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Biomedical subjects

J Austoker

Publications and source records attributed to J Austoker.

At least 37 records · Page 2Linked to original sources
PubMed1998

Effect on attendance at breast cancer screening of adding a self administered questionnaire to the usual invitation to breast screening in southern England.

STUDY OBJECTIVE: The primary aim of the research described in this paper was to ascertain whether inclusion of a self administered questionnaire with the usual invitation to routine breast screening affected screening uptake. Secondary aims included establishing appropriate questionnaire distribution and collection methods within the framework of the National Health Service Breast Screening Programme and optimisation of questionnaire design. DESIGN: Randomised study. SETTING: Oxfordshire and West of London Breast Screening Units. PARTICIPANTS/METHODS: 6400 women invited for routine screening mammography were individually randomised to receive either the usual breast screening invitation alone, or to receive the usual invitation accompanied by a self administered questionnaire, to be returned at the time of screening. Participants were then followed up and attendance rates at screening were compared between groups. MAIN RESULTS: Screening attendance rates were similar in women who did and did not receive a questionnaire (71% in each group). Of those who were sent a questionnaire and attended for screening, 77% returned a completed questionnaire. Screening uptake was not affected by the way in which the questionnaire was returned or by whether or not personal details and signed permission for follow up were requested. CONCLUSIONS: The inclusion of a self administered questionnaire accompanying the invitation to breast screening did not adversely affect screening uptake. A high proportion of women completed the questionnaire.

Breast Neoplasms↗
PubMed1998

Early rescreen/recall in the UK National Health Service breast screening programme: epidemiological data.

OBJECTIVE: In the United Kingdom in 1994-95 about 16,500 women aged 50 to 64 were asked to come back earlier than the usual three yearly screening interval for further mammography (early rescreen (ES)) or for a range of further investigations at an assessment centre (early recall (ER)). This study aimed at providing epidemiological data on ES/ER, in particular, how often and why it is used, and what the outcome is of using it. SETTING: National Health Service breast screening programme in the United Kingdom. METHODS: All breast screening units were invited to complete a postal questionnaire. Two reminders were sent. The units were asked retrospectively to provide breast screening data about women aged 50 to 64 from their local computer systems. Women placed on ES/ER were followed up for at least one year. RESULTS: The response rate was 71% (69/97), of which 14% (10/69) were unable to provide the required data, leaving 59 completed questionnaires (61%). The rate of placing women on ES/ER was above 1.0% for 26/54 (48%) responding breast screening units and above 2.0% for 13/54 (24%) units. Women were placed on ES/ER because of (a) previous breast cancer (21% of cases; cancer detection rate 2.4%), (b) diagnostic uncertainty (51%; cancer detection rate 3.0%), or (c) family history (27%; cancer detection rate 0.6%). Breast screening units with a high rate of placing women on ER were significantly more likely to have a high recall rate (rs = 0.63; n = 53; p < 0.0005) or a high benign surgical biopsy rate (rs = 0.33; n = 49; p < 0.05), or both. The cancer detection rate of ES/ER tended to decrease with increasing ES/ER rates (rs = -0.37; n = 51; p < 0.01). CONCLUSIONS: A relatively large number of women were placed on ES or ER for a range of reasons. If the recommendations given are followed, the number of women placed on ER may be reduced while maintaining the cancer detection rate at the required level. The option of ES should not be used.

Breast Neoplasms↗
PubMed1997

Recalling women for further investigation of breast screening: women's experiences at the clinic and afterwards.

BACKGROUND: In 1993-1994 about 66 000 women in breast screening were called back (recalled) to a specialized centre for further investigation (assessment). The information requirements of these women during and after their appointment were investigated. Ninety per cent of recalled women were found not to have cancer. METHODS: Consecutive women (n = 2132) from eight breast screening centres throughout the United Kingdom were asked to complete a postal questionnaire two weeks after attendance at assessment. No reminder was sent. RESULTS: The response rate was 70 per cent. Communication was viewed by women as the most stress-relieving aspect of the recall appointment. Women from centres where nurses provided the opportunity to talk in private before further investigation were less likely to want to talk later about why assessment was needed for them (4 per cent) than women from centres not using a nurse for this purpose (30 per cent) (p < 0.0001). The former were also less likely to want more information about the tests they had had (2 per cent physical examination, 2 per cent X-rays, 3 per cent ultrasound) than the latter (6 per cent, 9 per cent and 10 per cent, respectively) (p < 0.005). Distressed/very distressed women were more likely to have wanted to talk to someone at the centre about the reason for recall (26 per cent) than somewhat distressed/ not distressed women (18 per cent) (p < 0.0001). However, the former were no more likely to have spoken to staff about it than the latter (33 per cent vs 32 per cent). Ways to improve the giving of results were identified. After the appointment women commented that there was a need for more information about harmless breast conditions. CONCLUSIONS: Overall the quality of communication at assessment was viewed highly by women, but varied considerably between centres. There is scope for substantial further improvement. Breast care nurses can play an important role in this.

