part of the Centers for Disease Control and Prevention's Vaccine Safety Datalink project. Patients or Other Participants: A total of 155 persons with codes from International Classification of Diseases, Ninth Revision specific for IBD, born between 1958 and 1989 and enrolled from birth to the onset of disease, were identified. Up to 5 controls were matched by sex, HMO, and birth year. Intervention: None. Main Outcome Measures: Risk for IBD, Crohn's disease, and ulcerative colitis. Results: Past vaccination was not associated with an increased risk for Crohn's disease (odds ratio [OR] for measles-mumps-rubella vaccine [MMR], 0.4; 95% confidence interval [CI], 0.08-2.0), ulcerative colitis (OR, 0.8; 95% CI, 0.18-3.56), or IBD (OR, 0.59; 95% CI, 0.21-1.68). Risk for IBD was not increased among children vaccinated who were younger than 12 months (OR for MMR, 0.61; 95% CI, 0.15-2.45) or aged 12 to 18 months (OR, 0.86; 95% CI, 0.28-2.59) relative to unvaccinated children. Children vaccinated with MMR who were older than 18 months were at significantly decreased risk for IBD (OR, 0.16; 95% CI, 0.04-0.68). Neither past vaccination nor age at vaccination with other MCV was associated with increased risk for Crohn's disease, ulcerative colitis, or IBD. Risk for Crohn's disease, ulcerative colitis, or IBD was not elevated in the time immediately following vaccination with either vaccine. Conclusions: Vaccination with MMR or other MCV, or the timing of vaccination early in life, did not increase the risk for IBD. Arch Pediatr Adolesc Med. 2001;155:354-359

The Group Health Cooperative of Puget Sound is the largest health maintenance organization in the US which is governed by consumers. Since 1985 the Cooperative has had a screening program for breast cancer. However, unlike programs which recommend screening simply on the basis of age, the Cooperative recommends screening based on the calculated risk of the individual woman. Such a method dramatically reduces the cost of the program. Among women over 50, those without any risk factors are encouraged to have mammography every three years. Those with a first degree relative, i.e. mother, sister, or daughter, with breast cancer or with two minor risk factors are urged to have mammography every two years. Women with two first degree relatives with breast cancer, or a personal history of breast cancer, or abnormal breast tissue, should have mammography on a yearly basis. The recommendations for women between 40 and 50 are similar; they are urged to have a yearly mammogram if they have major risk factors. A single first degree relative with breast cancer is an indication for biannual mammography, and minor factors are an indication for mammography every three years. Women under 40 without any major or minor risk factors should receive mammography only on referral by their physician. For the purposes of breast screening, minor risk factors have been defined as a more distant relative with breast cancer, menarche before 11 or menopause after 54, first child after 30 or no children, or a previous breast biopsy. Using this risk-based method has resulted in about 10 early case findings per 1,000 women, which is nearly double the rate of programs without patient pre-selection based on risk. Although this is indicative of risk concentration, much more time will be needed before a comparison of breast cancer incidence in all the risk groups can be analyzed for cancer staging (which reflects severity) at diagnosis and mortality rate. (Consumer Summary produced by Reliance Medical Information, Inc.)