Attitude to Health↗
PubMed1997

Breast screening: adverse psychological consequences one month after placing women on early recall because of a diagnostic uncertainty. A multicentre study.

BACKGROUND: It was the original intention of the UK National Health Service Breast Screening Programme (NHSBSP) to place women who were not diagnosed with cancer on three yearly routine recall (RR). In 1994-5 approximately 16,500 women, aged 50 to 64, were placed on early recall (ER) at a shorter time interval, of which about 98% will have a normal result. This large number exceeds the expectations of the NHSBSP. OBJECTIVE: To establish the adverse psychological consequences (PCs) for women one month after placement on ER because of a diagnostic uncertainty, and if detected, to suggest practical solutions to reduce them. METHODS: Thirteen breast screening centres throughout the UK participated in the study. From March to October 1995 all women who were placed on ER because of a diagnostic uncertainty were identified and compared with groups of women placed on RR (after mammography, assessment, fine needle aspiration, and a benign biopsy). These women were invited to complete a postal questionnaire one month after they were placed on ER or RR. One reminder was sent. RESULTS: Overall 75% of women completed the questionnaire. The adverse PCs of placing women on ER because of a diagnostic uncertainty were higher (63%; n = 81 of 130) than those of women placed on RR after mammography (29%; n = 38 of 130) (P < 0.00001) or assessment (50%; n = 64 of 128) (P < 0.05), but lower than the adverse PCs of women who underwent a benign biopsy (87%; n = 26 of 30) (P < 0.05). Factors that were significantly associated with subsequent adverse PCs were identified. CONCLUSIONS: The adverse PCs of being placed on ER because of a diagnostic uncertainty were significantly higher than those of women who turned out to have a false-positive mammographic result after assessment. Possible practical solutions are discussed.

Breast Neoplasms↗
PubMed1994

Cancer prevention in primary care. Current trends and some prospects for the future--1.

Cancer control encompasses the whole spectrum from prevention and early diagnosis to treatment and palliation. The key to the future of cancer control will be to establish multidisciplinary approaches to each type of cancer across this spectrum. For primary prevention this requires some understanding of the causes of each cancer. Although understanding of the aetiology of cancer has greatly improved, prospects for the primary prevention of many common cancers remain remote. Other approaches currently under evaluation include chemoprevention and the use of biomarkers. The identification of predisposing genes for some of the common cancers may have a considerable impact on the ability to recognise those at risk. Overall, however, mortality trends indicate that reduction of smoking remains the main priority for cancer prevention in the United Kingdom. For primary care teams, brief interventions to reduce smoking are likely to achieve the greatest benefit. This should be seen as part of broader policies aimed at achieving change in the whole population. The government must acknowledge its major responsibility to cancer prevention by banning all forms of advertising and promotion of tobacco.

Family Practice↗
PubMed1994

Screening for colorectal cancer.

In the United Kingdom there are almost 31,000 new cases of colorectal cancer each year and nearly 20,000 deaths. It is the second most common cause of all deaths from cancer in the United Kingdom. The efficacy of screening with faecal occult blood tests to detect and treat tumours at an early stage, and thereby to reduce mortality, is currently being assessed in several randomised controlled trials. In general, faecal occult blood tests have a low sensitivity and only moderate levels of uptake among the population invited for screening. Until the studies in Denmark, Sweden, and Nottingham report their findings, there is no case for providing such screening routinely to an asymptomatic population. Detecting and removing premalignant adenomas by flexible sigmoidoscopy could be more effective than detecting early localised, asymptomatic cancers in reducing deaths from colorectal cancer. It is estimated that screening people at about the age of 60 by a single flexible sigmoidoscopy examination with appropriate colonoscopic surveillance could prevent 5500 cases of colorectal cancer and 3500 deaths in the United Kingdom each year. A randomised controlled trial to confirm these observations should be seen as a priority.

Adult↗
PubMed1994

Screening for ovarian, prostatic, and testicular cancers.

Screening for cancer should not be offered routinely to a symptomatic people on a population basis unless it has been shown to be effective in reducing mortality in randomised controlled trials. A suitable screening test should have high sensitivity and specificity and a high positive predictive value. There is an ethical imperative to ensure that the benefit to each person from screening is likely to outweight the possible harm. Preliminary studies have identified suitable screening tests for ovarian cancer, and a randomised controlled trail is about to start. There is considerable controversy about whether to screen for prostatic cancer. Likewise, there is uncertainty about the best means of treating localised prostatic cancer. Screening for prostatic cancer raises important ethical considerations which should not be ignored. Testicular self examination is of unproved benefit. Although there is a need for education about the early signs and symptoms of testicular cancer to reduce delay at presentation, a case cannot be made for screening.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1994

Cancer prevention in primary care. Screening for cervical cancer.

Cervical screening has been shown to be effective in several countries, although not by means of randomised controlled trials. A screening programme has been in operation in the United Kingdom since 1964, but it has, in the past, been beset with problems of organisation, accountability, and commitment. The introduction in 1988 of a systematic call and recall introduction in 1988 of a systematic call and recall system and the setting up of an NHS cervical screening programme national coordinating network has brought a greater sense of coherence. Coverage of the target population in England between 1989-90 and 1992-3 increased from 61% to 83%, and there is a strong indication that cervical screening is now beginning to reach those most at risk--namely, older women from lower social classes. Primary care is central to the overall success of the cervical screening programme. General practitioners are in a unique position to invite women for a smear test, to take smears, to ensure that abnormal smear test results are followed up, and to check on reasons for non-attendance. Numerous studies have looked at the involvement of general practice in cervical screening, identifying many ways in which the programme can be improved. Many practices are now running well organised and effective programmes.

Family Practice↗
PubMed1994

Screening and self examination for breast cancer.

Breast cancer is the major form of cancer in women, with nearly 30,000 new cases and over 15,000 deaths in the United Kingdom each year. Breast screening by mammography has been shown in randomised trials to reduce mortality from breast cancer in women aged 50 and over. An NHS breast screening programme has been in operation in the United Kingdom since 1988. Its aim is to reduce mortality from breast cancer by 25% in the population of women invited to be screened. The uptake of mammography among the eligible population may be the single most important determinant if the programme is to be effective. Primary care teams have an important part to play in encouraging women to attend for screening and in providing information, advice, and reassurance at all stages of the screening process. To date, routine breast self examination has not been shown to be an effective method of screening for breast cancer and should not therefore be promoted as a primary screening procedure. There is, however, a case to be made for women to become more "breast aware."

Adult↗
PubMed1994

Melanoma: prevention and early diagnosis.

Over the past two decades there has been a rapid rise in the numbers of people developing and dying from malignant melanoma. Sunlight is the main aetiological factor linked with melanoma. Exposure to the sun is a risk factor that can be modified provided that people are aware of the dangers. Health promotion campaigns can play a part in producing such change. General practitioners and practice nurses have an important part to play in providing those most at risk with information and advice about sensible sun exposure and sun protection measures. Campaigns to reduce delay in diagnosis by a combination of professional and public education have been reported from several centres around the world. The effects of these campaigns in reducing the depth distribution of cutaneous malignant melanoma have sometimes been encouraging, but in other instances have shown little effect. Until there is clear evidence that early detection reduces mortality from melanoma, the opportunistic promotion of early detection may not be cost effective and will fail to reach all sections of the community at risk. At the present time, therefore, the emphasis should be on the primary prevention of skin cancer.

Adolescent↗
PubMed1994

Diet and cancer.

Accumulating data indicate that modifications in diet may reduce the risk of cancer by as much as one third and possibly by as much as two thirds. On the basis of the existing evidence, however, it is not possible to be certain which cancers are causally related to diet and what proportion of them are due to specific components of the diet. Diet is currently thought to be a major factor in the aetiology of cancers of the large bowel and stomach, and it may also be important in the aetiology of several other cancers. With the exception of strong and consistent evidence of the protective effect of fruit and vegetables, practical dietary interventions that reduce the risk of cancer are difficult to formulate as, in general, the evidence is theoretical or contradictory and too weak to justify specific intervention. Authoritative guidelines on dietary management in primary care are conspicuously absent because of lack of research. The success of an individual based strategy will depend on adequate education, training, and support being made available to the relevant members of primary care teams.

Diet↗
PubMed1994

Reducing alcohol intake.

Alcohol is second in importance only to smoking as a proved cause of cancer. The risk associated with excessive alcohol consumption can be reduced by adopting national and local population based policies. The population approach is aimed at reducing the level of consumption across the whole population, which contains many modest drinkers. Underlying this approach is the fact that a larger proportion of the total morbidity and mortality attributed to alcohol in a population occurs in modest drinkers, even though individually they are at lower risk. This approach should be complemented by risk reduction initiatives in primary care, focused on high risk individuals. Several studies have shown the efficacy of brief interventions by general practitioners in patients with excessive alcohol consumption. Brief interventions, taking 5 to 10 minutes, use simple assessments to identify those at risk and provide information and advice. Evidence exists that general practitioners underuse opportunities to identify and advise patients about excessive drinking.

Alcohol Drinking↗
PubMed1994

Smoking and cancer: smoking cessation.

Smoking is the single most important cause of cancer. The risk of developing cancer is reduced by stopping smoking and decreases substantially after five years. Reduction in smoking must be central to any programme aimed seriously at the prevention of cancer. An individual approach, based in primary care, has the potential to bring about modest but important reductions in risk. Many randomised trials have shown the effectiveness of various smoking cessation interventions in primary care. Given resource limitations in primary care, individual effort should be focused on those at highest risk who are motivated to stop smoking. A population strategy has considerable advantages over the high risk approach as the potential for reducing morbidity and mortality in the whole population is much greater. The government must acknowledge its major responsibility; the outstanding example of its failure to do this is its persistent refusal to ban outright all forms of advertising and promotion of tobacco. There is clear evidence that a ban would contribute to a reduction in smoking prevalence and especially in the uptake of smoking by children.

Adolescent↗
PubMed1994

Cancer prevention: setting the scene.

Each year in the United Kingdom there are over 300,000 new cases of cancer and nearly 165,000 deaths from cancer. It is widely believed that as many as four fifths of all cancers are preventable by means that are already available. The Health of the Nation and the Europe Against Cancer programme have set targets and strategies for reducing the risk of cancer. An approach based on the whole population will achieve the greatest reductions in morbidity and mortality. Complementary to this is the individual approach, which can be based in primary care and targeted at high risk subjects. Health promotion and screening in primary care are not in themselves self evidently valuable. Their effectiveness must be tested rigorously and scientifically. Furthermore, because of limited time and resources, health education in primary care should be focused on interventions that are likely to achieve the greatest benefit, such as helping people to stop smoking.

Family Practice↗
PubMed1994

Written information needs of women who are recalled for further investigation of breast screening: results of a multicentre study.

OBJECTIVE: To assess the written information needs of women who are recalled for further investigation of breast screening. METHODS: Women from eight breast screening centres in England, Scotland, and Wales who had been recalled for further investigation were invited to complete a structured questionnaire about aspects of recall. Four hundred and eighty four consecutive women were invited to be interviewed immediately before assessment. Two weeks after attendance for assessment 2132 consecutive women (including all women who had been interviewed) were sent a postal questionnaire. No reminder was sent. Subjects from four of the centres received an information leaflet with their recall letter, the remainder did not. Letters/ leaflets used by the centres differed markedly. RESULTS: The response rate was 95% for the interview questionnaires and 70% for the postal questionnaires. Women who were prepared in advance for a possible recall were less likely to feel distressed/ very distressed when receiving a recall letter. The more aspects of the recall process included in the recall literature, the more women were likely to think that assessment had been explained (89% of women (544/ 609) receiving six or more items of information compared with 73% of women (269/370) receiving four or fewer items (P < 0.0001). Women who received a leaflet with their recall letter were significantly more likely to find some aspect of the information about recall reassuring than women who did not (61% (313/510) v 50% (278/557); P < 0.0001). Distressed/very distressed women were significantly more likely than somewhat/not distressed women to want further information about the reasons for recall (48% (403/834) v 26% (157/598); P < 0.0001 and how to get more information (29% (237/811) v 19% (116/ 616); P < 0.0001). CONCLUSIONS: Information can increase satisfaction and reduce distress. The amount of information women needed about recall was consistently underestimated. Inclusion of a leaflet improved satisfaction. Sensitive topics, words, and phrases should be carefully expressed.

Breast Neoplasms↗
PubMed1991

Organisation of a national screening programme.

Since March 1988 Health Authorities and Health Boards in the United Kingdom have been phasing in the National Health Service Breast Screening Programme (NHSBSP) which implements the recommendations of the Forrest Report. The Report examined the evidence from a number of countries on the value of screening and concluded that, for women aged 50 and over, screening for breast cancer can reduce mortality by up to one-third. The experience gained in setting up the programme has led to a second document in which are detailed 7 requirements considered essential for high quality and ultimate success.

Aged↗